METHODS AND METHODOLOGIES

doi: 10.1111/scs.12194

Review of sampling, sample and data collection procedures in nursing research - An example of research on ethical climate as perceived by nurses Riitta Suhonen PhD, RN, FEANS (Professor)1, Minna Stolt PhD (Podiatrist, University Teacher)1, Jouko Katajisto MSocSci (Statistician, Senior Lecturer)2 and Helena Leino-Kilpi PhD, RN, FEANS (Professor and Chair/Nurse Director)3 1

Department of Nursing Science, University of Turku, Turku, Finland, 2Department of Mathematics and Statistics, University of Turku, Turku, Finland and 3Department of Nursing Science/Turku University Hospital, University of Turku, Turku, Finland

Scand J Caring Sci; 2015; 29; 843–858 Review of sampling, sample and data collection procedures in nursing research – an example of research on ethical climate as perceived by nurses

Objective: To report a review of quality regarding sampling, sample and data collection procedures of empirical nursing research of ethical climate studies where nurses were informants. Surveys are needed to obtain generalisable information about topics sensitive to nursing. Methodological quality of the studies is of key concern, especially the description of sampling and data collection procedures. Design: Methodological literature review. Data sources and methods: Using the electronic MEDLINE database, empirical nursing research articles focusing on ethical climate were accessed in 2013 (earliest-22 November 2013). Using the search terms ‘ethical’ AND (‘climate*’ OR ‘environment*’) AND (‘nurse*’ OR ‘nursing’), 376 citations were retrieved. Based on a four-phase retrieval process, 26 studies were included in the detailed analysis.

Introduction It has been argued that survey studies lack methodological quality and rigour especially in the sampling methods used in data collection and thereby in obtaining a representative sample that can produce generalisable and valid information (1, 2). In particular, low response rates to surveys have been identified in healthcare professionals Correspondence to: Riitta Suhonen, Department of Nursing Science, University of Turku, Lemmink€ aisenkatu 1, 2nd floor, Turku 20014, Finland. E-mail: [email protected] © 2015 Nordic College of Caring Science

Results: Sampling method was reported in 58% of the studies, and it was random in a minority of the studies (26%). The identification of target sample and its size (92%) was reported, whereas justification for sample size was less often given. In over two-thirds (69%) of the studies with identifiable response rate, it was below 75%. A variety of data collection procedures were used with large amount of missing data about the details of who distributed, recruited and collected the questionnaires. Methods to increase response rates were seldom described. Discussion about nonresponse, representativeness of the sample and generalisability of the results was missing in many studies. Conclusion: This review highlights the methodological challenges and developments that need to be considered in ensuring the use of valid information in developing health care through research findings. Keywords: ethical climate, generalisability, literature review, methodology, nurses, nursing research, quality, sample, sampling. Submitted 24 June 2014, Accepted 17 October 2014

(2–4) or when using online surveys (3, 5). National or cultural differences also exist (4). The framework for achieving rigour in sampling and data collection procedures includes sample selection, sample recruitment and data collection (6). Thus, in this review, we were interested in these topics from the point of view of methodological quality. Ethical climate was selected as an example of an important and timely research topic in nursing. Ethical climate has been found to be a key concept in the healthcare systems. These systems currently struggle with increasing possibilities in care and treatment options including technological developments and complex processes, increasing demands of 843

844

R. Suhonen et al.

population level health and individual patients’ expectations and, finally, limited resources (7, 8). These conditions produce ethically difficult situations in the working environment, having also an impact on patient, professional and organisational outcomes (8), which makes the research on this topic very timely, especially from nurses’ point of view. Nurses are the largest and a diverse professional group (2, 9). Ethical climate is also a topic where researchers aim to produce generalisable information for organisations.

Background Adequate sampling and sample in nursing research There is a belief that studies are unethical due to too small sample size lacking adequate power (10, 11). However, it has been said that any study producing important information would benefit science and practice and is therefore important, without sacrificing the respondents (high risk, high pay-off studies) (11). Vice versa, it has been pointed out that too large sample size is a more legitimate ethical issue (11) meaning that there is unnecessary burden for people who participate. Therefore, the justification of sample size, using different methods for estimations, is needed in any case (12). The accurate estimation of sample size including the achievement of both statistically and clinically significant results (13) is needed to make also generalisations legitimate. Three major facets of sampling are outlined: (i) the sample frame including the population of interest, (ii) the sample size and (iii) the specific design of the selection procedures (6, 14, 15). These are important to achieve sufficient adequacy (number of participants) and appropriateness (the characteristics of participants) (16). It has been found that nursing research studies lack statistical power and generalisability, are unrepresentative, have poor description of sampling techniques, are convenient or have too small samples (1, 2). Sampling is necessary because it is not usually possible to collect data from every individual, event or unit in the population aimed for (16, 17). With sampling, one aims to estimate or predict outcomes about the larger population based on data from a sample (18). There is a need to identify the population, the group about which the investigator wishes to draw general conclusions, the drawn sample, the representative sample on which the researcher plans to gather data and finally, the achieved sample, the group the researcher succeeded in gathering the data from (17). Therefore, generalisations are made about individuals from data that has not been collected. To make these generalisations, it is necessary to ensure that the sample is representative of the population (16) and adequate to make the interpretations. It has been stated that in sampling, it is important to identify the

specific characteristics of the target population, that is the population to which the generalisations will be made (16). Concerns exist about sample size (17). Sample size is important, for example, for providing accurate measurement, for drawing any conclusions about the results, validity of the study, generalisations that will be made and for selecting possible statistical analyses (13, 15, 19). Furthermore, nonresponse in survey has many implications for interpreting the results (4). Low response rates can result in bias (1, 6) and nonresponders may be different from responders (4), which is why nonresponse analysis in interpreting survey results is important (17). Therefore, a nonresponse should be considered as influencing the degree to which the judgement may vary according to the congruence of the drawn and achieved sample (17). Many strategies to increase response in research have been developed. One of these is Dillman’s Tailored Design method (TDM; Dillman et al.) (20), which has been considered as a golden standard for maximising response rates in surveys. This method suggests, firstly, making the survey questionnaires user-friendly, including piloting (20, 21). Secondly, a variety of contacts with the survey informants to initiate and carry on the data collection (2, 20) need to be planned. These include for example researcher contacts with the study sites, prenotifications, reminders and prompts for respondents and undersigned letters by faculty staff. There is, however, no evidence of the optimal number of contacts (22). Thirdly, personalising the correspondence and information provided for the informants during the data collection is necessary to keep the interest of the respondents (20, 22). Fourthly, returning the completed survey by means of paid return envelopes (2, 20, 22), especially paid stamp, increases response rates. Fifthly, using incentivebased interventions such as small gifts or monetary incentives have been suggested, but they may produce an unsystematic effect on response rate and may involve some problems (2, 20, 23).

Definition and nursing research on ethical climate One means of assessing ethical climate is with the application of questionnaires aiming to achieve generalisable results. Ethical climate has been considered as an identifiable part of an organisation’s climate and thus part of the social environment. By using a measure of ethical climate, the influence of workplace on nurses’ ethical practice can be studied. The concept of ethical climate consists of two separate concepts, ethical meaning ‘relating to beliefs about right and wrong’ (Collins Cobuild Advanced Learner’s English Dictionary, p. 483) (24) and climate, which refers to ‘the general atmosphere or situation somewhere’ (Collins © 2015 Nordic College of Caring Science

Sampling, sample and data collection procedures Cobuild Advanced Learner’s English Dictionary, p. 250) (24). Organisation’s ethical climate can be assessed by measuring employee perceptions of organisational practices that reflect how decisions having ethical content are solved or the presence of organisational conditions under which employees engage in ethical reflection (25). Measuring ethical climate can make the organisational behaviour visible as it can be viewed as the personality of an organisation influencing the attitudes and behaviours of its workers (26, 27). Usually, climate questionnaires capture an observer’s description of the styles and forms of behaviour in organisations (26). While ethical climate has been perceived as an organisational phenomenon, it is expected that it can be manipulated (7). Linking the two areas of interest, firstly, methodological quality regarding sampling, sample and data collection procedures having an impact on the generalisability of results, and secondly, a timely topic in nursing research, ethical climate, was done to evaluate the state of nursing research. Shortage of healthcare professionals makes every effort aimed at facilitating working conditions valuable. Furthermore, nursing research aiming for knowledge expansion and evidence base calls for serious reflections on research methodology to produce valid and generalisable results.

Aim This paper reports an evaluative review of quality regarding sampling, sample and data collection procedures of empirical nursing research of ethical climate studies with nurses as informants. The goal is to highlight and develop nursing research study conduct and reporting of research methodology, including data collection issues and research quality. The following research questions were set: • What is the methodological quality related to sampling and sample of the empirical nursing studies focusing on nurses’ assessments of ethical climate? • What data collection procedures to increase response rate have been described in the articles? • How do investigators describe the reasoning about representativeness, generalisability and sample adequacy?

Methods Search protocol Articles were identified for the review by conducting an electronic database search on MEDLINE (PubMed Medline from earliest through 22 November 2013). Using the search terms ‘ethical’ AND (climate* OR environment*) AND (‘nurse*’ OR ‘nursing’) (the Boolean operators) limited to English language and title and abstract, 376 citations were retrieved. © 2015 Nordic College of Caring Science

845

Inclusion/exclusion criteria applied The following inclusion criteria were applied in retrieving the possible articles for the analysis: (i) empirical research article published in English language, (ii) focused on ethical climate or environment, (iii) including nurse professionals as research informants and (iv) being a nursing research study.

Retrieval of the studies for the review The retrieval process was conducted in three phases. Firstly, 376 abstracts found in the MEDLINE database were examined against the inclusion criteria on a title and abstract level by two independent researchers. If the decision differed as to whether to include a certain abstract in the review, a consensus was negotiated. A total of 28 possible empirical research articles based on the abstracts met the inclusion criteria. A total of 348 abstracts were excluded based on the fact that they did not focus on the topic or were not empirical. Secondly, in the eligibility phase of the review, the included abstracts with full texts were examined independently by two researchers. In this phase, two of the 28 full texts were excluded because they were not empirical studies with a true sample. The inclusion of the remaining 26 articles was confirmed in a research group. Finally, a systematic analysis of the 26 full-text articles was conducted by two researchers using a data collection sheet. Thus, the results presented in this paper are based on the synthesis of the information collected from 26 empirical studies, which are marked with ‘*’ in the reference list.

Analysis of the studies The following general information about the studies was collected for working sheets: author, year and country where the study took place, type of study setting and data collection method. From the point of view of methodological quality, firstly, the following information about sampling was collected (sample selection – creating a sampling frame): sampling technique, sample aimed (target sample) and sample size estimation/justification. The following information was collected from the achieved, realised sample: number of respondents, response rate (Table 1) (1, 6). Secondly, the following data collection procedures were collected: researcher contact, type of information provided for the participants, person who recruited participants and collected data, method of data collection, data collection time frame, procedures or incentives to increase response rates and returns of the completed survey (Table 2). Finally, information was collected about authors’ reflections of limitations or discussion about representativeness,

Goldman & Tabak 2010 Israel (41)

Filipova 2009 USA (37)

Pauly et al. 2009 Canada (44)

Ulrich et al. 2007 USA (29)

Hamric & Blackhall 2007 USA (28)

Corley et al. 2005 USA (31) Hart 2005 USA (36)

Health care in general, state level Skilled nursing facilities, long-term care (over 50 beds, free standing) Central hospital (6 internal medicine wards)

Health care in general, 4 states

Acute care hospitals, state level Adult ICUs, hospitals

Healthcare organisations Medical centres

Nonprofit private hospital Acute care hospital, units Acute care inpatient settings Acute care hospitals ICU units in Finland Hospitals

Joseph & Deshpande 1997 USA (43) McDaniel 1998a USA (40) McDaniel 1998b USA (58) Olson 1998 USA (30)

Leino-Kilpi et al. 2002 Finland (51) €rk Bahcecik & Oztu 2003 Turkey (32) Bell 2003 USA (50)

Setting

Author, year

Survey, questionnaire

Survey, questionnaire

359, 100 participates

1, 6 wards

Survey, questionnaire

Survey, questionnaire

Survey, questionnaire

Survey, questionnaire Survey, questionnaire Survey, questionnaire Survey, questionnaire Survey, questionnaire Survey, questionnaire Survey, questionnaire Survey, questionnaire Survey, questionnaire

Data collection method

n/a

n/a

2 (I, 7 units, II, 7 units)

n/a

2

3

4

35

2

n/a

3

1

Study sites

Random, generated from lists of 4 different states registries Random, randomly generated list from databases in 1 state

n/a

Random

Convenience

n/a

n/a

Total sampling

Convenience

n/a

n/a

n/a

Sampling method

Nurses, 95

Registered nurses, licensed practical nurses 3060

Nurses, 1700

Nurses and doctors (N = (I) 280 + (II) 280) Nurses and social workers, 3000

Nurses, 2000

Nurses, 170

Nurses, 190

ICU Registered nurses, 1047 Nurses, 394

Nurses, not stated

Nurses, 40 (20 + 20) Nurses, 450

Nurses, 226

Target sample, identified

Persons: 728 (24%), eligible 656 (21.4%) Facilities 100, 28%

374 (22%)

1215 (41%, not reported)

681 (34%) returned surveys, eligible 463 (23%) I: 198 (50%) II: 94 (33%

106 (62%)

276 (70%, but not reported) 97 (51%)

814 (77%)

360 (48%)

450 (100%)

40

114 (50%)

Sample size, response rate

Table 1 Study settings, data collection and sampling methods in the studies reviewed (n = 26) in the order by time, n/a not available or not reported

n/a

n/a

Anticipated response rate of 40%.

Estimated margin errors, adjusting estimated response rate

n/a

Proportion of population, CI95%

n/a

n/a

n/a

Nunnally’s recommendation, 10 subjects/item Total sampling

n/a

Power analysis for comparison

n/a

Sample size justification

846 R. Suhonen et al.

© 2015 Nordic College of Caring Science

© 2015 Nordic College of Caring Science

Local governments, all public health units

Hospital metropolitan from 3 different parts of country, regional hospitals

Asahara et al. 2012 Japan (52)

Huang et al. 2012 Taiwan (39)

Varcoe et al. 2012 Canada (38)

Sil en et al. 2012 Sweden (46)

Borhani et al. 2012 Iran (34)

Acute care Wards One university hospital and one county hospital, 3 medical and 1 surgical wards British Columbia area, database, state level

Acute psychiatric hospital ward University and county hospital, acute care units Government, nonprofit and for-profit nursing homes, 1 state Hospitals

€tzen et al. 2010 Lu Sweden (33) Silen et al. 2011 Sweden (45)

Filipova 2011 USA (49)

Setting

Author, year

Table 1 (Continued)

Survey, questionnaire

N/a

Random (not said)

Survey, questionnaire

2193 local govern-ments, all public health units 9 (3 hospitals in each area)

Random

Intensive (Purposeful), sampling technique based on earlier questionnaires survey, Silen et al. 2011

Quota sampling

n/a

N/A

Convenience

Sampling method

Survey, open-ended questions

Interview, critical incident technique

Survey, questionnaire

Survey, questionnaire

Survey, questionnaire Survey, questionnaire

Data collection method

Acute care settings

4 wards

4, medical surgical critical, emergency

100 nursing homes

2/16

4

Study sites

Public health nurses, 10965/5 questionnaires to each of the 2193 local governments Nurses 450

Registered nurses 1700

Nurses 23 gave written consent

Nurses, 300 roosted from 500 possible

RNs and LPNs 3060

Nurses, 432

Nurses, 100

Target sample, identified

352 (78%)

374 (22%) responded, 292 of those (78%) gave answers to open-ended questions 3493 (31.9%) returned, usable 3409 (31.1%)

20

280 received, 275 with completed (92% not stated)

656 (21.4%)

49 (49%, not reported) 249 (58%)

Sample size, response rate

n/a

Nationwide survey

To estimate the minimum correlation coefficient of 0.15 with %95 confidence interval, and design effect 2, the required sample size was 300 and had to be selected by nonprobability quota sampling from the rooster of 500 active nurses of hospitals affiliated to the university hospital

n/a

n/a

n/a

Sample size justification

Sampling, sample and data collection procedures 847

Korean public hospitals

Teaching hospital, southeastern region of Iran

Teheran university of Medical Sciences, ICU units Emergency, surgery and internal medicine, cardiac unit and ICU Care settings for older people, different clinical settings

Hwang & Park 2014 South Korea (48)

Borhani et al. 2014 Iran (59)

Joolaee et al. 2013 Iran (42)

Suhonen et al. 2014 Finland (47)

Setting

Author, year

Table 1 (Continued)

62 units

n/a

4

33 out of 40 regional hospitals

Study sites

Survey, questionnaires

Survey, questionnaires

Survey, questionnaires

Survey, questionnaires

Data collection method

Total sample of different level nurses

Stratified sampling with proportional allocation, nurses randomly selected from the unit

Random, quota basis.

Total Yes, 2358 eligible nurses all of whom we surveyed.

Sampling method

Nursing staff, direct patient care 1513

Nurses

Nurses 300

Nurses 2358 eligible

Target sample, identified

874 (58%)

210 (n/a)

280 returned, 275 (92%) for analysis

2116 returned, 1826 (77.4%) for analysis

Sample size, response rate

Based on analysis methods: Stability in parameter estimates was assumed according to the recommendation that the number of cases for each predictor in a logistic regression model ranges from 10 to 20 Sample size was calculated to be 88 people, considering a = 5% and the correlation coefficient 0.18, sample size 085 people, clustered, design effect taken into account 1.5, final sample size 300 n/a

Sample size justification

848 R. Suhonen et al.

© 2015 Nordic College of Caring Science

© 2015 Nordic College of Caring Science

Bahcecik & €rk Oztu 2003 (32)

n/a

Covering letter

n/a

Coordinator in each unit

Written in the cover letter

Having contact with study sites, meetings with groups of nurses on their clinical units Contact number of the researchers was given to participants for possible questions

Leino-Kilpi et al. 2002 (51)

n/a

n/a

n/a

n/a

n/a

Research assistant

n/a

n/a

Surveys were distributed to the nurses at the workplace by a hospital administrator.

McDaniel 1998a (40) McDaniel 1998b (58) Olson 1998 (30)

n/a

n/a

Type of information provided

Joseph & Deshpande 1997 (43)

Author, year

Researcher contact, role

Who collected, recruited participants, how Paper–pencil

Paper–pencil

Paper–pencil

Paper–pencil

Paper–pencil

2 months, May–June 2001

in year 1999

5 months, October 1993– February 1994

n/a

n/a

n/a

Method of survey data collection

Paper–pencil

The length of data collection period, year of data collection

Table 2 Description of the data collection procedures to increase response, n/a not available or not reported

The respondents were assured that only the researchers were able to look at the completed questionnaires (p. 130) n/a

Written and telephone reminders to managers were sent, meetings in the units

n/a

n/a

n/a

Procedures to increase response (e.g. reminders)

n/a

Completed questionnaires in envelopes, coordinator mailed them to researchers (p. 130)

Sealed envelopes addressed to the investigators

n/a

Nurses were provided stamped, prepaid envelopes to send the completed surveys directly to the researchers (p. 76) n/a

Return of the completed survey

70% (counted by authors)

77%

48%

100%

n/a

50%

Result response rate

Sampling, sample and data collection procedures 849

n/a

Researcher collected data, initial contact with nurses

n/a

Pilot, focus groups used in sites

n/a

Bell 2003 (50)

Corley et al. 2005 (31)

Hart 2005 (36)

Hamric & Blackhall 2007 (28)

Ulrich et al. 2007 (29)

Author, year

Researcher contact, role

Table 2 (Continued)

Written in the cover letter

n/a

n/a

n/a

Written in the cover letter

Type of information provided

Dillman’s Tailored Design Method guided the data collection procedure

‘Site champion’ encouraged participation, coordinated data collection (p. 424)

n/a

Participants were identified only by organisation. A key contact at each organisation facilitated recruitment of participants and distribution of the questionnaires (p. 135) One of the investigators, in contact with nurses or for those absent, questionnaires were put in their mailboxes. (p. 385)

Who collected, recruited participants, how

Self-administered mailed paperpencil or web-based

Paper–pencil

Mailed paper–pencil

Self-reported paper–pencil instruments

Paper–pencil

Method of survey data collection

2004

n/a

4 months Aug–Nov 2003

n/a

over 6-month period

The length of data collection period, year of data collection

Two weeks after initial contact, a postcard reminder. 4 weeks after initial contact, a 2nd copy of the form was sent to the nurses who had not responded. (p. 385) A reminder postcard 14 days after the initial mailing site 1: $25 for each returned questionnaire, strong administrative support site 2: no incentives $2 financial incentive, 4 mailings were sent

n/a

Procedures to increase response (e.g. reminders)

41% (not reported, counted by authors)

56%

n/a

n/a

43% returned, eligible 23%

62%

51%

Result response rate

n/a

n/a

Completed questionnaires were returned to the researcher in the self-addressed stamped envelopes (p. 135)

Return of the completed survey

850 R. Suhonen et al.

© 2015 Nordic College of Caring Science

© 2015 Nordic College of Caring Science

n/a

n/a

Goldman & Tabak 2010 (41)

€tzen et al. Lu 2010 (33) Silen et al. 2011 (45)

Filipova 2011 (49)

Send letters, contacted facilities

Filipova 2009 (37)

Send request letter

2 researchers at a workplace meeting

n/a

Pauly et al. 2009 (44)

Author, year

Researcher contact, role

Table 2 (Continued)

Written, Cover letter

Written in the cover letter Verbal, written in the cover letter

n/a

Cover letter, personally signed

n/a

Type of information provided

Sent to administrators of each facility, or mailed directly to nurses’ facility address if nurses’ names were provided in advance

Researchers distributed the questionnaires at the meeting, head nurses to those not attending the meeting

n/a Distribution and collection was carried out during different shifts Managers of the wards

Consent asked to be contacted on their registration forms, CRNBC generated a list of random list Administrators of the facilities listed names

Who collected, recruited participants, how

n/a

3 weeks

Paper–pencil

Paper–pencil

n/a

over 2 months

September through December 2006

n/a

Paper–pencil?

Paper–pencil

Mailed paper–pencil

Mailed paper–pencil survey

Method of survey data collection

The length of data collection period, year of data collection

n/a

Reminder after 2 weeks, a month follow-up of those who did not participate

n/a

n/a

Reminder cards to administrators

2 reminder notices, a small gift of a teabag, sponsored by university

Procedures to increase response (e.g. reminders)

Prepaid envelopes, send to the researcher OBS: Reasons for not participating were asked, 184 did not respond, 19 did N does not correspond! Business reply envelope

n/a

Postage-paid business reply envelopes addressed to investigator’s university n/a

Returned anonymously to the researcher

Return of the completed survey

24%, deletion based on missing values 21.4%

49% (judged to be moderate) 58% (judged to be somewhat low)

n/a

21.4%

22% (lower than expected)

Result response rate

Sampling, sample and data collection procedures 851

Borhani et al. 2014 (59)

Hwang & Park 2014 (48)

Asahara et al. 2012 (52) Huang et al. 2012 (39)

Recruitment

n/a

n/a

Contact the nurse managers of the 4 wards to help to identify the potential participants n/a

n et al. Sile 2012 (46)

Varcoe et al. 2012 (38)

n/a

Borhani et al. 2012 (34)

Author, year

Researcher contact, role

Table 2 (Continued)

Through intrahospital communication channels, nurses were invited. Written, cover letter n/a

Written in explanatory letter

A full description of the sampling strategy and quantitative analysis is presented elsewhere. Written Cover letter

Verbal explanation of the study, signed informed consent Written information

Type of information provided

Recruited from RPH profile Staff in the healthcare planning department distributed via representatives of each unit n/a

n/a

n/a

List of random

Was considered by nurse managers to find 5–8 nurses interested in to be interviewed

n/a

Who collected, recruited participants, how

Paper–pencil

Paper–pencil

Mailed paper-pencil

Mailed paper–pencil

Mailed paper–pencil

Interview

Paper–pencil

Method of survey data collection

2011

n/a

n/a

2009

n/a

n/a

n/a

The length of data collection period, year of data collection

n/a

A reminder after 2 weeks

Ballpoint pen for participation

No remainder

2 reminder notices, a small gift of a teabag, sponsored by university

n/a

n/a

Procedures to increase response (e.g. reminders)

n/a

Prestamped return envelope, returned by mail to investigator or through nursing departments Staff in the healthcare planning department collected the sealed questionnaires

Returned anonymously to the researcher

n/a

n/a

Return of the completed survey

92%

77.4%

78%

31.1%

22% lower than expected, but 2 open-ended questions analysed here, so rich data obtained

n/a

92 (not stated)

Result response rate

852 R. Suhonen et al.

© 2015 Nordic College of Caring Science

58% Completed questionnaires were returned into letter boxes, situated in the units. Research team members collected the completed questionnaires from the units 1 February–27 April 2012 Paper–pencil

Phone reminder to the units after 2 weeks from the start

n/a n/a n/a

Suhonen et al. 2014 (47)

Joolaee et al. 2013 (42)

Researcher handed the questionnaires to the unit heads Informed ward managers, orally and written, meet all by the research team members

Participants were provided with information Written guideline for the units, oral discussion and information by units Written cover letter, for participants

Unit heads distributed questionnaires to nurses Contact nurses in each unit

Paper–pencil

n/a

Result response rate Author, year

Researcher contact, role

Table 2 (Continued)

Type of information provided

Who collected, recruited participants, how

Method of survey data collection

The length of data collection period, year of data collection

Procedures to increase response (e.g. reminders)

Return of the completed survey

Sampling, sample and data collection procedures

© 2015 Nordic College of Caring Science

853

generalisability of the results based on the sample, analysis of nonresponse and possible reasons identified for nonresponse. The terms the authors used in their article were used to describe and analyse the original articles. Only these articles retrieved from this search were analysed and no secondary articles were retrieved. Data categorised by the topics above and set in the data sheet were used for synthesising the information. Content analysis of the extracted data guided by the research questions was undertaken, and the findings were summarised according to themes followed by quantification, where appropriate.

Results Description of the studies reviewed Altogether 26 empirical nursing research papers were analysed (Table 1), first published in 1997. The studies were conducted in the United States of America (n = 11), Sweden (n = 3), Iran (n = 3), Finland (n = 2), Canada (n = 2), and Israel, Japan, South Korea, Taiwan and Turkey, one in each. In most of these (n = 24, 92%), ethical climate/environment was measured using structured questionnaire surveys. In one study, an interview using critical incident technique was used and one study used survey with open-ended questions. Most of the studies were conducted in acute hospital care settings (n = 19, 73%), while the rest were conducted in community or primary care settings (n = 4) or regional state level (n = 3). The study sites used in the studies ranged from one hospital to 2193 local governments public health units showing a great variability in organisations and units. Five studies (19%) did not include any descriptions of study sites.

Sampling methods Sampling method was reported in over half of (n = 15, 58%) the studies. Random sample was used in six studies, followed by quota (n = 1), total (n = 3), and convenience, stratified and purposeful sampling, one of each. The majority of the studies focused solely on nursing professionals, one study having both nurses and doctors (28) and one nurses and social workers (29). The identification of target sample and its size (n = 24, 92%) was reported in the majority of the studies. Ten studies had a target sample of more than 1000 participants. The size of the target sample in the studies reviewed ranged from 40 to 10 965. For some studies, the target sample size could be calculated based on the information about response rate and derived sample given (30, 31). Vice versa, the achieved response rate of four studies could be calculated as the target sample and the response rate were stated (29, 32–34).

854

R. Suhonen et al.

The number of participants (achieved sample) in the studies reviewed was 10 055 (Mean 387, range 20– 10 055). Reported or counted response rates varied from 22 to 100% (average 54%, based on calculation of 23 studies), and in more than two-thirds (n = 16, 69%) of the studies in which the response rate of achieved sample was identifiable, it was below the suggested 75% (see Bowling) (35). In some studies, after deleting some questionnaires from the statistical analysis, the response rate dropped from 34 to 23% (36), from 24 to 21.4% (37), 24 to 17% (38) and from 78 to 77.4% (39). Three studies did not provide information about the response rate (40– 42). In the other four studies (29, 33, 34, 43), the response rate could be calculated based on the target and achieved sample sizes. Sample size justification was given in a minority of the studies reviewed (n = 10, 38%). Justification was based on statistical testing using power analysis, proportion of the population and estimated confidence intervals, the number of the items in the scales used or using anticipated response rate estimation. A thumb rule of collecting 10 subjects per item used was used as sample size justification in one study (30). Sample size calculation based on the level of precision and confidence required of the results (36) or estimating margin errors and using adjusted estimated response rates was used (29, 44).

Procedures of data collection to increase response rates An analysis was also carried out for procedures of data collection to increase response rates. These empirical articles explained interchangeably the detailed procedure in data collection (Table 2). Less than half (n = 11, 42%) of the articles included reporting of the role and contact of the researcher or research group to the study site. This was done in meetings with groups of nurses, participants, on their clinical units (e.g. 30, 31), workplace meetings (e.g. 45) contacting leaders (42, 46, 47), having a meeting during the piloting phase (e.g. 28) or being in contact with the respondents using letters (37). In one study, the researchers recruited the study participants directly (48). Only a few studies reported the type of information provided by the researcher to the participants. This was usually written in a cover letter (n = 13). This information was missing in nine of the articles. Two studies reported verbal information to participants complemented with written information in cover letters (34, 45). The collection of data was conducted by a hospital administrator (37, 43, 48, 49), key contact at each organisation (50), ‘site champions’ [no description of what this means (28)], investigators themselves or research assistants (31, 40, 45), contact persons at the wards (47, 51), or ward managers (35, 42, 46). Almost all studies (n = 24) used self-administered paper–pencil surveys. In one study, the option of a

web-based survey (29) was used besides a paper–pencil questionnaire, and one study was an interview with open-ended questions. Seven articles described the use of mailed questionnaires (29, 36–39, 52). In eight of the articles, the length of the data collection period (range from 3 weeks to over 6 months) was reported. One-third reported the year of data collection. Studies reported the use of some procedures to increase response rate. These were written or telephone reminders to managers (30, 37), written reminder, for example postcard (31, 36, 44) or unidentified reminder (38). The usual time for a reminder was 2 weeks, and new questionnaires were sent once after 4 weeks (31). A reminder was also sent four times in one study (29). In two studies, the investigators (in collaboration with study sites) used financial incentives (28, 29) or small gifts (28, 38, 39). Strong administrative support was described in one study (28). The return of the completed questionnaires to the investigators (39, 43, 45, 50) or to investigators’ organisation (37, 49) was done via prepaid sealed envelopes, which were gathered together at the study site and forwarded to the researchers (48, 51) or fetched by the research team members (47). The method for delivering the completed questionnaire to researcher was not reported in detail (30, 38, 44). This information was missing in more than half of the studies (n = 14, 54%). These procedures resulted in only low or moderate response rates [e.g. 22% (44), 43% (36)]. One study (40) reached the response rate of 100%, but no methods or procedures to achieve this were described.

Reasoning representativeness, generalisability and the sample adequacy Regardless of the varying, mostly low or moderate response rates, only a few studies pointed out reflections about representativeness or interpretations about generalisability of the results based on the sample derived. In most of the studies, the authors stated some conclusions about the generalisability and representativeness of the sample (n = 21, 81%). Some of the studies compared the sample to statistics, for example the overall demographics of the target population (e.g. 38, 43, 47), using homogeneous population (37), comparing the sample to the sample characteristics reported in earlier studies (32), widening research into wider area and other types of sites (43) and general discussion about ample size (31, 50). Some authors pointed out the lack of generalisability or selection bias (34, 44, 49). To avoid generalisability bias, research data were obtained from different regions of the country (39, 48) or throughout the whole nation (52). Only a few authors took a position to judge the level of response rates: Pauly et al. (44). regarded that the response rate of 22% was low, while Silen et al. (45). © 2015 Nordic College of Caring Science

Sampling, sample and data collection procedures stated that 58% was a low response rate. However, L€ utzen et al. (33). stated their response rate was moderate, being 50%. Five out of fifteen (33%) studies did not include any kind of statement about representativeness, limitations due to the sample or generalisability based on the sample. Some reasons for nonresponse were given, such as nurses who are not satisfied with ethical climate not having responded (50). Pauly et al. (44). listed many possible reasons including the amount of time needed to complete the questionnaire, relevance and content of the questionnaire items to nurses, uncomfortable feelings generated due to the survey, not having sufficient reminders and a second mailing of questionnaires. Silen et al. (45). listed lack of time and too many questions as reasons for nonresponse. In addition, administrators’ refusal to provide workers’ names was listed as a reason for not being able to analyse nonresponse, followed by ongoing studies at the same organisations, overresearched staff (37) and timing of the survey study (52).

Discussion Ethical climate or environment has increasingly been studied, and the importance of studying it has been shown. Healthcare organisations can possibly improve job satisfaction (34, 39, 41, 42), organisational commitment (39) or moral sensitivity (33) by influencing ethical climate. Positive ethical climate can protect against intentions to leave work (28, 29, 36, 48), moral distress (28, 31, 44) or dissatisfaction with the quality of care (28). The more positive the ethical climate was perceived to be, the less frequently morally distressing situations were reported (43). Only this information makes it worth of studying the topic. However, the methodological flaws found in the review need further consideration whether this information is valid enough to make any further conclusions about ethical climate in clinical practice, for example by nurse managers. This review, using the topic of ethical climate as an example, provided knowledge of some methodological flaws in research, especially in sampling. As it is well known that there are no perfect studies without any flaws or unpredictable biases (see e.g. 4, 35), our aim was not only to point out flaws in the methodological quality but to highlight the need to learn and develop research protocols to achieve adequate sampling, representative samples and generalisable results. Given the importance of the topic, it was surprising that such a small number of nursing research studies had been conducted since the first publication in 1997 (43). This may, however, give some hints about the difficulty of measuring this abstract concept consisting of two parts (ethical and climate), producing the new concept ethical climate that appears on the organisational level. On the one hand, research on the level of healthcare organisations is © 2015 Nordic College of Caring Science

855

an emerging research area due to the rapid changes in the systems resulting from the tight economic situation in many countries calling for evidence-based management of patient, staff and organisational outcomes (e.g. 8, 53, 54). On the other hand, single studies producing some significant results are not sufficient in predicting necessary changes in clinical practice. In addition, the clinical significance remains still unknown. An increasing number of studies conducted in different countries used the same measures to investigate ethical climate, and the analysis of this topic was therefore interesting. However, differences were seen in study methods and procedures. Thus, there is a need to take a serious look at the development of research protocols by researchers, and in collaboration with organisation leaders on different levels, also learn from fellow researchers in different counties. It is of vital importance for the discipline’s sake to produce valid information that can be generalisable to wider populations and thereby develop evidence-based practices as well. This is not, however, only the intention of researchers but should also be the intention of professionals. Most notably, random sample and sampling was seldom used. Instead, many of the reviewed studies used convenience sampling, but most importantly, the type of the sampling remained unreported (Table 1). Most of the studies lacked generalisability based on the low response rate, which did not reach the 75% response rate suggested as acceptable (35). This may be due to the difficulties in finding or recruiting the potential participants. An ideal response rate of 100% is hardly ever seen (55), and usually, the informants who respond differ in their sociodemographic characteristics from those who do not (55) weakening generalisability and drawing firm conclusions. The evaluation of the sample by nonresponders or nonresponse bias was undertaken in only a few studies, for example by using statistics or other evidence, although supporting earlier findings from surveys has been considered highly important (4). However, low response rates are not only a concern for nurses, but also for physicians and the general public (2, 22). In addition, studies conducted in different countries (4) or using different groups of healthcare professionals (55) have revealed crosscountry differences in response rates. This may result from over-researched sites or cultural differences as well as the novelty of research of healthcare systems in the countries concerned. Statistical power analysis is the best way to define adequate sample size (56). To achieve statistically and clinically significant findings, other types of sample size justifications are not reasonable. However, power analysis was used in only few of the studies reviewed (n = 3, 11.5%). Response rates have been found to be increased by researchers’ contact with study sites (20). However, only a minority of the studies reviewed reported contact to

856

R. Suhonen et al.

have taken place. During the data collection period, reminders or other procedures were not usually used. Only a few reported the year of data collection, which can be regarded a major flaw and needs to be reported (57). Without the time frame, it is impossible to analyse the stability and responsiveness of the methods and the usability and generalisability of the results derived. However, it seems that these general procedures including reminders and targeting data collection time to fit the units (2, 6, 22) did not work to increase the response rate. Incentives for the respondents were used in only a few studies to increase the response rate. Moreover, it has been reported that there is a declining response rate trend currently in surveys (4), but this was not systematically present in our review of the literature about ethical climate. Instead, different data collection techniques in some of the studies succeeded well in producing sufficient response rates. The readers need to carefully consider the survey results if they lack of information about the sampling and sample. Finally, there may also be implications for journals. In the review process of submitted manuscripts, the journal editors and reviewers need to require proper description and justification of sampling, sample and representativeness. This study pointed out some methodological flaws in the nursing research on ethical climate. It is surprising as the main aim of studying working conditions, in this case ethical climate, is to produce new information for the development of working environment and conditions. On one hand, there is serious concern about the participation of healthcare professionals in studies of this kind (2). On the other, although researchers strive for proper data collection and sampling techniques needed to collect representative and justified samples ensuring generalisability, the protocols do not necessarily produce adequate samples and representative data. This may reflect the fact that the concept under measurement is difficult and that it may be easier to measure concrete events and individual level variables. Therefore, there may be need for methodological review of empirical papers of other topics.

Strengths and limitations The strength of this review is a broad view on analysis of studies on ethical climate, sampling methods, quality and breadth of sample aimed and obtained, data collection procedures to increase response rate, and reasoning representativeness, generalisability and the sample adequacy. Previous reviews on methodological issues focussed, for example, on sample selection (16), response rates, response bias, and nonresponse (1, 4–6, 17), sample size estimation (19), strategies to improve participation (2, 3), or practical issues in survey sampling (14). Thereby, this review provided new and useful

information about the critical issues in obtaining highquality samples and generalisable results. Some limitations also need to be taken into consideration in interpreting the results. Firstly, there are many definitions of ethical climate, and the terms ethical environment, ethical climate, ethical climates are used interchangeably in the literature. Due to this reason, some studies could have remained undetected in the retrieval process. However, the search was undertaken twice within 2 months to ensure the accuracy of the search, and only the most recent online entries were added since the first search. Second, we used only English language empirical articles that were retrieved from only one electronic database, MEDLINE. However, this review was undertaken to analyse the methodological issues under focus, mainly sampling issues in the narrow research field of ethical climate as an example. Furthermore, this review focused on nursing research studies from nurses’ point of view, the participants representing different levels of nurse professionals. It has been argued that all professionals create the ethical climate, not only those groups with the largest number of individuals (8, 53). It can be argued that the development of working climate and conditions would have been in the interest of nurses. Also, ethical problems in nursing organisations have been identified (8) making this topic very important and timely. Finally, our sample included studies from several countries, and due to this, the results can be considered representative of the professionals’ views or attitudes to surveys. Two researchers conducted the rigorous inclusion on the studies. The analysis was based on the concrete information found in the articles, no interpretations were done, and a synthesis was created followed by quantification. The results of this review highlight a careful consideration of sampling and sample adequacy to make conclusions about the findings and generalisability of the findings.

Conclusion This study provided some information about the critical issues in obtaining high-quality samples and responsible and generalisable results to guide evidenced-based clinical practice. There is a need for developing better data collection procedures to obtain acceptable response rates and a need for quality development of the reporting of sampling and the samples obtained. There is a need to highlight these topics in the education of research methods in master and doctoral level programmes and guarantee high-quality methodological education. As research is not only important for researchers but also for healthcare systems’ need for evidence, collaboration between researchers and clinicians is of vital importance. However, there is a need for forums for collaboration, identification of needs and detailed determination of the roles for both © 2015 Nordic College of Caring Science

Sampling, sample and data collection procedures parties. Careful consideration is needed in balancing the research needs and instrumentation with the respondent burden and ethical considerations. Obtaining reliable and valid results is a combination of many methods and procedures where researchers’ skills are keys.

857

drafting of manuscript; Helena Leino-Kilpi participated in critical revisions for important intellectual content; Riitta Suhonen contributed to supervision; Jouko Katajisto participated in statistical expertise; Riitta Suhonen and Helena Leino-Kilpi contributed to administrative/technical/ material support.

Acknowledgements Anna Vuolteenaho is gratefully acknowledged for the checking of the language.

Ethical approval Not applicable for literature review.

Author contributions

Funding

Riitta Suhonen, Minna Stolt and Helena Leino-Kilpi contributed to study conception and design; Minna Stolt and Riitta Suhonen participated in data collection and analysis; Riitta Suhonen and Minna Stolt participated in

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. No conflict of interest has been declared by the authors.

References 1 Barriball KL, While AE. Exploring variables underlying non-response in a survey of nurses and nurses’ aides in practice. J Adv Nurs 1999; 29: 894–904. 2 VanGeest J, Johnson TP. Surveying nurses: identifying strategies to improve participation. Eval Health Prof 2011; 34: 487–511. 3 VanGeest JP, Johnson TP, Welsh WL. Methodologies for improving response rates in surveys of physicians. Eval Health Prof 2007; 30: 303– 21. 4 Cook JV, Dickinson HO, Eccles MP. Response rates in postal surveys of healthcare professionals between 1996 and 2005: an observational study. BMC Health Serv Res 2009; 9: 160. 5 Scott A, Jeon SH, Joyce CM, Humphreys JS, Kalb G, Witt J, Leahy A. A randomised trial and economic evaluation of the effect of response mode on response rate, response bias, and item non-response in a survey of doctors. BMC Med Res Methodol 2011; 11: 126. 6 Barribal KL, While AE. Non-response in survey research: a methodological discussion and development of an explanatory model. J Adv Nurs 1999; 30: 677–86. 7 Schluter J, Winch S, Holzhauser K, Henderson A. Nurses’ moral sensi-

© 2015 Nordic College of Caring Science

8

9

10

11

12

13

14

15

16

17

tivity and hospital ethical climate: a literature review. Nurs Ethics 2008; 15: 304–21. Suhonen R, Stolt M, Virtanen H, Leino-Kilpi H. Organisational ethics: a literature review. Nurs Ethics 2011; 18: 285–303. WHO. Working Together for Health, 2006. The World Health Report 2006. World Health Organization, Geneva, Switzerland. Altman DG. Statistics and ethics in medical research III: how large a sample? Br Med J 1980; 281: 1336–8. Bacchetti P, Wolf LE, Segal MR, McCullock CE. Ethics and sample size. Am J Epidemiol 2005; 161: 105– 10. Devane D, Begley CM, Clarke M. How many do I need? Basic principles of sample size estimation. J Adv Nurs 2004; 47: 297–302. Burmeister E, Aitken LM. Sample size: how many is enough? Aust Crit Care 2012; 25: 271–4. Johnson M, Marsden J, Day E. Practical issues in survey sampling. Aust J Adv Nurs 1998; 15: 8–45. Fitzner K, Heckinger E. Sample size calculation and power analysis: a quick review. Diabetes Educ 2010; 36: 701–7. Endacott R, Botti M. Clinical research 3: sample selection. Accid Emerg Nur 2007; 15: 234–8. Moseley LG, Mead DM. When is it safer to say nothing some

18

19

20

21

22

23

24

considerations on biases in sampling. Nurse Res 2004; 12: 20–34. Schofield M. Sampling in quantitative research. In Handbook Research Methods for Nursing and Health Science, 2nd edn (Minichiello V, Sullivan G, Greenwood K, Axford R eds), 2004, Pearson Education Australia, Frenchs Forest, NSW, Australia, 176–209. Eng J. Sample size estimation: how many individuals should be studied? Radiology 2003; 227: 309–11. Dillman DA, Smyth JD, Christian LM. Internet, Mail and Mixed Mode Surveys. The Tailored Design Method. 2008, John Wiley&Sons Inc, Hoboken, New Jersey, USA. Rosenbaum J, Lidz CW. Maximizing the results of internet surveys. Center for Mental Health Services Research 2007; 4. http://escholarship.umassmed.edu/cgi/viewcontent. cgi?article=1017&context=pib (last accessed 9 January 2014). Field TS, Cadoret CA, Brown ML, Ford M, Greene SM, Hill D, Hornbrook MC, Meenan RT, White MJ, Zapka JM. Surveying physicians: do components of the “Total Design Approach” to optimizing survey response rates apply to physicians? Med Care 2002; 40: 596–605. Ulrich CM, Grady C. Financial incentives and response rates in nursing research. Nurs Res 2004; 53: 73–74. Collins Cobuild Advanced Learner’s English Dictionary. Harper Collins

858

25

26

27

28

29

30

31

32

33

34

35

36

37

R. Suhonen et al.

Publishers. 2003, William Clowes Ltd, Beccles, London. Brown MT. Working Ethics: Strategies for Decision Making and Organizational Responsibility. 1991, Jossey-Bass Publishers, San Francisco, California. Schneider B. The people make the place (attraction – selection – attrition). Pers Psychol 1987; 40: 437–53. Victor B, Cullen JB. The organisational bases of ethical work climates. Adm Sci Q 1988; 22: 101–25. Hamric AB, Blackhall LJ. Nurse-physician perspectives on the care of dying patients in intensive care units: collaboration, moral distress and ethical climate. Crit Care Med 2007; 35: 422–9.* Ulrich C, O’Donnell P, Taylor C, Farrar A, Danis M, Grady C. Ethical climate, ethics stress, and the job satisfaction of nurses and social workers in the United States. Soc Sci Med 2007; 65: 1708–19.* Olson LL. Hospital nurses’ perceptions of the ethical climate of their work setting. Image J Nurs Sch 1998; 30: 345–9.* Corley MC, Minick P, E€ oswick RK, Jacobs M. Nurse moral distress and ethical work environment. Nurs Ethics 2005; 12: 381–90.* Bahcecik N, Ozt€ urk H. The Hospital Ethical Climate survey in Turkey. JONAS Healthc Law Ethics Regul 2003; 5: 94–99.* L€ utz en K, Blom T, Ewalds-Kvist B, Winch S. Moral stress, moral climate and moral sensitivity among psychiatric professionals. Nurs Ethics 2010; 17: 213–24.* Borhani F, Jalali T, Abbaszadeh A, Haghdoost AA, Amiresmaili M. Nurses’ perception of ethical climate and job satisfaction. J Med Ethics Hist Med 2012; 5: 6 HTTP://journals. tums.ac.ir/abs/22177* Bowling A. Data collection methods in quantitative research: questionnaires, interviews and their response rates. In Research Methods in Health: Investigating Health and Health Services. 2004, Open University Press, Maidenhead, 257–72. Hart SE. Hospital ethical climates and registered nurses’ turnover intentions. J Nurs Scholarsh 2005; 37: 173–7.* Filipova A. Licensed nurses’ perceptions of ethical climates in skilled

38

39

40

41

42

43

44

45

46

47

48

nursing facilities. Nurs Ethics 2009; 16: 574–88.* Varcoe C, Pauly B, Storch J, Newton L, Makaroff K. Nurses’ perceptions of and responses to morally distressing situations. Nurs Ethics 2012; 19: 488–500.* Huang CC, You CS, Tsai MT. A multidimensional analysis of ethical climate, job satisfaction, organizational commitment, and organizational citizenship behaviors. Nurs Ethics 2012; 19: 513–29.* McDaniel C. Enhancing nurses’ ethical practice. Development of a Clinical Ethics Program. Nurs Clin North Am 1998; 33: 299–311.* Goldman A, Tabak N. Perception of ethical climate and its relationship to nurses’ demographic characteristics and job satisfaction. Nurs Ethics 2010; 17: 233–46.* Joolaee S, Jalali HR, Rafii F, Hajibabaee F, Haghani H. The relationship between ethical climate at work and job satisfaction among nurses in Teheran. Indian J Med Ethics 2013; 10: 238–42.* Joseph J, Deshpande SP. The impact of ethical climate on job satisfaction. Health Care Manage Rev 1997; 22: 76– 81.* Pauly B, Varcoe C, Storch J, Newton L. Registered nurses’ perceptions of moral distress and ethical climate. Nurs Ethics 2009; 16: 561–73.* Silen M, Svantesson M, Kjellstr€ om S, Sidenvall B, Christensson L. Moral distress and ethical climate in a Swedish nursing context: perceptions and instrument usability. J Clin Nurs 2011; 20: 3483–93.* Silen M, Kjellstr€ om S, Christensson L, Sidenvall B, Svantesson M. What actions promote a positive ethical climate? A critical incident study of nurses’ perceptions. Nurs Ethics 2012; 19: 501–12.* Suhonen R, Stolt M, Gustafsson ML, Katajisto J, Charalambous A. The association among the ethical climate, the professional practice environment and individualized care in care settings for older people. J Adv Nurs 2014; 70: 1356–68.* Hwang JI, Park HA. Nurses’ perception of ethical climate, medical error experience and intent-to-leave. Nurs Ethics 2014; 21: 28–42.*

49 Filipova A. Ethical climates for-profit, non-profit, and governmental skilled nursing facilities. JONAS Healthc Law Ethics Regul 2011; 13: 125–31.* 50 Bell SE. Ethical climate in managed care organisations. Nurs Adm Q 2003; 27: 133–9.* 51 Leino-Kilpi H, Suominen T, M€akel€a M, McDaniel C, Puukka P. Organizational ethics in Finnish intensive care units: staff perceptions. Nurs Ethics 2002; 9: 126–36.* 52 Asahara K, Kobayashi M, Ono W, Omori J, Todeme H, Konishi E, Miyazaki T. Ethical issues in practice: a survey of public health nurses in Japan. Public Health Nurs 2012; 29: 266–75.* 53 Gibson JL. Organizational ethics and the management of health care organizations. Health Manage Forum 2007; 20: 32–34, 38–41. 54 WHO. Towards People-Centred Health Systems: An Innovative Approach for Better Health Outcomes. 2013, WHO Regional Office for Europe, Division of Health Systems and Public Health, http://www.euro.who.int/__data/as sets/pdf_file/0006/186756/Towardspeople-centred-health-systems-an-in novative-approach-for-better-healthoutcomes.pdf (last accessed 9 January 2014). 55 Listyowardojo TA, Nap RE, Johnson A. Demographic differences between health care workers who did or did not respond to a safety and organizational culture survey. BMC Res Notes 2011; 4: 328. 56 Cohen J. Statistical Power Analysis for the Behavioral Sciences, 2nd edn. 1988, Lawrence Erlbaum Associations Publishers, Hillsdale, New Jersey. 57 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008; 61: 344–9. 58 McDaniel C. Ethical environment. Reports of practicing nurses. Nurs Clin North Am 1998b; 33: 363–72.* 59 Borhani F, Jalali T, Abbaszadeh A, Haghdoost A. Nurses’ perception of ethical climate and organizational commitment. Nurs Ethics 2014; 21: 278–88.*

© 2015 Nordic College of Caring Science

Review of sampling, sample and data collection procedures in nursing research--An example of research on ethical climate as perceived by nurses.

To report a review of quality regarding sampling, sample and data collection procedures of empirical nursing research of ethical climate studies where...
119KB Sizes 0 Downloads 7 Views