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Relationship between nurses’ organizational trust levels and their organizational citizenship behaviors

Serap Altuntas, Ulku Baykal

Abstract
Purpose: This research used a descriptive and explorative design to determine the levels of nurses’ organizational trust and organizational citizenship and to investigate relationships between the levels of organizational trust and organizational citizenship behaviors.

Design and Methods: Nurses who had completed their orientation from a total of 11 hospitals with bed capacities of 100 and located in the European district of Istanbul were included in the sample for this study. Formal, written applications and approval of the ethical committee were obtained from concerned institutions before proceeding with the data collection step. The Organizational Trust Inventory and the Organizational Citizenship Level Scale, a questionnaire form including five questions regarding nurses’ personal characteristics, were used in data collection. Data collection tools were distributed to 900 nurses in total, and usable data were obtained from 482 nurses. Number and percentage calculations and Pearson correlation analysis were used to assess research data.

Findings: The results of the present research showed that nurses had a higher than average level of trust in their managers and coworkers and they trusted more in their managers and coworkers than their institutions. The Organizational Citizenship Level Scale indicated that the behavior most frequently demonstrated by the nurses was conscientiousness, followed by courtesy and civic virtue, whereas sportsmanship was displayed to an average extent. An analysis of relationships between nurses’ level of organizational trust and their organizational citizenship behaviors revealed that nurses who trust in their managers, institutions, and coworkers demonstrated the organizational citizenship behaviors of conscientiousness, civic virtue, courtesy, and altruism more frequently.

Conclusions: The findings attained in this study indicated that the organizational trust the staff had in their institutions, managers, and coworkers influenced the organizational citizenship behaviors of conscientiousness, civic virtue, altruism, and courtesy, whereas it had no effect on sportsmanship behavior. Nurse managers should introduce studies to improve their subordinates’ organizational trust to ensure that they develop organizational citizenship behaviors, and they should support them in this process.

Clinical Relevance: These topics for nursing services will provide guidance to managers, particularly to managers of nursing services, in establishing processes to predict nurses’ organizational commitment, job satisfaction, performance, intention to leave, and other relevant issues.

Altuntas S, Baykal U. Relationship between nurses’ organizational trust levels and their organizational citizenship behaviors. J Nurs Scholarsh. 2010 Jun;42(2):186-94.

The physician’s right to conscientious objection: an evolving recognition in Europe

Tom Goffin

Abstract
Due to the growing number of medical treatments, physicians–who are also human beings with their own conscience and beliefs–are increasingly confronted with treatments that may conflict with their principles and convictions. Although several human rights documents recognize the freedom of conscience and belief, we could not locate the recognition of an explicit right to conscientious objection. Furthermore, a direct application of the right to freedom of thought, conscience and religion, as recognized by article 9 of the ECHR, does not include such a right due to the narrow interpretation of this right by the European Court of Human Rights. However, the Court seems to have taken steps away from this narrow interpretation in Pichon and Sajous v. France. Notwithstanding these steps, no general right to conscientious objection exists. Physicians therefore are dependent on a judgment if they refuse a certain treatment because of conscientious objections.

Goffin T. The physician’s right to conscientious objection: an evolving recognition in Europe. Med Law. 2010 Jun;29(2):227-37.

Crisis of Conscience: Pharmacist Refusal to Provide Health Care Services on Moral Grounds

Eileen P Kelly, Aimee Dars Ellis, Susan PS Rosenthal

Employee Responsibility and Rights Journal

Abstract
Advances in technology have resulted in medical procedures and practices that were unthought-of in previous generations. Embryonic stem cell research, abortifacients, birth control, and artificial insemination are just a few examples of these technological advances. While many individuals readily embrace such medical advances, others find them morally objectionable. A contentious national debate is now occurring over whether employee pharmacists have the right to refuse to fill legal prescriptions for emergency contraception because of conscientious objections. In the United States, existing public policy is somewhat muddled in both protecting and encroaching on the employee pharmacist’s right of refusal. This article discusses the legal and ethical nature of that controversy, as well as the clash of interests, rights and responsibilities between employers, employee pharmacists and customers from a U.S. perspective.

Kelly EP, Ellis AD, Rosenthal SP. Crisis of Conscience: Pharmacist Refusal to Provide Health Care Services on Moral Grounds. Employee Responsibilities and Rights J. 2011 May 22;23(1):37-54.

Conscience, Contraception, and Catholic Health-Care Professionals

Janet E Smith

Abstract
The Church’s teachings are often very challenging. Those who are involved in the health-care professions and who conduct their practices in accord with Church teaching can expect misunderstanding and even rejection from their colleagues and patients. One of the most difficult teachings of the Church is its condemnation of contraception. In 1968 Pope Paul VI issued the encyclical Humanae vitae, which hit the world like a bomb. In it he affirmed the Church’s long-standing teaching on human sexuality and condemned contraception in particular. Today scientific advances such as in vitro fertilization and embryonic stem-cell research, as well as the challenges in making moral decisions about end-of-life care, make it increasingly difficult for health-care professionals to practice in accord with their deeply held moral convictions. Developing a properly formed conscience, which is the voice of God, is essential in dealing with these contemporary issues and making right choices. This essay outlines the process for properly forming the conscience. It also explains why prescribing contraception is morally wrong.

Smith JE. Conscience, Contraception, and Catholic Health-Care Professionals. Linacre Quarterly. 2010 May;77(2):204-228. Edited transcript of a talk given at the first annual symposium for health-care professionals, “Conscience and Ethical Dilemmas in Catholic Healthcare,” hosted by the Archdiocese of Baltimore Respect Life Office and Baltimore Guild of the Catholic Medical Association, Baltimore, MD, May 9, 2009. The text is more conversational than a written paper and not as closely documented as a professional piece. Much of the material was accompanied by PowerPoint slides.

The difference of being human: Morality

Francisco J Ayala

Proceedings of the National Academy of Sciences (USA)

Abstract
In The Descent of Man, and Selection in Relation to Sex, published in 1871, Charles Darwin wrote: “I fully . . . subscribe to the judgment of those writers who maintain that of all the differences between man and the lower animals the moral sense or conscience is by far the most important.” I raise the question of whether morality is biologically or culturally determined. The question of whether the moral sense is biologically determined may refer either to the capacity for ethics (i.e., the proclivity to judge human actions as either right or wrong), or to the moral norms accepted by human beings for guiding their actions. I propose that the capacity for ethics is a necessary attribute of human nature, whereas moral codes are products of cultural evolution. Humans have a moral sense because their biological makeup determines the presence of three necessary conditions for ethical behavior: (i) the ability to anticipate the consequences of one’s own actions; (ii) the ability to make value judgments; and (iii) the ability to choose between alternative courses of action. Ethical behavior came about in evolution not because it is adaptive in itself but as a necessary consequence of man’s eminent intellectual abilities, which are an attribute directly promoted by natural selection. That is, morality evolved as an exaptation, not as an adaptation. Moral codes, however, are outcomes of cultural evolution, which accounts for the diversity of cultural norms among populations and for their evolution through time.

Ayala FJ. The difference of being human: Morality. Proc Natl Acad Sci U S A. 2010 May 11;107 Suppl 2:9015-22. Epub 2010 May 5.

Moral distress related to ethical dilemmas among Spanish podiatrists

Marta Losa Iglesias, Ricardo Becerro de Bengoa Vallejo, Paloma Salvadores Fuentes

Abstract
Objectives: To describe the distress experienced by Spanish podiatrists related to ethical dilemmas, organisational matters, and lack of resources.

Design: A 2008 email survey of a representative sample of 485 Spanish podiatrists presenting statements about different ethical dilemmas, values and goals at the workplace.

Results: The response rate was 44.8%. Of all the respondents, 57% described sometimes having to act against their own conscience as distressing. Time constraints is the main cause of moral distress (67%) and 58% of respondents said that they found it distressing that patients have long waits for treatment. Distress related to inadequate treatment due to economical constraints or ineffectiveness was described by 60% of the podiatrists. Another 51% reported that time spent on administration and documentation is distressing. Female doctors experienced more distress than their male colleagues. Last, 36% of respondents reported that their workplace lacked strategies for dealing with ethical dilemmas.

Conclusion: These study results identify moral distress among Spanish podiatrists mainly related to time constraints, patient demands and lack of resources. Moral distress varies with sex and age. Organisational strategies such as moral deliberation and responsive evaluation offer the potential to address moral distress.

Iglesias ML, de Bengoa Vallejo RB, Fuentes PS. Moral distress related to ethical dilemmas among Spanish podiatrists. J Med Ethics. 2010 May 6;36(5):310-314.

Practice against our beliefs

Colly A Tettelbach

Extract
The United States has embarked on a dangerous course. When the right of healthcare workers to refuse participation in certain procedures based on conscience is denied, we have started down the path of preparing rightminded, conscience-driven people to abandon ethical practice and in some situations to become killers. Anytime people are forced to act against what they believe to be right and coerced to do what they consider to be wrong, a very treacherous gulf has been crossed. When the right of conscience is removed from healthcare workers, we will have healthcare workers without conscience.

Tettelbach CA. Practice against our beliefs. J Christ Nurs. 2010;27(2):106-109.

Religious Hospitals and Primary Care Physicians: Conflicts over Policies for Patient Care

Debra B Stulberg, Ryan E Lawrence, Jason Shattuck, Farr A Curlin

Abstract
BACKGROUND
Religiously affiliated hospitals provide nearly 20% of US beds, and many prohibit certain end-of-life and reproductive health treatments. Little is known about physician experiences in religious institutions.
OBJECTIVE
Assess primary care physicians’ experiences and beliefs regarding conflict with religious hospital policies for patient care.
DESIGN
Cross-sectional survey.
PARTICIPANTS
General internists, family physicians, and general practitioners from the AMA Masterfile.
MAIN MEASURES
In a questionnaire mailed in 2007, we asked physicians whether they had worked in a religiously affiliated hospital or practice, whether they had experienced conflict with the institution over religiously based patient care policies and how they believed physicians should respond to such conflicts. We used chi-square and multivariate logistic regression to examine associations between physicians’ demographic and religious characteristics and their responses.
KEY RESULTS
Of 879 eligible physicians, 446 (51%) responded. In analyses adjusting for survey design, 43% had worked in a religiously affiliated institution. Among these, 19% had experienced conflict over religiously based policies. Most physicians (86%) believed when clinical judgment conflicts with religious hospital policy, physicians should refer patients to another institution. Compared with physicians ages 26–29 years, older physicians were less likely to have experienced conflict with religiously based policies [odds ratio (95% confidence interval) compared with 30–34 years: 0.02 (0.00–0.11); 35–46 years: 0.07 (0.01–0.72); 47–60 years: 0.02 (0.00–0.10)]. Compared with those who never attend religious services, those who do attend were less likely to have experienced conflict [attend once a month or less: odds ratio 0.06 (0.01–0.29); attend twice a month or more: 0.22 (0.05–0.98)]. Respondents with no religious affiliation were more likely than others to believe doctors should disregard religiously based policies that conflict with clinical judgment (13% vs. 3%; p = 0.005).
Conclusions
Hospitals and policy-makers may need to balance the competing claims of physician autonomy and religiously based institutional policies.

Stulberg DB, Lawrence RE, Shattuck J, Curlin FA. Religious Hospitals and Primary Care Physicians: Conflicts over Policies for Patient Care. J Gen Intern Med. 2010;25(7):725-730. Available from:

Freedom of conscience. Biojuridical conflicts at multicultural societies

Marta Albert Márquez

Pub Med Abstract
The paper [in Spanish] analyzes the right of healthcare professionals to conscientious objection in multicultural societies. The ethical relativism characteristic of these societies abides with an apparently paradoxical reduction of the exercise of freedom of conscience. “Apparently” because, in the end, ethical relativism tends to adopt dogmatic attitudes. Special attention is paid to the situation of Spanish healthcare in relation to euthanasia and abortion. With regard to euthanasia, the “death with dignity” draft bill of Andalucía is considered. With regard to abortion, we will pay attention to the reform of the Penal Code in the context of a new regulation about “reproductive health” of women, which means the adoption of a system of time limits, and the characterization of abortion as a women’s right. It is concluded that freedom of conscience of healthcare professionals will probably be at risk if proposed legal policies don’t change.

Albert Márquez M. [Freedom of conscience. Biojuridical conflicts at multicultural societies]. Cuadernos de Bioetica : Revista Oficial de la Asociacion Espanola de Bioetica y Etica Medica. 2010 Jan-Apr;21(71):61-77. Spanish

Are there different spheres of conscience?

Erica J Sutton, Ross EG Upshur

Journal of Evaluation in Clinical Practice

Abstract
Interest in understanding the meaning of conscience and conscientious objection in medicine has recently emerged in the academic literature. We would like to contribute to this debate in four ways: (1) to underscore and challenge the existing hierarchy of conscientious objection in health care; (2) to highlight the importance of considering the lay public when discussing the role of conscientious objection in medicine; (3) to critique the numerous proposals put forth in favour of implementing review boards to assess whether appeals to conscience are justifiable, reasonable and sincere; and (4) to introduce the Universal Declaration of Human Rights and the Siracusa Principles into the dialogue around conscience and suggest that perhaps conscientious objection is a human right.

Sutton EJ, Upshur RE. Are there different spheres of conscience? J Eval Clin Pract. 2010;16(2):338-343.