Professional Values, Perceived Ethical Climate, and Dignity-Protecting Behaviors Among Intensive Care Nurses: A Moderation Analysis.

BACKGROUND

In intensive care unit (ICU) patients, diminished consciousness, device dependency, and limited privacy leave dignity preservation largely dependent on nurses' behavior, which may be shaped by both individual professional values and the unit's ethical climate.

AIM: To examine the predictive roles of professional values and perceived ethical climate on dignity-protecting behaviors among ICU nurses and to test whether perceived ethical climate moderates the professional values-dignity-protecting behavior relationship.

METHODS

This descriptive, cross-sectional study included 165 nurses from the adult ICUs of six private hospitals in Istanbul, Türkiye. Data were collected using the Nurses' Professional Values Scale, the Intensive Care Unit Dignified Care Scale, and the Hospital Ethical Climate Scale. Regression analyses, Hayes' PROCESS macro, and simple slope analysis were used to test the moderation model.

RESULTS

Professional values (β = 0.521) and perceived ethical climate (β = 0.679) significantly predicted dignity-protecting behaviors, with large effect sizes. The interaction term significantly predicted dignity-protecting behaviors (B = -0.005, p < 0.001): The effect of professional values was significant at low and mean levels of ethical climate, but not at high levels.

CONCLUSION

Professional values and ethical climate independently predicted dignity-protecting behaviors, and ethical climate moderated this relationship, with professional values mattering most when ethical climate was weak. A strongly perceived ethical climate appears to reduce, rather than amplify, the behavioral influence of professional values, offering a more consistent pathway to safeguarding patient dignity in ICUs.

IMPLICATIONS FOR NURSING MANAGEMENT: Since professional values mattered most under weak ethical climates, nurse managers should pair efforts to strengthen the ethical work environment with strategies to reinforce nurses' individual professional values, including transparent decision-making, sensitivity to patient rights, and support for ethical discussion within ICU teams.