Hospital ethical climate mediates moral sensitivity and ethical decision-making ability

BackgroundEthical decision-making ability is critical for senior nursing interns in addressing complex clinical dilemmas. However, the mediating role of hospital ethical climate in the relationship between moral sensitivity and ethical decision-making remains unexamined. This gap limits evidence-based strategies for enhancing interns' ethical decision-making and the delivery of high-quality care.Research AimsTo examine the mediating role of hospital ethical climate in the relationship between moral sensitivity and ethical decision-making among senior nursing interns, and to determine the relationship among these three variables.Research DesignThe study is a cross-sectional correlational design.Participants and Research ContextBetween August 2023 and January 2024, 1096 senior nursing interns from 44 universities across seven Chinese regions participated. The general information questionnaire, Judgement About Nursing Decision scale, Chinese Moral Sensitivity Questionnaire-Revised Version, and Hospital Ethical Climate Survey were distributed online. SPSS 27.0 was used for descriptive statistics and Pearson correlation analysis, while PROCESS macro handled mediation analysis.Ethical ConsiderationsThis study was approved by the Ethical Review Board of Xiangya School of Nursing, Central South University (No. E2023125).FindingsA total of 935 valid questionnaires were collected, with a response rate of 85.3%. Participants demonstrated moderate levels in ethical decision-making ability (276.41 ± 18.51), moral sensitivity (42.01 ± 7.61), and perceived hospital ethical climate (102.17 ± 14.63). There were significant positive correlations between each pair of these three variables (r = 0.248-0.474, p < 0.05). Moral sensitivity was associated with hospital ethical climate and ethical decision-making; hospital ethical climate mediated the relationship between moral sensitivity and ethical decision-making (β = 0.252-0.580, p < 0.05).DiscussionsComparing our findings with international research, this study highlights the influence of hospital ethical climate and moral sensitivity on ethical decision-making, emphasizing the mediating role of ethical climate and its implications.ConclusionsHospital ethical climate played a mediating role between moral sensitivity and ethical decision-making among senior nursing interns. Interventions targeting both are recommended to enhance ethical decision-making ability. Future research should explore specific measures for this population.