Ethical climate and its relationship with students' attitude towards field of study and job satisfaction among operating room personnel of teaching hospitals affiliated to Tabriz University of Medical Sciences, 2013

Dissertation to receive a nursing master's degree

(Internal Surgery orientation)

Abstract

Context and purpose: The moral atmosphere of the hospital work environment, in addition to affecting the quality of care provided by personnel, is also effective in their job satisfaction. On the other hand, it has been reported that the atmosphere prevailing in clinical environments is one of the factors affecting the quality of clinical education and the attitude of students towards their field of study. Due to the lack of a study on the effect of the moral climate of operating rooms on the job satisfaction of its personnel, as well as the effect of such an atmosphere on the attitude of operating room students towards their field of study, the present study was conducted in Tabriz teaching hospitals. Methodology: The present study is a descriptive study that was conducted cross-sectionally in 2013 on operating room students and operating room staff of educational hospitals affiliated to Tabriz University of Medical Sciences. Due to the limited number of personnel (approximately 200 people) and students (approximately 120 people), all these people were included in the research. The tools used are the personal-social profile form and the questionnaires of Olson hospital ethical climate and Minnesota job satisfaction and students' academic attitude. Descriptive and inferential statistical methods, including Spearman's rank correlation coefficient and chi-square test, were used under SPSS18 statistical software to analyze the data. Findings: The results showed that 78% of the studied personnel were female and 75.3% were married, and they were in the age range of 22 to 56 years with a mean and standard deviation of 34.54±6.98. Regarding the students, 61.4% were female and 86.8% were single, and their average age was 20.87. According to the results, 64.9% of students and 58.1% of staff had a negative view of the moral atmosphere in operating rooms. Also, 48.4% of the staff had moderate job satisfaction and 51.8% of the students had a positive attitude towards their field of study. According to the results, a significant relationship was found between moral atmosphere and staff job satisfaction (r=0.93, P?0.001) and between moral atmosphere and the attitude of operating room students towards their field of study (r=0.56, P?0.001).

Conclusion: Despite the negative moral atmosphere of operating rooms from the perspective of staff and students, the majority of staff had moderate job satisfaction and the majority of students had a positive attitude towards their field. However, due to the direct relationship between the moral climate and the job satisfaction of the personnel and the attitude of the operating room students towards their field of study, it is necessary for the hospital officials to use strategies to improve the moral climate of the operating rooms and increase the job satisfaction of its personnel. Also, by improving the moral atmosphere of the operating rooms and improving the attitude of the students towards their field, their career future can be guaranteed in this field.

Key words: moral atmosphere, job satisfaction, attitude, operating room personnel, operating room students, field of study.

Introduction of the research

Context Research:

Ethics is a collection of ethical principles and rules and has standards for professional behavior. Professional ethics [1] is also defined as the moral responsibility of individuals in their profession and the responsibility of organizations in their profession and both of them against the rights of the right holders (1). Maintaining professional ethics requires that personnel show their commitment to the professional values ??and ideals of the organization and do not allow these moral values ??to be compromised due to personal and emotional issues and other issues (2). Ethical issues in hospitals and health care organizations are also different from other organizations (3). On the other hand, in the nursing profession, ethics is an inherent matter (2); Because if nurses are not morally honest with themselves or others about their values, abilities and actions, it will be difficult for them to behave ethically (4). Both the hospital itself as a health care organization and each individual working in it, as professionals in health care, are committed to implementing ethical principles in their profession (2).

One ??of the main concepts in occupational ethics is the organizational atmosphere (5), which is considered as the perceptions of the organization's members about the values, beliefs and behaviors in that organization (6).. Ethical climate is one of the dimensions of the organizational climate and it is referred to as the personality of the organization (7). In fact, the ethical climate as a part of the organization's personality confirms the organization's ethics (8). Ethical climate in health care systems is the atmosphere of the work environment that is favorable for dealing with moral problems and promotes the moral performance of personnel (9). But according to Olson's definition [2], moral climate is a person's understanding of the organization, which affects his attitude and behavior and acts as a reference for the person's behavior. According to him, ethical atmosphere in health organizations is manifested in the communication that health care professionals have with each other, managers and patients. By knowing the concept of ethical climate, nurses, doctors and hospital managers can identify and apply strategies to improve the ethical climate of their work environment. Olson places the moral climate in five areas and points out that the perception that nurses have of the moral climate of their work environment lies in their relationships with colleagues, doctors, managers, patients and the hospital (7).

From Olson's point of view, the hospital work environment as one of the areas affecting the moral climate (7), greatly affects the emergence of moral virtues of medical personnel and can support or even prevent ethical behavior (10). An ethical environment has certain principles based on ethical theories that help people make better decisions in unethical situations (11). Many factors in the work environment can moderate the application of ethical principles (12). When these factors create unbearable conditions in the environment for the individual, the work environment can be an obstacle to ethical performance. What is important is that creating an ethical environment in the hospital and maintaining it is a shared responsibility that requires the efforts of all members of the medical team in the workplace (10). Another important point is that it is necessary to match the moral values ??of nurses with the accepted values ??of the hospital to promote moral performance (11). If there is a conflict between the moral values ??of the nurse and the work ethics of the hospital, moral distress [3] occurs (13), which is not specific to a specific group and is experienced by all health care professionals (14). Nurses who work in an unsupportive environment are more likely to experience moral distress due to the lack of ethically effective policies for the performance of their professions (13). On the contrary, nurses who are supported for following professional standards are more likely to apply these standards and actively correct or improve unethical behaviors that are against the accepted standards (10).

From Olson's point of view, the relationships that nurses have with colleagues, doctors, managers and patients are other important factors in people's perception of the moral climate (7). A collaborative team with high moral flexibility significantly affects the nurse's behavior in the work environment (15). The ethical behavior of colleagues is not only an important factor, but it is more important than other determining factors of ethical behavior (16). It is important to mention that ethical behavior refers to ethical decisions and actions used by nurses (12). On the other hand, nurses always want to participate in ethical decision-making along with other professionals such as doctors, and they want their opinions to be heard and respected (17). Feeling unable to make ethical decisions is a common experience of nurses (18). In Martin's study about nurses' ethical decision-making, 70% of participating nurses stated that the main source of job stress and ethical pressures was not participating in ethical decisions (19). Also, in the study of Malloy and his colleagues about nurses' views on relationships with doctors, the studied nurses stated that they are often voluntarily silent in terms of ethical decision-making and noted that their way of ethical decision-making is different from that of doctors (20). In the study by Varcoe and his colleagues about ethical practice in nursing, many nurses stated that in the relationship with doctors, despite the disrespect; Because of the fear of the consequences, doctors are unsuccessful in notifying the relevant authorities to solve the behavioral problems, and this leads to the feeling of the nurses' inability to deal with the doctors' moral incompetence (21).