The role of perceived organizational support for nurses' ability to handle and resolve ethical value conflicts: A mixed methods study

Abstract

AimTo explore if and how nurses' perceived organizational support affects their ability to handle and resolve ethical value conflicts.DesignA mixed methods design with a longitudinal questionnaire survey and focus group interviews.MethodsA questionnaire survey in six hospitals in two Swedish regions provided data from 711 nurses responding twice (November–January 2019/2020 and November–January 2020/2021). A cross‐lagged path model tested the mutual prospective influence between the organizational climate of perceived organizational support, frequency of ethical value conflicts, and resulting moral distress. Four focus group interviews were conducted with 21 strategically selected nurses (April–October 2021). Qualitative data collection and analysis were inspired by Grounded Theory.ResultsA climate of perceived organizational support was empowering, contributing to role security. It prospectively decreased the frequency of ethical value conflicts but not the moral distress when conflicts did occur.ConclusionIt is important to facilitate the development of perceived organizational support among nurses, but also to reduce the occurrence of ethical value conflicts that the nurses cannot resolve.Implications for the ProfessionBy ensuring a shared care ideology, good inter‐professional relations within the entire care organization, providing clear and supportive organizational structures, and utilizing competence adequately, healthcare managers can facilitate and support the development of perceived organizational support among nurses. Nurses who are empowered by perceived organizational support are stimulated by and take pride in their work and experience the work as meaningful and joyful.ImpactThe study addressed the question of whether healthcare organizations could support nurses to resolving ethical value conflicts, and thus reduce moral distress. Perceived organizational support is related to factors such as ideological caring alignment and supportive organizational preconditions. This study contributes specific knowledge about how healthcare organizations can empower nurses to effectively resolve ethical value conflicts and thereby reduce their moral distress.Patient or Public ContributionNo patient or public contribution.

Ethical value conflicts in healthcare and their effects on nurses’ health, turnover intent, team effectiveness, and patient safety: a longitudinal questionnaire study

“…Further, fostering healthy organizational conditions and interpersonal relationships can positively impact care effectiveness. Focus group interviews conducted among a subsample of nurses in the CU included in the present study highlighted perceived organizational support as a critical condition for improving nurses’ ability to resolve EVC ( 15 ). These results highlight the need to address factors on the organizational level to support nurses’ ability to handle and resolve EVC among nurses in a manner that does not induce moral distress.…”

“…Exploratory factor analyses indicate that the EVC included in the present study can be modelled as two distinct factors: EVC induced by insufficient resources and EVC induced by inapt organizational structures or interpersonal staff relations ( 15 ). These results are similar to those found in a recent literature review, demonstrating that nurses experience EVC associated with the nurse–patient relationship, organizational structures, and with collaboration with colleagues ( 26 ).…”

“…All items had five fixed response alternatives for frequency (range 0–4) from “never” to “very often” and for distress from “not at all stressful” to “highly stressful”. Exploratory factor analyses indicated that 17 of these items could be modelled as two separate factors ( 15 ): EVC frequency resources comprising EVC induced by insufficient resources, with sample item “ be forced to prioritize between patients due to too high patient occupancy in the hospital”) (9 items: in the cross-sectional sample α=0.89 at T1, and in the longitudinal sample α=0.89 at both T1 and T2); and EVC frequency structures comprising EVC induced by inapt organizational structures or interpersonal staff relations, with sample item “ ignore situations in which patients have not been given adequate information to ensure informed consent”) (8 items: in the cross-sectional sample α=0.82 at T1 and in the longitudinal sample α=0.82 at T1 and 0.81 at T2). The variable EVC distress consisted of distress ratings of all 17 items (in the cross-sectional sample α=0.94 at T1, and in the longitudinal sample α=0.95 at both T1 and T2).…”

“…EVC were investigated using a combination of items from the Moral Distress Scale (MDS-R) (13,14) and items that were constructed within the present project (15), based on the results from Kävlemark et al (16). The purpose was, as completely as possible, to capture the types of EVC occurring in nurses' work.…”

Sequential Mediation Effects of Organizational Support and Collaboration on Missed Nursing Care

“…Perceived organizational support empowers nurses through clear and supportive organizational care and by utilizing nurse competence. 26 Empowering work conditions, such as opportunities, information, support, and resources, significantly influence employee attitudes and behaviors toward achieving organizational goals. 27 This structural empowerment provides information to effectively carry out their work and support peers, ultimately fostering collaboration among professionals.…”