We report the results of an investigation of nurses’ and physicians’ sensitivity to ethical dimensions of clinical practice. The sample consisted of 113 physicians working in general medical settings, 665 psychiatrists, 150 nurses working in general medical settings, and 145 nurses working in psychiatry. The instrument used was the Moral Sensitivity Questionnaire (MSQ), a self-reporting Likert-type questionnaire consisting of 30 assumptions related to moral sensitivity in health care practice. Each of these assumptions was categorized into a theoretical dimension of moral (...) sensitivity: relational orientation, structuring moral meaning, expressing benevolence, modifying autonomy, experiencing moral conflict, and following the rules. Significant differences in responses were found between health care professionals from general medical settings and those working in psychiatry. The former agreed to a greater extent with the assumptions in the categories ‘meaning’ and ‘autonomy’ and to a lesser degree with the categories ‘benevolence’ and ‘conflict’. Moreover, those from the psychiatric sector agreed to a greater extent to the use of coercion if necessary. Significant differences were also found for some of the MSQ categories, between physicians and nurses, and between males and females. (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)

OBJECTIVES: To identify ethical dilemmas experienced by occupational and physical therapists working in the UK National Health Service (NHS). To compare ethical contexts, themes and principles across the two groups. DESIGN: A structured questionnaire was circulated to the managers of occupational and physical therapy services in England and Wales. SUBJECTS: The questionnaires were given to 238 occupational and 249 physical therapists who conformed to set criteria. RESULTS: Ethical dilemmas experienced during the previous six months were reported by 118 occupational and (...) 107 physical therapists. The two groups were similar in age, grade, and years of experience. Fifty of the occupational therapy dilemmas occurred in mental health settings but no equivalent setting emerged for physical therapy. Different ethical themes emerged between the two groups, with the most common in occupational therapy being difficult/dangerous behaviour in patients and unprofessional staff behaviour, and for physical therapists resource limitations and treatment effectiveness. No differences were found in the ethical principles used. CONCLUSION: The ethical dilemmas reported by the therapists were primarily concerned with health care ethics, rather than the more dramatic ethics reported in much of the biomedical ethics literature. Differences were found between the two professional groups when ethical contexts and themes were compared but not when ethical principles were compared. This suggests that educators and researchers need to be aware of work settings and the interdisciplinary nature of employment as well as ethical principles held by individual therapists. (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)

The purpose of this study was to investigate some factors which may influence moral decision-making in psychiatric nursing practice. The Moral Sensitivity Questionnaire, a 30-item, seven-point Likert scale, measures six dimensions that are assumed to be related to moral sensitivity. In scoring, the test is divided into six categories: interpersonal orientation, structuring moral meaning, expressing benevolence, modifying autonomy, experiencing conflict, and reliance on medical authority. Seventy-nine nurses, employed in the same psychiatric district, were included in the sample. Significant differences were (...) found for some items in five of the six categories regarding gender, post-basic nursing education, experience as a mental care worker and type of clinical setting. Le but de cette étude était d'investiguer quelques éléments qui pourraient influencer les décisions morales dans la pratique infirmière psychiatrique. Le Questionnaire de Sensibilité Morale de 30 questions, sept points échelle Likert, mesure six dimensions qu'on assume d'être lié à la sensibilité morale. En marquant les points, le test est divisé entre les six catégories: orientation interpersonnelle, structurant un sens moral, l'expression de bénévolence, la modification de l'autonomie, l'expérience de conflit et dépendance de l'autorité médicale. Soixante-dix neuf infirmiers/ères, employé(e)s dans le même rayon de psychiatrie, ont participé dans l'étude. On a trouvé des différences considérables pour quelques questions dans cinq des six catégories en ce qui concerne le genre, l'éducation avancée, l'expérience d'infirmier/ère psychiatrique et type de cadre clinique. Das Ziel dieser Studie war die Untersuchung einiger Faktoren, die Einfluss haben auf die moralische Entscheidungsfindung in der psychiatrischen Krankenpflege. Der Fragebogen zur 'Moralischen Einfühlsamkeit' ist eine sieben-Punk Likert Skala für 30 Sachaspekte und misst sechs Dimensionen, von denen man annimmt, daß sie zur moralischer Einfühlsamkeit gehören. Für die Auswertung ist der Test in sechs Kategorien eingeteilt: Orientierung zu andem Personen, das Strukturieren moralischer Bedeutungselemente, Wohlwollen ausdrücken, Modifizierung von Selbstbestimmung. (shrink)

Physiotherapy raises serious bioethical questions that are far too little discussed. Concerns include the lack of a clearly defined end point, the closeness of interaction between therapist and patient, the patient’s own share of responsibility, and the common failure to refer patients for rehabilitation.Physiotherapy has evolved dramatically in recent years, to the point where it is now a major healthcare profession offering assessment, diagnosis and treatment for a wide range of conditions, from sports injuries to rehabilitation for major injuries and (...) diseases. According to the World Confederation for Physical Therapy, “Physical Therapy is providing services to people and populations to develop maintain and restore maximum movement and functional ability throughout the lifespan” .1However, almost uniquely among the healthcare professions, physiotherapy has aroused little or no philosophical interest or engagement. This is surprising, because some of the salient features of physiotherapy raise interesting and to some extent novel problems in ethics. There are, it is true, some papers on ethically related themes,2–5 but in comparison with the size of the discipline and the complexity of the problems, the profile of physiotherapy in bioethics is worryingly low.A first problem is that unlike many areas of medicine—surgery, for example, or radiography or obstetrics and gynaecology—physiotherapy has no obvious end point. In medicine, the end points of treatment are generally well defined, with only a few exceptions, such as plastic surgery or psychiatry. It is my impression that physiotherapy, with few exceptions, does not operate with the concept of end points. Although what physiotherapy aims at is clear, the point at which the aims are achieved is uncertain. For example, in many cases the patient would go on benefiting from sessions of physiotherapy, perhaps with diminishing returns but still with …. (shrink)

Objectives—This study examined the issue of confidentiality in relation to i) undergraduate curriculum content in physiotherapy, and ii) the awareness, experiences and attitudes of clinical physiotherapists.Design—Postal survey of universities and focus group interviews with physiotherapists.Setting—Twenty-five universities in the UK and Ireland and 44 therapists in five hospitals in southern England.Results—The survey of universities indicated that legal and ethical aspects of confidentiality featured in virtually all preregistration courses that responded. However, whereas its inclusion was rated as extremely important, the degree of (...) coverage of confidentiality varied considerably between courses. Within the focus groups, 35 informants recollected coverage of confidentiality in their preregistration education, and 12 in postregistration in-service training; in neither case was this coverage in great detail. Informants identified environmental factors and working practices as barriers to preserving confidentiality. Disclosure to others also gave rise to difficulties. Informants were only aware in general terms of the relevant sections of the Chartered Society of Physiotherapy's Rules of Professional Conduct.Conclusions—Aspects of hospital-based physiotherapy practice were seen to create specific problems in relation to confidentiality. More detailed sources of education and guidance on this issue appear to be required. (shrink)