Interventions to promote an ethical climate: a scoping review

Schaefer, Rafaela; Müller, Rafaela Tonietto; Weber, Geise Klipel; Schmidt, Ariadne Machado; Goulart, Daiana Dozol de Andrade; Lopes, Priscila Pereira da Silva

doi:10.1590/1983-803420243544EN

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RESEARCH • Rev. Bioét. 32 • 2024 • https://doi.org/10.1590/1983-803420243544EN copy

Interventions to promote an ethical climate: a scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This review aims to identify and describe interventions to promote an ethical climate in health institutions. Method: a scope review carried out on PubMed, Virtual Health Library, EBSCOhost, and Google Scholar from October to December 2022. Data were analyzed using numerical and thematic synthesis and included two quasi-experimental and one experimental studies. Physicians, nurses, and other team members participated in this review, which describes the carried out interventions and obtained results. The interventions included workshops, ethics rounds, and an early action protocol that lasted from two weeks to six months. This review found a difference in the ethical climate for all participants in one study, only for nurses in another study, and no significant differences in the last studies. Few studies implement and evaluate interventions to promote an ethical climate. More studies are needed to improve content, didactics, and assessment methods in different contexts with several professionals.

Keywords
Evaluation of the efficacy-effectiveness of interventions; Ethics, professional; Ethics, institutional; Organizational culture; Health services

English	Portuguese	Spanish
((“Ethics”) or (“ethical climate”)) and (“educational activities”)	((“Ética”) or (“clima ético”)) and (“atividades educacionais”)	((“Ética”) or (“clima ético”)) and (“actividades educativas”)
(“ethical climate”) and (interventions)	((“clima ético”)) and (“intervenções”)	((“clima ético”) and (intervenciones)
((“Ethics”) or (“ethical climate”)) and (“educational activities”) and (“healthcare professionals”)	((“Ética”) or (“clima ético”)) and (“atividades educacionais”) and (“profissionais de saúde”)	((“Ética”) or (“clima ético”)) and (“actividades educativas”) and (“profesionales de la salud”)

Author/Year	Title	Country	Journal	Method	Participants	Intervention
Silén, Haglund, Hansson, Ramklint; 2015 ⁹	“Ethics rounds do not improve the handling of ethical issues by psychiatric staff”	Sweden	Nordic Journal of Psychiatry	Quasi-experimental study. Hospital Ethical Climate Survey	55 healthcare professionals from four psychiatric outpatient clinics participated	Six rounds of ethics, lasting one hour, using an imaginative approach, discussing a clinical situation, with the inclusion of ethical issues
Maghsoudi, Mohsenpour, Hamed; 2021 ¹⁰	“Comparison of ethical decision-making and interpersonal communication skills training effects on nurses’ ethical climate”	Iran	Clinical Ethics	Experimental study. Ethical Climate Questionnaire	Nurses working in the wards of general university hospitals participated in the research (n=90)	Two six-hour workshops for training in ethical decision-making and interpersonal communication skills
Pavlish and collaborators; 2021 ¹¹	“An ethics early action protocol to promote teamwork and ethics efficacy”	United States	Dimensions of Critical Care Nursing	Quasi-experimental study. Hospital Ethical Climate Survey	182 professionals participated, including 149 nurses and 32 physicians from six intensive care units (ICU) located in three academic medical centers	An early action protocol in ethics was presented to professionals online and individually, lasting 15 minutes, to later apply it in a daily care process existing in the ICU

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[1] Correspondence Rafaela Schaefer – Av. Unisinos, 950, Cristo Rei CEP: 93.022-750. São Leopoldo/RS, Brasil.