Abstract

Background Caring practice begins with awareness of the suffering of patients in a given context. Understanding the interrelationship between the perceived ethical climate of the clinical environment and the ethical sensitivity and caring efficacy of nurses is crucial for strengthening the caring competency of nurses. Research aim This study aimed to examine the associations between the ethical climate of the clinical environment and the ethical sensitivity and caring efficacy of nurses and to investigate the mediating effect of ethical sensitivity on the association between ethical climate and caring efficacy. Research design This was a quantitative study with a cross-sectional descriptive correlational design. The participants completed an online survey that measured the ethical climate, ethical sensitivity and caring efficacy using the Hospital Ethical Climate Survey, Moral Sensitivity Questionnaire-Revised and Caring Efficacy Scale, respectively. Participants and research context The study recruited 293 nurses from two general hospitals that provided acute in-patient and extended care in Hong Kong. Ethical considerations Ethical approval was obtained from the ethics committee of the university and the hospitals involved. Written consent was obtained from the participants. Results Ethical climate was associated with caring efficacy ( β = 0.340, p <.001) and ethical sensitivity ( β = 0.197, p <.001). After adjusting for ethical climate, ethical sensitivity was associated with caring efficacy ( β = 0.860, p <.001). Ethical sensitivity showed a significant mediating effect on the association between ethical climate and caring efficacy (indirect effect = 0.169, 95% confidence interval: 0.097 to 0.261), which accounted for 50% of the total effect. Conclusions The study reveals the complex and interwoven relationship between contextual and personal factors that affect nurses’ caring efficacy from an ethical perspective. It provides insights into the significant roles of ethical climate and ethical sensitivity in strengthening caring efficacy. The results suggest theoretical and clinical implications for professionalisation.