Ethical behavior among psychiatric nursing staff in Japan: Associations with job stressors and professional self-efficacy—A cross-sectional web-based survey

Ethical behavior is fundamental to psychiatric nursing practice; however, its association with workplace stressors and professional self-efficacy remains unclear. This study examines these relationships while controlling for demographic characteristics. A cross-sectional web-based survey was conducted in Japan from November to December 2024, and data from 575 psychiatric nurses and licensed practical nurses were analyzed. Job stressors were measured using the Psychiatric Nurse Job Stressor Scale, self-efficacy-related factors using the Psychiatric Nurse Self-Efficacy Scales, and ethical behaviors using the Ethical Behavior Scale for Nurses (revised version). Hierarchical multiple regression analyses were performed. Demographic characteristics showed a limited association with ethical behavior. By contrast, job stressors and self-efficacy-related factors were independently associated with all dimensions of ethical behavior; however, the direction of these associations—whether positive or negative—varied by dimension. Job stressors showed substantial contributions to "Risk avoidance" (Δ R 2 = 0.17) and "Good care" (Δ R 2 = 0.24). In the inpatient setting, higher stressors and lower self-efficacy were associated with lower ethical behavior scores. Notably, some stressors and lower self-efficacy were positively associated with "Risk avoidance," suggesting that, in certain contexts, stress may be associated with more preventive behavior. These findings indicate that ethical behavior in psychiatric nursing is associated with individual attributes, workplace stress, and professional self-efficacy, highlighting the need for organizational- and individual-level interventions.