|Year : 2017 | Volume
| Issue : 3 | Page : 684-693
|Characteristics of an ethical leader: A qualitative content analysis of Iranian nurses' experiences
Fatemeh Esmaelzadeh1, Abbas Abbaszadeh2, Fariba Borhani3, Hamid Peyrovi4
1 Nursing Research Center, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
2 Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Medical Ethics and Law Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Department of Critical Care Nursing, Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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|Date of Web Publication||21-Aug-2017|
| Abstract|| |
Introduction: Leaders' personal characteristics help followers understand them as an ethical leader and increase their attractiveness and credibility as a functional role model. The objective of this study was to identify the characteristics of an ethical leader from Iranian nurses' points of view. Methods: This was a qualitative study based on conventional content analysis, in 2015. Data were collected using deep and semistructured interviews with 17 Iranian nurses. The participants were chosen using purposive sampling until data saturation. For data analysis, MAXQDA 10 software was used based on the conventional content analysis. Findings: The findings emerged as four main categories and 13 subcategories. The categories consist of personal characteristics and professional, leadership, and ethical capabilities. Personal characteristics consist of personal attributes and adherence to religious beliefs. Professional capability consists of interest in the profession, scientific ability, law-abidingness, and dutifulness. Leadership capability consists of charismatic features, effectiveness, and ability to manage emotions and behaviors. Ethical capability consists of moralism, altruism, ethical sensitivity, and ethical courage. Conclusion: Findings of this study help promote characteristics of ethical leaders in nursing, development of an ethical leadership, and ultimately promotion of quality of nursing care.
Keywords: Characteristics, content analysis, ethical leader, nursing, qualitative research
|How to cite this article:|
Esmaelzadeh F, Abbaszadeh A, Borhani F, Peyrovi H. Characteristics of an ethical leader: A qualitative content analysis of Iranian nurses' experiences. Ann Trop Med Public Health 2017;10:684-93
|How to cite this URL:|
Esmaelzadeh F, Abbaszadeh A, Borhani F, Peyrovi H. Characteristics of an ethical leader: A qualitative content analysis of Iranian nurses' experiences. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Aug 25];10:684-93. Available from: http://www.atmph.org/text.asp?2017/10/3/684/213145
| Introduction|| |
Individuals need attention and expect to be understood and respected in their workplace. They also like to belong to an organization in which honesty, righteousness, and trustworthiness are a common culture. To create such a milieu, an ethical leader is required whose actions reflect his/her own ethical capabilities and honesty as well as dignity in all aspects of life. Ethical leadership includes administrative measures through which the dignity and rights of humans are respected and fulfilled. Since ethical leadership plays an important role in creating a healthy work environment and improves organizational and individual outcome,, it is of keen interest in leadership studies.
Ethical leadership is defined as “the demonstration of normatively appropriate conduct through personal actions and interpersonal relationships, and the promotion of such conducts to followers through two-way communication, reinforcement, and decision-making.” It seems that an ethical leader with personal characteristics such as honesty, righteousness, interest in other people, justice, and trustworthiness ,, influences the followers through social learning processes., In other words, the leader's personality inspires the followers to accept him/her as an ethical leader, increasing his/her attractiveness, and credibility as a role model.
Nursing is an ethics-based profession, and any failure in ethics can have adverse effects even on the best nursing practices; therefore, ethical and moral issues are preferred over the patient care protocols.,, In the nursing system of Iran, there are some challenges and limitations such as insufficiency of ethical knowledge, work overload, job dissatisfaction,,, which decreases compliance with ethical codes of conduct  and in turn the quality of nursing care., On the other hand recently, nursing ethics has been the subject of several research projects in Iran, suggesting procedures for higher compliance with principals of ethical conduction in professional nursing practice. For example, code of ethics for Iranian nurses was released by the Iranian Nursing Organization in 2010, containing national codes of conduct for ethical nursing. An ethical nursing leader is considered as a role model for the other nurses; a person who works in the same context. He/she understands the work and ethics-related issues and helps resolve them. He/she tries to create an ethical climate and improve ethical compliance in nursing practices. However, to the best of our knowledge, in Iran, this study is the first attempt to determine the characteristics of ethical leaders as the predicting variables of ethical leaders' personalities. In this study, the work-related experiences of Iranian nurses were investigated to extract common features of the personality of ethical leaders. The aim of the study was to identify the characteristics of an ethical leader from Iranian nurses' points of view.
| Materials and Methods|| |
Qualitative methodology was used because the ethical leadership process is complex and likely to has a symbolic and subjective component  which is understood and interpreted by everyone based on her/him lived experiences, and then, these may be difficult to be captured by other methodologies., Qualitative content analysis method was used to explore the characteristics of nursing ethical leaders. Qualitative content analysis is a research method used for the subjective interpretation of written data. It is capable of discovering and clarifying the understanding of human emotions and meanings behind daily life experiences. Since researchers sought to discover the inner meaning of characteristics of the ethical leader from the perspective of Iranian nurses, the conventional content analysis was selected. This type of design is appropriate when the existing theory or research on a phenomenon is limited , and ethical leadership is a recent concept and there is not enough former knowledge about it in Iranian nursing context.
Participants for this study were employees of five general university hospitals of Mashhad University of Medical Sciences, Mashhad, Iran. The participants who consented to share their experiences in the field of ethical leadership were interviewed. They were introduced to the researchers by the practitioners in this profession as nurses who have more compliance with ethics in their professional practices. To achieve maximum variation sampling, the nurses were chosen from various nursing experiences in terms of the period of experience, type of ward, and position in nursing. At first, data collection began with nursing managers consisted of head nurses, supervisors, and matrons and then continued with nurses. In total, 17 individuals were interviewed, including one matron, four supervisors, four head nurses, seven nurses, and one Master of Science student in nursing who was also working as a supervisor. [Table 1] shows the demographic characteristics of participants.
Data collection methods
The participants were chosen using purposive sampling. This is a judgmental sampling that involves the conscious selection by the researcher of particular subjects or elements to include in a study. The interviews were conducted in a 9-month period from September 2014 to May 2015. All the interviews were conducted at the time and place convenient for the participants. First, one researcher who was responsible for interviews introduced herself and continued with a brief explanation about the subject and objectives of the study. If the participant consented, demographic data were collected. The interviews were deep and semistructured, and the main questions of the interview were as follows:
“Could you please talk about your experience regarding personality characteristics of an ethical leader whom you know?”
“Who can be an ethical leader to promote ethics among nurses?”
“Whom do you consider as an ethical leader?”
The interviews took from 30 to 100 min (a mean of 45 min) to be completed. All interviews were recorded with the permission of the participants. Field notes were taken as a complementary method to collect extra data and fill the gaps in the categories of codes. No new information was gained during the last four interviews, at which time the data were considered to be saturated. It was occurred with the 17th interview when new concepts were no longer emerged.
For data analysis, conventional content analysis  was used. Initially, the recorded interviews were listened to, and the recorded audio files and notes were repeatedly read. Interviews were transcribed verbatim and saved in Microsoft Word 2013 and then attached to MAXQDA software (VERBI GmbH, Berlin, Germany). The data classification and management were performed using MAXQDA 10 software. Data from field notes were analyzed and combined too. Meaning units were composed of the sentences and paragraphs in transcripts as well as the field notes taken during the interview. Meaning units were identified and discussed. A first level code was assigned to every keyword or key sentence, followed by grouping similar codes in subcategories. Then, similar subcategories were merged to form the main categories or themes with the highest level of abstraction. To ensure accurately, inclusion of all data in the intended categories and improvement of the data classification, transcripts, and extracted codes were reviewed several times.
According to the Lincoln and Guba criteria, the credibility of data was improved by individual interviews, triangulation of the data by interview, and using field notes. Comments by the experts in the field of qualitative research and nursing ethics were used to assure conformability. Constant comparative analysis and negative cases analysis and explaining the analysis process and reviewing by peer raters were used to ensure dependability. Finally, sampling with maximum variance was used to improve transferability of the study.
This study approved by the Research Ethics Committee of Kerman University of Medical Sciences (Code k/93/488). To comply with ethical considerations, the participants were informed about the aims of the study, confidentiality, possibility to withdraw from the study at any time of the research as well as the procedure to access the final results if they wish. Then, written informed consent was signed by them.
| Results|| |
Constant comparative analysis of data resulted in four main categories and 13 subcategories [Table 2]. The main categories included personal characteristics and professional, leadership, and ethical capabilities.
|Table 2: Main categories and subcategories of ethical leaders characteristics from the perspective of Iranian nurses|
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This category incorporates the two subcategories of personal attributes and adherence to religious beliefs.
According to the nurses interviewed in this study, kindness, humbleness, and positive thinking, self-confidence, openness to criticism, rationality and accountability, seriousness, precision and discipline, perseverance and dynamism, foresight and creativity were mentioned as the personal attributes of an ethical leader.
From the nurses' perspectives, an ethical leader is kind to employees and patients, practices forgiveness and humility, and has a positive and fair attitude toward other people and his/her colleagues.
A head nurse: “She was so humble that her humility could attract the others and make them pay more attention to her behavior and follow her practices.”
Ethical leaders are people of high self-confidence who do not easily withdraw from the right actions. They are also open to criticism.
A head nurse: “My colleagues may not be able to talk to me about my weak points directly. Therefore, I ask the person in charge of the shift to pass me the feedbacks on behalf of the other nurses.”
Reasonable treatment of the workforce and training the right way to rationally treat the coworkers are other characteristics of the mentioned leaders.
A head nurse: “She was rational and responded appropriately even to the inappropriate actions of the others. I was greatly influenced by her…”
The participants considered that such ethical leaders would emphasize to their followers the need to be accountable and committed to patients and their nursing duties as well. They also are serious in practices and duties.
A matron: “I always tell my staffs that we are responsible for fulfilling all our duties toward the patients.”
Perseverance and effort are other features of personal attributes and the ethical leader also teaches them to others.
A nurse: “I had a professor who was a hardworking person and an amazing dynamic personality, and I believed in her…”
Among the other characteristics considered by the participants were foresight and planning. For example, they stated that their ethical leaders would properly deal with the wrongdoers so as not to hide the errors of their subset employees in the future. Moreover, creativity was from among other mentioned characteristics, which includes right and proper work routines as well.
A nurse: “She set some new routines for us to do. She was a very creative person.”
Adherence to religious beliefs:
Religious adherence was mentioned by the participants as one of the characteristics which greatly influenced the performance of an ethical leader. In addition, such leaders were more influential on other nurses.
A head nurse: “Sometimes religious adherence greatly affects the way I do my job and treat patients and the others.”
This category includes four subcategories of interest in the profession, scientific ability, law-abidingness, and dutifulness.
Interest in the profession
According to many participants, an ethical leader in nursing is interested in the profession. He/she enjoys caring for patients so that others enjoy viewing such a love and interest.
A supervisor: “I love nursing… like it.”
A head nurse: “She cared and communicated with the patients so well and with such a pleasure that everyone would enjoy it…”
According to the study nurses, an ethical leader has good theoretical and practical information and applies it to his/her performance in such a way that others are impressed by his/her knowledge and intelligence and the coworkers know him/her as a source of information or a guidance booklet.
A head nurse: “Her influential nature was to the extent that other nurses would ask her what they did not know and thus gain information from her just like a guidance booklet… or an encyclopedia…”
In the opinion of participants, the ethical leader sees law-abidingness as right performing the tasks and believes that observing laws and regulations facilitate the affairs. He or she is a pioneer in the enforcement of legislation.
A head nurse: “I make the laws, and I am the first one to enforce them.”
The participants considered the ethical leader as a dutiful person who is aware of the scopes of authorities and duties and emphasizes on the description of nursing duties.
A nurse: “She was very dutiful. For example, she would never neglect even a single duty, and when she pursued a case, she did her best to fulfill it.”
The participants also believed that their ethical leader was a perfectionist person who always tries to do nursing cares in the best way regardless of the outcomes of diseases.
A head nurse: “There was a 100-year-old patient, we all knew would not stay alive; but my head nurse did all the needed caring procedures for her perfectly… regardless of whether the patient would survive or not.”
This capability consists of charismatic features, effectiveness, and ability to manage emotions and behaviors.
The participants believed that having knowledge and skills are necessary but not sufficient for leadership. In other words, an ethical leader is a charismatic person who attracts the employees, that is, she penetrates into and leads their hearts. Many participants stated that interest in a leader was the factor behind performing the tasks more effectively. They would accept and imitate the performance of a leader whom they liked and acted as he or she wishes.
A supervisor: “Although A is highly skilled and knowledgeable, she cannot be my leader. She can conduct me in my duties but has not been able to attract my heart.”
The participants stated that an ethical leader has credibility and popularity by being outstanding among others. He or she is a strong and influential person to be seen by the employees. Furthermore, by occupying the existing workspace, he or she would prevent doing incorrect measures and values different tasks, which is the underlying basis for his/her effectiveness.
A supervisor: “I had a head nurse with whom I could never get along. She was not taken into account by us due to her poor performance; therefore, I could never take her as my role model.”
A nurse: “We had an experienced colleague who uses to be a volunteer to serve the patients, for example, when they needed a bed pan. He educated us practically to pay immediate attention to the needs of patients. He showed us to value the jobs with this behavior. He influenced us.”
Ability to manage emotions and behaviors
The participants said an ethical leader is a good-tempered person who is smiling and affable, thus transferring a positive energy to others with her smiles.
A head nurse: “I have always tried to attend the ward with a smiling face and transfer this positive energy to my staffs.”
In their views, the ethical leader patiently maintains his/her composure in contact with patients and personnel, thus being able to manage his/her emotions in difficult situations.
A nurse: “She could manage the problems of the ward. I never saw her become angry with patients and colleagues or lose her temper. She was always able to control her feelings and behaviors.”
This capability includes moralism, altruism, ethical sensitivity, and ethical courage.
Nurses believed that an ethical leader is a moralist person whose positive ethical traits are internalized in a way that he or she prefers ethical values to any other things. For example, a nurse participant said, “She never tolerated unethical practices and never ignored her ethical values. She preferred moralities to everything.”
Moreover, the participants unanimously considered moralism to include honesty in caring for others and treating others.
A head nurse: “She is honest with everybody, no lies in her work; she is what she is and shows this in her behavior.”
Nurses also considered an ethical leader as the one who likes and values humans. He or she loves to help others and works wholeheartedly for the patients.
A head nurse: “She taught me how to spend time wholeheartedly with patients. She would work for patients this way herself.”
According to the nurses who participated in this study, ethical sensitivity means paying attention to work conscience and being sensitive toward ethical performance.
Many participants stated that an ethical leader would affect them by his/her conscience-based performance and awaken the work conscience of others by emphasizing on putting oneself in the place of a patient.
A head nurse: “I always recommend my staffs to work in a way that they have an easy conscience, at last, take patients as their family members whose pains and problems would be theirs too…”
The nurses stated that the ethical leader is sensitive in taking nursing ethical values into account. He/she is constantly challenging himself/herself for being ethical in his/her actions before and after the job.
A supervisor: “She always challenged herself before and after an action to see whether the job that she was going to do was ethical or not.”
Furthermore, an ethical leader cares about observing ethics in practice and support people with ethical performance. This indirectly affects others so that they will be encouraged to consider ethics in their work.
In the view of participants, the ethical leader does not keep silent against the lack of observing ethics by the employees. He or she reminds them of observing ethics in practice and gives them feedbacks on doing unethical measures.
A head nurse: “I usually tell my staff that moralities are more important even than what we do and I would encourage or punish you accordingly.”
The ethical leader is also strict on an unethical performance, that is, he or she does not approve of a person with unethical performance and if it is not possible to correct his/her behaviors. The ethical leader will exclude him/her from the caring of patients or assign other responsibilities to him/her.
A head nurse: “When I saw that this is a remiss person, I thought that the best alternative was to exclude her since as the saying goes if you have a rotten tomato in your bag, be sure the rest of the tomatoes will be rotten too.”
Furthermore, the nurses stated that an ethical leader is always trying to correct the unethical performance in a way to review and find its roots, thus helping the individuals to correct their behaviors and seeking help from others in this regard.
A head nurse: “If I see that the unethical performance of my staff is due to a special reason, I talk to him/her to find out the reason and try to resolve it, and I will sometimes get help from others to make him/her correct his/her behavior.”
| Discussion|| |
The findings of this study showed characteristics of an ethical leader from the perspectives of Iranian nurses and they include personal characteristics, professional, leadership, and ethical capabilities.
Concerning personal characteristics, the participants mentioned the two cases of personal attributes and adherence to religious beliefs. Some personal attributes such as humbleness,,,, positive thinking,, openness to criticism,,,, rationality, accountability,,, discipline,,, initiative and creativity, perseverance and dynamism, seriousness, and planning and foresight , were reported in different studies as characteristics of an ethical leader.
Kindness was mentioned in various studies ,,,,, too and Brown et al. considered it as a characteristic that increases the effectiveness and credibility of an ethical leader. In many other studies, it was pointed out that ethical leaders always try to increase the confidence of their employees.,,,,
In the opinion of the Iranian nurses, another characteristic of an ethical leader is adherence to religious beliefs. It seems that Iranian cultural-religious backgrounds and the people's adherence to the principles of Islam has caused nurses to have positive attitudes toward those who have a greater adherence to religious beliefs. In general, moral and ethical issues have been greatly emphasized by Islam, and it seems that the religious atmosphere dominating the nursing context in Iran is an ethical-based one. Brown and Treviño stated that the ethical context of organizations supports the attitudes and behaviors relevant to ethics, and perhaps, it is on this basis that Iranian nurses accepted as a role model who had greater adherence to religious beliefs.
The second set of capabilities of the ethical leader in nursing was professional capability consisting of the four subcategories of interest in the profession, scientific ability, law-abidingness, and dutifulness.
The nurses considered the ethical leader as a person who is very fond of nursing and enjoys taking care of patients. Since interest in a profession is one of the bases of nursing, it seems that Iranian nurses accept and take as a role model the performance of a nurse who is interested in his/her profession and take him/her as their ethical leader.
Another finding was the scientific ability of an ethical leader. He or she is like a guidance booklet and source of information for others. Gallagher and Tschudin  argued that an ethical leader in nursing should be aware of new professional knowledge and intelligence. In addition, Brown et al. introduced an ethical leader as a source of information who attracts the attentions of his/her followers and guides them by playing a role in ethical behaviors.,
The nurses knew the ethical leader as a law-abiding person. This finding was confirmed in other studies. Brown and Treviño  introduced ethical leaders as principled people. These leaders set clear standards and principles and are accurate when they are applied by them and others.,, It seems that law-abidingness and commitment to observe the rules and regulations are among the necessities of the nursing practice, in which any fault may be at the expense of a human life. Therefore, the need for the presence of this feature in the ethical leader is more pronounced and highlighted as the Iranian nurses agreed on it.
Dutifulness was another characteristic. Various researchers unanimously agree on the ethical leader's dutifulness,, while Zahiri et al. considered it as one of the characteristics of his/her conscientious nature. On the other hand, the participants viewed the ethical leader as a nurse who has a type of perfectionism in his/her performance. Brown et al. asserted that ethical leaders mostly emphasize on providing people with services in the best possible ways and seriously pay attention to how their actions impact others. This finding too was confirmed in the study conducted by Treviño et al. Furthermore, they stated that ethical leaders emphasize on “serving the greater good.” These researchers did not mention perfectionist in a similar way as the participants of this study did, but it seems that it is consistent with the participants' statements in the current study. On the other hand, perfectionism is a major issue in nursing profession which is associated with people's health and lives, so that performing the tasks in the best possible ways clearly affects the patients' improvement as was pointed out by some of the participants.
The next category is leadership capability, which consists of the three subcategories of the charismatic feature, effectiveness, and ability to manage emotions and behaviors.
Participants considered charisma and attractiveness as characteristics of an ethical leader. Consistent with the statement of these nurses, Robbins et al. said that charisma refers to the characteristic of a person who has excellent leadership ability personally or based on the opinions of others. On the other hand, some researchers do not consider charisma as a characteristic of the ethical leader., Treviño et al. explain that their study's informants did not identify ethical leaders as charismatic in the sense that charisma has to do with being heroic and extraordinary. Furthermore, none of the current study's participants talked about unusual actions to be performed by an ethical leader in nursing, but they considered the ethical leader's charismatic feature as an encouragement to nurses to perform actions in a manner desired by their leaders.
Effectiveness was another characteristic of an ethical leader mentioned by the nurses. Brown et al., based on the Bandura's social learning theory, considered an ethical leader as an effective role model for the followers' ethical behaviors. Furthermore, in this study, the nurses argued that an ethical leader be someone who is strong and influential and is seen by other nurses and values the different professional tasks by occupying the existing workspace. It seems that these characteristics, especially valuing different tasks, are unique features for an ethical leader in nursing because of its making nurses feel less dissatisfaction and discomfort while performing such unpleasant and necessary tasks as suctioning secretions from patients, etc.
The nurses considered an ethical leader as a person who is affable, patient, and calm with the ability to manage his/her emotions in difficult situations. Given that today communication in nursing has special status, it seems that these characteristics have a special role for the ethical leaders who affect different people's ethical behaviors  and serve as their role models. Ethical leaders provide their employees and followers with the opportunities to talk and criticize the interpersonal and procedural conditions and processes. They are good listeners to whom individuals can relate bad news., This requires the ability to manage emotions and behaviors, which is essential for an ethical nursing leader.
Another category of the ethical leader's capabilities of the study nurses was ethical capability, which included moralism, altruism, ethical sensitivity, and ethical courage.
Moralism has also been emphasized in different studies in which Mahdad et al. referred to an ethical leader's commitment to the ethics. Stouten et al. argued that ethical leaders stress on ethical values both in their personal and professional lives. Furthermore, in two different studies, Treviño et al. explained that an ethical leader possesses ethical values and tries to develop them in the organization., In another study, Brown and Treviño  stated that ethical leaders do not only talk about a good game but also actively play a role in modeling ethical behaviors, and this is the same ethical acts that nurses' ethical leaders do. These features indicate the internalization of positive ethical traits in ethical leaders, which is in line with the findings of this study.
Furthermore, the nurses mentioned that honesty is one of the internalized ethical traits in their ethical leaders and it has been referred to as one of their most important characteristics in almost all the studies.,,,,,,
Altruism was another characteristic of an ethical leader. It means loving people, valuing them, and caring for them wholeheartedly. Altruism is among the features mentioned as an ethical leader in various studies.,, Kanungo and Mendonca  stated that altruism provides the ethical basis for leadership. Moreover, Resick et al. referred to altruism as one of the most important characteristics of an ethical leader, which is characterized by displaying behaviors that tend to help others without expecting any external rewards or taking into account any personal benefits. These explanations were similar to what the nurses noted in this study.
Regarding ethical sensitivity, the nurses considered a conscience-based performance as a significant feature of ethical leaders. In various studies, an ethical leader's conscientiousness was emphasized. Furthermore, Behzady et al. introduced ethical leaders as conscientious people and expressed that conscientiousness is associated with all aspects of ethical principles and their observance. Zahiri et al. studied conscientiousness as one of the personality predictors of ethical leaders and concluded that there is a significant positive relationship between conscientiousness and ethical leadership. He further explained that the conscientiousness of an ethical leader enhances his/her credibility and effectiveness. Furthermore, Brown et al. see conscientiousness as a characteristic that augments the effectiveness and credibility of an ethical leader. The results of these studies are consistent with the findings of our research. Paying attention to one's conscience in nursing, especially in Iranian nursing practice is imperative; since the challenges and shortages exist there, monitoring and control of the nurses' performance are not sufficient. Therefore, individuals' consciences can be their internal monitoring system.
Regarding ethical sensitivity, the nurses also considered an ethical leader as the one who is sensitive toward professional ethics and constantly challenges himself/herself regarding the morality of his/her performance. Joshi et al. defined ethical awareness as the ability to understand and be sensitive to ethical issues, especially in decisions that significantly impact to others and also ethical awareness was considered as one of the characteristics of an ethical leader in various studies.,,,, It seems that this characteristic overlaps the ethical sensitivity that nurses referred to as a leader's characteristic. More so, it appears to be critical for nurses who see ethical leaders as their performance role models because of the high impact of nursing measures on other humans' health and lives.
On the other hand, the nurses stated that an ethical leader emphasizes on observing ethical issues and supports individuals who care about ethical performance. In numerous studies, it has been pointed out that ethical leaders define appropriate punishment and reward method for compliance or noncompliance with certain ethical criteria and expectations.,,, Encouragement of moralist nurses is also seen as a support stated by the study nurses that it leads to the strengthening and development of ethical performance among employees. Brown et al. considered paying attention to ethical principles and values during the decision-making process and the use of reward and punishment methods as the measures used by ethical leaders to promote normative ethic-based behaviors. In addition, the nurses noted that by punishing the person who violates moralities, other nurses would understand that his/her leader is making a distinction between him/her and those who lack ethical performance and this will lead to a further feeling of being supported and encouraged. This is ethical courage that was mentioned by the nurses as another ethical capability of their leaders. According to the nurses, their ethical leader is strict about the unethical performance of the employee and does not know it as justified or approved. He or she tries to correct the individuals' unethical behaviors and seeks help from them and others in this process. As mentioned above, after defining the ethical standards and expectations, an ethical leader will punish and guide those who do not follow those standards. These explanations representing punishment of those who do not follow the ethical standards as well as efforts to promote the ethical performance overlap with participants' descriptions of this study.
These findings have below clinical applications:
- Regarding the context and background of Iranian nursing practice, this study contributes to the promotion of ethical leaders' characteristics, which can be considered in the selection of nurses and developed among the employees so as to help expand ethical leadership and promote ethics in nursing practice
- Considering ethical leaders' characteristics in nursing, it is recommended that the organizations support and encourage those who work in nursing fields which possess a greater number of the mentioned characteristics. This will eventually be in favor of the patients and public health by developing ethic-based performances
- Given its qualitative approach, this research can be moderately generalized to other organizational cultures different from the Iranian nursing system and it is thus recommended that the same studies should be repeated in other organizations.
| Conclusion|| |
The findings of this study indicate four groups of capabilities for ethical leaders in nursing, which were obtained using the experiences of Iranian nurses working in Mashhad University of Medical Sciences. The nurses acknowledged that their ethical leader had personal characteristics in a way that displayed personal attributes such as kindness, humbleness, openness to criticism, accountability, discipline, creativity, perseverance and dynamism, seriousness and foresight, and adherence to religious beliefs. Furthermore, the nurses believed that their ethical leader had a professional capability so that she was interested in nursing and showed good scientific and practical abilities in nursing. She was a dutiful and law-abiding person who was a pioneer in enforcing laws. The nurses also noted charismatic features, effectiveness, and ability to manage emotions and behaviors as other characteristics of their ethical leader, which were referred to as leadership capabilities. Finally, the nurses acknowledged that their ethical leader had ethical capabilities including moralism, altruism, ethical sensitivity, and ethical courage. Such leaders were those who preferred moralities to anything else and penetrate into their employees' hearts and influence them by having these traits and characteristics. Findings of this study can help identify the individuals with high effectiveness and credibility among nurses who act as role models. Professionally supporting ethical leaders can result in the further implementation of ethics in nursing practices.
This article is part of a nursing Ph.D. dissertation approved by the Nursing Organization of Iran that performed with the collaboration of Kerman University of Medical Sciences. We would like to thank all the collaborators and participants in this study.
Financial support and sponsorship
This study was supported by Nursing Organization of Iran with the collaboration of Kerman University of Medical Sciences (code k/93/488).
Conflicts of interest
There are no conflicts of interest.
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Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2]
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