Factors that influence ethical competence among nurses in health facilities in Malawi

Background Clinical nurses' (CNs) ethical competence (EC) is essential for nursing practice because it facilitates high-quality care to patients. To develop ethically competent nurses, factors that positively affect EC must be explored and promoted. Few studies have explored ethical issues in Malawi and the aim of this study was to explore the factors that affect EC. Methods This study used a qualitative exploratory design to collect data through in-depth interviews from 10 key informants (KI) and 9 focus group discussions (FGD) in the selected government, CHAM and private hospitals in Malawi. It was conducted between April and May 2019. Data were analysed manually using thematic content analysis. The data were coded, and words with similar meaning were organized into categories from which themes and sub themes were developed. The themes and sub themes are reported as the results of the study. Results One major theme emerged from the thematic content analysis namely: systems influencing EC among nurses in Malawi. The study has identified continuing professional development in ethics, supportive supervision, availability of resources and leadership to be among the major factors that facilitate EC. Factors that hinder EC among the nurses included; inadequate supervision, inadequate resources, lack of teamwork, increased workload coupled with inadequate nursing staff. Conclusion This study has exposed the factors that influence EC in health facilities and shown that nurse leaders are key to enhancing EC through continuing ethics education, supportive supervision, staffing and provision of resources. Therefore, all the stakeholders in nursing should support the efforts to remove the factors that hinder EC in the health facilities.