The relationship between nurses' moral courage and whistleblowing approaches.

BACKGROUND: Whistleblowing is an action that particularly requires moral courage. Understanding the relationship between nurses' levels of moral courage and their whistleblowing approaches is important for reducing adverse situations in healthcare services. OBJECTIVES: This study aims to understand and analyze the relationship between nurses' levels of moral courage and their whistleblowing approaches. RESEARCH DESIGN: This is a descriptive and correlational study. METHODS: The study sample consists of 582 nurses actively working in a province in northwest Türkiye. Research data were collected using an Information Form, the Nurses' Moral Courage Scale, and the Whistleblowing Scale. ETHICAL CONSIDERATIONS: Ethical approval from the ethics committee, institutional permission, and informed consent from the participants were obtained for data collection. FINDINGS: Nurses were found to perceive their moral courage as high, and their whistleblowing levels were at a moderate level. There was a significant and moderate relationship between participants' levels of moral courage and whistleblowing levels (p < .05). CONCLUSIONS: The findings emphasize the importance of promoting moral courage and creating an appropriate environment for exposing ethical violations. This study can contribute to the development of strategies to enhance nurses' moral courage and foster a more ethical working environment in healthcare services.

Nurses' ethical responsibilities: Whistleblowing and advocacy in patient safety.

BACKGROUND: In the dynamic landscape of healthcare, nurses play a crucial role as ethical stewards, responsible for whistleblowing, nurse advocacy, and patient safety. Their duties involve ensuring patient well-being through ethical practices and advocacy initiatives. AIM: This study investigates the ethical responsibilities of nurses regarding whistleblowing and advocacy in reporting concerns about patient safety. RESEARCH DESIGN: A cross-sectional study utilized cluster and simple random sampling to gather a representative sample of actively practicing registered nurses. Data collection involved a demographic form, Nurse Whistleblowing Intentions Scale, Nursing Advocacy Scale, and Clinical Decision-Making Scale. PARTICIPANTS AND RESEARCH CONTEXT: The study utilizing a robust sample size determination formula for reliable findings included 96 diverse nurses, predominantly females. Engaged actively in direct patient care across various outpatients clinics. The recruitment process specifically sought individuals with expertise in safety protocols and reporting, contributing to a nuanced understanding of the study's focus. ETHICAL CONSIDERATIONS: Ethical approval was obtained from the ethics committee of the university and the hospitals involved. Written consent was obtained from the participants. A thorough ethical review was conducted to guarantee participant protection and adherence to ethical principles. RESULTS: Surveyed nurses demonstrated positive whistleblowing (Overall Mean Score: 3.58), high advocacy (Overall Mean Score: 12.2), and nuanced ethical decision-making for patient safety (Overall Mean Score: 15.78). Demographic factors, such as nationality and ethical training, significantly impacted whistleblowing intentions, while age, gender, and ethical training correlated with nursing advocacy behavior. Associations with experience and qualification emerged in ethical decision-making. CONCLUSION: The gained insights foster targeted interventions, improving ethical practices, advocacy, and informed decision-making in nursing. This study explores the intricate link between demographics and ethical considerations among surveyed nurses, acting as a catalyst for ongoing initiatives to strengthen the ethical foundation in healthcare sector.

The relationship between ethical position and whistleblowing: A cross-sectional study among nurses.

AIM AND OBJECTIVES: The aim of this study is to determine nurses' ethical positions, whistleblowing intention and its causes, and to analyse the correlation between them, while revealing the personal and professional characteristics causing significant difference. BACKGROUND: In today's challenging healthcare settings, ethical dilemmas are inherent to nursing practices, leading to situations whereby nurses must consider whistleblowing and reasons such as reporting medical errors or misbehaviors. DESIGN: The study is descriptive, cross-sectional and correlational. METHODS: The data were collected from a convenience sample consisting of 294 nurses between 1 April and 30 June 2019, in four hospitals in two cities. An introductory information form, Ethics Position Questionnaire, Whistleblowing Scale and Causes of Whistleblowing Scale were employed to collect data. The data were analysed with descriptive, correlational, comparative and internal consistency analyses (Guidelines for reporting cross-sectional studies (Data S1)). RESULTS: It was found that nurses encountered (31.3%) and reported (85.9%) unethical incidents. According to the subscales, they obtained higher scores from idealism (4.37 ± 0.52), supportive whistleblowing (3.75 ± 0.72), and moral and professional values (3.77 ± 0.67). The Ethics Position Questionnaire, as well as the Whistleblowing Scale (r = .302) and the Causes of Whistleblowing Scale (r = .211) had a positive weak correlation (p < .001). Nurses' age, marital status, and professional and institutional experiences all created a significant difference (p < .05). CONCLUSIONS: The nurses mostly encountered unethical incidents associated with management. The rates of reporting the unethical incidents were high, and they were found not hesitating to report using whistleblowing, yet intended to keep the incidents within the institution. In addition, idealistic nurses were more likely to whistleblow, and their causes for whistleblowing were mostly associated with moral and professional values. RELEVANCE TO CLINICAL PRACTICE: It is recommended that nurses' ethical position, and whistleblowing intentions and causes should be supported and improved through the corporate culture.

Reasoning for whistleblowing in health care.

BACKGROUND: Whistleblowing is recognised as part of solving wrongdoing. It requires individual reasoning as it is a potentially complicated process with a risk of possible negative consequences for oneself. Knowledge on how individuals reason for whistleblowing in healthcare context is lacking. AIM: This study aimed to create a theoretical construct to describe individual reasoning for whistleblowing. METHODS: The methodology was grounded theory, with 244 nurses as informants. The data consisted of nurses' written narratives in response to a wrongdoing situation presented in a video vignette. To ensure the heterogeneity of the population and variation in nurses' professional expertise, experiences and geographical locations in health care to capture the multidimensionality of the responses, nurses were invited to participate, and data were collected electronically from the membership register of the Finnish Nurses' Association on a national level. Constant comparison was used to analyse the open data. RESULTS: The core category of the theoretical construct, 'The formation of morally courageous intervening', was discovered, reflecting individual's values and beliefs. It forms mentally as an integration of cognition and emotion for recognising one's own strengths and limits to act to do the right thing despite the risk of negative consequences for oneself. The core category consists of three dimensions of reasoning: (1) Reasoning Actors, (2) Reasoning Justifications and (3) Reasoning Activities, their categories and three patterns of reasoning connecting the dimensions and their categories with each other: (I) Individual Reasoning, (II) Collaborative Reasoning and (III) Collective Reasoning. DISCUSSION AND CONCLUSION: The theoretical construct indicate that reasoning is a multidimensional phenomenon. In future, a theoretical construct could be further developed. In health care, managers could use the theoretical construct to support employees in their whistleblowing.

Post-publication Peer Review with an Intention to Uncover Data/Result Irregularities and Potential Research Misconduct in Scientific Research: Vigilantism or Volunteerism?

Irregularities in data/results of scientific research might be spotted pre-publication by co-workers and reviewers, or post-publication by readers typically with vested interest. The latter might consist of fellow researchers in the same subject area who would naturally pay closer attention to a published paper. However, it is increasingly apparent that there are readers who interrogate papers in detail with a primary intention to identify potential problems with the work. Here, we consider post-publication peer review (PPPR) by individuals, or groups of individuals, who perform PPPRs with a perceptible intention to actively identify irregularities in published data/results and to expose potential research fraud or misconduct, or intentional misconduct exposing (IME)-PPPR. On one hand, such activities, when done anonymously or pseudonymously with no formal discourse, have been deemed as lacking in accountability, or perceived to incur some degree of maleficence, and have been labelled as vigilantism. On the other, these voluntary works have unravelled many instances of research misconduct and have helped to correct the literature. We explore the tangible benefits of IME-PPPR in detecting errors in published papers and from the perspectives of moral permissibility, research ethics, and the sociological perspective of science. We posit that the benefits of IME-PPPR activities that uncover clear evidence of misconduct, even when performed anonymously or pseudonymously, outweigh their perceived deficiencies. These activities contribute to a vigilant research culture that manifests the self-correcting nature of science, and are in line with the Mertonian norms of scientific ethos.

Addressing Clinical Misconduct: Resigning and Whistleblowing in Clinical Ethics Consultation.

Clinical ethics consultants occasionally encounter unethical and/or unprofessional behavior as part of their normal job functions. In this article, we explore whether resigning (i.e., threatening resignation or resigning) and whistleblowing are acceptable methods ethics consultants can use to address these situations. Per our analysis, whether one considers ethics consultants private or public employees, loyal to their employer or to patients, families, and the public, resigning and whistleblowing are all acceptable, if not obligatory, actions of ethics consultants in certain circumstances. In this article, we analyze salient characteristics of ethics consultation as a profession as they pertain to resignation and whistleblowing in the context of ethics consultation. We also present tentative criteria for when ethics consultants are justified, if not obligated, to resign or blow the whistle.

Unprofessional behaviours experienced by hospital staff: qualitative analysis of narrative comments in a longitudinal survey across seven hospitals in Australia.

BACKGROUND: Unprofessional behaviours of healthcare staff have negative impacts on organisational outcomes, patient safety and staff well-being. The objective of this study was to undertake a qualitative analysis of narrative responses from the Longitudinal Investigation of Negative Behaviours survey (LION), to develop a comprehensive understanding of hospital staff experiences of unprofessional behaviours and their impact on staff and patients. The LION survey identified staff experiences and perceptions related to unprofessional behaviours within hospitals. METHODS: Two open-ended questions within the LION survey invited descriptions of unprofessional staff behaviours across seven hospitals in three Australian states between December 2017 and November 2018. Respondents were from medical, nursing, allied health, management, and support services roles in the hospitals. Data were qualitatively analysed using Directed Content Analysis (DCA). RESULTS: From 5178 LION survey responses, 32% (n = 1636) of participants responded to the two open-ended questions exploring staff experiences of unprofessional behaviours across the hospital sites surveyed. Three primary themes and 11 secondary themes were identified spanning, i) individual unprofessional behaviours, ii) negative impacts of unprofessional behaviours on staff well-being, psychological safety, and employee experience, as well as on patient care, well-being, and safety, and iii) organisational factors associated with staff unprofessional behaviours. CONCLUSION: Unprofessional behaviours are experienced by hospital staff across all professional groups and functions. Staff conceptualise, perceive and experience unprofessional behaviours in diverse ways. These behaviours can be understood as enactments that either negatively impact other staff, patients or the organisational outcomes of team cohesion, work efficiency and efficacy. A perceived lack of organisational action based on existing reporting and employee feedback appears to erode employee confidence in hospital leaders and their ability to effectively address and mitigate unprofessional behaviours.

Blowing the whistle during the first wave of COVID-19: A case study of Quebec nurses.

The experiences of nurses who blew the whistle during the COVID-19 pandemic have exposed gaps and revealed an urgent need to revisit our understanding of whistleblowing. AIM: The aim was to develop a better understanding of whistleblowing during a pandemic by using the experiences and lessons learned of Quebec nurses who blew the whistle during the first wave of COVID-19 as a case study. More specifically, to explore why and how nurses blew the whistle, what types of wrongdoing triggered their decision to do so and how context shaped the whistleblowing process as well as its consequences (including perceived consequences). DESIGN: The study followed a single-case study design with three embedded units of analysis. METHODS: We used content analysis to analyse 83 news stories and 597 forms posted on a whistleblowing online platform. We also conducted 15 semi-structured interviews with nurses and analysed this data using a thematic analysis approach. Finally, we triangulated the findings. RESULTS: We identified five themes across the case study. (1) During the first wave of COVID-19, Quebec nurses experienced a shifting sense of loyalty and relationship to workplace culture. (2) They witnessed exceedingly high numbers of intersecting wrongdoings amplified by mismanagement and long-standing issues. (3) They reported a lack of trust and transparency; thus, a need for external whistleblowing. (4) They used whistleblowing to reclaim their rights (notably, the right to speak) and build collective solidarity. (5) Finally, they saw whistleblowing as an act of moral courage in the face of a system in crisis. Together, these themes elucidate why and how nurse whistleblowing is different in pandemic times. CONCLUSION: Our findings offer a more nuanced understanding of nurse whistleblowing and address important gaps in knowledge. They also highlight the need to rethink external whistleblowing, develop whistleblowing tools and advocate for whistleblowing protection. IMPACT: In many ways, the COVID-19 pandemic has challenged our foundational understanding of whistleblowing and, as a result, it has limited the usefulness of existing literature on the topic for reasons that will be brought to light in this paper. We believe that studying the uniqueness of whistleblowing during a pandemic can address this gap by describing why and how health care workers blow the whistle during a pandemic and situating this experience within a broader social, political, organizational context.

The principle of double effect and external whistleblowing in nursing.

Nurses are generally expected to raise concerns when a harm or wrongdoing is committed against patients. Should their concerns not be adequately addressed, then nurses may take the decision to engage in external whistleblowing. Given that it could have a negative effect on the health care organization or service, nurses may question whether they should engage in external whistleblowing. Consequently, is there an ethical criterion to discern whether the negative effect on the health care organization or service is ethically permissible? This paper argues for the suitability of the Principle of Double Effect as an ethical criterion. The position of this paper is that external whistleblowing by a nurse when understood as an advocacy act with two effects (i.e. the effect of defending a patient and the further negative effect on the health care organization or service) can be ethically permissible through meeting the conditions of the Principle of Double Effect.

Whistle-blowers - morally courageous actors in health care?

BACKGROUND: Moral courage means courage to act according to individual's own ethical values and principles despite the risk of negative consequences for them. Research about the moral courage of whistle-blowers in health care is scarce, although whistleblowing involves a significant risk for the whistle-blower. OBJECTIVE: To analyse the moral courage of potential whistle-blowers and its association with their background variables in health care. RESEARCH DESIGN: Was a descriptive-correlational study using a questionnaire, containing Nurses Moral Courage Scale©, a video vignette of the wrongdoing situation with an open question about the vignette, and several background variables. Data were analysed statistically and inductive content analysis was used for the narratives. PARTICIPANTS AND RESEARCH CONTEXT: Nurses as healthcare professionals (including registered nurses, public health nurses, midwives, and nurse paramedics) were recruited from the membership register of the Nurses' Association via email in 2019. A total of 454 nurses responded. The research context was simulated using a vignette. ETHICAL CONSIDERATIONS: Good scientific inquiry guidelines were followed. Permission to use the Nurses' Moral Courage Scale© was obtained from the copyright holder. The ethical approval and permission to conduct the study were obtained from the participating university and the Nurses' Association. FINDINGS: The mean value of potential whistle-blowers' moral courage on a Visual Analogue Scale (0-10) was 8.55 and the mean score was 4.34 on a 5-point Likert scale. Potential whistle-blowers' moral courage was associated with their socio-demographics, education, work, personality and social responsibility related background variables. DISCUSSION AND CONCLUSION: In health care, potential whistle-blowers seem to be quite morally courageous actors. The results offer opportunities for developing interventions, practices and education to support and encourage healthcare professionals in their whistleblowing. Research is needed for developing a theoretical construction to eventually increase whistleblowing and decrease and prevent wrongdoing.

Legal Issues: Advocacy by and Disabilities of School Nurses.

This article summarizes the facts and rulings of a recent representative federal appeals court decision concerning the legal claims of two school nurses who lost their positions after advocating on behalf of students with diabetes. Their primary claim was the anti-retaliation protection under the pair of federal laws prohibiting disability discrimination-Section 504 of the Rehabilitation Act and the Americans with Disabilities Act. The second of the two nurses additionally asserted protection under this pair of laws based on her own asserted disabilities. The discussion reveals the sometimes significant difference between legal requirements, as determined by appellate courts, and professional norms, as perceived by practitioners and professors in school nursing.

Shall I tell my mentor? Exploring the mentor-student relationship and its impact on students' raising concerns on clinical placement.

AIMS: To explore student nurses' and nurse mentors' perceptions and experiences of raising concerns on clinical placement and the influence (if any) of their relationship on this process. A secondary aim is to consider the above, from a regulatory perspective in light of current literature and policy developments. BACKGROUND: Raising concerns whilst on clinical placement has been shown to be challenging for student nurses internationally. Registered nurses in the UK (in this case called "nurse mentors") facilitate learning and assessment in practice. However, limited research exists on the influence of the relationship between the nurse mentor and student nurse on the raising concerns process. DESIGN: A qualitative approach was used to undertake secondary thematic analysis of interview data. The primary data set was generated during a PhD study, focusing on the mentor-student dynamic and the possible influence of this relationship on students' raising concerns. METHODS: 30 individual semi-structured interviews were subjected to concurrent and thematic analysis. Interviews were undertaken with student nurses (n = 16) and nurse mentors (n = 14) between April 2016-January 2018. The COREQ 32-item checklist was used during the preparation of this article. FINDINGS: The following three interrelated analytical themes were generated from the data, "developing a mentor-student relationship," "keeping your mentor sweet" and "the mentor role in the raising concerns process." CONCLUSION: Our analysis of participants' experiences and perceptions offers an original contribution to understanding the factors associated with student nurses raising concerns in practice. Student nurses and most mentors believed that students should be encouraged and supported to raise concerns, but students' decisions were strongly influenced by their perceptions of the immediate interpersonal and educational context. Similar barriers to raising concerns have been shown to exist regardless of geographical boundaries, therefore the findings of this study are nationally and internationally relevant. Relevance to clinical practice This study provides new insight into the role of the nurse mentor in supporting students who raise concerns on clinical placements. The majority of the mentor participants believed that students should be encouraged and supported to speak up if they witness poor care or unprofessional behaviour. Focusing on the compexities around raising concerns in mentorship training and updates would rovide a forum for open discussion amongst mentors and educators.

On the Willingness to Report and the Consequences of Reporting Research Misconduct: The Role of Power Relations.

While attention to research integrity has been growing over the past decades, the processes of signalling and denouncing cases of research misconduct remain largely unstudied. In this article, we develop a theoretically and empirically informed understanding of the causes and consequences of reporting research misconduct in terms of power relations. We study the reporting process based on a multinational survey at eight European universities (N = 1126). Using qualitative data that witnesses of research misconduct or of questionable research practices provided, we aim to examine actors' rationales for reporting and not reporting misconduct, how they report it and the perceived consequences of reporting. In particular we study how research seniority, the temporality of work appointments, and gender could impact the likelihood of cases being reported and of reporting leading to constructive organisational changes. Our findings suggest that these aspects of power relations play a role in the reporting of research misconduct. Our analysis contributes to a better understanding of research misconduct in an academic context. Specifically, we elucidate the processes that affect researchers' ability and willingness to report research misconduct, and the likelihood of universities taking action. Based on our findings, we outline specific propositions that future research can test as well as provide recommendations for policy improvement.

Whistleblowing: A concept analysis.

The concept of whistleblowing, which began to emerge in the 1970s, has gained significant traction over time and across disciplines, including law, management, public administration, sociology, psychology, and health sciences. Interestingly, nurses and nursing students account for the majority of the participants in studies pertaining to whistleblowing. Nursing research conducted in the past two decades provide a good foundation on which to build a better understanding of the context in which whistleblowing takes place, the process of whistleblowing itself, and the repercussions experienced by whistleblowers, but major conceptual gaps remain. In fact, limited attention has been given to the conceptual underpinnings and the use of the concept of whistleblowing in nursing. The goal of the present conceptual analysis was to start addressing this gap and raise some critical questions about the future application of this concept in nursing, including potential opportunities and limitations. Our analysis allowed us to identify a number of antecedents, attributes, and consequences of whistleblowing in nursing. It also revealed three areas needing more attention: the concept itself, organizational culture, and research into the complexities of whistleblowing.

Wrongdoing and whistleblowing in health care.

AIM(S): To describe healthcare professionals' experiences of observed wrongdoing and potential whistleblowing acts regarding it. The main goal is to strengthen the whistleblowing process described based on the existing literature and to make it more visible for future research. DESIGN: A descriptive cross-sectional survey. METHODS: Data were collected between 26 June 2015-17 July 2015 from the Finnish trade union's membership register, electronically using one open question. A total of 226 healthcare professionals participated providing written narratives, which were analysed using inductive content analysis. FINDINGS: The whistleblowing process in health care was strengthened, identifying the content of observed wrongdoings and whistleblowing acts regarding them. Three themes were identified: wrongdoing related to patients, healthcare professionals, and healthcare managers. Whistleblowing acts were performed internally, externally, or left undone. Three main paths: internal, external, and no whistleblowing, between an observation of wrongdoing and whistleblowing act were identified. CONCLUSION: The whistleblowing process should be further developed and ethically effective programmes and interventions should be developed for increasing whistleblowing and preventing wrongdoing in health care.

To Whistleblow or Not to Whistleblow: Affective and Cognitive Differences in Reporting Peers and Advisors.

Traditional whistleblowing theories have purported that whistleblowers engage in a rational process in determining whether or not to blow the whistle on misconduct. However, stressors inherent to whistleblowing often impede rational thinking and act as a barrier to effective whistleblowing. The negative impact of these stressors on whistleblowing may be made worse depending on who engages in the misconduct: a peer or advisor. In the present study, participants are presented with an ethical scenario where either a peer or advisor engages in misconduct, and positive and the negative consequences of whistleblowing are either directed to the wrongdoer, department, or university. Participant responses to case questions were evaluated for whistleblowing intentions, moral intensity, metacognitive reasoning strategies, and positive and negative, active and passive emotions. Findings indicate that participants were less likely to report the observed misconduct of an advisor compared to a peer. Furthermore, the findings also suggest that when an advisor is the source of misconduct, greater negative affect results. Post-hoc analyses were also conducted examining the differences between those who did and did not intend to blow the whistle under the circumstances of either having to report an advisor or peer. The implications of these findings for understanding the complexities involved in whistleblowing are discussed.

Whistle-blowing process in healthcare: From suspicion to action.

BACKGROUND:: Whistle-blowing is an ethical activity that tries to end wrongdoing. Wrongdoing in healthcare varies from inappropriate behaviour to illegal action. Whistle-blowing can have negative consequences for the whistle-blower, often in the form of bullying or retribution. Despite the wrongdoing and negative tone of whistle-blowing, there is limited literature exploring them in healthcare. OBJECTIVE:: The aim was to describe possible wrongdoing in Finnish healthcare and to examine whistle-blowing processes described on the basis of the existing literature in healthcare as perceived by healthcare professionals. RESEARCH DESIGN:: The study was a cross-sectional descriptive survey. The data were collected using the electronic questionnaire Whistle-blowing in Health Care and analysed statistically. PARTICIPANTS AND RESEARCH CONTEXT:: A total of 397 Finnish healthcare professionals participated, 278 of whom had either suspected or observed wrongdoing in healthcare, which established the data for this article. ETHICAL CONSIDERATIONS:: Ethical approval was obtained from the Ethics Committee of the University (20/2015). Permission to conduct the study was received according to the organisation's policies. FINDINGS:: Wrongdoing occurs in healthcare, as 96% of the participants had suspected and 94% had observed wrongdoing. Regarding the frequency, wrongdoing was suspected (57%) and observed (52%) more than once a month. Organisation-related wrongdoing was the most common type of wrongdoing (suspected 70%, observed 66%). In total, two whistle-blowing processes were confirmed in healthcare: (1) from suspicion to consequences occurred to 27%, and (2) from observation to consequences occurred to 37% of the participants. DISCUSSION AND CONCLUSION:: Wrongdoing occurs in healthcare quite frequently. Whistle-blowing processes were described based on the existing literature, but two separate processes were confirmed by the empirical data. More research is needed on wrongdoing and whistle-blowing on it in healthcare.

Clinical governance breakdown: Australian cases of wilful blindness and whistleblowing.

BACKGROUND: After their attempts to have patient safety concerns addressed internally were ignored by wilfully blind managers, nurses from Bundaberg Base Hospital and Macarthur Health Service felt compelled to 'blow the whistle'. Wilful blindness is the human desire to prefer ignorance to knowledge; the responsibility to be informed is shirked. OBJECTIVE: To provide an account of instances of wilful blindness identified in two high-profile cases of nurse whistleblowing in Australia. RESEARCH DESIGN: Critical case study methodology using Fay's Critical Social Theory to examine, analyse and interpret existing data generated by the Commissions of Inquiry held into Bundaberg Base Hospital and Macarthur Health Service patient safety breaches. All data was publicly available and assessed according to the requirements of unobtrusive research methods and secondary data analysis. ETHICAL CONSIDERATIONS: Data collection for the case studies relied entirely on publicly available documentary sources recounting and detailing past events. FINDINGS: Data from both cases reveal managers demonstrating wilful blindness towards patient safety concerns. Concerns were unaddressed; nurses, instead, experienced retaliatory responses leading to a 'social crisis' in the organisation and to whistleblowing. CONCLUSION: Managers tasked with clinical governance must be aware of mechanisms with the potential to blind them. The human tendency to favour positive news and avoid conflict is powerful. Understanding wilful blindness can assist managers' awareness of the competing emotions occurring in response to ethical challenges, such as whistleblowing.

Improving patient safety by enhancing raising concerns at medical school.

BACKGROUND: Doctors and medical students have a professional responsibility to raise concerns. Failure to raise concerns may compromise patient safety. It is widely known that medical students frequently encounter unprofessional behaviours in the workplace, but little is known about the barriers to raising concerns amongst medical students. This paper explores these issues and discusses some innovations in the medical undergraduate curriculum, offering a good practice model for other medical and healthcare curricula. We set out to ascertain the attitudes and experiences of medical students in relation to raising concerns. This data was then used to innovate the raising concerns curriculum, and access to the raising concerns system, in order to fundamentally improve patient safety and experience, as well as the student experience. METHODS: The authors conducted a mixed methods quantitative and qualitative research study. Research was based at a UK medical school and involved data collection using an anonymous, voluntary survey emailed to all medical students (n = 363) as well as voluntary attendance focus groups (n = 24) recruited by email. Both tools investigated student attitudes towards raising concerns and explored student ideas for solutions to improving the process. The focus group data was thematically analysed by three researchers. RESULTS: The authors identified five key themes which described medical student attitudes towards raising concerns. This article discusses these themes and the resulting work to enhance medical education within the medical school curriculum. CONCLUSIONS: More research is needed to further address the barriers that medical students find in raising concerns. However, despite being a single study in one UK medical school, the authors propose some changes which they hope may inspire other educators to build upon their raising concerns curricula to foster more transparent undergraduate cultures and ultimately improve patient experience and safety.

Ethical climate as a moderator between organizational trust and whistle-blowing among nurses and secretaries.

OBJECTIVES: To reveal the effect of perception of ethical climate by nurses and secretaries and their level of organizational trust on their whistleblowing intention. METHODS: Nurses and secretaries working in a University Hospital in Ankara, Turkey, were enrolled in the study conducted in 2016. Responses were received from 369 nurses and secretaries working at Clinics and Polyclinics. Path analysis, investigation of structural equation models used while multi-regression analysis was also applied. RESULTS: According to the regression model, ethical climate dimensions, profession, gender, and work place had significant impact on the whistleblowing intention. According to Path analysis, ethical climate had direct impact of 69% on whistleblowing intention. It was seen that organizational trust had an indirect impact of 27% on the whistleblowing score when ethical climate had a moderator role. CONCLUSION: In order to promote whistleblowing in organizations, it is important to keep the ethical climate perception of employees and the level of their organizational trust at high levels.