Ethical approach assessment in emergency psychiatric care and its association with malpractice risk awareness

Medical malpractice is a significant issue throughout the care process that adversely affects patient safety, a fundamental priority in healthcare services. This study aimed to determine whether sociodemographic and professional characteristics are associated with malpractice risk awareness among physicians and nurses in emergency departments and to assess the relationship between ethical approach and malpractice risk awareness. This methodological and cross-sectional study enrolled 397 healthcare professionals working in emergency departments in Turkey, recruited using a snowball sampling method. It involved 2 phases. In phase 1, the Ethical Approach Assessment Scale for Psychiatric Patients was adapted to the emergency department context. In phase 2, data were collected using an information form, the adapted scale, and the Malpractice Risk Assessment Scale in Emergency Health Services to examine participants’ awareness of malpractice risk and ethical approaches in treating patients with psychiatric conditions. In phase 1, adaptation of the Ethical Approach Assessment Scale for Psychiatric Patients to the emergency department context yielded a 16-item unidimensional scale. In phase 2, the mean adapted scale score among participants indicated a positive orientation toward ethical principles and values, while the mean malpractice risk awareness score was slightly above the theoretical midpoint. Malpractice risk awareness differed significantly by sex, profession, income status, malpractice training, malpractice experience, and witnessing malpractice. Moreover, the adapted ethical approach scale score showed a statistically significant but weak association with malpractice risk awareness, accounting for an additional 1.5 percentage points of explained variance beyond sociodemographic and professional characteristics. The adaptation of the Ethical Approach Assessment Scale for Psychiatric Patients to the emergency department context yielded an instrument with evidence supporting its content validity, internal structure, and internal consistency within the present sample. The findings indicate that healthcare professionals’ ethical approach was modestly associated with malpractice risk awareness. Therefore, ethical considerations should be incorporated into broader, multifaceted efforts to address malpractice risk, and clinical decision-making should be supported by frameworks that integrate both ethical and legal dimensions.