Purpose
This study aimed to ascertain the influence of moral distress and ethical nursing competence on retention intention among nurses.
Methods
Participants included 191 nurses working in general hospitals. Data were collected from July 11 to 18, 2023 and analyzed using SPSS/WIN 23.0.
Results
Factors Influencing retention intention were clinical experience in the present department (β=.22, t=3.20, p=.002), moral distress (β=-.22, t=-3.15, p=.002) and ethical nursing competence (β=.26, t=3.82, p<.001). These variables accounted for 19.7% of nurses' retention intentions.
Conclusion
Based on our findings, it is necessary to identify interventions aimed at alleviating moral distress, and establish and implement systematic programs to improve ethical nursing competence in order to increase the retention intention of nurses.

Purpose
This study aimed to identify the effects of clinical nurses' ethical climate and ethical nursing competence on moral distress.
Methods
The participants were clinical nurses who provided direct nursing care; nurses with more than one year of work experience in general hospitals were targeted. The data were collected between January 3 and 19, 2024, and analyzed using t-test, analysis of variance, Games-Howell test, Pearson correlation coefficient, and multiple regression.
Results
Moral distress was significantly and negatively correlated with ethical climate and ethical nursing competence. Factors affecting the moral distress of clinical nurses included having a position of charge nurse or higher, total clinical experience of more than 20 years, turnover intention from current job due to ethical issues, hospital sub factors of the ethical climate, and ethical behavior sub factors of ethical nursing competence, showing 27.0% explanatory power.
Conclusion
Establishing a positive ethical climate and improving ethical nursing competence providing opportunities for nurses to raise and solve ethical issues will contribute to resolving nurses' ethical conflicts and reducing moral distress.

Citations

• Influential factors of moral distress and job satisfaction on turnover intention of long-term care hospital nurses: A cross-sectional descriptive study
  Ningjie Liu, Sun Mi Ha
  Journal of Korean Gerontological Nursing.2025; 27(2): 216.     CrossRef

Purpose
This study aimed to identify the factors influencing nurses’ perceptions of the disclosure of patient safety incidents in tertiary hospitals.
Methods
As a descriptive study, data were collected from 315 nurses working in two tertiary hospitals in Busan via structured self-report questionnaires from June 28 to September 3, 2023, through an online survey. Data were analyzed using descriptive statistics, t-test, one-way ANOVA, Pearson’s correlation coefficients, and hierarchical regression analysis with SPSS/WIN 27.0.
Results
Analysis was conducted by controlling for the characteristics of the study participants, which revealed significant differences in their perceptions of the disclosure of patient safety incidents. Ethical nursing competence (β=.30, p<.001) and patient safety culture (β=.15, p=.012) were significant influencing factors on the perception of such disclosure, and the explanatory power of the regression model was 21.0% (F=14.63, p<.001).
Conclusion
To enhance the aforementioned perception among nurses in tertiary hospitals, healthcare institutions should provide learning opportunities to improve their ethical nursing competence. Fostering an organizational culture that promotes and encourages open disclosure of patient safety incidents is also essential.

Citations

• Impact of Nursing Professionalism, Ethical Sensitivity, and the Clinical Learning Environment on Nursing Students' Intention to Report Near Misses and Adverse Events
  Sookhee Yoon, Ha-Young Park
  Journal of Korean Academy of Fundamentals of Nursing.2025; 32(2): 209.     CrossRef
• Factors Influencing End-of-life Care Competency in Nursing Students
  Jinryung Park, Minjeong Seo
  Korean Journal of Medical Ethics.2024; 27(4): 267.     CrossRef

Purpose
This study aimed to investigate the relationship between' perceived ethical climate, workplace bullying, and turnover intention among hospital nurses.
Methods
This study was conducted with 190 full-time nurses working in hospitals in Korea as participants. Data were collected from online communities using Google Docs from July 22 to July 25, 2022.
Results
Average values were as follows: ethical climate was 3.79±0.60, workplace bullying was 2.31±0.77, and turnover intention was 3.79±0.60. While turnover intention had no correlation with ethical climate, it had a positive relationship with workplace bullying. Workplace bullying was influenced by verbal aggression (β=.48, p=.001), inappropriate task assignment (β=.26, p=.006), monthly salary (β=.18, p=.001), and working department (β=-.13, p=.012). These four variables may explain 60.0% of hospital nurses' turnover intention.
Conclusion
To prevent turnover of hospital nurses, nursing managers should establish nursing career development programs to ensure adequate retention of experienced nurses. The need to provide nurses with communication skills training to prevent verbal attacks and bullying in the workplace has been identified.

Citations

• Effects of Clinical Nurses' Ethical Climate and Ethical Nursing Competence on Moral Distress
  Sun Mi Ha, Yeong Ju Yoon
  Journal of Korean Academy of Nursing Administration.2025; 31(1): 25.     CrossRef

Purpose
This study investigated the mediating effect of patient participation culture in the relationship between ethical leadership and performance in patient-engaged nursing services.
Methods
This study employed a cross-sectional descriptive online survey design. The sample comprised 104 nurses from small- and middle-sized Korean hospitals. Data were collected between May 10 and September 10, 2019 using the Smart Patient Engagement Assessment Checklist, Korean versions of the Patient Participation Culture Tool for healthcare workers, the Ethical Leadership Scale, and a questionnaire about nurses' demographic and work characteristics. A mediation analysis was conducted using multiple regression and a simple model applying the PROCESS macro using SPSS/WINdows software version 26.0.
Results
Ethical leadership directly affected (c'=0.28, p<.001) performance in patient-engaged nursing services. Patient participation culture partially mediated the relationship between ethical leadership and performance in patient-engaged nursing services (a ․ b=0.51×0.20=0.10, 95% Boot CI=0.18~0.20).
Conclusion
Optimizing the patient participation culture and adherence to ethical leadership among hospital administrators and managers can improve nurses' performance in patient-engaged nursing services. Nurse managers' ethical leadership should be strengthened, and patient participation culture should be encouraged at policy levels through systematic nurse education on patient safety and engagement to enhance performance-engaged nursing services.

Citations

• Characteristics of Leadership Competency in Nurse Managers: A Scoping Review
  Silvia Perez-Gonzalez, Pilar Marques-Sanchez, Arrate Pinto-Carral, Alberto Gonzalez-Garcia, Cristina Liebana-Presa, Carmen Benavides, Ruishuang Zheng
  Journal of Nursing Management.2024;[Epub]     CrossRef

Purpose
The purpose of this study is to identify the effect of nursing students' perception of emerging infectious disease, ethical awareness and nurse image on their career identity in a pandemic situation. Methods: Data were collected from 247 nursing students within universities of Daejeon, Gimcheon and Yeongdong area from May 18 to June 20, 2020. The data were analyzed using t-test, ANOVA, Pearson's correlation coefficient and regression analysis. Results: The subjects of this study had high level of perception of novel infectious disease (3.72±0.43), ethical awareness in pandemic situations (4.06±0.48), and nurse image (4.07±0.49), but low level of career identity (1.99±0.51). Career identify was significantly correlated with perception of novel infectious disease (r=.18, p=.005), ethical awareness in pandemic situation (r=.16, p=.011), and nurse image (r=.32, p<.001). However, excluding grade and residential area among the general characteristics, only the nurse image (β=.35, p<.001) was identified as a factor influencing career identity, and the explanatory power was 13.1%. Conclusion: To increase the career identity of nursing students, it is necessary to raise professional nurses’ social awareness and develop a positive nurse image.

Citations

• Factors Influencing Graduate Nurses’ Intention to Care for Emerging Infectious Disease Patients Based on Theory of Reasoned Action
  Seonhye Jeong, Yeoungsuk Song
  Journal of Korean Academy of Fundamentals of Nursing.2024; 31(1): 60.     CrossRef

Purpose
This study conducted a systematic review and meta-analysis to identify trends in nursing ethics education research for Korean nursing students and nurses. Methods: The data search was conducted in July 2020; domestic and foreign academic journals were targeted for the search. A combination of search terms was entered into major databases, and the year of publishing was limited to the last 10 years (2010~2020). Results: The systematic review analyzed 25 experimental and 13 non-experimental studies, and education methods included lectures, discussions, role play, film-use classes related to nursing ethics, action learning, and case-based learning. The meta-analysis of 12 studies revealed that ethical education has significant differences in effect size of biomedical ethics, critical thinking, moral judgment, and moral sensitivity. A subgroup analysis of education methods showed that in addition to traditional lecture and discussion education methods, there were significant differences in the effect size of sense of biomedical ethics between the following two methods: lecture and discussion including additional methods and lecture and discussion only. Conclusion: Ethics education for nursing students and nurses has been found to be effective in improving ethics-related competencies, and various teaching methods other than lectures and discussions must be utilized.

Citations

• Development and Application of Biomedical Ethics Education e-Learning Contents for College Students Based on Scenarios Using Generative Artificial Intelligence
  Bon-Jin Koo
  Journal of Digital Contents Society.2024; 25(10): 3091.     CrossRef

Purpose
This study was done to investigate the mediating effect of trust in supervisor in the relationship between ethical leadership of nursing unit managers and job embeddedness of staff nurses. Methods: Participants were 216 staff nurses from one tertiary general hospital and three general hospitals. Data were collected from June to August, 2018, using self-report questionnaires. Data were analyzed using descriptive statistics, independent t-test, Mann-whitney U test, One-way ANOVA, Kruskal-wallis, Welch test, Scheffé test, Games-Howell, Pearson correlation coefficients and multiple regression, with the SPSS/WIN 23.0 program. A mediation analysis was performed according to the Baron and Kenny method and Sobel test. Results: There were significant relationships between ethical leadership and trust in supervisor (r=.85, p<.001), ethical leadership and job embeddedness (r=.38, p<.001), and trust in supervisor and job embeddedness (r=.41, p<.001). Trust in supervisor showed full-mediating effects in the relationship between ethical leadership and job embeddedness. Conclusion: The results of this research show the importance of the role of trust in the supervisor as a full mediating variable. To increase the nurses’ job embeddedness, it is necessary to develop programs and strategies to enhance trust in supervisors, as well as training nursing unit managers to provide ethical leadership.

Citations

• Commitment to Organizational Change in Clinical Nurses: A Structural Model Applying Lewin's Change Theory
  Mihwa Hong, Sujeong Han
  Journal of Korean Academy of Fundamentals of Nursing.2024; 31(1): 38.     CrossRef

Purpose
This study was done to identify the mediating effect of biomedical ethics awareness in the relationship between moral sensitivity and perceived ethical confidence among nursing students. Methods Participants were 211 nursing students from 7 universities in G city. A self-report questionnaire was used to measure moral sensitivity, biomedical ethics awareness, and perceived ethical confidence. The data were analyzed with descriptive statistics, Pearson correlation coefficient analysis, and multiple regression analysis using Baron and Kenny's method. Results Moral sensitivity was significantly positively correlated with biomedical ethics awareness (r=.52, p<.001) and perceived ethical confidence (r=.60, p<.001). Biomedical ethics awareness was also significantly correlated with perceived ethical confidence (r=.50, p<.001). Also, biomedical ethics awareness (β=.25, p<.001) showed a partial mediating effect on the relationship between moral sensitivity and perceived ethical confidence. Conclusion The impact of moral sensitivity on perceived ethical confidence in nursing students was mediated by biomedical ethics awareness. Therefore, it is suggest that strategies for improving biomedical ethics awareness in nursing students should be considered when developing an educational program for enhancing their perceived ethical confidence.

Citations

• Assessing the relationship between ethical reasoning confidence and self-esteem among female nursing students for enhancing the quality of work life: A cross-sectional study
  Shaherah Yousef Andargeery, Sally Mohammed Farghaly Abdelaliem
  Medicine.2024; 103(14): e37614.     CrossRef
• Mediating effect of moral sensitivity on the relationship between nursing professionalism and ethical decision-making confidence in nursing students
  Bae-Hwa Kang, Hye-Young Cho
  The Journal of Korean Academic Society of Nursing Education.2023; 29(2): 180.     CrossRef
• The impact of nursing students’ biomedical and artificial intelligence ethical awareness, ethical values, and professional self-concept on their ethical decision-making confidence
  Seungmi Park, Insun Jang
  The Journal of Korean Academic Society of Nursing Education.2023; 29(4): 371.     CrossRef

PURPOSE
The purpose of this study was to identify the relationships among nursing students' knowledge, attitudes to advance medical directives and ethics values.
METHODS
The study was a cross-sectional and descriptive survey, carried out with 232 students from two schools of nursing, one located in B and C city. Student nurses' knowledge, attitudes for advance medical directives and ethics values were measured using structured self-report questionnaires. Data were analyzed using t-test or one-way ANOVA, and Pearson correlation coefficients.
RESULTS
The scores for knowledge, attitudes for medical advance directives were 7.18 and 3.07, and for ethics values, 3.47. Nursing students' knowledge and attitude showed a significant difference depending on grade. Nursing students' ethics values showed significant differences depending on whether a study on ethics had been completed. A positive correlation was observed between nursing students' knowledge, attitudes for advance medical directives and ethics values.
CONCLUSION
The results of this study indicate that basic data for the development of an effective education program on ethics is important in establishing a positive attitude toward advance medical directives and the appropriate ethical values in student nurses.

Citations

• Factors Associated with Family Caregivers’ Intentions to Complete an Advance Directive for Individuals with Dementia: A Cross-Sectional Descriptive Study
  Hyeseon Park, Sujin Kang, Youngji Kim
  Healthcare.2025; 13(11): 1297.     CrossRef
• Knowledge, Attitudes and Nursing Stress Related to Life-Sustaining Treatment among Oncology Nurses
  Seul Lee, Suyoun Hong, Sojung Park, Soojung Lim
  The Journal of Hospice and Palliative Care.2023; 26(3): 112.     CrossRef
• Determinants of nursing students’ inclination to ethical values: Compassionate love and perceived social support from the family
  Neslihan Lok, Gülten Uzun, Alime Selçuk Tosun
  Nurse Education in Practice.2023; 67: 103556.     CrossRef
• Health Personnel's Knowledge, Attitudes, and Self-Efficacy Related to Providing Palliative Care in Persons with Chronic Diseases
  EunSeok Cha, Sojung Lee, Jooseon Lee, Insil Lee
  The Korean Journal of Hospice and Palliative Care.2020; 23(4): 198.     CrossRef
• Effects of Awareness to Well-dying, Knowledge and Attitudes toward Advance-directives on Attitude toward End-of-life Care in Nursing Students
  Insun Jang, Youngji Kim
  The Korean Journal of Rehabilitation Nursing.2019; 22(2): 104.     CrossRef

PURPOSE
This study was done to identify the experiences of ethical issues and needs for ethics education in clinical nurses.
METHODS
A cross-sectional survey was used and data were collected in 2013. Participants were 428 clinical nurses working in the general units of seven medical hospitals. The Ethical Issues in Clinical Practice Tool was used. Data analysis was performed using SPSS/WIN 19.0.
RESULTS
'Providing care with a possible risk to your health' was the most frequent and disturbing ethical problems for nurses. The highest helpful ethical topic was 'the patients' right, autonomy and informed consent'. The ethical issue experience was significantly different according to education level, work units, and type of employment. The necessity of ethics education was statistically different according to age, religion, level of education, duration of working as RN, position, shift type, and continuing education about nursing ethics.
CONCLUSION
The results of this study show that nursing educators need to provide practical ethics education based on frequent ethical issues and helpful education topics. These findings can be used in developing effective education strategies for clinical nurses and nursing organizations to improve nurses' ethical decision-making abilities.

Citations

• Effects of Clinical Nurses' Ethical Climate and Ethical Nursing Competence on Moral Distress
  Sun Mi Ha, Yeong Ju Yoon
  Journal of Korean Academy of Nursing Administration.2025; 31(1): 25.     CrossRef
• Influential factors of moral distress and job satisfaction on turnover intention of long-term care hospital nurses: A cross-sectional descriptive study
  Ningjie Liu, Sun Mi Ha
  Journal of Korean Gerontological Nursing.2025; 27(2): 216.     CrossRef
• Nurses’ intention to care of COVID-19 patients in hospitals dedicated to infectious disease in South Korea: application of the theory of planned behavior and verification of the moderating effect of ethical nursing competence
  Mira Mo, Seongmi Moon, Eun Kyeung Song
  BMC Nursing.2024;[Epub]     CrossRef
• The Influence of Ethical Nursing Competence and Positive Nursing Organizational Culture on Person-Centered Care in Intensive Care Unit Nurses: A Cross-Sectional Survey
  Jae Eun Lee, Hye-Young Jang
  Journal of Korean Academy of Fundamentals of Nursing.2024; 31(3): 304.     CrossRef
• Social Influencing Factors of Clinical Nurses’ Patient Advocacy
  Myungji Kim, Hyunkyung Choi
  Journal of Korean Academy of Nursing Administration.2023; 29(4): 363.     CrossRef
• Nurses’ ethical decision-making during end of life care in South Korea: a cross-sectional descriptive survey
  Arum Lim, Sanghee Kim
  BMC Medical Ethics.2021;[Epub]     CrossRef
• Development of Ethical Nursing Competence Self-rating Scale for Clinical Nurses
  Borah Kang, Heeyoung Oh
  Korean Journal of Adult Nursing.2020; 32(5): 482.     CrossRef
• Emergency nurses’ experience of coping with moral distress
  Na Kyoung Lee, Jee-In Hwang
  The Journal of Korean Academic Society of Nursing Education.2020; 26(2): 176.     CrossRef
• Types of Perception toward Ethical Issues in Perioperative Nurses: Q-Methodological Approach
  Jin Nam Kim, Seok Hee Jeong
  Journal of Korean Academy of Nursing.2018; 48(6): 679.     CrossRef
• Factors Influencing Patient Privacy Protection Behavior among Nursing Students
  Eun Joo Lee, Hyun Sook Shin, Eun Chae Ha
  Journal of Korean Academic Society of Nursing Education.2018; 24(3): 225.     CrossRef
• Impact of Superior's Ethical Leadership as Perceived by Nurses on Nursing Performance: Mediating Effect of Faith in Supervisor
  Miyoung Kim, Hyung-Eun Seo, Eun-Young Doo, Won-Jin Ju
  Journal of Korean Academy of Nursing Administration.2017; 23(5): 483.     CrossRef
• Development of Hospital Nurses' Job Description based on DACUM Method: Focusing on General Ward and Intensive Care Unit
  Sun Mi Lee, Yeon Hee Kim, Yu Mi Shim, Jin Sun Choi, Mi Yu
  Journal of Korean Academy of Nursing Administration.2017; 23(5): 535.     CrossRef
• Operation Room Nurses' Ethical Value regarding Their Attitude and Meaning of Life about Organ Transplantation in Brain Death
  Hyung-Eun Seo, Miyoung Kim
  Korean Journal of Adult Nursing.2016; 28(4): 355.     CrossRef
• The Experience of Nursing Students' Moral Distress in Clinical Practice
  Chanhee Kim, Heeseung Choi
  The Journal of Korean Academic Society of Nursing Education.2016; 22(3): 355.     CrossRef

PURPOSE
This study was done to develop a realistic clinical case and investigate nurses' decision-making about nurses' ethical dilemmas with physicians in the fields of nursing practice.
METHODS
Case development and a hypothetical case study were used. Participants were 52 nurses. Data were collected in 2012 and 2013 using an open-ended questionnaire and interviews and analyzed using content analysis and descriptive statistics.
RESULTS
Various dilemma situations between nurses and physicians, such as violence, deathbed, medication-prescription, and physicians' incapacity-unfairness, were suggested. A clinical dilemma case about medication-prescription was developed based on nurses' experiences. Nurses' responses to the developed case situation and responses were classified into five types. Various reasons were given for making the decisions and about 56% of the nurses decided to notify their supervisor without deleting nursing records.
CONCLUSION
In this study, a realistic clinical dilemma case was developed, and nurses' ethical decision making was identified. These findings can be used in developing effective strategies for nurses to solve ethical dilemmas and to improve ethical decision-making abilities.

Citations

• Factors Affecting Ethical Competence in Nurses*
  Sanghee KIM, Minjeong SEO, Doo Ree KIM
  Korean Journal of Medical Ethics.2023; 26(2): 151.     CrossRef
• Effectiveness of Conducting Interprofessional Education Virtually among Pharmacy and Medical Students
  Ganesh Sritheran Paneerselvam
  International Journal of Information and Education Technology.2022; 12(10): 1065.     CrossRef
• Perception of interprofessional education and educational needs of students in South Korea: A comparative study
  So Jung Yune, Kwi Hwa Park, Yul Ha Min, Eunhee Ji, Etsuro Ito
  PLOS ONE.2020; 15(12): e0243378.     CrossRef
• Types of Perception toward Ethical Issues in Perioperative Nurses: Q-Methodological Approach
  Jin Nam Kim, Seok Hee Jeong
  Journal of Korean Academy of Nursing.2018; 48(6): 679.     CrossRef
• The Effects of Critical Thinking and Clinical Decision-Making on Ethical Dilemmas by Some Dental Hygienists
  Hyun-Kyung Kang
  The Korean Journal of Health Service Management.2015; 9(1): 67.     CrossRef

PURPOSE
This study was done to investigate changes in nursing students' moral judgment throughout their professional education, and to identify more suitable ways to evaluate ethics education by using P (%) scores only and P (%) scores with 4th scores.
METHODS
The study consisted of cross-sectional and longitudinal surveys as well as a study using a nonequivalent control group pre-post experimental design. The participants were nursing students attending a university in Gyeongju, Korea. The data were collected from September 1, 2006 to October 31, 2009 using the Korean version of the Defining Issues Test.
RESULTS
In the cross-sectional survey, there was no significant difference in the nursing students' moral judgment scores according to their school grades. In the longitudinal survey, nursing students' moral judgment scores did not change significantly over the duration of their education. In the nonequivalent control group study, the effectiveness of nursing ethics education was identified by P (%) scores only.
CONCLUSION
The evidence indicates that nursing professional education does not influence the development of nursing students' moral judgment, and using P (%) scores only seems to be a better way compared to other ways to evaluate the effects of nursing ethics education.

Citations

• When You Think of and Identify Yourself as a Nurse, You Will Become More Deontological and Less Utilitarian
  Mufan Zheng, Junhua Zhao, Xielan Zhang
  International Journal of Environmental Research and Public Health.2024; 21(6): 712.     CrossRef
• EEG Correlates of Moral Decision-Making: Effect of Choices and Offers Types
  Giulia Fronda, Laura Angioletti, Michela Balconi
  AJOB Neuroscience.2024; 15(3): 191.     CrossRef
• Ethical Sensitivity in Nursing Students: Developing a Context–based Education
  Marzieh Shayestehfard, Camellia Torabizadeh, Sakineh Gholamzadeh, Abbas Ebadi
  Electronic Journal of General Medicine.2020; 17(2): em195.     CrossRef
• The Experience of Nursing Students' Moral Distress in Clinical Practice
  Chanhee Kim, Heeseung Choi
  The Journal of Korean Academic Society of Nursing Education.2016; 22(3): 355.     CrossRef
• Cross-sectional comparison on human rights sensitivity changes in nursing students and non-nursing students
  Seong-Eun Kim
  Journal of Digital Convergence.2016; 14(4): 355.     CrossRef
• Effectiveness of a Case-Based Computer Program on Students’ Ethical Decision Making
  Eun-Jun Park, Mihyun Park
  Journal of Nursing Education.2015; 54(11): 633.     CrossRef
• Comparing the Ethical Knowledge, Ethical Values and Class Satisfaction by Students' Cognitive Style to Develope the Convergent Nursing Ethic Class
  Sun-Young Jeong, Chang-Hee Kim
  Journal of Digital Convergence.2015; 13(11): 205.     CrossRef
• Effects of a Blended Learning Program on Ethical Values in Undergraduate Nursing Students
  Sang Dol Kim
  Journal of Korean Academy of Nursing Administration.2014; 20(5): 567.     CrossRef