title: Validation of the Hospital Ethical Climate Survey for older people care.
abstract: BACKGROUND
  The exploration of the ethical climate in the care settings for older people is highlighted in the literature, and it has been associated with various aspects of clinical practice and nurses' jobs. However, ethical climate is seldom studied in the older people care context. Valid, reliable, feasible measures are needed for the measurement of ethical climate.
  
  
  OBJECTIVE
  This study aimed to test the reliability, validity, and sensitivity of the Hospital Ethical Climate Survey in healthcare settings for older people.
  
  
  METHODS
  A non-experimental cross-sectional study design was employed, and a survey using questionnaires, including the Hospital Ethical Climate Survey was used for data collection. Data were analyzed using descriptive statistics, inferential statistics, and multivariable methods.
  
  
  METHODS
  Survey data were collected from a sample of nurses working in the care settings for older people in Finland (N = 1513, n = 874, response rate = 58%) in 2011.
  
  
  METHODS
  This study was conducted according to good scientific inquiry guidelines, and ethical approval was obtained from the university ethics committee.
  
  
  RESULTS
  The mean score for the Hospital Ethical Climate Survey total was 3.85 (standard deviation = 0.56). Cronbach's alpha was 0.92. Principal component analysis provided evidence for factorial validity. LISREL provided evidence for construct validity based on goodness-of-fit statistics. Pearson's correlations of 0.68-0.90 were found between the sub-scales and the Hospital Ethical Climate Survey.
  
  
  CONCLUSIONS
  The Hospital Ethical Climate Survey was found able to reveal discrimination across care settings and proved to be a valid and reliable tool for measuring ethical climate in care settings for older people and sensitive enough to reveal variations across various clinical settings.
  
  
  CONCLUSIONS
  The Finnish version of the Hospital Ethical Climate Survey, used mainly in the hospital settings previously, proved to be a valid instrument to be used in the care settings for older people. Further studies are due to analyze the factor structure and some items of the Hospital Ethical Climate Survey.
authors.affiliation: University of Turku, Finland suhonen.riitta@kolumbus.fi riisuh@utu.fi.
authors.forename: Riitta
authors.initials: R
authors.lastname: Suhonen
authors.affiliation: University of Turku, Finland.
authors.forename: Minna
authors.initials: M
authors.lastname: Stolt
authors.affiliation: University of Turku, Finland.
authors.forename: Jouko
authors.initials: J
authors.lastname: Katajisto
authors.affiliation: Cyprus University of Technology, Cyprus; University of Turku, Finland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Charalambous
authors.affiliation: North Park University School of Nursing, USA; National Council of State Boards of Nursing (NCSBN), USA.
authors.forename: Linda L
authors.initials: LL
authors.lastname: Olson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D004991:Ethics, Institutional; D005260:Female; D005387:Finland; D005851:Geriatric Nursing / Q000941:ethics*; D019538:Health Care Surveys; D006757:Hospital Units / Q000941:ethics / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology / Q000706:statistics & numerical data; D015279:Organizational Culture; D015203:Reproducibility of Results; D055815:Young Adult
keywords: Care settings for older people; ethical climate; instrument; validity; work environment