Ethical Reasoning of Nurses and its Correlation with the Quality of Care from Patient’s Viewpoint in Hospitals of Tabriz University of Medical Sciences,2016

Abstract

Abstract Background and Aim: Professional ethics and moral reasoning are among the critical factors influencing professional nursing practice, the quality of patient care, and the patient’s health outcome. Given to present challenges in studies which related to ethical issues in nursing practice and its impact on nursing quality of care, the aim of this study was to determine ethical reasoning of nurses and its relationship with the quality of care of patients' viewpoints in hospitals affiliated to the Tabriz University of Medical Sciences. Method: This is a descriptive correlational study that was carried out with 180 hospitalized patients and 180 nurses who working in medical wards of the hospitals affiliated to Tabriz University of Medical Sciences in 2016. Samples were selected in nurses by the census method and in patients by random method. Data collection tools included a demographic questionnaire, Nursing Dilemma Test (NDT) and Quality Patient care Scale (QUALPAC). Data were analyzed by SPSS version 21.0 with descriptive statistics, one-way ANOVA, t-test and Pearson correlation tests. Results: The results showed that the mean score for ethical reasoning among nurses in medical wards was 45.07±6.1,and it was in middle range. where nurses scored 37.5%, 35.08% and 27.42% for pre-conventional, conventional and post-conventional levels respectively. There was a statistically significant relationship between nurses ethical reasoning and nurses’ shift (p<0.05). There were no significant relationships between age, sex, work history and other demographic characteristics, with ethical reasoning scores (p>0.05). The results also showed that the total mean score of nurse’ quality care was 91/71± 14/81 and 42.22% of patients were addressed the nursing quality of care is favorable in psycho-social domain and 43.33% of them in communication domain. There was no significant relationship between the mean scores of quality of care and nurse's ethical reasoning (p>0.05). Discussion and Conclusion: Regarding the average ability of nurses in ethical reasoning, the planning and adopting appropriate strategies in this regard such as professional ethics training in order to increase the moral sensitivity and the ability of moral reasoning and ethical decision making process in nurses when dealing with ethical issues, is needed. Given the results and importance of ethical reasoning in nurses about facing moral dilemmas and caring to patients, the precise identification of effective clinical factors affecting on ethical decision making and improvement of clinical environments can help to accurate and long-term planning and culture development in this regard. Considering the relationship between the type of shift and the place of nurses' service with the level of ethical reasoning, it is necessary for managers and health authorities to adopt specific management strategies and plans for adjusting work shift and improving organizational climate. Key words: Quality of care, ethical reasoning, nurses, patients