Effects of nursing professionalism, ethical issues experience, and hospital ethical climate on ethical nursing competence of nurses in long-term care hospitals: A cross-sectional study

PURPOSE: This study examined factors associated with ethical nursing competence among nurses working in long-term care hospitals (LTCHs), focusing on nursing professionalism, experiences with ethical issues, and the hospital ethical climate. METHODS: Using a descriptive cross-sectional design, we recruited nurses via convenience sampling who had at least 6 months of LTCHs inpatient-care experience in J Province and G City. Data were collected with a structured, self-administered questionnaire from February 24 to March 14, 2025. Analyses included descriptive statistics, independent t-tests, one-way ANOVA with Scheffé post-hoc tests, Pearson's correlation coefficients, and multiple linear regression. RESULTS: The mean ethical nursing competence score was 3.18 out of 4, with ethical behavior being the highest-scoring subdomain and ethical reflection the lowest. Ethical nursing competence was positively correlated with nursing professionalism (r=.33, p<.001) and the hospital ethical climate (r=.37, p<.001), and negatively correlated with experiences of ethical issues (r=-.27, p<.001). In multiple regression, significant predictors of ethical nursing competence were the hospital ethical climate (β=.35, p<.001) and completion of ethics education (β=.20, p=.006). CONCLUSION: Strategies to enhance ethical nursing competence through hospital ethical climate are needed, particularly those that prioritize facilitating an ethical climate of nursing organizations. In-service programs that consider the content and methods of ethics education appropriate to the characteristics of nursing practice in LTCHs are also needed.