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Ethical value conflicts in healthcare and their effects on nurses’ health, turnover intent, team effectiveness, and patient safety: a longitudinal questionnaire study
Department of Psychology, University of Gothenburg, Gothenburg (SWE).
Department of Psychology, University of Gothenburg, Gothenburg (SWE).
University West, Department of Health Sciences, Section for nursing - graduate level. (LOVHH)ORCID iD: 0000-0003-0084-4636
University West, School of Business, Economics and IT, Division of Business Administration. (LOVHH)ORCID iD: 0000-0003-2476-4411
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2024 (English)In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 50, no 2, p. 113--121Article in journal (Refereed) Published
Abstract [en]

Objective: Moral distress emanating from value conflicts comprising ethical dimensions pose a threat to nurses’ health and retention, as well as to the quality of care. The aim of the present study was to investigate the relationships between the frequency of ethical value conflicts (EVC), and the perceived distress when they occur, respectively, and nurses’ work-related stress, burnout symptoms, turnover intent, team effectiveness, and patient safety.

Method: A two-wave longitudinal cohort questionnaire study was performed among registered nurses at six hospitals in two Swedish regions. Cross-sectional analyses (T1) were based on 1817 nurses in 228 care units (CU), and longitudinal analyses (T1 – T2) on 965 nurses in 190 CU. Hypothesis testing was performed using multilevel controlled regression modeling.

Result: The results indicated that nurses who were often exposed to EVC also to a higher extent tended to report these conflicts as stressful. Frequent exposure to EVC induced by insufficient resources, inapt organizational structures or interpersonal staff relations were cross-sectionally associated with work-related stress, burnout symptoms, turnover intent, and team effectiveness. The longitudinal analyses indicated that EVC induced by a lack of resources primarily had negative effects on nurses’ health and well-being. At the CU level, such conflicts also impaired team effectiveness. At the individual level, EVC induced by organizational constraints or interpersonal relations negatively affected care effectiveness.

Conclusions: EVC are related to negative consequences in healthcare, and such processes take place both on the individual and organizational levels.</p>

Place, publisher, year, edition, pages
Nordic Association of Occupational Safety and Health (NOROSH) , 2024. Vol. 50, no 2, p. 113--121
Keywords [en]
ethical dilemma; ethical value conflict; healthcare; longitudinal questionnaire; moral distress; nurse; nurses’ health; nurses’ well-being; nursing; patient safety; quality of care; team effectiveness; turnover
National Category
Nursing Work Sciences
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
URN: urn:nbn:se:hv:diva-21216DOI: 10.5271/sjweh.4138ISI: 001165233500001PubMedID: 38232184Scopus ID: 2-s2.0-85186566663OAI: oai:DiVA.org:hv-21216DiVA, id: diva2:1842275
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Available from: 2024-03-04 Created: 2024-03-04 Last updated: 2024-04-29

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Skyvell Nilsson, MariaGadolin, Christian

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