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Published on: February 16, 2011
The Legal Mindset in Oncology Nursing: How Legal Consciousness and Just Culture Shape Defensive Practice of Oncology
Ahmed Abdelwahab I El-Sayed1, Samira A Alsenany2, Noura M F Abdel Razek1
1Department of Nursing Administration, Faculty of Nursing, Alexandria University, Alexandria, Egypt (El-Sayed and Abdel Razek).
Background:
Oncology nurses frequently practice in high-liability settings that expose them to legal scrutiny, leading to defensive nursing practices. While legal consciousness can drive such behaviors, the role of just culture as a potential mitigating factor remains underexplored.
Objective:
To examine the association between legal consciousness and defensive nursing practices among oncology nurses, and to assess whether just culture moderates this relationship.
Methods:
A cross-sectional study was conducted with 486 oncology nurses from 4 cancer care centers in Egypt. Participants completed validated measures of legal consciousness, perceived just culture, and defensive nursing practices. Moderated multiple regression analysis was performed to test the hypothesized relationships, controlling for demographic and professional variables.
Results:
Legal consciousness was positively associated with defensive nursing practices (B = 0.198, P <.001), while just culture was negatively associated (B = -0.267, P <.001). A significant interaction effect (B = -0.128, P =.005) revealed that higher levels of just culture weakened the association between legal consciousness and defensive practices. Nurses with postgraduate education reported lower defensive practices, whereas prior legal involvement and training were linked to increased defensive practices.
Conclusion:
While legal consciousness contributes to defensive behaviors, a strong just culture environment can buffer this effect, supporting ethical and autonomous clinical practice in oncology nursing.
Implications For Practice:
Oncology nurse leaders and educators should integrate just culture principles into clinical governance and legal training to reduce risk-averse behaviors and enhance ethical, patient-centered care. Legal education should emphasize applied reasoning and confidence-building rather than fear-based compliance.
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