Background:Moral distress is considered to be the negative feelings that arise when one knows the morally correct response to a situation but cannot act because of institutional or hierarchal constraints.Objectives:To analyze moral distress and its relation with sociodemographic and academic variables in undergraduate students from different universities in Brazil.Method:Quantitative study with a cross-sectional design. Data were collected through the Moral Distress Scale for Nursing Students, with 499 nursing students from three universities in the extreme south of Brazil answering the scale. (...) The data were analyzed in the statistical software SPSS version 22.0, through descriptive statistical analysis, association tests (t-test and analysis of variance), and linear regression models.Ethical considerations:Approval for the study was obtained from the Research Ethics Committee at Universidade Federal do Rio Grande.Findings:The mean intensity of moral distress in the constructs ranged from 1.60 to 2.55. As to the occurrence of situations leading to moral distress in the constructs, the frequencies ranged from 1.21 to 2.43. The intensity level of moral distress showed higher averages in the more advanced grades of the undergraduate nursing course, when compared to the early grades of this course (between 5 and 10 grade, average = 2.60–3.14, p = 0.000).Conclusion:The demographic and academic characteristics of the undergraduate nursing students who referred higher levels of moral distress were being enrolled in the final course semesters, were at a federal university, and had no prior degree as an auxiliary nurse/nursing technician. (shrink)

Background Ethics education can be developed in undergraduate nursing curriculum using a variety of teaching and learning strategies, and the content of narrative-based stories has rarely been evaluated in ethics courses. Objective This study aimed to compare the effect of teaching ethical principles through narrative ethics and lectures on the moral sensitivity of undergraduate nursing students. Methods This was a pretest and posttest quasi-experimental study with a control group. A total of 105 undergraduate nursing students from the nursing department of (...) Kerman University of medical science were included in the study. The narrative-based story and lecture lasted for four two-hour sessions. The outcomes were measured by a moral sensitivity questionnaire. Results The study results showed that teaching ethical principles had a significant effect on the mean score of moral sensitivity in the intervention groups after the intervention, but it was not significant in the control group. Based on the mean score of moral sensitivity, the students in the narrative story group got a higher score in all subscales of moral sensitivity questionnaire. Conclusion Based on this study’s findings, it can be concluded that narrative-based education is an effective way for undergraduate nursing students to promote their moral sensitivity and the ability to make ethical decisions. (shrink)

The present study aimed to reflect on the predictive role of socio-demographic characteristics (SDCs), moral sensitivity (MS) and moral distress (MD) in nurses’ ageism toward older adults. A total of 145 nurses were recruited to complete the main research instruments, i.e. a Sociodemographic Information Form, the Tool for Evaluating Ageism in Nursing Care of Older People, the Moral Sensitivity Questionnaire and the Moral Distress Scale. The results of the study confirmed that gender and MS could predict nurses’ ageism toward older (...) adults. However, MD was not correlated with ageism. The results of the study could therefore contribute to the development of some strategies to improve nurses’ gerontological nursing knowledge and skills through continuing education. (shrink)

Background Ethical decision-making education in nursing can be taught effectively by combining different teaching models that support the visualisation of taught concepts and integrating theory into practice. Objectives The study aims to examine the effect of flipped and jigsaw learning models on ethical decision-making and ethical sensitivity in nursing. Research design We used a nested mixed design. A pretest-posttest single-group quasi-experimental design was used in the quantitative part, and a case study method was used in the qualitative part. Participants and (...) research context This study was conducted in fall semester with second-year nursing students who studied an ethics course for the first time, using two different collaborative learning models. In the quantitative part, ethical dilemma and ethical sensitivity scales were made as pre-test with 117 and post-test with 128 students. In the qualitative part, a semi-structured three focus group interviews was conducted with 16 students. Ethical considerations After obtaining the approval of the University’s ethics committee, the study was carried out after obtaining participants’ informed written and verbal consent. Findings Students’ perspectives changed positively after training. This was related to six cases in section A of the Ethical Dilemma Scale. In part B, Practical Consideration (PC) and Principled Thinking (PT) mean scores were similar, showing no significant difference. For Familiarity in section C, it was determined that 68.4% of students in the pre-test and 77.3% in the post-test were familiar with similar dilemmas. The ethical sensitivity scale’s total scores were in a similar range. In the qualitative stage, ethical decision-making, ethical sensitivity, ethical dilemma and the improvement process were obtained as a theme. Conclusions There was an increase in the level of ethical sensitivity and familiarity with ethical dilemmas of nursing students after education. Flipped and jigsaw learning models can be used for nursing ethics courses. (shrink)

This study examined the validity and reliability of a Turkish version of the Modified Moral Sensitivity Questionnaire for Student Nurses. After obtaining permission to adapt the MMSQSN into Turkish, the translation/back-translation method was used with expert opinions to determine content validity. Factor analysis was conducted to examine the construct validity and test–retest was performed on the questionnaire to determine reliability. Cronbach’s alpha coefficients were calculated to assess for internal consistency. Participants included 272 baccalaureate degree student nurses who took ethics lessons (...) prior to their clinical internship. The factor analysis revealed that even though the factor structure in the original scale was the same, relevant items were categorized with similar components, and factor loads were sufficient. The correlation coefficient in the analyses of test–retest scores was.66 for the total scale and the Cronbach’s alpha was.73 for the total scale. The translated MMSQSN is a valid and reliable measure of ethical sensitivity in student nurses in Turkey. (shrink)

Objective:To describe the professional values of the nurse lectures according to 241 nursing students, who participated voluntarily, in three different universities of Bogotá.Methodology:This is a quantitative, descriptive cross-sectional study that applied the Nurses Professional Values Scale—permission secured—Spanish; three dimensions of values were applied: ethics, commitment, and professional knowledge.Ethical consideration:Project had ethical review and approval from an ethics committee and participants were given information sheets to read before they agreed to participate in the project.Findings:It was concluded that nursing students, in general, (...) do perceive these values in their professors, and they give priority to the dimension of ethics, followed by the knowledge dimension, and finally, commitment.Discussion:It is evident that professional values are transmitted by professors and students place importance to such values. Values related to the other’s care are paramount in nursing training in Colombia as well as in other countries.Conclusion:It was found that participating students observed professors directly in relation to values focused on direct patient care, respect for privacy, respect for life, while matters related to professional improvement, participation in unions were not actually analyzed may be due to poor promotion activities and unions during undergraduate studies. The results obtained are primary approach to the study of values related to nursing, a topic which needs to be researched, something vital to all the country offering nursing training programs. (shrink)

Background:The Taiwan Nursing Accreditation Council has proposed eight core professional nursing qualities including ethical literacy. Consequently, nursing ethics education is a required course for student nurses. These courses are intended to improve the ethical literacy. Moral sensitivity is the cornerstone of ethical literacy, and learning moral sensitivity is the initial step towards developing ethical literacy.Objectives:To explore the effect of nursing ethics educational interventions based on multiple teaching strategies on student nurses moral sensitivity. Based on the visual, auditory and kinaesthetic model, (...) three strategies were developed for determining the programme components and corresponding learning styles.Research design:This was a quasi-experimental study.Participants:A total of 234 junior-college student nurses participated in this study. All participants were aged 18–19 years.Ethical considerations:The study protocol was approved by the institutional review boards of Kaohsiung Veterans General Hospital. Only the participants who signed an informed consent form took part in the study. The participants were permitted to withdraw from the study at any point if they wished to do so without affecting their academic score.Results:The scores of Modified Moral Sensitivity Questionnaire for Student Nurses were significantly improved after the intervention of integrating multiple teaching strategies. Significant relationships were observed between the satisfaction scores of two teaching strategies and moral sensitivity. The results indicated that using multiple teaching strategies is effective for promoting nursing ethics learning.Conclusion:This strategy was consistent with the student nurses’ preferred learning style and was used to correct their erroneous ethical conceptions, assisting in developing their ethical knowledge. (shrink)

Background Moral sensitivity and academic integrity discernment hold paramount importance for healthcare professionals. Owing to distinct undergraduate educational backgrounds, nurses and physicians may exhibit divergent moral perspectives, academic integrity cognisance, and moral sensitivity within clinical environments. A limited number of studies have investigated the disparities and congruencies pertaining to moral sensitivity and academic ethical awareness among nursing and medical students. Objective The study compares moral sensitivity and academic ethical awareness of undergraduate nursing and medical students with and without clinical exposure. (...) Research design A self-administered cross-sectional survey conducted from January to February 2022 was used to collect data from a medical school in Hong Kong. Participants and research context A total of 545 respondents, including 137 nursing students and 408 medical students, completed the questionnaire. Ethical consideration Ethics approval of the study was obtained. Written consent was waived to maintain anonymity because completing the questionnaire was considered implied consent. Findings Both groups of undergraduates demonstrated a high level of bioethics knowledge. In terms of academic integrity, medical students were found to have a less concerned attitude towards punctuality, attendance, and skipping classes. Regarding moral sensitivity, senior medical students with clinical experience put less emphasis on decision-making involving patient participation, while senior nursing students were more hesitant in withholding treatment for incompetent patients who refused treatment. Both nursing and medical students showed decreased moral sensitivity in the ‘conflicts’ domain with increased clinical exposure. Conclusion Study findings contribute to the discussion comparing the ethical attitudes of nursing and medical students. More effort should be made in nursing and medical education to promote practices in line with high academic integrity and to develop the ability to be morally sensitive in professional settings. (shrink)

Background Ethical decision‑making and behavior of nurses are major factors that can affect the quality of nursing care. Moral development of nurses to making better ethical decision-making is an essential element for managing the care process. The main aim of this study was to examine and comparison the effect of training in ethical decision-making through lectures and group discussions on nurses’ moral reasoning, moral distress and moral sensitivity. Methods In this randomized clinical trial study with a pre- and post-test design, (...) 66 nurses with moral reasoning scores lower than the average of the community were randomly assigned into three equal groups (n = 22) including two experimental groups and one control group. Ethical decision-making training to experimental groups was provided through the lectures and group discussions. While, the control group did not receive any training. Data were collected using sociodemographic questionnaire, the nursing dilemma test (NDT), the moral distress scale (MDS) and the moral sensitivity questionnaire (MSQ). Unadjusted and adjusted binary logistic regression analysis was reported using the odds ratio (OR) and 95% confidence intervals. Results Adjusted regression analysis showed that the probability of increasing the nursing principle thinking (NPT) score through discussion training was significantly higher than lecture (OR: 13.078, 95% CI: 3.238–15.954, P = 0.008), as well as lecture (OR: 14.329, 95% CI: 16.171–2.005, P < 0.001) and discussion groups compared to the control group (OR: 18.01, 95% CI: 22.15–5.834, P < 0.001). The possibility of increasing moral sensitivity score through discussion training was significantly higher than lecture (OR: 10.874, 95%CI: 6.043–12.886, P = 0.005) and control group (OR: 13.077, 95%CI: 8.454–16.774, P = 0.002). Moreover, the moral distress score was significantly reduced only in the trained group compared to the control, and no significant difference was observed between the experimental groups; lecture group vs. control group (OR: 0.105, 95% CI: 0.015–0.717, P = 0.021) and discussion group vs. control group (OR: 0.089, 95% CI: 0.015–0.547, P = 0.009). Conclusions The results of this study indicate that ethical decision-making training is effective on empowerment of ethical reasoning. Whereas the group discussion was also effective on increasing the ethical sensitivity, it is recommended the training plan provided in this study to be held as workshop for all nurses in health and treatment centers and placed in curricular plan of nursing students. Registration This randomized clinical trial was registered in Iranian Registry of Clinical Trials under code (IRCT2015122116163N5) in 02/07/2016. (shrink)

BackgroundValue sensitivity – the ability to recognize value-related issues when they arise in practice – is an indispensable competence for medical practitioners to enter decision-making processes related to ethical questions. However, the psychological competence of value sensitivity is seldom an explicit subject in the training of medical professionals. In this contribution, we outline the traditional concept of moral sensitivity in medicine and its revised form conceptualized as value sensitivity and we propose an instrument that measures value sensitivity.MethodsWe developed an instrument (...) for assessing the sensitivity for three value groups in a four step procedure: 1) value identification ; 2) value representation ; 3) vignette construction and quality evaluation ; and 4) instrument validation by comparing nursing professionals with hospital managers.ResultsWe find that nursing professionals recognize and ascribe importance to principle-related issues more than professionals from hospital management. The latter are more likely to recognize and ascribe importance to strategy-related issues.ConclusionsThese hypothesis-driven results demonstrate the discriminatory power of our newly developed instrument, which makes it useful not only for health care professionals in practice but for students and people working in the clinical context as well. (shrink)

Background Nurses frequently experience ethical issues in their area of practice. In the challenging reality of today’s healthcare environment, nursing students need to be prepared to deal with ethical issues in their future roles. Nevertheless, Chinese nursing students’ ethical sensitivity status and the factors influencing it have not been described. Objective This study aims to explore the level of ethical sensitivity and its influencing factors among Chinese nursing students. Research design This was a cross-sectional study. We firstly cross-culturally adapted the (...) Japanese version of the Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS) into a Chinese version. Then, we administered the Chinese version of ESQ-NS, the Caring Ability Inventory (CAI), and general information questionnaire to nursing undergraduates. Participants and research context The invitations were sent to 600 nursing undergraduates from four universities in Hunan, China. Ethical considerations The study was supported by the Institutional Review Board (IRB) of the lead university. The Approval No. was E202092. Results A total of 489 undergraduate nursing students participated in the study. The mean score for ethical sensitivity of the samples was 36.34 ± 4.90, and 187.99 ± 22.64 for their humanistic care ability. Pearson’s correlation coefficient test indicated a meaningful and positive relationship between the ethical sensitivity and humanistic care ability (r = 0.576 and p <.01). And regression analysis showed that age, school year, experience in studying nursing ethics, how much you like nursing major, and humanistic care ability were of relevance to nursing students' ethical sensitivity. Discussion Our findings suggest that the mean ethical sensitivity score of Chinese nursing students is 36.34 (13–52). The humanistic caring ability of Chinese nursing students is still at a low level. Conclusion Future interventions for improving the ethical sensitivity of the nursing students should consider general information of participants and their humanistic care ability. (shrink)

This study was carried out to determine the ethical sensitivity levels of students enrolled in the nursing faculty. The sample of the descriptive study consisted of 594 students who were taught at the Faculty of Nursing in February - May 2018 and agreed to participate in the study. The data were collected by Personal Information Form prepared by researchers to evaluate the demographic characteristics of students and The Modified Moral Sensitivity Questionnaire for Student Nurses. The data obtained from the application (...) were analyzed using SPSS for Windows 23.0 program. The majority of the students (75.9%) participating in the study were women and 74.9% stated that they internalized the profession. The total score average of The Modified Moral Sensitivity Questionnaire for Student Nurses is 4.93 ± 0.49. While the lowest average score in all classes is “Experiencing Ethical Dilemma” sub-dimension, the highest average score is in the “Interpersonal Orientation” sub-dimension. It is the 3 rd year student with the highest average score received from the scale. It was determined that the ethical sensitivity of the nursing students was medium and there was a significant difference between the ethical sensitivity levels of the students between the classes. It is thought that ensuring the continuity of the ethical education of the nursing students will be effective in increasing the awareness of the students on the subject. For this reason, it is recommended to integrate ethical issues in all courses in the structuring of nursing education curriculum programs. (shrink)

Background:Moral distress, moral sensitivity, and moral courage among healthcare professionals have been explored considerably in recent years. However, there is a paucity of studies exploring these topics among baccalaureate nursing students.Aim/objective:The purpose of this study was to explore the relationship between and among moral distress, moral sensitivity, and moral courage of undergraduate baccalaureate nursing students.Research design:The research employed a descriptive-correlational design to explore the relationships between and among moral distress, moral sensitivity, and moral courage of undergraduate nursing students.Participants and research (...) context:A total of 293 baccalaureate Filipino nursing students who have been exposed to various clinical areas participated in the study.Ethical considerations:Institutional review board approval was sought prior to the conduct of the study. Self-determination was assured and anonymity and confidentiality were guaranteed to all participants.Findings:Results indicate that a majority of the nursing students in the clinical areas encounter morally distressing situations that compromise quality patient care. However, despite the fact that they want to do what is in the best interest of their patients, their perception of being the inexperienced among the healthcare team drives the majority of them to ignore morally distressing situations to avoid conflict and confrontation. Another interesting finding is that 79.20% of the respondents hardly consider quitting the nursing profession even if they frequently encounter morally distressing situations. Analysis also shows associations between moral distress intensity and frequency ( r = 0.13, p < 0.05) and moral distress intensity and moral sensitivity ( r = 0.25, p < 0.05). The dimensions of moral courage are also related to both moral distress and moral sensitivity.Conclusion:Results of the study imply that moral distress is a reality among all healthcare professionals including nursing students and requires more consideration by nurse educators. (shrink)

Providing effective care to patients and making the right decisions in difficult working environments depend on moral sensitivity. Emotional intelligence and ethical sensitivity affect nursing care. This study aimed to investigate the relationship between nursing students’ emotional intelligence and ethical sensitivity levels. The research employed a descriptive-correlational design, 201 nursing students studying at a university in the Central Anatolia region, Turkey, participated in the study. Students’ ethical sensitivity was found to be significant. The nursing students received the highest score in (...) the “Interpersonal Orientation” sub-dimension of the Moral Sensitivity Scale, while their lowest score was observed in the “Experiencing ethical dilemma” sub-dimension. The SSREIT and MMSQSN total scores of the students who willingly chose the nursing department and loved their field were found to be higher. It was found that the ethical sensitivity of nursing students was at a significant level and gender, family type, having sibling and perception of economic status affected the level of ethical sensitivity. (shrink)