BackgroundMoral distress (MD) is the psychological damage caused when people are forced to witness or carry out actions which go against their fundamental moral values. The main objective was to evaluate the prevalence and predictive factors associated with MD among health professionals during the pandemic and to determine its causes.MethodsA regional, observational and cross-sectional study in a sample of 566 professionals from the Public Health Service of Andalusia (68.7% female; 66.9% physicians) who completed the MMD-HP-SPA scale to determine the level (...) of MD (0-432 points). Five dimensions were used: i) Health care; ii) Therapeutic obstinacy-futility, iii) Interpersonal relations of the Healthcare Team, iv) External pressure; v) Covering up of medical malpractice.ResultsThe mean level of MD was 127.3 (SD=66.7; 95% CI 121.8-132.8), being higher in female (135 vs. 110.3; p<0.01), in nursing professionals (137.8 vs. 122; p<0.01) and in the community setting (136.2 vs. 118.3; p<0.001), with these variables showing statistical significance in the multiple linear regression model (p<0.001; r2=0.052). With similar results, the multiple logistic regression model showed being female was a higher risk factor (OR=2.27; 95% CI 1.5-3.4; p<0.001). 70% of the sources of MD belonged to the dimension "Health Care" and the cause "Having to attend to more patients than I can safely attend to" obtained the highest average value (Mean=9.8; SD=4.9).ConclusionsFemale, nursing professionals, and those from the community setting presented a higher risk of MD. The healthcare model needs to implement an ethical approach to public health issues to alleviate MD among its professionals. (shrink)

Background: Moral sensitivity has been identified as a foundational component of ethical action. Diminished or absent moral sensitivity can result in deficient care. In this context, assessing moral sensitivity is imperative for designing interventions to facilitate ethical practice and ensure that nurses make appropriate decisions. Objective: The main purpose of this study was to validate a scale for examining the moral sensitivity of Brazilian nurses. Research design: A pre-existing scale, the Moral Sensitivity Questionnaire, which was developed by Lützén, was used (...) after the deletion of three items. The reliability and validity of the scale were examined using Cronbach’s alpha and factor analysis, respectively. Participants and research context: Overall, 316 nurses from Rio Grande do Sul, Brazil, participated in the study. Ethical considerations: This study was approved by the Ethics Committee of Research of the Nursing School of the University of São Paulo. Findings: The Moral Sensitivity Questionnaire contained 27 items that were distributed across four dimensions: interpersonal orientation, professional knowledge, moral conflict and moral meaning. The questionnaire accounted for 55.8% of the total variance, with Cronbach’s alpha of 0.82. The mean score for moral sensitivity was 4.45 (out of 7). Discussion and conclusion: The results of this study were compared with studies from other countries to examine the structure and implications of the moral sensitivity of nurses in Brazil. The Moral Sensitivity Questionnaire is an appropriate tool for examining the moral sensitivity of Brazilian nurses. (shrink)

Background: The global COVID-19 pandemic has imposed challenges on healthcare systems and professionals worldwide and introduced a ´maelstrom´ of ethical dilemmas. How ethically demanding situations are handled affects employees’ moral stress and job satisfaction. Aim: Describe priority-setting dilemmas, moral distress and support experienced by nurses and physicians across medical specialties in the early phase of the COVID-19 pandemic in Western Norway. Research design: A cross-sectional hospital-based survey was conducted from 23 April to 11 May 2020. Ethical considerations: Ethical approval granted (...) by the Regional Research Ethics Committee in Western Norway (131421). Findings: Among the 1606 respondents, 67% had experienced priority-setting dilemmas the previous two weeks. Healthcare workers who were directly involved in COVID-19 care, were redeployed or worked in psychiatry/addiction medicine experienced it more often. Although 59% of the respondents had seen adverse consequences due to resource scarcity, severe consequences were rare. Moral distress levels were generally low (2.9 on a 0–10 scale), but higher in selected groups (redeployed, managers and working in psychiatry/addiction medicine). Backing from existing collegial and managerial structures and routines, such as discussions with colleagues and receiving updates and information from managers that listened and acted upon feedback, were found more helpful than external support mechanisms. Priority-setting guidelines were also helpful. Discussion: By including all medical specialties, nurses and physicians, and various institutions, the study provides information on how the COVID-19 mitigation also influenced those not directly involved in the COVID-19 treatment of patients. In the next stages of the pandemic response, support for healthcare professionals directly involved in outbreak-affected patients, those redeployed or those most impacted by mitigation strategies must be a priority. Conclusion: Empirical research of healthcare workers experiences under a pandemic are important to identify groups at risks and useful support mechanisms. (shrink)

There is considerable variability across people in their punitive responses to employee offenses in the workplace. We attempt to explain this variability by positing a novel antecedent of punishment: moral recognition. We find consistent evidence that identifying moral considerations and implications for workplace offenses predicts punitive responses toward employees who commit those offenses. Drawing on functional theoretical accounts of morality and punishment, we posit that people are motivated to punish others to the extent that they believe a moral offense has (...) been committed, because much of what it means to commit a moral offense (as opposed to a non-moral offense) is to act in a way that prevents, or inhibits, cooperative behavior to achieve social goals. Punishment can discourage group members from committing those offenses in the future, thereby regulating behavior in a way that facilitates cooperation and social cohesion. We offer correlational and causal evidence that the link between moral recognition and punishment is explained, in part, by participants’ beliefs that committing these offenses prevents cooperative behavior to achieve organization-related goals. (shrink)

Background: Nursing practice is complex, as nurses are challenged by increasingly intricate moral and ethical judgments. Inadequately studied in underrepresented groups in nursing, moral distress is a serious problem internationally for healthcare professionals with deleterious effects to patients, nurses, and organizations. Moral distress among nurses has been shown to contribute to decreased job satisfaction and increased turnover, withdrawal from patients, physical and psychological symptoms, and intent to leave current position or to leave the profession altogether. Research question: Do significant gender (...) differences exist in the moral distress scores of critical care nurses? Research design: This study utilized a quantitative, descriptive methodology to explore moral distress levels in a sample of critical care nurses to determine whether gender differences exist in their mean moral distress scores. Participants and research context: Participants ( n = 31) were critical care nurses from an American Internet nursing community who completed the Moral Distress Scale–Revised online over a 5-day period in July 2013. Ethical considerations: Institutional review board review approved the study, and accessing and completing the survey implied informed consent. Findings: The results revealed a statistically significant gender difference in the mean moral distress scores of participants. Females reported statistically significantly higher moral distress scores than did males. Overall, the moral distress scores for both groups were relatively low. Discussion: The findings of a gender difference have not previously been reported in the literature. However, other findings are consistent with previous studies on moral distress. Conclusion: Although the results of this study are not generalizable, they do suggest the need for continuing research on moral distress in underrepresented groups in nursing, including cultural and ethnic groups. (shrink)

A public accounting firm’s ethical environment has an important role in encouraging ethical behavior, but prior research has shown that firm leaders perceive the ethical environment of their firms to be stronger than do non-leaders : 637–654, 2010). This study draws on several research streams in management to investigate the reasons behind this discrepancy. Our online questionnaire was completed by 139 accounting professionals. We find that when non-leader accounting professionals believe that they have a meaningful role in shaping and maintaining (...) the ethical environment and/or have strong organizational fit with the accounting firm, they are more likely to perceive the ethical environment as strong and to perceive it similarly to firm leaders. That is, differences in leaders’ and non-leaders’ perceptions of the ethical environment are mediated by non-leaders’ perceptions of their role in participating in shaping and maintaining the ethical environment of their firms. Further, we find that among firm leaders, a stronger public interest orientation and a higher frequency of receiving mentoring are both associated with stronger perceptions of the ethical environment. Overall, our study is one of the first to directly test potential explanations for why firm leaders and non-leaders can have disparate views of a firm’s ethical environment. In addition, these findings provide practical feedback to practitioners on actions they can take to improve perceptions of their firms’ ethical environment. (shrink)

Background: Today’s healthcare environment is often characterized by an ethically demanding work situation, and nursing students need to prepare to meet ethical challenges in their future role. Moral sensitivity is an important aspect of the ethical decision-making process, but little is known regarding nursing students’ moral sensitivity and its possible development during nursing education. Objectives: The aims of this study were to investigate moral sensitivity among nursing students, differences in moral sensitivity according to sample sub-group, and the relation between demographic (...) characteristics of nursing students and moral sensitivity. Research design: A convenience sample of 299 nursing students from one university completed a questionnaire comprising questions about demographic information and the revised Moral Sensitivity Questionnaire. With the use of SPSS, non-parametric statistics, including logistic regression models, were used to investigate the relationship between demographic characteristics and moral sensitivity. Ethical considerations: The study followed the regulations according to the Swedish Ethical Review Act and was reviewed by the Ethics Committee of South-East Sweden. Findings: The findings showed that mean scores of nursing students’ moral sensitivity were found in the middle to upper segment of the rating scale. Multivariate analysis showed that gender (odds ratio = 3.32), age (odds ratio = 2.09; 1.73), and parental status (odds ratio = 0.31) were of relevance to nursing students’ moral sensitivity. Academic year was found to be unrelated to moral sensitivity. Discussion and conclusion: These demographic aspects should be considered when designing ethics education for nursing students. Future studies should continue to investigate moral sensitivity in nursing students, such as if and how various pedagogical strategies in ethics may contribute to moral sensitivity in nursing students. (shrink)

Gender is one of the most researched and contentious topics in consumer ethics research. It is common for researchers of gender studies to presume that women are more ethical than men because of their reputation for having a selfless, sensitive nature. Nevertheless, we found evidence that women behaved less ethically than men in two field experiments testing a passive form of unethical behavior. Women benefited to a larger extent from a cashier miscalculating the bill in their favor than men. However, (...) in three follow-up studies, we found that women did not necessarily intend to benefit at the expense of someone else. Women are less prone to speak up to a cashier than men are, even when the mistake is made in their disfavor. These results reveal that gender differences in assertiveness affect differences in unethical behavior. (shrink)

One of the key learning objectives in any health professional course is to develop ethical and judicious practice. Therefore, it is important to address how medical and pharmacy students respond to, and deal with, ethical dilemmas in their clinical environments. In this paper, we examined how students communicated their resolution of ethical dilemmas and the alignment between these communications and the four principles developed by Beauchamp and Childress. Three hundred and fifty-seven pharmacy and medical students (overall response rate=63%) completed a (...) questionnaire containing four clinical case scenarios with an ethical dilemma. Data were analysed using multiple methods. The findings revealed that 73% of the qualitative responses could be exclusively coded to one of the ‘four principles’ determined by the Beauchamp and Childress' framework. Additionally, 14% of responses overlapped between the four principles (multiple codes) and 13% of responses could not be coded using the framework. The subsequent subgroup analysis revealed different response patterns depending on the case being reviewed. The findings showed that when students are faced with challenging ethical dilemmas their responses can be aligned with the Beauchamp and Childress framework, although more contentious dilemmas involving issues of law are less easily categorised. The differences between year and discipline groups show students are developing ethical frames of reference that may be linked with their teaching environments and their levels of understanding. Analysis of these response patterns provides insight into the way students will likely respond in ‘real’ settings and this information may help educators prepare students for these clinical ethical dilemmas. (shrink)

This study explores the association between different types of morally challenging interactions during military deployment and response strategies, as well as the mediating role of moral emotions. Interviews with Dutch servicemen who participated in military operations were content coded. We found a relationship between local-cultural and team-related interactions and moral justification; these effects were mediated by other-condemning emotions. Similarly, other-condemning emotions mediated the relationship between local-cultural interactions and relativism. This study points at the importance of other-condemning emotions in shaping military (...) reactions to frequently occurring morally challenging interactions. (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)