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Word problems for Year 4 play an important role in Year 4 maths. In Year 4, the main focus is to ensure that pupils are becoming more fluent with whole numbers and the four operations. Students work to develop efficient written methods and to be accurate with their calculations. Pupils in Year 4 are exposed to a wider range of problem-solving questions and progress from one to two-step problems.
It is important that all children are given regular opportunities to access reasoning and word problem style questions. Fluency, reasoning and problem solving should be intertwined through every lesson, with all children having the opportunity to tackle each of these question types.
Strengthen your students' problem solving and multiplication skills with this pack of multiplication word problems
Addition and subtraction , multiplication and division, fractions, decimals and percentages, measurement, why are word problems important in year 4 maths, how to teach problem solving in year 4, addition word problems for year 4, subtraction word problems for year 4, multiplication word problems for year 4, division word problems for year 4, fraction and decimal word problems in year 4, time word problems in year 4, multi-step word problems in year 4., more primary word problems resources.
There can sometimes be a tendency for reasoning and problem solving questions to be treated as extension activities for only the higher attaining pupils to attempt, but children of all abilities need to be accessing them on a regular basis.
To help you with this, we have put together a collection of 20 word problems aimed at Year 4 pupils. For more Year 4 maths resources, take a look at our collection of Year 4 maths worksheets .
In Year 4, pupils progress from solving one-step problems, to also being exposed to two-step problems across a range of topics, as set out in the National Curriculum.
Solve word problems involving counting in multiples of 6,7,9, 25 and 100; finding 1000 more or less than a given number; counting backwards through 0 to include negative numbers; ordering and comparing numbers beyond 1000 and rounding numbers to the nearest 10. 100 and 1000
Solve addition and subtraction word problems with up to 4 digits, including two-step word problems, deciding which operations and methods to use and why.
Solve problems involving multiplying and adding, including using the distributive law to multiply two-digit numbers by 1 digit, integer scaling problems and harder correspondence problems.
Solve problems involving increasingly harder fractions word problems to calculate quantities, and fractions to divide quantities, including non-unit fractions where the answer is a whole number. Also Solve simple measure and money problems involving fractions and decimals to 2 decimal places.
Solve problems involving converting from hours to minutes, minutes to seconds, years to months, weeks to days.
Solve comparison, sum and difference problems using information presented in bar charts, pictograms, tables and other graphs.
Word problems are increasingly important as pupils move through Key Stage 2. As they become more confident with some of the core concepts pupils need to be applying this knowledge to a range of situations. By the end of Year 4, pupils should have memorised their multiplication tables up to and including the 12 times table and should be showing precision and fluency in their work.
Word problems in Year 4 should be fun and engaging for students. There are many ways to do this, including:
Children need to be encouraged to read word problem questions carefully, to ensure they have identified the key information needed to be able to solve the problem. Pupils need to think about what they already know and how that information can help them to answer the question. They should also be encouraged to draw pictures and visual images, where appropriate, to help them to understand what the question is asking.
Here is an example:
A shop has an 8m roll of fabric.
The first customer buys 125cm of fabric and the second customer buys 3m from the same roll.
How much fabric is left on the roll, once the two customers have taken theirs?
How to solve:
What do you already know?
How can this be drawn/represented pictorially?
We can draw a bar model to represent this problem:
In Year 4, addition word problems involve questions up to 4-digit numbers. They can include one and two-step addition and incorporate a range of concepts, such as measures and money word problems
It is 4164 miles to travel from London to Doha and 3266 miles to travel from Doha to Bangkok.
How far is it to travel from London to Bangkok, if the flight stops in Doha first?
Answer (1 mark): 7430 miles
Fill in the missing numbers in this calculation.
Answer (1 mark): 6840
On Saturday, 5486 fans attended a football game and 3748 fans attended a rugby game.
How many fans watched the two games in total?
Answer (1 mark): 9234
Subtraction word problems in Year 4, also involve numbers up to 4-digits, including both one and two-step problems, covering a range of concepts. By this stage, children should be confident in estimating and using the inverse, to check calculations.
3241 people visited the zoo on Saturday.
On Sunday 2876 people visited.
How many more people visited the lake on Saturday than on Sunday?
Answer (1 mark): 365
3241 – 2876 = 365
A teacher prints out 1242 worksheets in a term.
If 435 were maths worksheets, how many did she print out for the other subjects?
Answer (1 mark): 807
The temperature in Toronto dropped to minus 15 degrees celcius in December.
In July the temperature was 47 degrees celsius warmer than it was in December. What was the temperature in July?
Answer (1 mark): 32 degrees warmer
47 – 15 degrees = 32 degrees celsius
Counting on 47 degrees from minus 15 degrees = 32 degrees celsius
In Year 4, multiplication word problems can include recalling facts for times tables up to 12 x 12 and multiplying two and three-digit numbers by a 1-digit number, using formal written layout.
All the pupils in Year 4 complete a mental maths test.
27 pupils score 9 marks out of 10.
What is the total number of marks scored by the 27 pupils?
Answer (1 mark): 243
27 x 9 = 243
Year 3 and 4 children from a local primary school go on a school trip.
Six mini buses are used to transport the children.
There are 17 children on each minibus.
How many children go on the school trip?
Answer (1 mark): 102
17 x 6 = 102 children
Biscuits come in packs of 18.
Mrs Smith buys 8 packs for the parents at the Y4 maths workshop.
How many biscuits does she buy altogether?
Answer (1 mark): 144 biscuits
Division word problems in year 4 require pupils to be able to recall division facts for multiplication tables up to 12 x 12. Formal written method of division isn’t a requirement until Year 5 however, many schools choose to teach the formal method in Year 4. Pupils need to understand the concept of grouping and sharing and to understand the link between multiplication & division.
Sam has 28 friends coming to his birthday party.
Each child will receive a cupcake, which come in packs of 4.
How many packs of cupcakes will Sam need to buy?
Answer (1 mark): 7 packs
28 ÷ 4 = 7
4 children raised £96 between them on a sponsored walk.
If they split the money evenly between the four of them, how much did each pupil raise?
Answer (1 mark): £24 each
96 ÷ 4 = 24
Ahmed is thinking of a number
He says, ‘when I divide my number by 12, the answer is 108.
What number was Ahmed thinking of?
Answer (1 mark): 9
108 ÷ 12 = 9
In Year 4, decimal and fraction problems involve increasingly harder fractions to calculate quantities and fractions to divide quantities, including non-unit fractions, where the answer is a whole number. Decimal word problems include measure and money problems involving fractions and decimals up to 2 decimal places.
Jamie has 18 sweets.
He gives \frac{1}{6} of the sweets to his friend and keeps the rest himself.
How many sweets does Jamie have now?
Answer (1 mark): 15 sweets
\frac{1}{6} of 18 = 3
18 – 3 = 15
Jaxon collected 36 conkers.
\frac{1}{4} of the conkers fell out of a hole in his bag, when he was walking home.
How many conkers did Jaxon have left, when he got home?
\frac{1}{4} of 36 = 9
36 – 9 = 37 or \frac{3}{4} of 36 = 29 (3 x 9)
Sara ate \frac{3}{12} of a chocolate bar and gave \frac{2}{12} to her friend.
What fraction of the chocolate bar did she have left?
Answer (1 mark): \frac{7}{12}
In Year 4, time word problems include: converting from hours to minutes, minutes to seconds, years to months and weeks to days.
A cake was put in the oven at 4:35pm and taken out at 4:57pm.
How long was the cake in the oven?
Answer (1 mark): 22 minutes
57-35 = 22 minutes
Using an number line:
It took Evie 25 minutes to complete a page of number problems.
If she started at 2:45pm. What time did she finish?
Answer (1 mark): 3:10pm
In Year 4, children are introduced to multi-step word problems requiring up to two steps. These problems cover a range of concepts, including the four operations, fractions, decimals and measures.
Third Space Learning’s online one-to-one tutoring frequently incorporates multi-step questions to test students’ knowledge and problem solving skills. Our personalised tutoring programme works to identify gaps in students’ learning, fill those gaps, reinforce students’ knowledge and build confidence.
There are 6 handwriting pens in each pack.
A class has 30 children and each child needs 2 handwriting pens.
How many packs will the teacher need to buy?
Answer (2 marks): 10 packs of handwriting pens.
30 x 2 = 60
Sophie has £4.50.
She buy 3 books at a carboot sale, costing 50p, 65p and £1.20.
How much money does she have left?
Answer (2 marks): £2.15 left
Abullah is thinking of a number.
He doubles the number and adds 7.
He gets an answer of 25.
What was his original number?
Answer (2 marks): 9
Third Space Learning offers word problems for all primary year groups. Take a look at our word problems for year 3 , word problems for year 5 and word problems for year 6 . Our word problems span a range of topics such as ratio word problems and percentage word problems .
Do you have pupils who need extra support in maths? Every week Third Space Learning’s maths specialist tutors support thousands of pupils across hundreds of schools with weekly online 1-to-1 lessons and maths interventions designed to address learning gaps and boost progress. Since 2013 we’ve helped over 162,000 primary and secondary school pupils become more confident, able mathematicians. Learn more or request a personalised quote for your school to speak to us about your school’s needs and how we can help.
Subsidised one to one maths tutoring from the UK’s most affordable DfE-approved one to one tutoring provider.
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Share this post, table of contents, word problems year 4 - act them out.
Rather than simply working out the problem, get your students to act out the problem!
For example if your students are trying to work out this word problem: cinema tickets are £6 and 8 people are going.
How much did they pay altogether? You could print out 8 cinema tickets and have students work in a group to figure out the cost (8 students are going to the cinema and 1 person is the cashier).
This is a fun opportunity for your class to do some acting as well as learning how to work out year 4 word problems!
Using manipulatives is a really effective way of getting your students to visualise the word problem that they’re trying to solve.
Students can use anything from counters to pens!
Using manipulatives is always fun for students as they get to use fun tools like counters or building blocks – so the activity almost feels like play!
This gets students engaged in solving year 4 word problems!
Why not get your students to create their own year 4 word problems?
This activity allows your pupils to get creative and write their own problems! This way they can clearly see how word problems work and therefore will find it easier to solve them in the future.
The students can then swap word problems with their classmates and solve each other’s work. This could then involve some peer assessment where your students will mark the questions that they created!
Making up some silly word problems is a simple but fantastic way of engaging your students with this topic!
Whilst regular word problems may seem like a boring task for students, sillier problems may motivate them a little more to get learning!
Children love a chance to have some silly fun in the classroom, so this will help them to build a positive relationship with year 4 word problems.
Some Example Silly Word Problems – Year 4:
Getting students to pair up and work together to solve year 4 word problems is a really effective learning technique for this topic.
Think – Pair – Share gives pupils the opportunity to work through problems at their own pace and explain what they think the answer is to another student.
Students will initially think about the problem independently, then pair up and share their ideas with their partner! Explaining the solving process is really important to understanding word problems.
(I would recommend getting volunteers for this as not all students are comfortable at the front of the class!)
Why not get your students up to the front of the class to explain and work through some year 4 word problems?
As mentioned earlier, it is extremely beneficial for pupils to explain the process of solving the word problem as it can really increase their understanding.
Another great benefit of this is that it may help other students who are listening to their peers explain the problem solving process! Hearing explanations from a different perspective than the teacher can often be what makes the topic click!
Incorporating students’ names into the word problems that they’re solving is a really fun method of engaging them in the content.
Children love when their name appears in a paper or even a book you may be reading, so this is guaranteed to be effective in your classroom!
A fun activity could be writing one word problem for each student which has their name in it. Each student would then solve their own personalised word problem!
This is an easy way of getting students engaging with year 4 word problems!
Why not try to make year 4 word problems a little more creative?
Some students require visuals to really understand what they’re solving. So, get your students to draw out the problem that they’re working out!
For example, if your class is trying to work out how many books are on 3 shelves, they can draw out three shelves with the books on and count them! This shows they the problem and helps them to see what it is that they are solving.
Getting students used to year 4 word problems is really vital to their understanding! Having them consistently complete word problems is an effective way of ensuring that they won’t forget how to solve word problems. Why not introduce a daily word problem? Get their brains warmed up in the morning by giving them their daily word problem!
A great way to keep students familiar with this style of question is to incorporate word problems into different topics, such as fractions!
Emile is an excellent game-based online resource for primary schools!
Children will love playing on Emile and will be beyond excited to play the engaging and educational games!
With the assess, practise and achieve model, Emile is sure to allocate the right work for each individual!
Get your students learning year 4 word problems effectively with Emile today by requesting a demo!
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Eduardo velez bustillo, harry a. patrinos.
In 2022, we published, Lessons for the education sector from the COVID-19 pandemic , which was a follow up to, Four Education Trends that Countries Everywhere Should Know About , which summarized views of education experts around the world on how to handle the most pressing issues facing the education sector then. We focused on neuroscience, the role of the private sector, education technology, inequality, and pedagogy.
Unfortunately, we think the four biggest problems facing education today in developing countries are the same ones we have identified in the last decades .
1. The learning crisis was made worse by COVID-19 school closures
Low quality instruction is a major constraint and prior to COVID-19, the learning poverty rate in low- and middle-income countries was 57% (6 out of 10 children could not read and understand basic texts by age 10). More dramatic is the case of Sub-Saharan Africa with a rate even higher at 86%. Several analyses show that the impact of the pandemic on student learning was significant, leaving students in low- and middle-income countries way behind in mathematics, reading and other subjects. Some argue that learning poverty may be close to 70% after the pandemic , with a substantial long-term negative effect in future earnings. This generation could lose around $21 trillion in future salaries, with the vulnerable students affected the most.
2. Countries are not paying enough attention to early childhood care and education (ECCE)
At the pre-school level about two-thirds of countries do not have a proper legal framework to provide free and compulsory pre-primary education. According to UNESCO, only a minority of countries, mostly high-income, were making timely progress towards SDG4 benchmarks on early childhood indicators prior to the onset of COVID-19. And remember that ECCE is not only preparation for primary school. It can be the foundation for emotional wellbeing and learning throughout life; one of the best investments a country can make.
3. There is an inadequate supply of high-quality teachers
Low quality teaching is a huge problem and getting worse in many low- and middle-income countries. In Sub-Saharan Africa, for example, the percentage of trained teachers fell from 84% in 2000 to 69% in 2019 . In addition, in many countries teachers are formally trained and as such qualified, but do not have the minimum pedagogical training. Globally, teachers for science, technology, engineering, and mathematics (STEM) subjects are the biggest shortfalls.
4. Decision-makers are not implementing evidence-based or pro-equity policies that guarantee solid foundations
It is difficult to understand the continued focus on non-evidence-based policies when there is so much that we know now about what works. Two factors contribute to this problem. One is the short tenure that top officials have when leading education systems. Examples of countries where ministers last less than one year on average are plentiful. The second and more worrisome deals with the fact that there is little attention given to empirical evidence when designing education policies.
To help improve on these four fronts, we see four supporting trends:
1. Neuroscience should be integrated into education policies
Policies considering neuroscience can help ensure that students get proper attention early to support brain development in the first 2-3 years of life. It can also help ensure that children learn to read at the proper age so that they will be able to acquire foundational skills to learn during the primary education cycle and from there on. Inputs like micronutrients, early child stimulation for gross and fine motor skills, speech and language and playing with other children before the age of three are cost-effective ways to get proper development. Early grade reading, using the pedagogical suggestion by the Early Grade Reading Assessment model, has improved learning outcomes in many low- and middle-income countries. We now have the tools to incorporate these advances into the teaching and learning system with AI , ChatGPT , MOOCs and online tutoring.
2. Reversing learning losses at home and at school
There is a real need to address the remaining and lingering losses due to school closures because of COVID-19. Most students living in households with incomes under the poverty line in the developing world, roughly the bottom 80% in low-income countries and the bottom 50% in middle-income countries, do not have the minimum conditions to learn at home . These students do not have access to the internet, and, often, their parents or guardians do not have the necessary schooling level or the time to help them in their learning process. Connectivity for poor households is a priority. But learning continuity also requires the presence of an adult as a facilitator—a parent, guardian, instructor, or community worker assisting the student during the learning process while schools are closed or e-learning is used.
To recover from the negative impact of the pandemic, the school system will need to develop at the student level: (i) active and reflective learning; (ii) analytical and applied skills; (iii) strong self-esteem; (iv) attitudes supportive of cooperation and solidarity; and (v) a good knowledge of the curriculum areas. At the teacher (instructor, facilitator, parent) level, the system should aim to develop a new disposition toward the role of teacher as a guide and facilitator. And finally, the system also needs to increase parental involvement in the education of their children and be active part in the solution of the children’s problems. The Escuela Nueva Learning Circles or the Pratham Teaching at the Right Level (TaRL) are models that can be used.
3. Use of evidence to improve teaching and learning
We now know more about what works at scale to address the learning crisis. To help countries improve teaching and learning and make teaching an attractive profession, based on available empirical world-wide evidence , we need to improve its status, compensation policies and career progression structures; ensure pre-service education includes a strong practicum component so teachers are well equipped to transition and perform effectively in the classroom; and provide high-quality in-service professional development to ensure they keep teaching in an effective way. We also have the tools to address learning issues cost-effectively. The returns to schooling are high and increasing post-pandemic. But we also have the cost-benefit tools to make good decisions, and these suggest that structured pedagogy, teaching according to learning levels (with and without technology use) are proven effective and cost-effective .
4. The role of the private sector
When properly regulated the private sector can be an effective education provider, and it can help address the specific needs of countries. Most of the pedagogical models that have received international recognition come from the private sector. For example, the recipients of the Yidan Prize on education development are from the non-state sector experiences (Escuela Nueva, BRAC, edX, Pratham, CAMFED and New Education Initiative). In the context of the Artificial Intelligence movement, most of the tools that will revolutionize teaching and learning come from the private sector (i.e., big data, machine learning, electronic pedagogies like OER-Open Educational Resources, MOOCs, etc.). Around the world education technology start-ups are developing AI tools that may have a good potential to help improve quality of education .
After decades asking the same questions on how to improve the education systems of countries, we, finally, are finding answers that are very promising. Governments need to be aware of this fact.
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Consultant, Education Sector, World Bank
Senior Adviser, Education
Bowman, 32, was elected by fellow democrats last week to lead the caucus, by: julia shumway - march 27, 2024 6:00 am.
Rep. Ben Bowman, D-Tigard, works on the House floor at the Oregon State Capitol in Salem on Tuesday, Feb. 28, 2023. (Amanda Loman/Oregon Capital Chronicle)
Ten years after he started working in the Oregon House Majority Office as his first full-time job after graduating college, Ben Bowman will lead the Democratic caucus.
The freshman representative from Tigard was elected by Democratic colleagues during a closed-door meeting last week, beating out fellow Reps. Jason Kropf, D-Bend, and Andrea Valderrama, D-Portland. Eugene Rep. Julie Fahey, the former majority leader, was elected speaker of the House on the final day of the legislative session.
Bowman has wanted to work in politics his whole adult life, starting with knocking doors and calling voters for former Gov. John Kitzhaber’s 2010 campaign. He continued working on campaigns and for the Legislature while earning a bachelor’s degree in political science from the University of Oregon.
“What motivates me the most is solving problems,” Bowman told the Capital Chronicle. “That’s why I love working in politics. That’s why I love serving as a legislator, because it’s a place where you can actually solve big important problems in a collaborative way.”
At 32, Bowman is the second-youngest member of the state House, older only than 29-year-old Gresham Democrat Ricki Ruiz. The two are among a dozen millennials in the House.
Despite his relative youth, Bowman noted he has more experience in the Capitol than most other legislators. He worked for current U.S. Rep. Val Hoyle while she was the House majority leader and then served as chief of staff for former Rep. Margaret Doherty, D-Tigard.
Bowman holds a master’s degree in education policy from Stanford and worked for more than two years at the Oregon Department of Education. He served one year as chair of the Tigard-Tualatin School Board and now works for the Gladstone School District as an administrator focused on support for students and their families.
Along with college classmate Alex Titus, a former Trump administration official, Bowman launched the political podcast the Oregon Bridge and the accompanying Oregon360 Media newsletter and Substack site in 2021. Reagan Knopp, the son and chief of staff of Senate Minority Leader Tim Knopp, R-Bend, took over for Titus as the podcast’s Republican voice in 2022 and soon developed an unlikely friendship with Bowman. Their podcast and weekly newsletter have been on an indefinite hiatus since early this year because of time constraints, something Bowman joked is devastating for “dozens” of listeners.
“As a friend I’m really excited for him and as a political operative, I’m obviously disappointed that Democrats picked such a talented majority leader,” Knopp said.
Bowman told the Capital Chronicle his first priority as majority leader is making sure he maintains strong relationships with the other 34 members of the Democratic caucus.
“It’s my job to understand what they’re working on, what their priorities are, what’s happening in their districts, and make sure that they have all the support they need to be successful,” he said.
Beyond that, he hopes to continue a culture set by Fahey, former House Speaker Dan Rayfield and former and current House Minority leaders Vikki Breese-Iverson and Jeff Helfrich that focused on open communication. The House largely avoided the strife that plagued the Oregon Senate during the past couple legislative sessions and culminated in a six-week-long Senate Republican walkout last year.
Bowman said Helfrich, R-Hood River, was one of the first people to call him after his election as majority leader. Bowman is friends with him and with other Republican lawmakers: A bipartisan group of legislators would go out to dinner together every week or two during the 2023 session. Personally, he tries to find a Republican to sign on to every one of his bills as a chief sponsor.
“I think it works when you’re collaborative and you listen and you provide space,” Bowman said. “It doesn’t mean you compromise on Democratic values ever. But it does mean that you provide an opportunity for everyone to weigh in and participate in the process.”
Bowman’s counterpart in the Senate, Majority Leader Kate Lieber of Beaverton, praised him as a “proven champion” in a statement.
“I am so excited to welcome him as the new House Majority Leader. Never one to shy away from a challenge, I know he will be a force for good as we take on major priorities like housing and homelessness, the drug crisis, affordability and fixing our roads and bridges,” Lieber said.
Bowman is gay and shares a dog with his partner, Juan. He has spoken openly in committees and on the House floor about his experience growing up as a closeted teenager, including the shame and embarrassment he felt about his identity while he listened to politicians argue about whether gay people should be allowed to marry.
He sponsored an unsuccessful bill in the 2023 session to prohibit government workplaces from banning employees’ displays of “symbols of inclusion,” such as Pride flags or stickers, after school districts tried to crack down on teachers showing support for LGBTQ+ students and the Black Lives Matter movement. He also introduced a bill that would have allowed 16- and 17-year-olds to participate in school board elections.
This session, Bowman grappled with high-priced health care lobbyists as he pushed a bill to stop private equity firms from controlling medical practices, something analysts say leads to higher costs and worse care for patients. It looked like it was going to pass after approval in the House and two Senate committees but Republican delaying tactics killed the bill on the final day of the legislative session, and Bowman plans to bring it back next year.
He said caucus priorities will result from the elected representatives and the feedback they hear from voters during campaign season. Last cycle, housing and homelessness were the top issues for most legislators, candidates and voters, and the 2023 and 2024 legislative sessions overwhelmingly focused on housing and addiction , including allocating more than $1.5 billion in new funding for housing and homelessness over those two sessions.
“I think we’ll learn from hearing from voters what is on top of mind,” Bowman said. “For sure we’re going to want to monitor implementation of some of the big concepts we’ve passed in recent years and make sure that they’re operating effectively, making sure that the outcomes that we intended are being produced. But I’m also sure that there will be other new items that we’ll want to tackle.”
As caucus leader, he’ll work closely with House Democrats’ campaign arm, Future PAC, and its strategists as Democrats try to maintain and potentially expand their 10-seat majority in the state House during the November elections. Republicans hope to pick off a trio of first-term Democrats who narrowly won their 2022 elections, while Democrats are eying vulnerable Republicans in swing districts in the Columbia River Gorge, along the coast and in the mid-Willamette Valley.
“The first priority is always protecting the incredible candidates, incredible legislators we already have, but I know there are some seats right now that Joe Biden won in the 2020 election that are currently held by Republicans, so I think there are opportunities for Democrats to be competitive across the state,” Bowman said.
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Julia Shumway is the Capital Chronicle's deputy editor and lead political reporter. Before joining the Capital Chronicle in 2021, she was a legislative reporter for the Arizona Capitol Times in Phoenix and reported on local and state government and politics in Iowa, Nebraska and Bend. An award-winning journalist, Julia also serves as president of the Oregon Legislative Correspondents Association, or Capitol press corps.
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T oyota has stood as the car brand of reliability for decades. The RAV4, first introduced in 1994, holds a high position on the lineup for the most reliable Toyota models ever built . Many also consider the RAV4 one of the most affordable and durable Toyota cars . A car model that has been around this long has seen a lot of refinement over the years. However, although Toyota has adjusted to new car trends with each generation, issues can still linger.
Some of these problems can be avoided with a reasonably regular maintenance schedule. But with more used RAV4s in the market -- some with hundreds of thousands of miles on the odometer -- some of these hiccups will be unavoidable.
The RAV4's issues include excessive oil consumption, steering wheel problems, lagging transmissions, fuel system problems, and electrical complications, among other troubles. Here, you'll see which RAV4 model years frequently experience what issues and what might cause them. Although, this is not an exhaustive list.
Read more: The 15 Most Reliable SUVs Of All Time, Ranked
Third-generation RAV4s start with the 2006 model and end with the 2012. While it was the generation to introduce the optional third-row seating for extra passengers, many 2006-2008 owners complained about how frequently they had to replace the RAV4's oil.
These 2006 to 2008 models have the 2.4-liter 2AZ FE engine in common, an engine widely used in the Camry, Highlander, and Matrix, as well. The main suspect for this engine's oil consumption issue is how the piston ring is designed. The oil control ring (or scraper ring) is typically designed to remove excess oil from the cylinder wall, but the ones in the 2AZ FE do not scrape enough away, resulting in more oil consumption.
Driving an RAV4 from these oil-gulping years after driving an oil-efficient car could cause you to neglect to top up your oil as frequently as you should. Since this might be a piston problem, there's no easy way to fix this issue short of replacing the engine. The best thing to do is check your oil regularly to avoid stressing an unlubricated engine.
Some RAV4 owners have complained of strange clunking or clicking noises when attempting to turn the steering wheel. Once again, the 2006-2008 RAV4s are major culprits of this issue, which some speculate to be a result of a defective steering shaft.
It's also common to encounter trouble with the electric power steering (EPS), which could make the steering wheel much harder to turn. In some cases, it might completely freeze up suddenly, making it difficult to steer and more prone to accidents. EPS issues are not unlikely if you use an RAV4 from 2006 or later. These could be caused by electrical issues or water damage. You will see a warning light on your dashboard with a steering wheel and an exclamation point as an indicator.
Since all RAV4s before 2006 used a hydraulic steering system instead of EPS, it simply might be time to change the power steering fluid if you use an RAV4 from 2005 or earlier.
But the newer RAV4s aren't completely blameless in this matter. According to NHTSA (PDF) , Drivers in 2019-2021 RAV4s are prone to getting a "pulling" or "drifting" sensation after the car gets soaked. The 2019 RAV4 has especially built a bad reputation as one that could lose electric power steering assistance. Some consider the 2019 RAV4 as one of the most unreliable used Toyotas to avoid .
The 2001-2003 Toyota RAV4s are notorious for transmission issues. In fact, the 2002 RAV4 is one of the worst models for problems with shifting, jerking transmission, and ECM failures.
These problems were so bad that Toyota was forced to extend its warranty from five years-60,000 miles to 10 years-150,000 miles, and coverage for the ECM and transmission. There were other reports of hundreds of cases of transmission failure. However, most of these can be traced to the ECM.
More recently, the 2019 Toyota RAV4 also suffered a similar problem. Many owners have complained of the car's hesitation when they try to accelerate from a slow roll or lower gear. Resulting in lurches when they try to speed up. It's no surprise, though, seeing as that model has seen seven recalls since it was released.
Just like the second-generation RAV4, the likely culprit is the ECM. Take the vehicle to a verified service center and have them reprogram or replace the unit.
On November 1, 2023, Toyota recalled some 2013-2018 RAV4s because about 2 million were affected by electrical fire. The most common cause is that the battery could slip out of its tray while driving and come in contact with the hold-down clamp, resulting in a short circuit and a potential electric fire. Consequently, Toyota dealerships must replace the battery tray, battery hold-down bracket, and positive terminal cover at no cost to the owner.
Toyota claims that this fire occurred because of replacement 12-volt batteries. So, if your RAV4 has gotten a replacement battery that is smaller at the top than the original, you might want to be careful that the battery doesn't slip from the tray. You should also watch out for a recall from Toyota by December 3, 2023.
Less severe electrical issues other owners have reported on RAV4s include malfunctioning stereos, infotainment systems, and navigation displays (although this is mostly a poor interior problem). Additionally, many of the previously mentioned electric power steering issues come from an overall bad electric system.
Compared to the other more life-threatening problems on this list, some paint peeling off your car is a relatively mild problem. However, it doesn't make it any less annoying.
Some RAV4s have built a bad reputation as cars that peel off factory-applied paint, with some owners complaining about the paint job ripping off in sheets. This appears to happen commonly with Toyota cars painted with Toyota's Blizzard Pearl or Super White paint.
The peeling issue arises due to poor adhesion between the paint primer coat and the car's metal. After being exposed to sunlight for some time, paint peels from the exterior metal body panels. Many owners who fixed it themselves reported that a re-priming helped.
Toyota launched a Customer Support Program in 2019 to address this and offered an extended paint warranty. Since the warranty applies to 2008-2017 RAV4s, you can assume these are the most affected models.
Read the original article on SlashGear .
BMC Nursing volume 23 , Article number: 209 ( 2024 ) Cite this article
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Given the grave ethical tension and dilemmas posed continuously which are aggravated in the intensive care unit context and its related caregiving provision, combined with their impact on critical care nurses’ job satisfaction and work-related risks, exploring and analyzing these tensions and conflicts is crucial. This study was conducted to examine the relationship between perceived ethical work climate and problems among critical care nurses in addition to exploring their perspectives on the ethical work climates while caring for patients with infectious diseases.
A mixed-method research design was used to conduct this study among 635 participants, comprising 170 from Egypt, 144 from Jordan, 161 from Saudi Arabia, and 160 from the United Arab Emirates. Online or paper-based survey forms were distributed to all eligible critical care nurses who agreed to take part in the study. The survey contained both quantitative and qualitative data that were analyzed separately and integrated during the discussion. The study was reported following the STROBE guidelines.
The overall ethical work climate was fairly good and was significantly associated with ICU nurses’ personal and professional characteristics. The findings also identified three main themes: (1) an ethical sense of failure, (2) environmental condemnation, and (3) an instant action plan for resolving ethical conflicts.
ICU nurses perceived that ICU ethical climate was fairly good. The results indicated that ICU nurses generally had a relatively fair perception of the ethical work climate, with implications for addressing ethical issues and conflicts in various settings.
Mentorship and/or close supervision concerning ethical resilience, consultation, and decision-making is crucial in the ICU milieu. Metacognitive strategies to reinforce problem-solving and decision-making ICU nurses’ skills could help them overcome the different ethical challenges. Adequate resources, teamwork, and organizational support are promising tactics to improve ICU nurses’ ethical skills.
Not applicable.
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Intensive care units (ICUs) are one of the hospital’s most stressful and dynamic areas, in which nurses are subjected to various ethical problems [ 1 ]. These include issues related to informed consent [ 2 ], breaching of confidentiality [ 3 ], protection of patient rights [ 4 ], the provision of some unduly aggressive treatments [ 5 ], and failure to conduct end-of-life care measures [ 6 ], all of which could contribute to the development of ethical problems among critical care nurses, and affect their moral sensitivity [ 7 ]. The intensive nature of patients’ diseases, for example, infectious diseases and required treatment in the ICU could add more ethical burdens on nurses, especially with a low nurse-patient ratio, high workloads, and limited nursing time [ 8 ].
An ethical work climate is an important variable affecting nurses’ behavior, practice, and competence [ 9 ]. An ethical climate can be assessed by perceptions of how ethical issues in their work environment are handled [ 10 ]. Different ethical climates can be categorized according to whether they emphasize maximizing one’s own self-interests, maximizing the interests of others, or adhering to universal principles [ 11 ]. Victor and Cullen [ 11 ], states in their framework that deontology (upholding moral principles), benevolence (the welfare of others), and egoism (self-serving) serve as the foundation for moral decision-making. They suggest five different kinds of ethical climates based on these tenets: instrumental, rules and regulations, caring, independence, and rules. Olson’s conceptual framework of hospital ethical climate also posits that the ethical climate affects nurses’ level of performance, and a poor climate can reduce their work satisfaction, exacerbating stress and burnout, and increasing health system costs [ 12 ]. In the context of the Middle East, a study conducted in Iran by Tehranineshat [ 9 ] confirmed this hypothesis, reporting that the ethical work climate was associated with nurses’ professional quality of life. In Saudi Arabia, a study done by Almutairi et al., 2015 [ 7 ] reported that healthcare providers including nurses frequently deal with difficult ethical problems and practical decisions in their everyday work in healthcare settings. This would affect their wellbeing and increase their likelihood to moral distress.
Related to this dimension, an unpredictable work environment, ethical conflicts, and reluctant professional roles can lead to decreased quality of patient care, poor organizational dedication, moral distress, job dissatisfaction and burnout, and increased turnover rate [ 13 , 14 , 15 ]. Given the grave ethical tensions and dilemmas continuously arising in ICU contexts and related caregiving provision, combined with their impact on ICU nurses’ job satisfaction and work-related risks exploring and analyzing these tensions and conflicts is crucial in different contexts and cultures, for example, conflicts related to informed consent, confidentiality, and justice in the distribution of healthcare resources [ 4 , 5 , 16 ].
It is also valuable to evaluate the relationships between ICU nurses perceived ethical work climate, their personal and professional characteristics considering a deep understanding to their own perceptions. Consequently, this study focuses on perceived ethical work climate and risk among critical care nurses while caring for patients with infectious diseases as the first step to control such conflicts. The severity of the infectious diseases has dramatically exacerbated the ICU nurses’ ethical tension and challenge their responsibilities of protecting themselves, their families, community and from infection [ 13 ].
Ethical problems among ICU nurses might depend largely on professional and cultural background required in patient care [ 17 ]. However, despite many studies investigating professional competencies worldwide [ 1 , 8 , 18 ], the cultural background of nurses has largely been ignored, despite it being acknowledged to exert an important effect on their responses to ethical dilemmas. Accordingly, studying these variables among ICU nurses who are working in the Arab healthcare settings is pivotal.
Merriam-Webster [ 19 ] defines the concept of “culture” as “the set of values, conventions, or social practices associated with a particular field, activity, or societal characteristic”. Arab countries draw shared cultural beliefs and values, particularly those of the Middle Eastern region. Due to their shared history, religion, ethnic identity, language, and nationality, Arabs have a common set of traditions, behaviors, values, and belief sets. ICU nurses targeted in this study are from four different Arab countries where most of them are Arabs while others are expatriates. However, even expatriate nurses are (or ought to be) expected to exert cultural competence in treating majoritarian Arab service user populations. Therefore, to draw a meaningful and relevant conclusion about the ethical work climate in the Arabic countries, it is essential to study these variables rather than depending on similar studies done elsewhere in the other countries when developing evidence-based guidelines for fostering appropriate ethical caring ICU environments.
The aim of this study is to explore the ethical work climate in the ICUs within Arabic healthcare settings. The study included two phases: quantitative and qualitative one. The study examines the relationship between perceived ethical work climate and problems among critical care nurses. Through the qualitative component in the study, a deeper understanding of the nurses’ perspectives on the ethical work climates in their setting is achieved. This study aim is achieved by addressing four main research objectives, namely to:
Describe the frequency of proposed ethical problems in ICU.
Measure the ethical work climate as perceived by ICU nurses.
Determine the association between nurses’ personal and professional characteristics, perceived problems, and ethical work climate.
Understand the nurses’ perspectives on the ethical conflicts in ICU and how should be resolved.
A mixed-method research design [ 20 ] was used to conduct this study. Previous studies in literature mainly adopted single method approaches to study this issue, which might be unsuitable to explore all aspects of nurses’ experience with ethical problems. This study adopted the triangulation of data, which is necessary to elicit all dimensions of participants’ experiences.
This study was conducted in various adult ICUs across four Arab countries, namely Egypt, Jordan, the Kingdom of Saudi Arabia (KSA), and the United Arab Emirates (UAE). The sample included two governmental facilities from UAE, two governmental hospitals in KSA, two university hospitals located in Alexandria, Egypt, and one governmental hospital in Amman, Jordan. The studied hospitals’ ICUs receive patients from the general public with different disorders in acute stages of illness including infectious diseases.
Nurses working in the ICUs for more than six months were recruited conveniently to take part in the study. A pilot study was conducted with 10% of the study sample to examine the feasibility of the study; nurses who participated in the pilot study were excluded from the final study sample. Following the pilot, 928 participants invited to participate, 635 agreed to participate and were ultimately included in this study (170 from Egypt, 144 from Jordan, 161 from KSA, and 160 from UAE). Only 89 participants agreed to engage into the qualitative phase of the study.
Quantitative component (objectives 1, 2, and 3).
Data were collected concurrently from the four Arab countries. An online survey (described below) was distributed to all eligible critical care nurses who were agreed to fill it out in Jordan, KSA, and UAE, while paper-based forms were used in Egypt. Questions were presented in English in each of the four countries. Most of nurses working in UAE [ 21 ] and Saudi Arabia [ 22 ] are expatriates who do not speak Arabic as a first language. In Egypt and Jordan all of the participants happened to be native citizens, who are fluent in Arabic and who can understand English, and questions were presented in both languages in case participants had any difficulty in understanding any questions or wished to check any meanings. Translation and back-translation methods were used to translate the questionnaire from English into Arabic, the authors and a native speaker checked it twice.
The questionnaire included three sections. The first section collected data regarding nurses’ personal and professional characteristics, including age, marital status, residential arrangements (i.e., “living with family members”), profession, level of education, work experience, previous training in caring for patients with infectious diseases, and history of attending ethics education programs.
Section two included statements that aimed to extract the ethical problems facing nurses in caring for patients in ICU during the MERS-CoV pandemic time. It was developed by Choi and Kim [ 13 ], and compromises nine items, with a content validity index of 0.90, and reliability (Cronbach’s α) of 0.83. Nurses were asked to provide their answers with each item on a four-point scale, ranging from 1 (“not at all”) to 4 (“absolutely yes”). It showed good reliability in the current study, with a Cronbach’s α coefficient of 0.89.
The third section consists of the Ethical Work Climate Questionnaire as Perceived by Critical Care Nurses, adopted from Cullen and Victor [ 11 ]. It includes 36 items distributed over nine dimensions (four items each): self-interest, efficiency, personal morality, organizational profit, friendship, organizational rules and procedures, team interest, laws and professional codes, and social responsibility. Nurses were to respond for each item on a five-point Likert scale, ranging from 0 (“completely false”) to 5 (“completely true”). It has good reliability, with a Cronbach’s α coefficient of 0.83 [ 11 ]; in this study, the value was 0.93 for the whole scale. Reversed scoring was applied for negative statements. The total scale score is the sum of all dimensions’ scores (with a possible range of 0–180), whereby higher scores denote more positive perceptions of the ethical work climate by participants.
A qualitative component using written narratives was utilized to enable participants to share as much information as they desired. The objective was to uncover areas that could not be uncovered through the questionnaire and allow deeper understanding of the issues under the study. Nurses who finished the questionnaire were asked concurrently to answer an author-developed three narrative questions to allow them to express their experience with ethical problems more comprehensively and enrich the quantitative data with more illustrative texts. A similar approach was used in earlier studies [ 23 , 24 ]. The three narrative questions were (1) What kind of ethical problems do you face in your daily work in ICU while caring for patients with infectious diseases/in isolation room? (2) Please share with us the details of an ethical issue which you faced and consider relevant to be reported. (3) Tell us about your response to the ethical problem you faced?
A list of all participants who were involved in direct care of ICU patients with infectious diseases in the selected settings. Recruitment was managed via appointments arranged by the data collector in each country. Participants in each setting who agreed to take part in this study were asked to sign an informed consent form. The questionnaire was provided to them either soft copy or hard copy (in some settings), and it took them 10 min to complete. Data collectors were available in the selected settings to clarify the participants’ quires. The questionnaire was modified by the authors to ask participants about some proposed ethical problems they might face while they are caring for patients with infectious diseases in general (not specifically the MERS-CoV disease). After participants responded to all questionnaire questions, they were asked to answer three-narrative questions. All texts were written down by nurses anonymously and took around 15 min.
Quantitative data analysis.
Critical care nurses’ personal and professional characteristics and their associations with ethical work climate and problems were assessed using SPSS software (version 28.0). Cronbach’s alpha was used to test the reliability of the tool. Descriptive statistics with frequencies and percentages or mean and standard deviation (SD) values were used to describe the demographic characteristics of the sample, in addition to the total score of the ethical problems and ethical work climate in the ICU. Non-parametric tests (Kruskal Wallis, Mann Whitney U, and Spearmen correlation coefficient) were used to examine the relationship between ethical work climate and perceived ethical problem statements and nurses’ personal and professional characteristics.
We used content analysis approach [ 25 ] to examine the participants’ responses to the three narrative open-ended questions. Each relevant statement was given a code that conveyed its meaning, patterns were found across the transcript, and codes were then compiled into themes. A tree diagram was used to arrange and describe the findings, after multiple rounds of debate led to agreement on the overall conceptual topography of the findings.
The trustworthiness of the qualitative component in this study was assessed using credibility, transferability, dependability, and confirmability [ 26 , 27 , 28 ]. Credibility was attained through involving participants of different experiences from varied hospitals in the four studied Arab countries. Experts’ corrective views on the data extraction, analysis, coding, and categorization were considered. To allow reader scrutiny, for transferability, we described the study phases, including the study settings, sampling procedure, and how the data were acquired. To make sure that their intended meaning was conveyed in the transcripts, two ICU nurses were asked to evaluate them.
Dependability and confirmability were emphasized by preparing detailed drafts of the study phases to enable authors to follow the data and its source, as well as comprehend each other’s data interpretations. Also, over the data collection period, the authors had a biweekly conversation to assess the consistency of their perceptions and assessments. The authors were anonymous to all participants in the study guaranteeing reflexivity.
Ethical approval was obtained from the Research Ethics Committee of the Faculty of Nursing, Alexandria University, Egypt (approval number: 2023-9-138); the Institutional Review Board (IRB) at the Applied Science Private University, Jordan (approval number: 2022-2023-2-2); the Institutional Review Board at Princess Nourah bint Abdulrahman University, KSA (approval number: 21–0233); and the MOHP Research Ethics Committee, UAE (approval number: MOHAP/DXB-REC/AMM/No.33 /2021). Written consent, either online or in hard copy, was obtained from each participant before data collection, following explanation of the study details. A large number of participants, however, did not want to narrate their experience.
Participant characteristics.
The descriptive statistics for the characteristics of the 635 participating ICU nurses are presented in Table 1 . Their mean age was 33.0 ± 8.01 years. Females consisted of 65.7% ( n = 417) of the total sample. Similar proportions were recruited from each of the four countries, conferring geographical representativeness: 26.8% ( n = 170) from Egypt, 22.7% ( n = 144) from Jordan, 25.4% ( n = 161) from KSA, and 25.2% ( n = 160) from UAE. Most participants were married (72.1%, n = 458) and had children (63.0%, n = 400). In terms of professional characteristics, the majority of participants (77.5%) worked as ICU staff, with mean work experience of 10.24 ± 7.41 years. More than half (57.2%) of had a bachelor’s degree. Regarding the ethical issues related to training, more than half of the participants (56.9%, n = 361) reported having received adequate ethics training workshops (Table 1 ).
Table 2 represents the frequency of different incidents of ethical problems reported by ICU nurses. According to their report, caring for infected patients was stressful (2.49 ± 1.09), followed by their concerns about assignment to infected patients (2.45 ± 1.03) (maximum score 4). They found less conflict with changing their jobs because of caring for infected patients (1.79 ± 1.02). Table 3 shows the ethical work climate as perceived by ICU nurses. The highest mean score was for the “Organizational rules and procedures” subscale (M = 14.94, SD = 3.50), while the lowest was for the “Self-interest” subscale (M = 10.42, SD = 3.7). For ethical work environment, the mean score was 117.85 of 180 (SD = 24.42). Using percentile calculation, Quartile 4 ranged from [0–45], Quartile 3 ranged from [46–90], Quartile 2 ranged from [91–135], and Quartile 1 ranged from [136–180]. The ICU nurses’ mean perception score toward their ethical work climate fell in Quartile 2.
Pairwise correlations between personal and professional characteristics and the total score of ethical work environment are shown in Table 4 perceived ethical work environment showed a significant positive relationship with three personal characteristics, age, gender and number of children, ( p = 0.002, 0.001, and 0.004, respectively), but not marital status ( p = 0.516) and living with family members ( p = 0.208). In terms of professional characteristics, a significant positive relationship was found between perceived ethical work environment and four characteristics ( p = 0.001, 0.008, 0.004, and 0.001 respectively), but not for nurses’ pandemic previous experience ( p = 0.094). Moreover, perceived ethical work environment scores between participants in different workplaces differed significantly ( p < 0.001), with higher scores among Egyptian ICU nurses as it might be related to that nursing education has started early in Egypt and there are lot of managers and staff with wide experiences. Using Spearman’s correlation coefficient, five ethical problem statements perceived by ICU nurses were not significantly correlated with ethical work environment ( p = 0.436, 0.216, 0.266, 0.126, and 0.520, respectively), but were for statements 2, 3, 4, and 7 ( p = 0.000, 0.002, 0.025, and 0.007, respectively).
Participants differed in age, gender, and geographic location, providing a wide-ranging, rich sample of experiences to the study. However, not all participants filled out the narrative questions. Only those who provided the answers to the questions were included in the qualitative analysis ( n = 89). Three themes were identified from the analysis of the resultant data: ethical sense of failure, environment condemnation, and response to ethical conflicts, as presented in Table 5 and described below.
Participants reported that they “always” faced ethical problems while they cared for patients with infectious diseases. Despite their varied contexts and features (as discussed previously), most of them agreed on common ethical conflicts that left them emotionally exhausted, and which undermined their performance. They felt guilty for failing to behave ethically in some situations, and to follow ethical principles. A patient or surrogate has the right to participate in care-related decisions according to the principle of autonomy, but some participants reported that they felt unable to follow this principle in their care delivery.
…[It was] difficult to keep the surrogates informed with all decisions especially with the high workload… (P5).…A mother of 19-years girl patient was daily staying outside the ICU team to follow her daughter’s medical condition….either myself or my colleagues found few minutes to update her on her patient. It was really out of hands as we have a large amount of work throughout the shift…(P73).
Another source of suffering was failing to act based on their experiences.
…[I] worked hardly to provide the target quality of care, but [I] couldn’t… (P24). Another participant mentioned that some failure to act situations happened, but unintentionally. ….one time [I] forgot to give the patient a dose of antibiotics. It was only once, however, this was a big mistake because of the multiple responsibilities’ (P523).
They revealed that the financial hardship, workforce shortage, heavy workloads, and (in some cases) a lack of resources contributed to this issue. Moreover, the numbers of bad news they communicated to the families either due to deterioration or death, which sapped their personal morale.
…The situations [we] faced were beyond our empathic capacities, [we] really experienced a cocktail of emotions, for example, emotional fatigue, guilt, and moral injury… (P323).
Besides, they linked their suffering to unfair distribution between the staff working in the isolation units.
…[I] felt guilty to refuse a duty, therefore, [I] thought in resignation… (P246).
The participants’ narratives also reflected that they perceived imbalance between continuation of patient care and their personal safety (risk for cross-infection).
…[I] felt as [I am] in a dilemma…. should [I] continue caring for infected patient despite the high risk to infect myself or my family or renege from patient’s care… (P89).
Despite data being collected from varied participants who are working in different environments, most participants cited resource limitations as a common feature. In some units this was manifest in the form of equipment, while in others it was evident in limited time and high workload, unsafe staff ratios, and incompetent staff.
…Staff [ICU nurses] who are working here have a high patient ratio, with hyper-dynamic task cycles… (P498).
Most participants related their inability to adapt to the ethical climate because of job demotivation and dissatisfaction, especially for those who spent long shifts providing healthcare service in ICU isolation units.
…[We] need a motivation to continue working in such a drained environment, for example, rewards, promotions, or remuneration… (P12). ….[I] am personally afraid of getting infected while caring for patients. I have three kids, and I feel anxious about the possibility of getting infected and the impact it could have on my family…(P 344).Moreover, participants added that the processes for resolving conflicts might lead to unresolved tensions and dissatisfaction among them. …The workflow, how difficult situations are usually managed, and for how long these conflicts exist always affect my satisfaction, well-being and acts (P159).
Further, lack of proper communication channels leading to misunderstandings, confusion, or misinformation.
…I believe that clear and honest communications between us as nurses and the top management would increase our loyalty and morale. The style of communication can reinforce the one’s attitudes and behaviors (P10).
Few participants showed concerns on reporting unethical practices or violations to their supervisor.
…It’s not granted if I told my supervisors, they would understand the situation…[I] got scared of blame, and termination (P23).
They suggested that policy makers develop policies and regulations to regulate their working schedule in the isolated ICUs.
…[I] perceive that we need a policy that regulate our assignments to infected patients… (P35).
Most participants suggested that teamwork could support their responses to these ethical challenges and support either from managers or peers.
…[I] usually share ideas and suggestion with my colleagues…[I] feel this would help [me] doing the best for patient… (P45). …task management through prioritizing tasks could decrease the ethical conflicts [we] faced in the everyday practice… (P112).
Participants also recommended continuous ethical training to improve ethical resilience, consultation, and decision making.
…[We] need continuous training to guide us how to manage different ethical situations… (P189). …[I] need to read different scenarios as much as [I] can, so these could guide [me] how to act ethically (P18).
Also, enhancing metacognitive strategies to reinforce problem-solving and decision-making skills was recommended by multiple nurses.
…ICU nurse mangers should schedule [us] for a serious of workshops that allow recognizing the ethical conflicts, critically analyze the situations, and offering possible solutions while maximizing the use of the available resources… (P55).
Participants believed that the ethical climate/environment has an important role in their experience and response to ethical conflicts. Based on their narrations, the environment covers two key aspects: organizational support, resource availability, and personal coping strategies.
…[I] believe that the organization should encourage our endeavors…for example, training, motivation, rewards… (P93). …resources [equipment, policies, and consultancy services] supplement our practical, problem solving, ethical skills… (P1). …[We] should adopt certain coping strategies to help in handling the different situation in the everyday environment, for example, balancing the work-life activities, having emotional support, engaging into related training (P89).
The present study identified the perceived ethical work climate and problems among nurses in adult ICUs caring for patients with infectious diseases across a sample of four Arab countries. The findings showed the overall ethical work climate falls in quartile 2, and that the ethical work climate is significantly associated with ICU nurses’ personal and professional characteristics such as age, gender, number of children, level of education, profession, previous ethical training and years of experience. The qualitative findings highlighted that the ethical work climate played a role in ICU nurses’ experience of the various daily ethical conflicts. The qualitative findings disclosed more details of ICU nurses’ experiences with ethical problems and how they would respond to these existing ethical conflicts. ICU managers, clinicians, and policymakers should consider the recommended ethical strategies to target ICU nurses who are usually facing similar conflicts since despite over half of them had ethical training, they are requesting more support.
Prior studies concluded that ICU nurses commonly face some ethical problems while caring for patients with infectious diseases [ 13 , 29 , 30 ], similar to the findings of the current study. While the statements used in the questionnaire did not cover all ethical problems encountered in ICUs, the qualitative component of the study provided additional insight into other ethical issues and conflicts.
The scores of all the means of proposed ethical problems statements had a minimal difference between the lowest and the highest values, suggesting that participants’ experiences are, to some extent, similar across the different statements. This was in line with a study conducted in Korea [ 13 ]. Similar findings have been reported by other studies that utilized different methods to identify ethical conflicts [ 4 , 31 ].
In terms of the ethical work climate, most ICU nurses perceived that organizational rules have a contribution to nurses’ perception to the ethical work environment, similar to a study conducted by Dalmolin et al. [ 32 ]. This could be due to the ethical work environment attributed to the organizational culture, where bedside nurses are involved in shared decision-making [ 33 ]. Few of them perceived that self-interest would impact the ethical work environment, contrary to the findings of Sheedy et al. [ 34 ], which indicated that low ethical egoism enables the risk climate to exert a more significant influence on unethical pro-organizational behaviors.
In an independence climate, workers are expected to be guided by their personal beliefs [ 35 ]. Accordingly, the current findings showed that the ethical work climate is significantly associated with participants’ age, gender, and workplace. An ethical work climate is ascertained from workers’ general observations and opinions of the organization, rather than their individual attitudes and thoughts regarding how ethical problems are addressed and possible solutions [ 36 ]. In accordance with this definition, the findings also showed that nurses’ level of education, job rank, years of experience, and previous training were significantly associated with their positive perception to the ethical work climate. Participants’ narrations also linked the lack of training and incompetent staff with negative work climate perceptions. This is consistent with Okumoto et al. [ 37 ], who documented that the ethical climate of nurses in three Japanese teaching hospitals showed a significant association with hospital, gender, unit specialty, experience of ethics education, in-service ethical training, and workshops/ academic conferences on nursing ethics. In their narrations, participants suggested the policymakers to create specific policies targeting the isolation ICUs. They also asked the educators for continuous ethical training and emphasized the importance of ICU managers encouraging teamwork spirit.
Moreover, the quantitative results highlighted that the ethical work climate was significantly associated with some ethical problems, and these results were affirmed qualitatively, suggesting that the different healthcare systems targeting these ethical problems, while concurrently leverage the available resources, equipment, and workforce. According to the results of this study, the most common ethical problem experienced by ICU nurses while caring for patients with infectious diseases was having a mind-set of patient avoidance. The items showing the mind-set issue were as follows, in descending order of score: “It will be stressful for me to take care of patients with infectious disease”; “If I have to choose between infected patients and other kinds of patients, I will care for other kinds of patients”. Personal and family safety issues, fear of getting infected and infecting their families, afraid of abiding by non-maleficence, failure to act, urgent self-demands, and ignored autonomy as reported in their narrations might explain this avoidance.
The results of previous studies suggest the need for a positive ethical climate to support and help ICU nurses stay committed to delivering high-quality patient care while struggling with infectious diseases [ 9 , 34 , 38 , 39 ]. Our results showed an association between ethical work environment and related ethical problems, which also supports this suggestion. To our knowledge, ethical problems and their association with ethical work environment was not studied in previous studies; instead, most researchers focused on job satisfaction [ 9 ], and ethical sensitivity and quality of care [ 38 ]. Additionally, participants’ narrations disclosed their concerns about insufficient resources (either in terms of equipment or incompetent staff), the process of resolving conflicts, proper communication challenges, reporting unethical acts and job satisfaction, which interfered with their ability to deal with everyday ethical problems. These findings affirm those of prior studies [ 9 , 33 , 36 ].
The use of a mixed-method design in this study helps in achieving a deeper understanding of the association between the ethical work climate and proposed ethical problems in four low- and medium-income Arab countries. The results of the current study encourage future research studying predictors of the ethical work climate perceptions among ICU nurses. However, a number of limitations merit mentioned. First, convenience sampling might make it harder to generalize our results. Second, the data were collected only from ICU nurses, without considering other healthcare providers. Third, potential social desirability bias, given that the instrument implicitly queries nurses about their own personal and professional ethics. Fourth, using an online survey rather than face-to-face questionnaire.
This study targeted ICU nurses in Arab countries who directly cared for patients with infectious diseases. The findings provide insights into the association between the ethical climate and ICU nurses’ personal and professional characteristics including cultural background, in addition to their perceptions of ethical problems, based on using a mixed-method approach. The results indicated that ICU nurses had a relatively fair perception of the ethical work climate, with implications for addressing ethical issues and conflicts in various settings. Further, the study shed the light on the ethical and environmental deficiencies while suggesting instant actions to be followed by the ICU nurses, mangers, and policy makers. Further research is needed to determine predictors of ethical work climate perceptions among ICU nurses with regard to the differences between Arabic and non-Arabic speakers.
All data generated or analysed during the study are available from the corresponding author [Mohannad Anuruz] on request.
Intensive care units
Kingdom of Saudi Arabia
United Arab Emirates
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Our sincere appreciation goes to Emirates Health services, and all those who facilitated this study on their premises. Appreciation also goes to all participants of the study for the knowledge and information that they have shared.
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Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, UAE
Fatma Refaat Ahmed, Nabeel Al-Yateem, Mohammad Alkawaldeh, Muhammad Arsyad Subu & Jacqueline Maria Dias
Critical Care and Emergency Nursing Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt
Fatma Refaat Ahmed
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Farha Hisham Hijji
Clinical Nursing Department, Faculty of Nursing, Applied Science Private University, Amman, Jordan
Ghadeer Al Dweik & Mohannad Eid Aburuz
Nursing Management and Education Department, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
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Fatma Refaat Ahmed: Conceptualization, Methodology, Software, Validation, Formal analysis, Investigation, Resources, Data curation, Writing - original draft, Writing - review & editing, Visualization, Project administration.Nabeel Al-Yateem: Conceptualization, Methodology, Software, Validation, Formal analysis, Investigation, Resources, Data curation, Writing - original draft, Writing - review & editing, Visualization, Project administration.Farha Hisham: Conceptualization, Methodology, Software, Validation, Formal analysis, Investigation, Resources, Data curation, Writing - original draft, Writing - review & editing, Visualization, Project administration.Ghadir ALDWIK: Conceptualization, Methodology, Software, Validation, Formal analysis, Investigation, Resources, Data curation, Writing - original draft, Writing - review & editing, Visualization, Project administration.Mohammad ALKAWALDEH: Conceptualization, Methodology, Software, Validation, Formal analysis, Investigation, Resources, Data curation, Writing - original draft, Writing - review & editing, Visualization, Project administration.Muhammad Arsyad SUBU: Conceptualization, Methodology, Software, Validation, Formal analysis, Investigation, Resources, Data curation, Writing - original draft, Writing - review & editing, Visualization, Project administration. Jacqueline Maria DIAS: Conceptualization, Methodology, Software, Validation, Formal analysis, Investigation, Resources, Data curation, Writing - original draft, Writing - review & editing, Visualization, Project administration. Mohannad Eid AbuRuz: Conceptualization, Methodology, Software, Validation, Formal analysis, Investigation, Resources, Data curation, Writing - original draft, Writing - review & editing, Visualization, Project administration.Sally Mohammed FARGHALY: Conceptualization, Methodology, Software, Validation, Formal analysis, Investigation, Resources, Data curation, Writing - original draft, Writing - review & editing, Visualization, Project administration.
Correspondence to Mohannad Eid Aburuz .
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This study has been contacted according to declaration of Helsinki 1964. Institutional Review Board (IRB) approval was obtained from the Research Ethics Committee of the Faculty of Nursing, Alexandria University, Egypt (approval number: 2023-9-138); the Institutional Review Board (IRB) at the Applied Science Private University, Jordan (approval number: 2022-2023-2-2); the Institutional Review Board at Princess Nourah bint Abdulrahman University, KSA (approval number: 21–0233); and the MOHP Research Ethics Committee, UAE (approval number: MOHAP/DXB-REC/AMM/No.33 /2021).
Each participant signed an informed consent before the participation in this study.
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Ahmed, F.R., Al-Yateem, N., Hisham Hijji, F. et al. A multi-country mixed-method study identifying the association between perceived ethical work climate and problems among critical care nurses. BMC Nurs 23 , 209 (2024). https://doi.org/10.1186/s12912-024-01861-9
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