173417Chamberlain University, USA.
Nurs Ethics. 2021 Sep;28(6):1081-1089. doi: 10.1177/0969733021992448. Epub 2021 Mar 15.
Ethical relationships are important among many participants in healthcare, including the ethical relationship between nurse and employer. One aspect of organizational behavior that can impact ethical culture and moral well-being is institutional betrayal.
The purpose of this concept analysis is to develop a conceptual understanding of institutional betrayal in nursing by defining the concept and differentiating it from other forms of betrayal.
This analysis uses the method developed by Walker and Avant.
Studies were reviewed using health literature databases with no date restrictions.
Analysis was conducted using established guidelines for ethical research.
Although institutional betrayal is a concept applied in the literature, there was a paucity of studies exploring the concept within nursing. Examples of the concept in the literature include violation of trust between organization (i.e. employer) and nurse, such as provision of inadequate workplace protections, ineffective or hostile management, and gaslighting of those who experience negative events. Examples of institutional betrayal have become more visible during the COVID-19 pandemic.
A conceptual definition of institutional betrayal is a deep violation of trust or confidence or violation of moral standards committed by an institution toward a nurse. This definition incorporates experiences and issues suggested by the literature. Outcomes are likely negative, including impacts on nurse psychological and workplace well-being. This concept likely fits within a framework of ethical workplaces and has conceptual relationships with moral distress and moral resilience. Further studies can help qualitatively explore and empirically measure this concept.
In the pursuit of improving the ethical culture of healthcare workplaces, this concept can provide meaningful insight into organizational behavior and its consequences. Naming and describing the concept can promote conceptual clarity and equip researchers, nurses, and leaders to identify and mitigate the issue.
在医疗保健领域的许多参与者中，伦理关系很重要，包括护士和雇主之间的伦理关系。组织行为的一个方面会影响道德文化和道德福祉，那就是制度背叛。
本概念分析旨在通过定义概念并将其与其他形式的背叛区分开来，对护理中的制度背叛形成概念性理解。
本分析采用了沃克和奥凡特开发的方法。
使用健康文献数据库进行研究回顾，无时间限制。
使用既定的伦理研究准则进行了分析。
尽管制度背叛是文献中应用的一个概念，但在护理领域探索这一概念的研究却很少。文献中该概念的例子包括组织（即雇主）对护士的信任被破坏，例如提供不足的工作场所保护、管理不善或敌对，以及对经历负面事件的人的“煤气灯”操作。在 COVID-19 大流行期间，制度背叛的例子变得更加明显。
制度背叛的概念定义是指一个机构对护士的严重的信任或信心的破坏或违反道德标准。这一定义包含了文献中提出的经验和问题。结果可能是负面的，包括对护士心理和工作场所福祉的影响。这一概念可能属于道德工作场所框架的范畴，并与道德困境和道德弹性有概念上的关系。进一步的研究可以帮助从定性上探索和从经验上衡量这一概念。
在追求改善医疗保健工作场所的伦理文化的过程中，这一概念可以为组织行为及其后果提供有意义的见解。命名和描述这一概念可以促进概念的明晰，并使研究人员、护士和领导者能够识别和减轻这一问题。
