Fostering an ethical climate and ensuring safety in nursing: Pilot study results in Latvia

Abstract

Introduction. A positive ethical climate is essential for ensuring patient safety, quality of care, professional integrity and nurses' well-being. Ethical safety is an important part of a healthcare professional's competence and scientific progress gives rise to new challenges every day. However, limited evidence is available on how nurses in Latvia perceive ethical climate, ethical safety and moral distress in healthcare settings. Objectives. The purpose of this pilot study was to assess nurses' perceptions of the ethical climate, ethical safety, communication and moral distress in Latvian healthcare settings as well as to explore opportunities for creating a more ethically supportive working environment. Materials and Methods. A quantitative cross-sectional pilot study was conducted in Latvia between May and September 2023 using the Webropol online survey platform. The questionnaire included demographic questions, the Swedish Ethical Climate Questionnaire consisting of 10 items and the Ethical Safety Questionnaire consisting of 11 items. Descriptive statistics and frequency distributions were calculated, and internal consistency was assessed using Cronbach's alpha. Results. A non-probability convenience sample of 94 nurses participated in the study. The participants were nurses working in various Latvian healthcare settings, including hospitals, primary care, health centres and ambulatory care services. The respondents' age ranged from 22 to 64 years, with a median age of 46.5 years. The average length of nursing experience was 18 years, and the average length of experience in the current workplace was 8.8 years. The instruments demonstrated good internal consistency, with Cronbach's alpha values of 0.887 for the Ethical Safety Questionnaire and 0.813 for the Swedish Ethical Climate Questionnaire. The overall ethical climate score indicated a moderate perception of ethical dialogue and support in the workplace, with a mean score of 3.39. The overall ethical safety score was higher, with a mean score of 3.75, suggesting that respondents generally perceived themselves as capable of acting ethically, although organisational support for ethical participation appeared less consistent. Higher scores were observed for the ability to express opinions about what is right and good, initiate discussions about ethical aspects of care, and admit mistakes without losing credibility. Lower scores were found for addressing ethical problems regardless of professional hierarchy and questioning decisions that do not align with personal or professional values. These findings suggest that organisational and hierarchical factors may influence nurses' participation in ethical dialogue. Conclusions. The findings suggest that Latvian nurses perceive themselves as ethically competent, and capable of contributing to ethical practice. However, ethical dialogue and organisational support within healthcare workplaces appear to be only moderate. Strengthening ethical climate requires organisational strategies that promote open communication, interprofessional dialogue, ethical leadership and recognition of nurses' ethical contributions. Further research with larger and more representative samples is recommended.