title: Healthcare professionals' perceptions of the ethical climate in paediatric cancer care.
abstract: BACKGROUND
  How well ethical concerns are handled in healthcare is influenced by the ethical climate of the workplace, which in this study is described as workplace factors that contribute to healthcare professionals' ability to identify and deal with ethical issues in order to provide the patient with ethically good care.
  
  
  OBJECTIVE
  The overall aim of the study was to describe perceptions of the paediatric hospital ethical climate among healthcare professionals who treat/care for children with cancer.
  
  
  METHODS
  Data were collected using the Hospital Ethical Climate Survey developed by Olsson as a separate section in a questionnaire. Descriptive statistics were used to analyse perceptions of the ethical climate. Participants and research context: Physicians, nurses and nurse-aides (n = 89) from three paediatric units participated in this study: haematology/oncology, chronic diseases and neurology. Ethical considerations: The study was approved by the regional ethical review board.
  
  
  RESULTS
  Different perceptions of the ethical climate were rated as positive or negative/neutral. Nurses' ratings were less positive than physicians on all items. One-third of the participants perceived that they were able to practice ethically good care as they believed it should be practised.
  
  
  CONCLUSIONS
  Differences in professional roles, involving more or less power and influence, might explain why physicians and nurses rated items differently. A positive perception of the possibility to practice ethically good care seems to be related to inter-professional trust and listening to guardians/parents. A negative/neutral perception of the possibility to practice ethically good care appears to be influenced by experiences of ethical conflicts as well as a lack of ethical support, for example, time for reflection and discussion.
  
  
  CONCLUSIONS
  The two-thirds of participants who had a negative/neutral perception of the possibility to practice ethically good care are at risk of developing moral stress. Clinical ethics support needs to be implemented in care where important values are at stake.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Bartholdson
authors.forename: Margareta Af
authors.initials: MA
authors.lastname: Sandeberg
authors.forename: Kim
authors.initials: K
authors.lastname: Lützén
authors.forename: Klas
authors.initials: K
authors.lastname: Blomgren
authors.affiliation: Karolinska Institutet, Sweden.
authors.forename: Pernilla
authors.initials: P
authors.lastname: Pergert
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002173:Cancer Care Facilities; D002648:Child; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D009726:Nurses / Q000523:psychology; D009728:Nursing Assistants / Q000523:psychology; D010372:Pediatrics / Q000941:ethics*; D010820:Physicians / Q000523:psychology; D011787:Quality of Health Care / Q000941:ethics*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Cancer; caregivers; descriptive statistics; ethical climate; paediatrics