آموزش و اخلاق در پرستاری
Education and Ethics In Nursing ISSN: 2322-5300

بررسی ارتباط بین مراقبت پرستاری از دست‌رفته و جوّ اخلاقی در بیمارستان‌های آموزشی دانشگاه علوم پزشکی یزد

https://doi.org/10.22034/ethic.2025.2070979.1197
دوره 14، شماره 2
مهر 1404
صفحه 105-113
آموزش و اخلاق در پرستاری

نوع مقاله : مقاله پژوهشی اصیل

نویسندگان

نیر سلمانی 1
شهناز خالقی پور 2
آتنا دادگری 3
محمد معین شیخ احمد صفاری 4

1 دانشیار، دانشکده پرستاری میبد، دانشگاه علوم پزشکی شهید صدوقی، یزد، ایران

2 دانشیار، گروه روانشناسی، واحد نائین دانشگاه آزاد اسلامی، نایین، ایران

3 مربی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید صدوقی، یزد، ایران

4 دانشجو، کارشناسی پرستاری، دانشکده علوم پزشکی میبد، دانشگاه علوم پزشکی شهید صدوقی یزد، یزد

چکیده
مقدمه: در شرایط کمبود منابع، پرستاران ناچار هستند که تصمیم بگیرند، کدام مراقبت‌ها را در اولویت قرار دهند که این موضوع، تحت تأثیر موارد متعددی می­باشد. پژوهش حاضر، با هدف تعیین ارتباط بین مراقبت پرستاری از دست‌رفته و جوّ اخلاقی در بیمارستان‌های آموزشی وابسته به دانشگاه علوم پزشکی شهید صدوقی یزد انجام شد.
روش­کار: پژوهش توصیفی– تحلیلی حاضر، بر روی 141 پرستار شاغل در بخش‌های داخلی- جراحی بیمارستان‌های آموزشی شهید رهنمون، شهید صدوقی و افشار یزد، به شیوة نمونه­گیری سهمیه­ای (1402–1401) انجام شد. ابزار گردآوری داده‌ها شامل پرسشنامه­های دموگرافیک، مراقبت پرستاری از دست‌رفتة کالیش و جوّ اخلاقی بیمارستان اولسون بود. داده­­های جمع آوری شده، با استفاده از نرم افزار SPSS-24 و بهره‌­گیری از روش­های آمار توصیفی، استنباطی و آزمون­­های همبستگی پیرسون، مورد ارزیابی قرار گرفتند.
یافته‌ها: میانگین سنی شرکت‌کنندگان، 8/11 ± 34/ 36 سال و میانگین سابقة کار آن‌ها 7/57± 10/48 سال بود. بیشتر پرستاران مورد پژوهش را زنان ( 71/6 %) دارای مدرک کارشناسی (72/3%) و متأهل (62/4%) تشکیل دادند. میانگین نمرة کل مراقبت پرستاری از دست‌رفته، 11/25± 54/61 درصد و میانگین نمرة کل جوّ اخلاقی، 14/98±99/62 درصد بود. نتایج نشان داد که میانگین نمرة مراقبت از دست‌رفته، با میانگین نمرة کل جوّ اخلاقی0/68R= و تمامی خرده‌مقیاس‌های آن ( مدیران0/63R=، همکاران 0/64R=، بیمارستان0/61R=، پزشکان 0/58R= و بیماران0/59R= ) ارتباط معکوس معناداری داشت(0/001 (P<.
نتیجه‌گیری: نتایج نشان داد که جوّ اخلاقی پرستاران، در سطحی بالاتر از حد میانه قرار دارد و هم­­زمان، میزان مراقبت از دست‌رفتة آن‌ها پایین‌تر از حد میانه است. این یافته‌ها حاکی از وجود ارتباط معکوس و معنادار بین جوّ اخلاقی و مراقبت‌های پرستاری فراموش‌شده می­باشد؛ یعنی هرچه جوّ اخلاقی در محیط کار، مناسب‌تر و بالاتر باشد، میزان مراقبت‌های فراموش‌شده، کمتر خواهد بود. این نتیجه می‌تواند، تأکید کند که ایجاد و تقویت یک محیط کار اخلاقی از طریق حمایت مدیریتی، بهبود روابط بین‌حرفه‌ای و آموزش اخلاق حرفه‌ای می‌تواند، به بهبود کیفیت مراقبت‌های پرستاری و کاهش مراقبت‌های از دست‌رفته منجر شود.

کلیدواژه‌ها

مراقبت پرستاری از دست‌رفته
جّو اخلاقی
پرستاران
بیمارستان‌های آموزشی
موضوعات

عنوان مقاله English

The Relationship between Missed Nursing Care and the Ethical Climate in Teaching Hospitals Shahid Sadoughi University of Medical Sciences in Yazd

نویسندگان English

Nayer Salmani 1
Shahnaz Khaleghi por 2
Atena Dadgari 3
Mohammad Moein Sheikh Ahmad Saffari 4
1 Associate Professor, Meybod Faculty of Medical Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
2 Associate Professor, Department of Psychology, Nain Branch, Islamic Azad University, Nain, Iran
3 Instructor, School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
4 Student, Bachelor of Nursing, Meybod Faculty of Medical Sciences, Shahid Sadoughi Yazd University of Medical Sciences, Yazd
چکیده English

Introduction: In resource-constrained settings, nurses are often forced to prioritize some aspects of care over others, which can lead to missed nursing care influenced by multiple factors. This study examined the relationship between missed nursing care and the perceived ethical climate in teaching hospitals affiliated with Shahid Sadoughi University of Medical Sciences in Yazd.
Methods and Materials: This descriptive–analytical study was conducted on 141 nurses working in the internal medicine and surgical wards of Shahid Rahnemoon, Shahid Sadoughi, and Afshar teaching hospitals during 2022–2023. Participants were selected through quota sampling. Data were collected using a demographic questionnaire, the Kalisch Missed Nursing Care Survey, and Olson’s Hospital Ethical Climate Survey. Data analysis was performed in SPSS version 24 using descriptive, inferential statistics and Pearson correlation tests.
Results: The mean age of participants was 34.36±8.11 years, and the mean work experience was 10.48±7.57 years. Most nurses were female (71.6%), held a bachelor’s degree (72.3%), and were married (62.4%). The mean total score of missed nursing care was 54.61±11.25, and the mean total score of ethical climate was 99.62 ±14.98. There was a significant inverse correlation between missed nursing care and the overall ethical climate (R= –0.68), as well as all ethical climate subscales (managers: R= –0.63; colleagues: R= –0.64; hospital: R= –0.61; physicians: R= –0.58; patients:
R= –0.59) (P<0.001).
Conclusion: Overall, nurses perceived the ethical climate to be above the median level, while the level of missed nursing care was below the median. These findings indicate a significant inverse relationship between ethical climate and missed nursing care; a more positive and supportive ethical climate is associated with a lower occurrence of missed nursing care. The results underscore the importance of strengthening the ethical work environment through managerial support, improved interprofessional relationships, and professional ethics education to enhance the quality of nursing care and reduce missed care.

کلیدواژه‌ها English

  • Missed Nursing Care
  • Ethical Climate
  • Nurses
  • Teaching Hospitals
1. Raeve P, Vanpoecke H, Ballotta M, Xyrichis A, DeJonghe Y, Žilić I. Strengthening healthcare through safe staffing levels: a European policy perspective on safe nurse-to-patient ratios and workforce sustainability. IJNC. 2025;5:1-12.
2. Kalisch BJ, Landstrom GL, Hinshaw AS. Missed nursing care: a concept analysis. Journal of advanced nursing. 2009;65(7):1509-17.
3. Janatolmakan M, Khatony A. Explaining the consequences of missed nursing care from the perspective of nurses: a qualitative descriptive study in Iran. BMC nursing. 2022;21(1):59.
4. Chaboyer W, Harbeck E, Lee BO, Grealish L. Missed nursing care: An overview of reviews. The Kaohsiung journal of medical sciences. 2021;37(2):82-91.
5. Monalisa M, Syukri M, Yellyanda Y. Factors involved in missed nursing care: A systematic review. 2023.
6. Mohammadpour, H., & Heydari, A. (2024). Missed nursing care and its related factors in Iranian hospitals: A systematic review. Navid No, 27(90), 85–95.
7. Tasneem S, Baig AM. Ethical Dilemmas and Clinical Decision-Making Processes Faced by Nurses Working in High-Stakes Critical and Emergency Care Environments. Mader-e-Milat International Journal of Nursing and Allied Sciences. 2025;3(2):48-63.
8. Suhonen R, Stolt M, Habermann M, Hjaltadottir I, Vryonides S, Tonnessen S, et al. Ethical elements in priority setting in nursing care: A scoping review. International journal of nursing studies. 2018;88:25-42.
9. Beadle ES, Walecka A, Sangam AV, Moorhouse J, Winter M, Munro Wild H, et al. Triggers and factors associated with moral distress and moral injury in health and social care workers: A systematic review of qualitative studies. PLoS One. 2024;19(6):e0303013.
10. Noh YG, Kim SY. Factors of Hospital Ethical Climate among Hospital Nurses in Korea: A Systematic Review and Meta-Analysis. Healthcare. 2024;12(3):372.
11. Amini K, Khani Lehdarboni L, Hanifi N. Relationship between ethical climate and missed nursing care from the point of View of patients with Cancer and nurses Working in Oncology wards of Zanjan and Rasht cities. Journal of Health and Care. 2022;24(2):95-107.
12. Dehghani F, Barkhordari-Sharifabad M, Fallah B, Khavari Z. Impact of Ethical Leadership on Missed Nursing Care: A Cross‐sectional Study from Nurses' Perspective. Avicenna Journal of Nursing and Midwifery Care. 2023;31(4):284-93.
13. Olson LL. Hospital nurses' perceptions of the ethical climate of their work setting. Image: the journal of nursing scholarship. 1998;30(4):345-9.
14. Shafipour V, Yaghobian M, Shafipour L, Heidari MR. Nurses' perception of the ethical climate in the Iranian hospital environment. Journal of Nursing and Midwifery Sciences. 2016;3(4):37-43.
15. Mobasher, M., Nakhaei, N., Nozar, S., & Gerousi, S. (2008). Assessment of ethical climate in teaching hospitals of Kerman city. Iranian Journal of Medical Ethics and History of Medicine, 1(1), 45–52.
16. Chegini Z, Jafari‐Koshki T, Kheiri M, Behforoz A, Aliyari S, Mitra U, et al. Missed nursing care and related factors in Iranian hospitals: A cross‐sectional survey. Journal of nursing management. 2020;28(8):2205-15.
17. Rahimeh, Kh., Behnaz, B., Logha, D. M., & Mansoureh, A. (2019). Missed nursing care and its related factors from the perspective of nurses at Kerman University of Medical Sciences (2017).
18. Pooneh, A., Sajjad, A. B., Arezoo, K., Behnaz, A., & Fatemeh, A. (2024). The relationship between perceived social support and missed nursing care among nurses.
19. Khoobi M. Investigating the Relationship Between Moral Sensitivity and Missed Nursing Care in Clinical Nurses. Iranian Journal of Nursing Research. 2025;20(1):43-56.
20. Khajooee R, Bagherian B, Dehghan M, Forouzi MA. Missed nursing care and its related factors from the points of view of nurses affiliated to Kerman University of Medical Sciences in 2017. 2019.
21. Ahmadzadeh-Zeidi MJ, Rooddehghan Z, Haghani S. The relationship between nurses’ professional commitment and missed nursing care: a cross-sectional study in Iran. BMC nursing. 2024;23(1):533.
22. Khrais H, Alsadi M, Oweidat I, Ahmad M. Determinants of missed nursing care in Jordanian hospitals during COVID‐19 pandemic. Nursing Open. 2023;10(3):1565-73.
23. Ahansaz N, Adib-Hajbaghery M, Baghaei R. Missed nursing care and its relationship with nurses’ moral sensitivity: a descriptive-analytical study. BMC nursing. 2024;23(1):169.
24. Alfuqaha OA, Alhalaiqa FN, Alqurneh MK, Ayed A. Missed nursing care before and during the COVID‐19 pandemic: A comparative cross‐sectional study. International Nursing Review. 2023;70(1):100-10.
25. Mandal L, Seethalakshmi A. Experience of missed nursing care: A mixed method study. Worldviews on Evidence‐Based Nursing. 2023;20(3):212-9.
26. Rezaee S, Baljani E, Feizi A, Delnavaz P. Reasons of missed nursing care from the viewpoints of nurses in educational, private, and social security hospitals in urmia-Iran in 2018. Preventive Care in Nursing & Midwifery Journal. 2021;11(4):26-34.
27. Yaghoubi M, Torki ME, Salesi M, Ehsani-Chimeh E, Bahadori M. The relationship between teamwork and missed nursing care: Case study in a military hospital in Tehran. Journal of Military Medicine. 2019;21(1):63-72.
28. Labrague LJ, De los Santos JAA, Tsaras K, Galabay JR, Falguera CC, Rosales RA, et al. The association of nurse caring behaviours on missed nursing care, adverse patient events and perceived quality of care: A cross‐sectional study. Journal of nursing management. 2020;28(8):2257-65.
29. Park S-K, Jeong Y-W. Relationship between hospital ethical climate, critical thinking disposition, and nursing task performance. BMC nursing. 2024;23(1):696.
30. Numminen O, Leino-Kilpi H, Isoaho H, Meretoja R. Ethical climate and nurse competence–newly graduated nurses' perceptions. Nursing ethics. 2015;22(8):845-59.
31. Kim H, Kim H, Oh Y. Impact of ethical climate, moral distress, and moral sensitivity on turnover intention among haemodialysis nurses: a cross-sectional study. BMC nursing. 2023;22(1):55.
32. Okumoto A, Yoneyama S, Miyata C, Kinoshita A. The relationship between hospital ethical climate and continuing education in nursing ethics. Plos one. 2022;17(7):e0269034.
33. Zadeh, Z., Taleghani, F., & Shahriari, M. (2024). The relationship between moral distress and organizational ethical climate among nurses in Seyed-Al-Shohada Educational Hospital, Isfahan (2020). Journal of Education & Ethics in Nursing, 13.
34. Bayat M, Shahriari M, Keshvari M. The relationship between moral distress in nurses and ethical climate in selected hospitals of the Iranian social security organization. Journal of medical ethics and history of medicine. 2019;12:8.
35. Skyvell Nilsson M, Gadolin C, Larsman P, Pousette A, Törner M. The role of perceived organizational support for nurses' ability to handle and resolve ethical value conflicts: A mixed methods study. Journal of advanced nursing. 2024;80(2):765-76.
36. Khadijeh, N., Mozhgan, B., & Elham, F. (2021). Ethical climate of hospitals affiliated with Yazd University of Medical Sciences and its relationship with nurses’ moral courage.
37. Ozdoba P, Jurek K, Dobrowolska B. Professional values, ethical climate and job satisfaction of nurses and their selected sociodemographic and occupational characteristics. Frontiers in Public Health. 2024;12:1501102.
38. Olson S, Rosenfeld JV, Honeybul S. Neurotrauma, COVID and the rationing of intensive care: an ethical approach. British Journal of Neurosurgery. 2022;36(5):594-9.
39. Kohnen D, De Witte H, Schaufeli WB, Dello S, Bruyneel L, Sermeus W. Engaging leadership and nurse well-being: the role of the work environment and work motivation—a cross-sectional study. Human Resources for Health. 2024;22(1):8.
40. Vryonides S, Papastavrou E, Charalambous A, Andreou P, Eleftheriou C, Merkouris A. Ethical climate and missed nursing care in cancer care units. Nursing ethics. 2018;25(6):707-23.
41. Ahmed Abdrbo A, Ahmed Bayoumy S. Relationship between Ethical Climate and Missed Nursing Care at Teaching Hospitals in Cairo. Egyptian Journal of Health Care. 2022;13(1):2141-58.

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