Health care often involves ethically difficult situations that may disquiet the conscience. The purpose of this study was to develop a questionnaire for identifying various perceptions of conscience within a framework based on the literature and on explorative interviews about perceptions of conscience (Perceptions of Conscience Questionnaire). The questionnaire was tested on a sample of 444 registered nurses, enrolled nurses, nurses’ assistants and physicians. The data were analysed using principal component analysis to explore possible dimensions of perceptions of conscience. The (...) results showed six dimensions, found also in theory and empirical health care studies. Conscience was perceived as authority, a warning signal, demanding sensitivity, an asset, a burden and depending on culture. We conclude that the Perceptions of Conscience Questionnaire is valid for assessing some perceptions of conscience relevant to health care providers. (shrink)

Background: High ethical sensitivity positively affects the quality of nursing care; nevertheless, Chinese nurses’ ethical sensitivity and the factors influencing it have not been described. Research objectives: The purpose of this study was to describe ethical sensitivity and to explore factors influencing it among Chinese-registered nurses, to help nursing administrators improve nurses’ ethical sensitivity, build harmony between nurses and patients, and promote the patients’ health. Research design: This was a descriptive, cross-sectional study. Participants and research context: We recruited 500 nurses (...) from several departments in three tertiary hospitals. The Chinese Moral Sensitivity Questionnaire–Revised version and the Jefferson Scale of Empathy-Health Professionals were used to assess the nurses’ ethical sensitivity and empathy ability, respectively. Fifteen sociodemographic variables were included in the questionnaires. Ethical considerations: Informed consent was obtained from the participants regarding participation and data storage and handling. This program has been examined and supported by the research center of medical ethics and professional ethics of Guilin Medical University. The Approval No. was 2016RWYB04. The whole research process is conducted strictly according to ethical requirements. Results: The valid response rate was 84.40%. The total score of Chinese Moral Sensitivity Questionnaire–Revised was 35.82 ± 8.17. The subscale scores of moral responsibility and strength and sense of moral burden were 21.50 ± 4.91 and 14.33 ± 3.98, respectively. Significant differences were found among age groups, gender, years of working, category of profession, and quality of family communication regarding nurses’ ethical sensitivity. Regression analysis showed that the main factors influencing nurses’ ethical sensitivity were gender, years of working, quality of family communication, career satisfaction, and empathic ability. Discussion: Our findings suggest that Chinese nurses’ ethical sensitivity in tertiary hospitals in Guilin is at a medium level. Conclusion: The director of nursing schools and hospitals in China should pay attention to nurses’ ethical sensitivity and should intensify education and training to improve nurses’ ethical sensitivity. Further studies should focus on interventions aimed at improving Chinese nurses’ ethical sensitivity. (shrink)

This theoretical paper proposes a new perspective to understand the moral distress of nurses more fully, using virtue ethics. Moral distress is a widely studied subject, especially with respect to the determination of its causes and manifestations. Increasing the theoretical depth of previous work using ethical theory, however, can create new possibilities for moral distress to be explored and analyzed. Drawing on more recent work in this field, we explicate the conceptual framework of the process of moral distress in nurses, (...) proposed by Ramos et al., using MacIntyrean virtue ethics. Our analysis considers the experience of moral distress in the context of a practice, enabling the adaptation of this framework using virtue ethics. The adoption of virtue ethics as an ethical perspective broadens the understanding of the complexity of nurses’ experiences of moral distress, since it is impossible to create a ready model that can cover all possibilities. Specifically, we describe how identity, social context, beliefs, and tradition shape moral discomfort, uncertainty, and sensitivity and how virtues inform moral judgments. Individuals, such as nurses, who are involved in a practice have a narrative history and a purpose ( telos) that guide them in every step of the process, especially in moral judgment. It is worth emphasizing that the process described is supported by the formation of moral competence that, if blocked, can lead to moral distress and deprofessionalization. It is expected that nurses seek to achieve the internal good of their practice, which legitimizes their professional practice and supports them in moral decision-making, preventing moral distress. (shrink)

Moral distress has been characterised as one of the main ethical problems affecting nurses in all health systems, and has been depicted as a threat to nurses’ integrity and to the quality of patient care. In recent years, several studies tried to investigate moral distress, its causes and consequences for health professionals, clients and organisations. However, such studies are considered controversial and vulnerable, mainly because they lack a solid philosophical and empirical basis. The present article aimed at elaborating a theoretical (...) model for moral distress, considering the process of moral deliberation, spaces of power and resistance and patient advocacy, and sought to carry out a reflection that culminated with the creation of a broader concept of moral distress. (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)

Background Cardiopulmonary Resuscitation (CPR) is one of the areas in which moral issues are of great significance, especially with respect to the nursing profession, because CPR requires quick decision-making and prompt action and is associated with special complications due to the patients’ unconsciousness. In such circumstances, nurses’ ability in terms of moral sensitivity can be determinative in the success of the procedure. Identifying the components of moral sensitivity in nurses in this context can promote moral awareness and improve moral performance. (...) Objective This study was conducted to explore and identify the experiences of critical care nurses about moral sensitivity components in CPR. Research design and methods This study was implemented with a qualitative approach. Data were collected via 22 in-depth semi-structured interviews held with 20 eligible participants with maximum variation. The data were then analyzed using the grounded theory approach. Participants and research context In total, thirteen clinical nurses, three head nurses, two educational supervisors, and two faculty members from different universities of Iran were interviewed. Ethical considerations This study was conducted with the ethical approval (IR.UMSU.REC.1399.337) of the Ethics Committee of Urmia University of Medical Sciences. Findings Four themes and 12 sub-themes were extracted from the analysis of the data, including “Consciously and compassionate attention to resuscitate the patient,” “Awareness of families’ anxiety,” “Understanding the teamwork and interactive guidance of the CPR process,” and “Compulsory violation of moral principles.” Discussion It is anticipated that this discussion will prompt further debate, raise awareness and help clarify the dimensions of moral sensitivity in unconscious patients especially during CPR, so that it can be more clearly named and defended as a moral authority in CPR. Conclusion identifying the components of moral sensitivity in nurses, facilitates their encounter with moral issues and can improve their moral performance and encourage right decisions. (shrink)

The aim of the present study was to investigate the association between work-related moral stress, moral climate and moral sensitivity in mental health nursing. By means of the three scales Hospital Ethical Climate Survey, Moral Sensitivity Questionnaire and Work-Related Moral Stress, 49 participants’ experiences were assessed. The results of linear regression analysis indicated that moral stress was determined to a degree by the work place’s moral climate as well as by two aspects of the mental health staff’s moral sensitivity. The (...) nurses’ experience of ‘moral burden’ or ‘moral support’ increased or decreased their experience of moral stress. Their work-related moral stress was determined by the job-associated moral climate and two aspects of moral sensitivity. Our findings showed an association between three concepts: moral sensitivity, moral climate and moral stress. Despite being a small study, the findings seem relevant for future research leading to theory development and conceptual clarity. We suggest that more attention be given to methodological issues and developing designs that allow for comparative research in other disciplines, as well as in-depth knowledge of moral agency. Copyright © 2011 by SAGE Publications. (shrink)

Although organizational and situational factors have been found to predict burnout, not everyone employed at the same workplace develops it, suggesting that becoming burnt out is a complex, multifaceted phenomenon. The aim of this study was to elucidate perceptions of conscience, stress of conscience, moral sensitivity, social support and resilience among two groups of health care personnel from the same workplaces, one group on sick leave owing to medically assessed burnout (n = 20) and one group who showed no indications (...) of burnout (n = 20). The results showed that higher levels of stress of conscience, a perception of conscience as a burden, having to deaden one’s conscience in order to keep working in health care and perceiving a lack of support characterized the burnout group. Lower levels of stress of conscience, looking on life with forbearance, a perception of conscience as an asset and perceiving support from organizations and those around them (social support) characterized the non-burnout group. (shrink)

The main purpose of this study was to validate a scale to examine the moral sensitivity of Korean nurses. A pre-existing scale, the Moral Sensitivity Questionnaire (MSQ), developed by Lützén, was used after deletion of three items. The reliability and validity of the scale were examined by using Cronbach’s alpha and factor analysis, respectively. According to the results, reliability of the scale was adequate but its construct validity was not fully supported. Through discussion on evidence of validity, five subconstructs emerged. (...) In particular, unlike the factor structure of the MSQ, two subconstructs, patient-oriented care and professional responsibility, were newly extracted. It was assumed that the other three MSQ subconstructs, conflict, meaning and benevolence (expressed as nurses being ethically good), would not be sensitive to cultural background. Given these findings, interpretations about the meaning of moral sensitivity of Korean nurses are discussed. (shrink)

Background Caring behaviour is critical for nursing quality, and the clinical internship environment is a crucial setting for preparing nursing students for caring behaviours. Evidence about how to develop nursing students’ caring behaviour in the clinical environment is still emerging. However, the mechanism between the clinical internship environment and caring behaviour remains unclear, especially the mediating role of moral sensitivity and the moderating effect of self-efficacy. Research objective This study aimed to examine the mediating effect of moral sensitivity and the (...) moderating function of self-efficacy on the association between the clinical internship environment and caring behaviours. Research design A cross-sectional design used acceptable validity scales. The hypothesised moderated mediation model was tested in the SPSS PROCESS macro. Participants and research context This survey collected data from 504 nursing students in an internship at a teaching hospital in Changsha, China. Ethical considerations This study was pre-approved by the ethics committee of the medical school (No. E2022210). Informed consent was obtained from all students. Results The clinical internship environment ( B = 0.450, 95% CI = [0.371, 0.530]) and moral sensitivity ( B = 1.352, 95% CI = [1.090, 1.615]) had positive direct effects on nursing students' caring behaviours. Clinical internship environment also indirectly influenced students’ caring behaviours via moral sensitivity ( B = 0.161, 95% CI = [0.115, 0.206]). In addition, self-efficacy played a moderating role between the clinical internship environment and caring behaviours ( B = 0.019, 95% CI = [0.007, 0.031]), as well as the relationship between the clinical internship environment and moral sensitivity ( B = 0.006, 95% CI = [0.003, 0.010]). Conclusion Moral sensitivity mediates the effect of the clinical internship environment on caring behaviour, and self-efficacy strengthens both direct and indirect effects. This study emphasises the importance of self-efficacy in developing moral sensitivity and caring behaviours in nursing students. (shrink)

Background Hospital ethical climate has important implications for clinical nurses’ service behavior; however, the relationships are complicated by the fact that five types of ethical climate (caring, law and code, rules, instrumental, and independence) can be combined differently according to their level and shape differences. Recent developments in person-centered methods (e.g., latent profile analysis (LPA)) have helped to address these complexities. Aim From a person-centered perspective, this study explored the distinct profiles of hospital ethical climate and then examined the relationships (...) of the profiles with clinical nurses’ service behavior (both in-role and extra-role service behavior). Research design A quantitative study was conducted using cluster random sampling. Latent profile analysis and binary coded hexadecimal (BCH) analysis were conducted using Mplus 8.2. Participants and research context A total of 871 clinical nurses in China were surveyed using the Ethical Climate Scale and Nurses’ Service Behavior Questionnaire. Ethical considerations Ethical approval was obtained from the IRB of the First Affiliated Hospital of Jinan University (No. KY-2020-090). Results A four-profile hospital ethical climate model provided the best fit for the data. The four different profiles not only varied in level, but also in shape: high normative and low egoism (45.8%), high ethical climate (19.9%), low ethical climate (3.6%), and moderate ethical climate (30.8%). These profiles differentially predicted clinical nurses’ overall, in-role, and extra-role service behaviors. Conclusions The results reveal new insights into the nature of hospital ethical climate and how different clinical nurses in these profiles can be best managed to accomplish different forms of service behavior. (shrink)

Background: Nurses’ service behaviors have critical implications for hospitals. However, few studies had adequate ethical considerations of service behaviors and accounted for how organizational or individual antecedents can induce nurses to engage in service behaviors. In addition, they mainly focused on the one side of role-prescribed or extra-role service behavior. Objective: This study aims to explore the chained mediation effect of ethical climate and moral sensitivity on the relationship between organizational ethical leadership and nurses’ service behaviors and to examine the (...) relationship, from a comparative view, of the role-prescribed service behavior and extra-role service behavior. Methods: In all, 476 nurses from three tertiary hospitals were investigated with the Ethical Leadership Scale, Ethical Climate Scale, Moral Sensitivity Questionnaire and Service Behavior Questionnaire. Structural equation modeling was adopted to analyze the data. SPSS and Mplus statistical software was used in the data analysis. Ethical considerations: Approval was obtained from the Ethics Committee at School of Nursing, Hebei Medical University. Data privacy and confidentiality were maintained and assured by obtaining subjects’ informed consent to participate in the research before data collection. Results: The effects of ethical leadership on nurses’ service behaviors are mediated by two variables in turn: ethical climate and nurses’ moral sensitivity. Ethical climate and moral sensitivity partially mediated the relationship between ethical leadership and nurses’ role-prescribed service behavior and fully mediated the relationship between ethical leadership and nurses’ extra-role service behavior. Conclusion: Organizational ethical leadership positively affected ethical climate, which positively affected nurses’ moral sensitivity and affected both their role-prescribed service behavior and extra-role service behavior. (shrink)

Background: The three-dimensional model of nurses’ moral sensitivity has typically been studied using a variable-centered rather than a person-centered approach, preventing a more complete understanding of how these forms of moral sensitivity are expressed as a whole. Latent profile analysis is a person-centered approach that classifies individuals from a heterogeneous population into homogeneous subgroups, helping identify how different subpopulations of nurses use distinct combinations of different moral sensitivities to affect their service behaviors. Objective: Latent profile analysis was used to identify (...) three distinct profiles of nurses’ moral sensitivity. Associations of the profiles with service behaviors were then examined. Methods: Five hundred twenty-five nurses from three tertiary hospitals in China were investigated with Moral Sensitivity Questionnaire and Nurses’ Service Behavior Scale. Latent profile analysis was used to analyze the data. Ethical considerations: Approval was obtained from the Ethics committee for biomedical research of Medical College, the Hebei University of Engineering. Results: A three-profile moral sensitivity model provided the best fit to the data. The resulting profiles were low moral sensitivity, moderate moral sensitivity, and high moral sensitivity. There were significant differences in service behaviors among different profiles of moral sensitivity. Conclusion: The results provide a new and expanded view of nurses’ moral sensitivity, which may be used to monitor nurses’ service behaviors comprehensively and to evaluate nursing ethics management strategies. (shrink)

Background:While nursing ethics education is commonly provided for undergraduate nursing students in most nursing colleges, consensus on the content and teaching modules for these ethics courses have still not been established.Objectives:This study aimed to examine the effects of nursing ethics education on the moral sensitivity and critical thinking disposition of nursing students in Korea.Research design:A one-group pre- and post-test design was used. Moral sensitivity was measured using the Korean version of the Moral Sensitivity Questionnaire. Critical thinking disposition was measured using (...) the Critical Thinking Disposition Questionnaire.Participants and research context:Participants were 70 undergraduate nursing students who were attending a university located in Seoul, Korea. The nursing ethics education was provided 7 times, from September to December 2010, and comprised 90-min sessions each week.Ethical considerations:This study was conducted in accordance with the Human Subject Research Ethics Committee guidelines.Findings:After the education, the levels for the patient-oriented care, a sub-domain of moral sensitivity, and inquisitiveness, a sub-domain of critical thinking disposition, significantly improved. There were no changes in overall scores for moral sensitivity and critical thinking disposition. There were significant positive correlations between moral sensitivity and critical thinking disposition both pre- and post-intervention.Conclusion:These results reflect the need for ongoing efforts to develop innovative content, structure, and instructional methods for undergraduate nursing ethics education programs. (shrink)

Little is known about the consequences of moral distress. The purpose of this study was to identify clinical situations that caused nurses to experience moral distress, to understand the consequences of those situations, and to determine whether nurses would change their practice based on their experiences. The investigation used a descriptive approach. Open-ended surveys were distributed to a convenience sample of 204 critical care nurses employed at a university medical center. The analysis of participants’ responses used an inductive approach and (...) a thematic analysis. Each line of the data was reviewed and coded, and the codes were collapsed into themes. Methodological rigor was established. Forty-nine nurses responded to the survey. The majority of nurses had experienced moral distress, and the majority of situations that caused nurses to experience moral distress were related to end of life. The nurses described negative consequences for themselves, patients, and families. (shrink)

Objective:The purpose of this study was to describe the current situation of moral distress and to explore its influencing factors among Chinese nurses.Methods:This is an exploratory, descriptive design study. A total of 465 clinical nurses from different departments in three Grade-III, Level-A hospitals in Jinan, Shandong Province, completed the questionnaires, including demographics questionnaire, Chinese version of Moral Distress Scale–Revised, and Job Diagnostic Survey.Ethical considerations:The study was approved by the university ethics board and the local health service director.Results:The total score of (...) Moral Distress Scale–Revised was 36.01 ± 24.02 points. The mean frequency and intensity scores of moral distress were 1.13 ± 0.49 and 1.09 ± 0.58, respectively. The level of moral distress among Chinese clinical nurses was low, and the frequency and intensity of moral distress were on low to moderate level. The level of moral distress experienced by clinical nurses is associated with demographics features and job characteristics, including age, education degree, department, task significance, autonomy, and dealing with others.Conclusion:Our conclusion suggests that hospital and organizational administrations should attach much importance to the moral distress experienced by clinical nurses in China. Further studies should focus on interventions about how to reduce the levels of the frequency and intensity of moral distress among clinical nurses. (shrink)

We acknowledge the limitations in measures of moral reasoning and pursue an alternative technique by investigating past behaviors as they relate to present behavioral intentions. Our purpose is to evaluate the merits of patterned normative behavior for predicting present and future, morally relevant outcomes. Participants completed a policy capturing experimental design responding to questions that orthogonally varied the situational nature of the decision context. Results indicate that past normative behaviors are significantly and directly related to ethical behavioral intentions. Moreover, they (...) moderate the relationships between situational factors and intended outcomes as well as moral reasoning and intended outcomes. (shrink)

The present study aimed at investigating the relationship between environmental and individual factors and Stress of Conscience among nursing staff in psychiatric in-patient care. A questionnaire involving six different instruments measuring Stress of Conscience, the ward atmosphere, the psychosocial work environment, Perceived Stress, Moral Sensitivity, and Mastery was answered by 93 nursing staff at 12 psychiatric in-patient wards in Sweden. The findings showed that Sense of Moral Burden, Mastery, Control at Work and Angry and Aggressive Behavior were related to Stress (...) of Conscience. We conclude that Mastery and Control at Work seemed to work as protective factors, while Sense of Moral Burden and perceptions of Angry and Aggressive Behavior made the nursing staff more vulnerable to Stress of Conscience. Future research should investigate whether measures to increase the level of perceived control and being part of decision making will decrease the level of Stress of Conscience among the staff. (shrink)

Ten nurses at a university hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of nurses and physicians about being in ethically difficult situations in surgical units. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation. The main theme in the narratives was being close to and moved by the suffering of patients and relatives. The nurses' responsibility for patients and relatives was expressed as a commitment to act, and they needed to ask themselves (...) whether their responsibility had been fulfilled, that nothing had been left undone, overlooked or neglected, before they could leave the unit. When there was confirmation by the patients, relatives, colleagues and themselves that the needs of patients and relatives had been attended to in a morally and professionally satisfying manner, this increased the nurses' confidence and satisfaction in their work, and their strength to live with the burden of being in ethically difficult situations. (shrink)

Background Healthcare professionals, especially professional nurses, experience various types of moral suffering due to inevitable ethical conflicts. Moral resilience is recently proposed as a resource to address moral suffering. However, there is no tool to measure moral resilience in Chinese professional nurses. Aim This study aimed to translate the Rushton Moral Resilience Scale (RMRS) into Chinese and evaluate the psychometric properties of the Chinese version of RMRS (Chi-RMRS). Research design A methodological and descriptive research design. Participants and research context A (...) convenience sample of 411 Chinese professional nurses was recruited through an online survey platform between February and March 2023. Ethical considerations This study was approved by the Research Ethics Committees of the University and hospitals involved. Results The RMRS was translated and culturally adapted into a Chinese version. Neither floor nor ceiling effects were observed. The scale-level content validity index (CVI) was 0.922 with the item-level CVIs ranging from 0.833 to 1.000. The explanatory factor analysis (EFA) generated a three-factor structure for the Chi-RMRS, and the confirmatory factor analysis (CFA) demonstrated the three-factor structure with factor loadings for each item ranging from 0.42 to 0.80. The scale-level Cronbach’s α coefficient was 0.811 with each dimension ranging from 0.717 to 0.821, and composite reliability (CR) coefficient for the overall scale was 0.920, with each dimension varying from 0.739 to 0.824. The standard error of measurement (SEM) and smallest detectable change (SDC) were 3.522 and 9.763, respectively. Discussion The Chi-RMRS is able to measure moral resilience of Chinese professional nurses, and has good validity and reliability. It can be used in research and practice to determine the level of moral resilience, thus helping nursing managers to monitor the status of Chinese professional nurses, then develop interventions to maintain the well-being of professional nurses and to ensure quality of care. (shrink)

Moral sensitivity is known to be the starting point for moral competence and even is a core concept in the curricula for bachelor’s-level nursing students in the Netherlands. While the development of moral sensitivity in nursing is commonly agreed to be important, there is no clear understanding of how to develop moral sensitivity through nursing education and what components of nursing education contribute to moral sensitivity. Studies on educational interventions could build knowledge about what works in developing moral sensitivity and (...) how to achieve this outcome. Therefore, the aim of this study is to explore if and how educational interventions contribute to the development of moral sensitivity in nursing students. A scoping review was conducted. Four electronic databases were searched: CINAHL, PubMed, MEDLINE and SpringerLink. Articles that were not about formal or initial nursing education and that had no link to moral development or moral sensitivity were excluded. After the final selection on educational interventions, 10 articles out of the initial 964 resources were included in the review. Three different but related dimensions of moral sensitivity emerged from the literature: (1) raising moral awareness, (2) providing the ability to frame and name ethical issues and (3) improving moral reasoning ability. Half of the studies used quantitative measures to evaluate the educational intervention, in particular the Moral Sensitivity Questionnaire; the other half used diverse qualitative evaluation methods. None of the studies presented teaching methods that included all three dimensions of moral sensitivity. Moral awareness of self appears to be more loosely connected to the other two dimensions, which raises the question of whether it can be seen as a prerequisite for them. To encompass all dimensions of moral sensitivity, a mix of quantitative and qualitative measures seems most appropriate to study that topic. (shrink)

Moral development has become an integral part in military training and the importance of moral judgment and behavior in military operations can hardly be overestimated. Many armed forces have integrated military ethics and moral decision-making interventions in their training programs. However, little is known about the effectiveness of these interventions. This study examined the effectiveness of a 1-week training program in moral decision making in the Swiss Armed Forces. The program was based on a strategy-based interactional moral dilemma approach. Results (...) of this quasi-experimental intervention study showed significant improvements in content-related (moral and instrumental awareness, quality of moral information processing, development of compensatory actions) as well as process-related (situational analysis, development and evaluation of alternative solutions, justification of decision) aspects in moral decision making. Results of a follow-up test indicated positive long-term effects with regard to moral and instrumental awareness and process-related aspects. Findings are discussed, and consequences for leadership development programs and further research are explored. (shrink)

Increased technological and pharmacological interventions in patient care when patient outcomes are uncertain have been linked to the escalation in moral and ethical dilemmas experienced by health care providers in acute care settings. Health care research has shown that facilities that are able to attract and retain nursing staff in a competitive environment and provide high quality care have the capacity for nurses to process and resolve moral and ethical dilemmas. This article reports on the findings of a systematic review (...) of the empirical literature (1980 — February 2007) on the effects of unresolved moral distress and poor ethical climate on nurse turnover. Articles were sought to answer the review question: Does unresolved moral distress and a poor organizational ethical climate increase nurse turnover? Nine articles met the criteria of the review process. Although the prevailing sentiment was that poor ethical climate and moral distress caused staff turnover, definitive answers to the review question remain elusive because there are limited data that confidently support this statement. (shrink)

BackgroundIn order to achieve the goals of the healthcare system, nursing managers are required to comply with ethical principles in decision-making. In complex and challenging healthcare settings, it is shown that the managers’ mere awareness of ethics does not suffice and managers need to be sensitive toward making ethical decisions.AimTo explore nursing managers and their sensitivity toward ethical decision-making by analyzing their related experiences.MethodThe current study has been conducted in Iran in 2017 through a qualitative content analysis approach. Nineteen nurse (...) managers were selected purposefully from different hospitals in Tehran. Data were collected using semi-structured, in-depth, face-to-face interviews, and after transcription, they were analyzed according to the Graneheim and Lundman method.Ethical considerationsThe research was approved by the ethics committee of Tarbiat Modares University, Tehran, Iran. Participants were informed about the purpose of the study and submitted written informed consents regarding their participation. The principle of autonomy, confidentiality, and anonymity was taken into account in data collection.ResultsFifteen subcategories, three categories (assertiveness, commitment, and insight), and one theme of excellent decision-making were the results of data analysis.DiscussionFindings showed that nursing managers’ sensitivity to ethical decision-making allows them to make the best decision by insight, commitment, and assertiveness. Making a morally excellent decision ensures that ethical principles are followed in the healthcare system.ConclusionConsidering that most managers are committed to making ethical decisions, it is required to develop the scope of their insights even further using a professional management and ethical principles training program. Also, by addressing some of the ethical barriers at personal and organizational levels, the assertiveness in managers can be improved, which in turn can facilitate their ethical decision-making. (shrink)

Background:The debate over the ethical implications of care robots has raised a range of concerns, including the possibility that such technologies could disrupt caregiving as a core human moral activity. At the same time, academics in information ethics have argued that we should extend our ideas of moral agency and rights to include intelligent machines.Research objectives:This article explores issues of the moral status and limitations of machines in the context of care.Design:A conceptual argument is developed, through a four-part scheme derived (...) from the work of Alasdair MacIntyre. No empirical data are used.Ethical consideration:No primary data were gathered for this study. Secondary sources and authorship have been acknowledged throughout.Findings / discussion:Certain kinds of social experience, including the narrative unity of a life, and the giving and receiving of care, are essential for moral development. Machines, no matter how advanced, cannot participate in such experiences in key respects, and thus cannot develop as practical reasoners.Conclusion:It follows that they cannot be moral agents and that they cannot care. There are, it seems, no such things as care robots. In view of the institutional power of tech companies and commissioning bodies, care practitioners need to take more of a lead in developing new assistive technologies which are appropriate to their practice. (shrink)

Die Anforderungen an die ethische Kompetenzentwicklung im Rahmen der hochschulischen Pflegeausbildung sind anspruchsvoll und methodisch zu konkretisieren. Der Beitrag geht zunächst der Frage nach, wie Ethikkompetenz in Bezug auf die hochschulische Pflegeausbildung zu konturieren ist. Basierend auf dieser definitorischen Rahmung liegt das Augenmerk auf dem Prozess der Ethik-Leitlinienentwicklung als mögliche zu diskutierende Methode der Ethikkompetenzentwicklung. Hierbei ist die Frage leitend, ob der Prozess der Ethik-Leitlinienentwicklung im Rahmen des Studiums – analog zu den bis dato vielfach realisierten Fallanalysen – eine weitere (...) beziehungsweise ergänzende Methode der Ethikdidaktik sein könnte, um die für das professionelle Pflegehandeln relevanten Ethikkompetenzen im Rahmen der hochschulischen Pflegeausbildung anzubahnen und/oder zu verdichteten. (shrink)

Die Anforderungen an die ethische Kompetenzentwicklung im Rahmen der hochschulischen Pflegeausbildung sind anspruchsvoll und methodisch zu konkretisieren. Der Beitrag geht zunächst der Frage nach, wie Ethikkompetenz in Bezug auf die hochschulische Pflegeausbildung zu konturieren ist. Basierend auf dieser definitorischen Rahmung liegt das Augenmerk auf dem Prozess der Ethik-Leitlinienentwicklung als mögliche zu diskutierende Methode der Ethikkompetenzentwicklung. Hierbei ist die Frage leitend, ob der Prozess der Ethik-Leitlinienentwicklung im Rahmen des Studiums – analog zu den bis dato vielfach realisierten Fallanalysen – eine weitere (...) beziehungsweise ergänzende Methode der Ethikdidaktik sein könnte, um die für das professionelle Pflegehandeln relevanten Ethikkompetenzen im Rahmen der hochschulischen Pflegeausbildung anzubahnen und/oder zu verdichteten. (shrink)

Moral distress in health care has been identified as a growing concern and a focus of research in nursing and health care for almost three decades. Researchers and theorists have argued that moral distress has both short and long-term consequences. Moral distress has implications for satisfaction, recruitment and retention of health care providers and implications for the delivery of safe and competent quality patient care. In over a decade of research on ethical practice, registered nurses and other health care practitioners (...) have repeatedly identified moral distress as a concern and called for action. However, research and action on moral distress has been constrained by lack of conceptual clarity and theoretical confusion as to the meaning and underpinnings of moral distress. To further examine these issues and foster action on moral distress, three members of the University of Victoria/University of British Columbia (UVIC/UVIC) nursing ethics research team initiated the development and delivery of a multi-faceted and interdisciplinary symposium on Moral Distress with international experts, researchers, and practitioners. The goal of the symposium was to develop an agenda for action on moral distress in health care. We sought to develop a plan of action that would encompass recommendations for education, practice, research and policy. The papers in this special issue of HEC Forum arose from that symposium. In this first paper, we provide an introduction to moral distress; make explicit some of the challenges associated with theoretical and conceptual constructions of moral distress; and discuss the barriers to the development of research, education, and policy that could, if addressed, foster action on moral distress in health care practice. The following three papers were written by key international experts on moral distress, who explore in-depth the issues in three arenas: education, practice, research. In the fifth and last paper in the series, we highlight key insights from the symposium and the papers in the series, propose to redefine moral distress, and outline directions for an agenda for action on moral distress in health care. (shrink)

Background:Nursing as an ethical practice requires courage to be moral, taking tough stands for what is right, and living by one’s moral values. Nurses need moral courage in all areas and at all levels of nursing. Along with new interest in virtue ethics in healthcare, interest in moral courage as a virtue and a valued element of human morality has increased. Nevertheless, what the concept of moral courage means in nursing contexts remains ambiguous.Objective:This article is an analysis of the concept (...) of moral courage in nursing.Design:Rodgers’ evolutionary method of concept analysis provided the framework to conduct the analysis.Data sources:The literature search was carried out in September 2015 in six databases: PubMed, CINAHL, Scopus, Web of Science, PsycINFO, and The Philosopher’s Index. The following key words were used: “moral” OR “ethical” AND “courage” OR “strength” AND “nurs*” with no time limit. After applying inclusion and exclusion criteria, 31 studies were included in the final analysis.Ethical considerations:This study was conducted according to good scientific guidelines.Results:Seven core attributes of moral courage were identified: true presence, moral integrity, responsibility, honesty, advocacy, commitment and perseverance, and personal risk. Antecedents were ethical sensitivity, conscience, and experience. Consequences included personal and professional development and empowerment.Discussion and conclusion:This preliminary clarification warrants further exploring through theoretical and philosophical literature, expert opinions, and empirical research to gain validity and reliability for its application in nursing practice. (shrink)

Background: Certain factors may facilitate or inhibit the formation of moral sensitivity in nurses performing cardiopulmonary resuscitation (CPR). The identification of these factors in the context can help develop strategies to promote nurses’ moral sensitivity and offer new insights into the consequences of their moral decisions. Objective: Taking into account the possibly multi-factorial nature of moral sensitivity, this study aimed to identify the factors affecting the formation of nurses’ moral sensitivity in CPR settings. Research design and methods: This study performed (...) a conventional qualitative content analysis. Twenty-one participants were selected via purposive and theoretical sampling. The data were collected through in-depth semi-structured interviews and simultaneously analyzed via content analysis. Participants and research context: In total, twenty-one participants (fourteen clinical care nurses, three head nurses, two educational supervisors, and two faculty members) from different cities of Iran were interviewed. Ethical considerations: The research was approved by the Ethics Committee of Urmia University of Medical Sciences in Iran (IR.UMSU.REC.1399.337). Findings: Four categories (underlying factors, professional factors, organizational inhibitors of ethics, and professional limitations) and 13 sub-categories were extracted. Discussion: The formation of moral sensitivity requires a range of ethical standards and their maintenance, not only at the individual level but also at the profession, organization, and community levels. So eliminating inhibitors of ethics in these contexts can improve nurse’s ethical performance in CPR settings. Conclusion: Any measures taken or decisions made by nurses in CPR are driven by numerous ethical issues to which nurses must be morally sensitive. Some factors facilitate and some inhibit the formation of moral sensitivity in nurses. (shrink)

Research in moral psychology has recently raised questions about the impact of context and the environment on the way the human mind works. In a 2012 call to action, Paley wrote: “If some of the conclusions arrived at by moral psychologists are true, they are directly relevant to the way nurses think about moral problems, and present serious challenges to favoured concepts in nursing ethics, such as the ethics of care, virtue, and the unity of the person” (p. 80). He (...) urges nurse ethicists and scholars to evaluate the impact these findings may have for moral theory.In this paper, I review some of Paley's (Nursing Philosophy, 13, 2012, 80) critique, focusing on the argument that theories of nursing ethics have failed to account for the role of context; both in terms of its impact on the way nurses make moral judgements and in terms of the environment's influence on the way the mind works. I then examine nursing literature on moral agency, and focus on the role of the environment and context play within existing theory. I argue that theories of moral agency have often accounted for the role of context on the way nurses make decisions; however, less attention has been paid to its impact on the mind. With this background, I use insights from the fields of moral philosophy and moral psychology to refine the conceptualization of nurse moral agency in a way that is reflective of current cognitive, philosophical and nursing practice‐based science. (shrink)

Research on ethical dilemmas in health care has become increasingly salient during the last two decades resulting in confusion about the concept of moral distress. The aim of the present paper is to provide an overview and a comparative analysis of the theoretical understandings of moral distress and related concepts. The focus is on five concepts: moral distress, moral stress, stress of conscience, moral sensitivity and ethical climate. It is suggested that moral distress connects mainly to a psychological perspective; stress (...) of conscience more to a theological–philosophical standpoint; and moral stress mostly to a physiological perspective. Further analysis indicates that these thoughts can be linked to the concepts of moral sensitivity and ethical climate through a relationship to moral agency. Moral agency comprises a moral awareness of moral problems and moral responsibility for others. It is suggested that moral distress may serve as a positive catalyst in exercising moral agency. An interdisciplinary approach in research and practice broadens our understanding of moral distress and its impact on health care personnel and patient care. (shrink)

The interconnection between moral distress, moral sensitivity, and moral resilience was explored by constructing two hypothetical scenarios based on a recent Swedish newspaper report. In the first scenario, a 77-year-old man, rational and awake, was coded as “do not resuscitate” (DNR) against his daughter’s wishes. The patient died in the presence of nurses who were not permitted to resuscitate him. The second scenario concerned a 41-year-old man, who had been in a coma for three weeks. He was also coded as (...) “do not resuscitate” and, when he stopped breathing, was resuscitated by his father. The nurses persuaded the physician on call to resume life support treatment and the patient recovered. These scenarios were analyzed using Viktor Frankl’s existential philosophy, resulting in a conceivable theoretical connection between moral distress, moral sensitivity, and moral resilience. To substantiate our conclusion, we encourage further empirical research. (shrink)

BackgroundThe COVID-19 pandemic called for a new ethical climate in the designated hospitals and imposed challenges on care quality for anti-pandemic nurses. Less was known about whether hospital ethical climate and nurses’ ethical sensitivity were associated with care quality. This study examined the association between the perceived hospital ethical climate and self-evaluated quality of care for COVID-19 patients among anti-pandemic nurses, and explored the mediating role of ethical sensitivity in this relationship.MethodsA cross-sectional study was conducted through an online survey. A (...) total of 399 anti-pandemic nurses from ten designated hospitals in three provinces of China were recruited to fill out an online survey. Multiple linear regression analysis and a bootstrap test were used to examine the relationships between ethical climate, ethical sensitivity and care quality.ResultsNurses reported mean scores of 4.43 ± 0.577 (out of 5) for hospital ethical climate, 45.00 ± 7.085 (out of 54) for ethical sensitivity, and 5.35 ± 0.661 (out of 6) for self-evaluated care quality. After controlling for covariates, perceived hospital ethical climate was positively associated with self-evaluated care quality (direct effect = 0.710, 95% confidence interval [CI] 0.628, 0.792), and was partly mediated by ethical sensitivity (indirect effect = 0.078, 95% confidence interval [CI] 0.002, 0.145).ConclusionsChinese nurses who cared for COVID-19 patients perceived high levels of hospital ethical climate, ethical sensitivity, and self-evaluated care quality. Positive perceptions of hospital ethical climate were both directly associated with a higher level of self-evaluated care quality and indirectly associated, through the mediation effect of ethical sensitivity among anti-pandemic nurses. (shrink)

Die Anforderungen an das ethisch-professionelle Handeln Pflegender und somit auch die Forderungen an die professionelle Ethikkompetenz Pflegender im praktischen Berufsfeld wandeln sich sowohl qualitativ als auch quantitativ. Dies wird auch in den veränderten normativen Rahmungen der Pflegebildung deutlich. Der Lernort Praxis als ein zentraler Ort pflegebezogener Bildungsprozesse rückt somit nochmals stärker in den Fokus der Ethikkompetenzentwicklung professionell Pflegender. Der Beitrag konturiert zentrale Anforderungen und veränderte Bezüglichkeiten für die Ethikbildung im beruflichen Handlungsfeld professioneller Pflege und formuliert davon ausgehend zentrale Prämissen an (...) organisationsethische Rahmenbedingungen mit dem Ziel, eine ethisch fundierte professionelle pflegerische Handlungspraxis zu unterstützen. (shrink)

Die Anforderungen an das ethisch-professionelle Handeln Pflegender und somit auch die Forderungen an die professionelle Ethikkompetenz Pflegender im praktischen Berufsfeld wandeln sich sowohl qualitativ als auch quantitativ. Dies wird auch in den veränderten normativen Rahmungen der Pflegebildung deutlich. Der Lernort Praxis als ein zentraler Ort pflegebezogener (Aus‑)Bildungsprozesse rückt somit nochmals stärker in den Fokus der Ethikkompetenzentwicklung professionell Pflegender. Der Beitrag konturiert zentrale Anforderungen und veränderte Bezüglichkeiten für die Ethikbildung im beruflichen Handlungsfeld professioneller Pflege und formuliert davon ausgehend zentrale Prämissen an (...) organisationsethische Rahmenbedingungen mit dem Ziel, eine ethisch fundierte professionelle pflegerische Handlungspraxis zu unterstützen. (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)

This study identified and described ethical problems encountered by physiotherapists in their practice and physiotherapists’ moral sensitivity in ethical situations. A questionnaire-based survey was constructed to identify ethical problems, and the Moral Sensitivity Questionnaire Revised version was used to measure moral sensitivity. Physiotherapists (n = 116) working in public health services responded to the questionnaire. Based on the results, most of the physiotherapists encounter ethical problems weekly. They concern mainly financial considerations, equality and justice, professionalism, unethical conduct of physiotherapists or (...) other professions and patients’ self-determination. The dimension of moral strength was emphasised in physiotherapists’ self-evaluations of their moral sensitivity. As a conclusion, ethical problems do occur not only at individual level but also at organisational and society level. Physiotherapists seem to have moral strength for speaking on behalf of the patient. Scarce resources make them feel insufficient but much could still be done to provide quality care in co-operation with other health-care professionals. (shrink)