Nowicka A.A-F 1, Kunecka D.*A,D,E,F 2
A- Conception and study design; B - Collection of data; C - Data analysis; D - Writing the paper;
E- Review article; F - Approval of the final version of the article; G - Other (please specify)
Introduction:Code of Conduct and Ethicsfor Nurses and Midwives is kind of a signpost for each and every member of professional association. They are so crucial, that one should not only know them but also implement in everyday situations in practice. Nowadays, in current organizational realities issues mentioned in Code on Conduct which are connected to professional relations in nursing teams in Poland become more predominant. This is why the aim of the study is the evaluation of ethical aspects in professional relations in nursing teams.
Materials and method:The study was conducted using the diagnostic survey method with the use of original survey questionnaire. 115 nurses and midwives took place in the survey all of them being active staff and workers of one of the hospital of West-Pomeranian Poland.
Results:A tree-step range was used to evaluate the researched issue. Obtained material showed that the professional relations in nursing teams are satisfactory.
Conclusions:Research data analysis allowed to formulate a following conclusion: received satisfactory assessment in a given research group can be understood as an average level when talking about ethical aspects of professional relations in nursing teams. This can be seen as difficulties or even the lack of proper professional relations between nurses. This can influence the quality of provided services. Thus, it is important to take into consideration actions which aim at improvement such as special training in terms of psychological aspects of interpersonal relations in teams with regard to practice in particular.
Keywords: work ethics, ethical ruler, interpersonal relations.
Danuta Kunecka, PhD, Pomeranian Medical University in Szczecin, Faculty of Health Science
Department of Social Medicine, ul. Żołnierska 48, 71-210 Szczecin, Poland
Tel.: +48 914 800 97, e-mail: firstname.lastname@example.org
Progress in Health Sciences
Vol. 8(1) 2018 pp 55-62
© Medical University of Białystok, Poland
Choosing the contemplation about ethical subjects it is worth mentioning that its basis and value is the broadly understood goodness and basic human responsibilities for other people. The most important ethical experience is the presence of other human being and the meaning of terms such as freedom, personal dignity of every man, ethos or responsibility . The fundamental ethical values also are incorporated into those terms. They clearly describe the sensitivity which is are included in each basic rights which should be present in nurses’ and midwives’ attitudes during their profession. Including the attitude of “constant urge for care” described in Care Ethics or also in Ethics of the Trustworthy Caretaker. Care means here the detailed diligence and the attitude of kindness and goodwill, the trustworthy caretaker, on the other hand, means here, according to T. Kotarbiński, the caretaker who take the actual care which can be characterized by trust and strong support giving the other person. T. Kotarbiński also underlines, that such a caretaker must be a good man him- or herself .
The profession of a nurse and midwife demands the broadly-understood acceptation of other person’s behavior and values. The person who, in the most cases, has their own problems or even their own life philosophy. A full contact with a patient requires empathy, high levels of professional proficiency and the responsibility considering complex interpersonal relations which emerges during the constant contact and are describes in altruist idea . They also contribute to the general increase in quality level of care . One should not forget about the fact, that strong bonds may threaten the quality of healthcare over the patient and, what is crucial, have to be accepted by all the sides of such a relation . Only then the cooperation becomes possible and can be understood as “active participation in activities and the desire of reaching a high quality of taking care over the patient, creating an appropriate attitude when it comes to providing care and good, mutual relations with everyone who cooperate with nurses” . In order to create this kind of cooperation equal treatment, values and aims are necessary to be present in relations with all personnel the nurses work with . In research literature the word ‘ethic’ has multiple meanings. In Greek ethike means morality. In W. Kopaliński’s dictionary of foreign terms one can find, that ethic is the “study of morality, philosophy of morality; a particular ethical system; overall rules and norms of behaving which apply in a given era and environment” . Ethic applies to ethos which can be describes as custom or the regular place of living. The morality comes for a Latin tern moralis and means customary. There, such values are perceived: good, bad, conscience, responsibility and righteousness. Both terms ethic and morality became similar to each other in the course of ages. Nowadays, they are used interchangeably [2, 6]. The basic document which specifies ethical rules of nurse and midwife professions is the Nursing and Midwifery Code of Ethics of the Republic of Poland being in power since 2003. It was adopted by the resolution no. 9 by the IV National Congress of Nurses and Midwives  and the Nurses Code of Ethics adopted by International Council of Nurses (ICN) . The understanding of the professional ethics rules of certain values and norms allows midwife and nurse for the safe professional activities . The general rule of the Nursing and Midwifery Code of Ethics of the Republic of Poland constitutes point system corresponding to professional activity and patient’s rights regulations. Furthermore, the rest of the document describes relations between a nurse, midwife and a patient, their attitude towards the professional practice and encourages to work development and to present behaviors which will increase the profession’s prestige in the society .
Taken actions, everyday work activities and corresponding relations of nurses and midwives translates into a holistic approach to healthcare. At the same time, those actions requires interpersonal communicating skills which allows the creation of any work relation. The essence of the communication process within a work staff group is the cooperation which is the basis of efficiency of a whole team and is a way of achieving success in the communicating process . While being a part of a therapeutic team, a nurse or a midwife communicates and creates bonds with all of the teammates. In most of the cases those relations emerge which members of the same professional group. The success of such relations depends on the effectiveness of the communication process and the current conditions which influences not only its success but also its effectiveness. Instances can be the omitting of competitiveness, avoidance of hierarchical system, partnership-like commu-nication, empathy, involvement of the team and shift of mindset towards changes and development in order to make the communication of a therapeutic team efficient . The communication is a process which implies honesty, kindness, understanding and respecting others with which we communicate. It is worth mentioning, that the term ‘communicate’ derives from Latin communico <making common, share something with others> .
Dynamic changes made in the healthcare system, its ways of organization or the individually taken organizational modifications, such as contracting of medical services, and the consequences of emerging issue of overload of work and dilemmas arising from the question: is the world is being unequal, contributed to high interest of the present authors in ethical aspects in professional relations of nursing teams. Visible barriers in communications and the consciousness of fulfilling different roles in the team became a source of inspiration for formulation of the main aim of this study which is the analysis and evaluation of ethical aspects of professional relations present in the nursing teams.
MATERIALS AND METHODS
The research was conducted with the help of diagnostic survey and the use of original survey questionnaire. The questionnaire, in paper format, consisted of two parts. The first part consisted of questions characterizing the group in terms of sociodemographic variables such as: age, education, occupation, place of living, facility type, work position and the additional evaluation of the use of Nursing and Midwifery Code of Ethics in everyday life. The second part consisted of six case studies found on the Internet such as professionals websites or situational descriptions and/or observations from colleagues reflecting the professional relations between nurses. Ethical aspects of professional relations in nursing teams characterized in this part of the questionnaire were described on the basis of the chapter IV of Nursing and Midwifery Code of Ethics  in relation to the aspects written in the articles 1-6. The basis for the articles became the citation: “Creation of the need of responsibility for the work done, habit of being honest, reliable, hard-working and precise is the moral duty” .
After receiving the hospital’s permission for carrying out research, the present author handed-out 174 questionnaires. We took into account the current work position based in named lists from work hours schedule in a particular facility. Initially, 119 people confirmed the willingness to participate in a survey (about 69% of all employed in a facility of this particular working group). Ultimately, 115 people submitted filled survey questionnaires. The biggest group represented by 58 persons were respondents in the age group of 46 and above (50.4% of all surveyed). People aged 35 and more below constituted the least populous group (20 persons making 17.4% of all surveyed). The majority of people had intermediate level of medical education (medical high school or postgraduate medical school). In total there were 59 people: medical high school graduates (30 people and 26.1% of all surveyed) and postgraduate medical school students (29 people and 25.2% of all surveyed). The minority group was represented by higher institution graduates with BA and/or MA degree. People with BA degree constituted 36 persons (31.3% of all surveyed), MA degree was held by 20 persons (17.4% of all surveyed).Among the researched groups the predominant one was represented by nurses with 76 persons constituting 66.1% of all researched, then 39 midwifes constituting 33.9% of all researched. 66 people were living in a city (57.4% of all researched) and the number of those living in the countryside was equal to 13 persons which constituted 11.3% of all surveyed. The majority of the researched group were the people employed in vaccination units. The hereby statement was claimed by 77 individuals which constituted 67% of all surveyed. 11 people (9.6% of all surveyed) pointed out the option titled as “other” specifying their workplace as, for instance, diabetological center or intervention room.
Table 1.Characterization of the researched group (N=115)
35 y. o. and more
36 – 45 y. o.
46 y. o. and above
Medical High School
Postgraduate Medical School
BA degree in Nursing/Midwife
MA degree in Nursing/Midwife
Place of living
City up to 40 000 civilians
City of more than 40 000 civilians
In further question of the questionnaire the respondents were asked to specify their work position. Nurse and midwifes constituted here 93 people and 80.9% of all surveyed. 20 nurses and midwifes identified as a functional position among which one can distinguish: vaccination nurse/midwife, coordinator or ward sister which constituted 17.4% of all surveyed. Only 2 persons (1.7% of all the research group) pointed out their position as “other”. A detailed sociodemographic characterization of the researched group was presented in a table 1.
Percentage distribution received in a given research group reflects a similar ratio of the total number of nurses and midwifes employed in the hospital in which the research took place.
Statistical analysis of the obtained data was made using Microsoft Excel spreadsheet and a statistical suite Statsoft, Inc. (2010) STATISTICA 9.1. During the initial analysis the received research material was described with the use of quantities and their corresponding percentages (percentage distribution of the given opinions were expressed in absolute figures - “N” sample size and percentage values). In further statistical analysis the relations between set variables were searched for. The chi-square test was conducted, where the level of relevancy was set to p = 0.05. The research was conducted between 4th of December 2017 and 21st of January 2018.
The main aim of the study was the evaluation of the ethical aspects in professional relationships present in the nursing teams. The survey questionnaire contained descriptions of six situations which, in professional practice, may cause doubts of the ethical nature. Based on the description, given one after another, in the second part of the tool, the respondents were giving opinions on whether the presented situation describes the procedures which are ethical or unethical for any of the characters’ actions – presented in a behavioral characteristics of any of the situations’ participants. In the case of a positive answer the respondents were given the task of placing on a scale to what extend they agree with the situations’ description. Further answers were proposed: I agree to a small extend, I agree to some point, I totally agree. During the further parts of the study, in order to evaluate the ethical aspects of the professional relations of the researched environment, the obtained research data (received answers) were classified by the key sequence which provided the proper evaluation of the ethical level of the respondents.
In return for the response pointing to a high ethical code of behavior, the respondent was given 2 points. For the positive response connected to perceiving a particular behavior as an ethical or unethical in relation to a particular occurrences the respondent was given 1 point. Finally, for the response where the respondent perceive a given behavior as unethical 0 points were given. The respondents’ results were, subsequently, aggregated. On its basis 3 levels of evaluation of the ethical aspects in professional relations of nurses were specified which showed the level of knowledge of ethic rules. In such an instance, the respondents’ result was the objective final grade. The grades were as following: unsatisfactory, satisfactory, highly satisfactory. The unsatisfactory level was presented by 20.1% of all respondents (N=27), the satisfactory level was presented by 56.5% of all respondents (N=65), highly satisfactory level was present among 23.4% of all surveyed (N=23).
In order to make the evaluation of the ethical aspects even more detailed, in the question number 6 the respondents were directly asked whether they apply or do not apply to the documents of Nursing and Midwifery Code of Ethics and its occurrences with such fixed answers as following: depending on the circumstances, regardless of the circumstances, in professional life, in private life, it is of no importance. Answers to these questions were basis for providing a subjective evaluation of the researched group, which is only a declarative reflection of respondents’ personal beliefs. The received results were classified by the following statements: unsatisfactory, satisfactory, highly satisfactory. Detailed results of the obtained grades were presented in the chart form on the Figure 1.
It is worth mentioning that while analyzing the hereby research results, in comparison with the subjective and objective evaluation of the respondents there are some significant discrepancies. This, in regards to the objective of the study – the ethical aspects in professional relations may be a particular reason of concern. On the further pats of statistical analysis the chi-square method was used in order to study whether, from the point of view of a statistics, there are common dependencies between researched phenomena as one of the most frequent method of variable research. A mentioned independent variable is, in this case, the deep understanding of ethic rules/ethical aspects in professional relations (an objective evaluation).
As independent variables the following sociometric data mentioned in the part I of the questionnaire was set. Detailed results of these analyses were presented in the Table 2.
As it can be observed in Table 2 the result showing the presence of statistically important correspondence of the understanding of ethic rules was received only at one variable: education. In this case the result is unsatisfactory – mostly in the group of the medical high school students, so from the group with the lowest level of professional education. Detailed evaluation of received grades among the respondents were presented on the Figure 2.