Psychometric properties of the Hospital Ethical Climate Survey: a cross-sectional study in a large sample of Belgian psychiatric nurses

Rational, aims and objectives: The complex situation of care giving during the nursing and accompaniment of psychiatric patients often results in ethical problems and dilemmas for the caregivers involved. The ethical climate on a ward is crucial for addressing these problems and dilemmas. To date, there has been no instrument for assessing the ethical climate on a psychiatric ward. The present study is the first study of ethical climate in a psychiatric hospital. It was investigated whether the only existing instrument that measures the ethical climate in general hospitals, the ‘Hospital Ethical Climate Survey’, is a reliable and valid instrument for measuring the ethical climate on psychiatric wards. Method: A cross-sectional study was performed in a large psychiatric inpatient setting in Belgium. All 320 nurses were invited to participate, 265 of them completed the survey, giving a response rate of 83%. The factor structure of the HECS was examined through explorative Principal Component Analysis (PCA) and Confirmatory Factor Analysis (CFA) and the reliability of the constructed scale and subscales were investigated. Results: Five factors were identified, which were largely identical compared to the factor structure obtained with the original instrument and its underlying theoretical basis. Items related to different allied healthcare professions were added, which expanded the subscale ‘relationship with physician’ to ‘relationship with other disciplines’ (medical and allied healthcare workers). Conclusion: The reliability of the instrument was good and comparable with reliability scores from earlier research. The investigated setting has a significantly higher main score for ethical climate, compared to previous studies.