Linking ethical leadership to nurses' internal whistleblowing through psychological safety

Nurses' attitudes, practices, and barriers toward sustainability behaviors: a qualitative study

BACKGROUND

The integration of sustainability into nursing practice is critical for addressing the environmental challenges posed by healthcare systems. Nurses, as frontline healthcare providers, are uniquely positioned to lead sustainability initiatives, though collaboration with other healthcare professionals is essential. However, nurses' engagement in sustainability behaviors is influenced by a complex interplay of attitudes, practices, barriers, and facilitators, which are not fully understood. This study aimed to explore nurses' attitudes, practices, and barriers and facilitators toward sustainability behaviors in clinical settings.

METHODS

The study employed a descriptive qualitative design. Data were collected through semi-structured interviews designed to explore participants' experiences in depth with 15 purposively sampled licensed staff nurses. The sample size was determined by data saturation. Thematic analysis was used to analyze the data. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.

RESULTS

Nurses viewed sustainability as an ethical responsibility linked to waste reduction and resource conservation, yet sustainability was often deprioritized due to immediate patient care demands. Sustainability behaviors included waste management and energy conservation, but inconsistent institutional policies and limited formal training posed significant challenges. Key barriers included organizational challenges, competing priorities, and lack of motivation, while facilitators such as leadership support, education, training, and teamwork emerged as critical enablers of sustainable practices.

CONCLUSION

The study highlights the complex interplay between individual attitudes, institutional barriers, and enabling factors influencing sustainability in nursing. Nurses demonstrate an ethical inclination toward sustainability, but systemic challenges hinder their engagement. Leadership support, targeted training, and organizational policies are critical for fostering sustainable practices in clinical settings.

IMPLICATIONS FOR PRACTICE

Addressing identified barriers and leveraging facilitators can enhance sustainability behaviors among nurses. Tailored interventions, such as sustainability-focused education, leadership engagement, and policy reforms, are essential to empower nurses as leaders in environmental stewardship. Recognizing and supporting nurses' roles as environmental advocates is crucial for advancing sustainability in healthcare.

CLINICAL TRIAL NUMBER

Not applicable.

The mediating role of moral courage in the relationship between ethical leadership and error reporting behavior among nurses in Saudi Arabia: a structural equation modeling approach

BACKGROUND

Ethical leadership in nursing is pivotal for fostering a transparent workplace culture and encouraging error reporting, a critical behavior for enhancing patient safety. In Saudi Arabia, cultural and organizational factors may influence nurses' willingness to report errors, making this an essential area of study. This study investigates the correlation between ethical leadership and error reporting behavior, emphasizing the mediating influence of moral courage among nurses in Saudi Arabia.

METHODS

This cross-sectional research used a simple random sampling technique to recruit 269 clinical nurses from four specialized medical centers affiliated with King Abdullah Medical City in Makkah, Saudi Arabia. Data was collected between October and December 2024 using online self-reported questionnaires that included validated scales for ethical leadership, moral courage, error reporting, and demographic information form. This study was conducted in accordance with the STROBE guidelines. Structural equation modeling was used to investigate hypothesized relationships.

RESULTS

Ethical leadership significantly impacted error reporting behavior (β = 0.58, p < 0.001) and ethical courage (β = 0.35, p < 0.001). Moral courage was a significant predictor of error reporting behavior (β = 0.30, p = 0.01) and partially mediates the link between ethical leadership and error reporting (β = 0.11, p = 0.01). The total effect of ethical leadership on error reporting behavior was substantial (β = 0.69), with a BC 95% CI of (0.51, 0.89).

CONCLUSIONS

The findings highlight the critical role of ethical leadership in fostering moral courage and promoting error reporting behavior among nurses. The mediation effect of moral courage underscores the importance of cultivating an ethical work environment that empowers nurses to act with integrity and report errors without fear of retaliation. These insights emphasize the need for nursing managers to prioritize ethical leadership practices and create transparent workplace cultures that enhance patient safety. By addressing cultural and organizational barriers, healthcare institutions in Saudi Arabia can further encourage error reporting, ultimately improving the quality of care and patient outcomes.

The moderating effect of psychological capital on the relationship between nurses' perceived workplace bullying and emotional exhaustion: a cross-sectional study

BACKGROUND

Workplace bullying (WPB) is common in nursing profession, leading to adverse effects on nurses' health and teamwork. Although it has been suggested that psychological capital (PsyCap) could potentially moderate the relationship between WPB and emotional exhaustion, there is currently a lack of direct empirical evidence supporting this claim. Therefore, this study aims to examine how PsyCap moderates the relationship between WPB and emotional exhaustion in nurses.

METHODS

A cross-sectional study was carried out involving 1068 nurses using a general information questionnaire, Negative Acts Questionnaire-Revised, Psychological Capital Questionnaire-Revision, and emotional exhaustion subscale of the Chinese version of Maslach Burnout Inventory-General Survey. The PROCESS macro was utilized to examine the moderating effect of PsyCap.

RESULTS

WPB led to emotional exhaustion among nurses (β = 1.488, P < 0.001), and PsyCap moderated this positive relationship (β = 0.300, P < 0.001). The group with high PsyCap exhibited lower levels of emotional exhaustion. However, as the perceived WPB increased, the disparity in emotional exhaustion between the high and low PsyCap groups diminished.

CONCLUSIONS

WPB significantly contributes to nurses' emotional exhaustion. PsyCap mitigates this impact, but this effect is limited in organizations with high WPB. it is recommended that nursing managers mitigate the detrimental impact of WPB on nurses' emotional well-being by both strengthening nurses' individual PsyCap and implementing comprehensive strategies to reduce WPB behaviors.

Barriers and facilitators to effective pain management in elderly Arab patients: a nursing perspective through a qualitative study

BACKGROUND

Effective pain management in elderly patients is crucial for quality of life, yet cultural and institutional factors can significantly impact care delivery, particularly in Arab healthcare settings.

AIM

To explore the barriers and facilitators to effective pain management in elderly Arab patients from the perspective of nurses.

METHODS

A qualitative descriptive study was conducted with 12 registered nurses from various departments at Tanta University Hospitals, Egypt. Data were collected through semi-structured interviews, observations, and document analysis. Content analysis was used to identify themes and subthemes.

RESULTS

Five main themes emerged: (1) Cultural Barriers to Pain Expression, including stoicism and religious beliefs; (2) Institutional Barriers to Pain Management, such as resource limitations and time constraints; (3) Facilitators to Effective Pain Management, including family support and nurse adaptability; (4) Interdisciplinary Collaboration, emphasizing teamwork and education; and (5) Emotional and Professional Rewards for nurses. Cultural factors often led to underreporting of pain, while institutional constraints hindered thorough assessments. Nurse adaptability and family support, when present, facilitated better pain management.

CONCLUSION

The study reveals complex interplay between cultural, institutional, and professional factors influencing pain management in elderly Arab patients. Findings suggest the need for culturally sensitive pain assessment tools, enhanced nurse education in pain management, and policies promoting family-centered care and interdisciplinary collaboration.

IMPLICATIONS

Results can inform the development of culturally appropriate pain management strategies and policies in Arab healthcare settings, potentially improving care quality for elderly patients.

Exploring the Relationship Between Ethical Leadership and Nurses' Moral Courage in China: The Mediating Effect of Psychological Empowerment

Aim: To empirically investigate the impact of ethical leadership on nurses' moral courage in China and examine the mediating role of psychological empowerment in this relationship. Background: Moral courage is essential for alleviating nurses' moral distress, safeguarding patients' safety and rights, and providing high-quality care. Previous studies have emphasized the strong relationship between ethical leadership and moral courage; however, little is known about the actual impact of ethical leadership on nurses' moral courage. This study introduces psychological empowerment, sets out to test empirically its role in the relationship between ethical leadership and moral courage, and provides countermeasures and a theoretical basis for cultivating nurses' moral courage. Methods: Between February and May 2023, a questionnaire survey was conducted among 837 nurses from five hospitals in Sichuan Province, southwest China. The three validated self-report scales, the ethical leadership scale, psychological empowerment scale, and nurses' moral courage scale, were used to collect data. We used IBM SPSS 27.0 for descriptive statistics, univariate analyses, Cronbach's α, and correlations of each variable, modeling a hypothesized model of ethical leadership on moral courage in nurses and testing the internal mechanisms by AMOS 26.0. Results: Ethical leadership significantly positively correlated with psychological empowerment (r = 0.374, p <  0.01), as well as moral courage (r = 0.341, p <  0.01). In addition, psychological empowerment significantly positively correlated with moral courage (r = 0.518, p <  0.01). The structural equation modeling (SEM) shows a satisfactory model fit: χ 2 = 2156.36, df = 849, χ 2/df = 2.540, root mean square of approximation = 0.043, standard root mean square residual = 0.047, normed fit index = 0.911, Tucker-Lewis index = 0.941, and comparative fit index = 0.944. Ethical leadership directly influenced moral courage (β = 0.135, p=0.006) and indirectly affected moral courage via psychological empowerment (β = 0.247, p=0.001). Conclusion: Promoting ethical leadership and psychological empowerment is essential for nurses to promote moral courage. The results of this study illustrate the pivotal role of psychological empowerment in establishing the impact of ethical leadership on nurses' moral courage and the partially mediating part of psychological empowerment in this relationship. Implications for Nursing Management: Nursing managers should understand the importance of moral courage in protecting patients' rights and interests, as well as in maintaining a stable nursing workforce. They should reinforce the positive influence of ethical leadership and embrace an ethical leadership style. In addition, providing relevant training to enhance nurses' psychological empowerment will help cultivate moral courage among them.