Well-Being and Professional Efficacy Among Health Care Professionals: The Role of Resilience Through the Mediation of Ethical Vision of Patient Care and the Moderation of Managerial Support

Relationship Between Ethical Climate and Burnout: A New Approach Through Work Autonomy

Burnout is a factor that affects organizational performance. Researchers have not determined whether an ethical climate and adequate work autonomy provide sufficient emotional stability to dampen burnout or, conversely, increase it. In addition, the abundant literature analyzing the relationship between work autonomy and burnout does not sufficiently establish whether it acts as a stress-reducing resource or a stress-increasing demand. It is also unknown to what extent work autonomy contributes to explaining the relationship between ethical climate and burnout. Therefore, the main aim of this study is to examine the relationship between an ethical climate based on principles and norms and burnout using the moderating effect of work autonomy. We approached this question using a multivariate moderation analysis. The sample consists of 448 employees in the Colombian electric sector. The results show that an ethical climate of principles and work autonomy are positively related to burnout, measured by the dimensions of emotional exhaustion and depersonalization. However, the relationship between an ethical climate of principles and burnout shifts from positive to negative when a rule-demanding work environment is associated with a high perception of work autonomy. In conclusion, when employees have considerable control over their usual tasks, they develop a pattern of behavior that incorporates both the organization's internal standards and the principles that shape individual morality. In this case, employees are able to balance the workload with the high psychological demands of an ethical climate of principles, without it being a disturbance to their emotional well-being. The results of this research are particularly relevant because they show for the first time that an ethical climate of principles can have opposite effects on employee burnout, both positive and negative, depending on the degree of work autonomy. This opens the door to new strategies for organizations to prevent certain psychosocial occupational risks, such as burnout, which often have a serious impact on employees' mental health. Moreover, the model of moderation proposed in this article can be replicated in other Latin American countries with similar characteristics to those of Colombia or even transferred to rich countries.

Italian Version of the Hospital Aggressive Behaviour Scale-Users: Initial Psychometric Evaluation among Hospital Healthcare Professionals

BACKGROUND

Healthcare professionals frequently encounter various forms of aggression, ranging from verbal abuse to physical assaults, which can compromise both their occupational well-being and patient-care quality. Despite its prevalence and serious consequences, workplace aggression is often underreported due to a lack of standardized assessment tools. This study aims to develop a valid Italian version of the Hospital Aggressive Behaviour Scale-Users.

METHODS

The scale's structure was evaluated using exploratory (EFA) and confirmatory (CFA) factor analyses on two samples of healthcare professionals during and after the pandemic. Reliability, measurement invariance, and nomological validity were examined.

RESULTS

EFA revealed a two-factor structure comprising eight items (χ2 = 59.651, df = 13, p = 0.00; CFI = 0.98; TLI = 0.95; RMSEA = 0.07; SRMR = 0.02), distinguishing non-physical and physical aggression, and meeting all recommended criteria. CFA confirmed this structure, demonstrating good reliability and outperforming alternative models. The same factor structure was confirmed in standard (χ2 = 35.01, df = 19, p = 0.00; CFI = 0.99; TLI = 0.99; RMSEA = 0.03; SRMR = 0.02) and emergency (χ2 = 30.65, df = 19, p = 0.04; CFI = 0.98; TLI = 0.97; RMSEA = 0.06; SRMR = 0.04) contexts. Full residual invariance was found across job tenure groups. Aggression was positively associated with emotional exhaustion, psychological distance, psychosomatic symptoms, post-traumatic stress symptoms, and turnover intentions while negatively related to job satisfaction. Nurses and healthcare assistants reported higher levels of aggression than doctors.

CONCLUSIONS

This study provides a reliable, context-specific instrument for documenting and analysing outsider aggression. The insights can inform targeted interventions, contributing to a healthier hospital environment.

Investigating the correlation between organizational ethics and professional ethics with job burnout and organizational commitment: a cross-sectional study in the nursing staff

BACKGROUND

Adherence to ethical principles and standards in all health professions, especially in the nursing, can have positive outcomes. This study was conducted with the aim of investigating the correlation between organizational ethics and professional ethics with organizational commitment and job burnout in nursing staff.

METHODS

This cross-sectional study was conducted on the nurses working in Shahid Montazeri hospital in Najafabad city. Participants were selected by census method. An online questionnaire was used to collect the data, which consisted of demographic information, Hunt et al.'s organizational ethics questionnaire, Petty's professional ethics inventory, Maslach and Jackson's job burnout questionnaire and Allen and Mayer's organizational commitment questionnaire. Data were analyzed using t-test, one-way analysis of variance, Pearson correlation coefficient and structural equation modeling (SEM) with SPSS-27 and Amos-23 statistical software.

RESULTS

A total of 197 subjects with the mean age of 34.67 ± 7.74 years participated in this study. Most of the participants were female (89.3%) and married (77.2%). The majority of them had a bachelor's degree (86.3%) and 61.4% of the participants participated as a nurse. There were significant positive correlations between organizational ethics (r = 0.551, p < 0.01) and professional ethics (r = 0.44, p < 0.01) with organizational commitment. Also, there were significant negative correlations between organizational ethics (r=-0.532, p < 0.01) and professional ethics (r=-0.602, p < 0.01) with job burnout.

CONCLUSION

Considering the importance of compliance with ethics in the workplace by nursing staff and its consequences such as increasing organizational commitment and reducing job burnout, it is suggested that hospital managers emphasize the compliance with ethics in the workplace as a model. They can also familiarize nursing staff with the principles and basics of organizational and professional ethics by holding training courses.

Interprofessional Differences in Multidimensional Self-Efficacy Associated With Professional Performance in Nephrology During Case-Based Learning

Introduction

Postgraduate medical education assumes rising importance in the rapidly advancing field of medicine. Case-based learning (CBL), a learner-centered pedagogy employing clinical cases to improve decision-making, is widely embraced in postgraduate medical education, including nephrology. Studies suggest that learning self-efficacy (SE) was closely associated with learning motivation and academic performance; however, very few studies examined this association in postgraduate nephrology education. None evaluated whether there were interprofessional differences concerning such association.

Methods

In 2022, we prospectively enrolled physicians and nurses participating in chronic kidney disease (CKD) care from institutions around Taiwan. They completed the Professional Medical Learning Self-efficacy (PMLS) questionnaire after attending >1 CBL session involving CKD care. We undertook confirmatory factor analysis (CFA), followed by structural equation modeling (SEM) to evaluate associations between 5 dimensions of learning SE (conceptual understanding [CU], higher-order cognitive skills [HC], practical work [PW], everyday application [EA], and medical science communication [MSC]) and their professional SE in nephrology according to participants' medical professions.

Results

A total of 513 healthcare providers were surveyed. The convergent and construct validity of our questionnaire were satisfied after analyses. We found that better perceived professional performance in the form of higher professional SE in nephrology was significantly associated with all 5 dimensions of learning SE among physicians and nurses. Only CU and PW were significantly associated with physicians' professional performance; whereas among nurses, only HC and MSC were significantly associated.

Conclusion

We showed that learning SE was an important determinant of nephrology professional performance. Different medical professions posed influences on major SE dimensions.

Workplace Ethical Climate and Workers' Burnout: A Systematic Review

OBJECTIVE

Workplace ethics is a central theme in occupational health; an ethical climate aims to implement and uphold standards of integrity and fairness. Furthermore, the correlation between ethical climate and burnout has been highlighted in several studies, and the impact of a negative ethical climate in the workplace has been reported to affect workers' mental health and job performances, resulting in increased burnout incidence. The aim of this systematic review is to assess the relationship between ethical climate and burnout in the workplace.

METHOD

This review was conducted following the PRISMA statements. Three databases were screened, including research articles written in the English language during the last 10 years, investigating the relationship between burnout and ethics in the workplace. The quality of articles was assessed with the Newcastle-Ottawa Scale.

RESULTS

1153 records were found across three databases; after duplicate removal and screening for title and abstract, 46 manuscripts were screened by full text, resulting in 13 included studies. The majority of the included studies were performed on healthcare workers (n=7, 53.8%), and with a majority of female participants (n=9, 69.2%). Most of the included studies (n=9, 69.2%) evaluated the correlation between ethical climate and burnout, while the other four (n=4, 30.8%) evaluated ethical leadership. Four studies reported a positive correlation between ethics and work engagement. Two studies highlighted that an ethical workplace climate reduced turnover intention.

CONCLUSIONS

Ethical climate plays an important role in burnout mitigation in workers and in improving work engagement, thus helping to reduce turnover intentions. Since all of these variables have been reported to be present in clusters of workers, these aforementioned factors could impact entire workplace organizations and their improvement could lead to a better work environment overall, in addition to improving the single factors considered. Further studies are needed to investigate the role of ethical climate in the workplace.

Physiotherapists' Ethical Climate and Work Satisfaction: A STROBE-Compliant Cross-Sectional Study

(1) Background: This study aimed to examine the relationship between Spanish physical therapists' perceptions of the ethical climate, their moral sensitivity (awareness of ethical issues), and job satisfaction. (2) Methods: the study analyzed descriptive correlational data on 104 physical therapists from three Spanish metropolitan hospitals. Respondents completed a demographic data form, an ethical climate questionnaire, a job satisfaction survey, and a moral sensitivity scale. This study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. (3) Results: With a mean score of 4.2, physical therapists are typically content with their jobs. The mean scores for the moral sensitivity and ethical climate questionnaires are high, at 40.1 (SD 6.3) and 96.8 (SD 17.1), respectively. There is a significant positive correlation between job satisfaction and ethical climate (r between 0.59 and 0.79) but only a weak correlation between job satisfaction and moral sensibility (r between 0 and 0.32 for the three aspects measured). (4) Conclusions: Generally speaking, physical therapists reported that they had high job satisfaction, a positive workplace environment, and excellent management support. Despite a weak relationship with moral sensibility, there is a strong association between ethical behavior, hospital organization, and higher levels of job satisfaction. It is important to encourage the development of moral sensibilities to boost psychological well-being and therapeutic decision-making.

Moral Distress among Frontline Physicians and Nurses in the Early Phase of COVID-19 Pandemic in Italy

During the COVID-19 health emergency, healthcare professionals faced several ethical demanding job stressors, becoming at particular risk of moral distress. To date, only a few scales have been developed to evaluate moral distress among frontline professionals working in contact with COVID-19 patients. Moreover, although many healthcare professionals from various disciplines were converted to COVID-19 patient care, no study has yet analyzed whether the resulting change in duties might represent a risk factor for moral distress. Thus, this study aimed to investigate how and when the change in duties during the emergency would be related to healthcare professionals' psycho-physical malaise. To this aim, a first Italian adaptation of the Stress of Conscience Questionnaire (SCQ) was provided. In total, 272 Italian healthcare professionals participated in this cross-sectional study. Healthcare professionals who had to perform tasks outside their usual clinical duties were more likely to experience moral distress and then psycho-physical malaise. This was particularly likely for those who were extremely concerned about becoming infected with the virus. The results also indicated that the Italian adaptation of the SCQ had a one-factor solution composed of six items. This study provides the first Italian adaptation of SCQ and practical suggestions on how supporting professionals' well-being during emergencies.

Helping others not always helps ourselves: the relationship between victim incivility and emergency workers' burnout through work-to-family conflict

Purpose

This study aims to analyse whether and when victim incivility may be related to work-to-family conflict and then burnout among emergency workers.

Design/methodology/approach

A total of 304 Italian emergency workers from five firehouses and six emergency rooms completed questionnaires, examining: victim incivility, work-to-family conflict, social support seeking and burnout symptoms. Descriptive analyses, confirmatory factor analyses and structural equation models were conducted.

Findings

Victim incivility was positively associated with burnout symptoms, both directly and indirectly, as mediated by work-to-family conflict. Additionally, social support seeking exacerbated (rather than mitigated) the impact of work-to-family conflict on burnout symptoms.

Practical implications

Organisations can greatly benefit from implementing family-friendly practices and providing their workers with training programmes on how to deal with difficult victims.

Originality/value

This study contributes to the existing literature on workplace incivility and work–life interface by supporting for the first time the notion that victim incivility can spill over into emergency workers' family domain and by clarifying how and when victim incivility is related to burnout symptoms.

How Supportive Ethical Relationships Are Negatively Related to Palliative Care Professionals' Negative Affectivity and Moral Distress: A Portuguese Sample

In the modern healthcare landscape, moral distress has become an increasingly common phenomenon among healthcare professionals. This condition is particularly prevalent among palliative care professionals who are confronted with bioethical issues in their daily practice. Although some studies described the effects of poor ethical climate and negative affectivity on moral distress, how these variables could be incorporated into a single model is still unclear. Thus, this study aims to investigate whether ethical relationships with the hospital could be related to the intensity and frequency of moral distress, both directly and as mediated by professionals' negative affectivity. Sixty-one Portuguese palliative care professionals completed web-based self-report questionnaires. After exploring descriptive statistics, mediation analyses were performed using the partial least squares method. The results indicated that the presence of positive relationships with the hospital reduced the professionals' negative affectivity levels. This, in turn, led palliative care professionals to experience a lower frequency and intensity of moral distress. Being a physician was positively associated with negative affectivity but not with the frequency of moral distress. Considering the protective role of ethical relationships with hospitals, health organizations could consider implementing interventions to improve hospitals' ethical climate and provide staff with ethics training programs.