This article presents the development, validation and application of an instrument to measure everyday moral distress in different health care settings. The concept of moral distress has been discussed and developed over 20 years. A few instruments have been developed to measure it, predominantly in nursing. The instrument presented here consists of two factors: level of moral distress, and tolerance/openness towards moral dilemmas. It was tested in four medical departments and three pharmacies, where 259 staff members completed a questionnaire. The (...) two factors were found to be reliable. Differences in levels of moral distress were found between pharmacies and clinical departments, and between the youngest and oldest age groups; departmental staff and the youngest group experienced higher levels of moral distress. Departments reported less tolerance/openness towards moral dilemmas than pharmacies. The instrument needs to be tested further, but its strengths are the focus on everyday ethical dilemmas and its usefulness in different health care settings. (shrink)

is to discuss the nurse leader's role in ensuring congruence between caring missions and caring practices. Ethical principles are discussed as the foundation necessary for creating an ethical climate for nursing practice. Components of ethical climate are presented and strategies to create a positive ethical climate for nursing practice are provided....

This classic and controversial book examines the roots of the idea of virtue, diagnoses the reasons for its absence in modern life, and proposes a path for its recovery.

This study examined ethical attitudes and perceptions of 691 undergraduate seniors and freshmen in a college of business. Gender was found to be correlated to perceptions of "what the ethical climate should be" with female subjects showing significantly more favorable attitude towards ethical behaviors than males. Further, Seniors had a more cynical view of the current ethical climate than freshmen. Freshmen were significantly more likely than seniors to believe that good business ethics is positively related to successful business outcomes. Ethical (...) education was significantly correlated to both perceptions of "current ethical climate" as well as "what the ethical climate should be". Students who had been exposed to ethical issues in a course were more likely to believe both, that ethical behavior is, and should be, positively associated with successful business outcomes. (shrink)

The aim of this article is to describe the synthesis of the concept of moral stress and to attempt to identify its preconditions. Qualitative data from two independent studies on professional issues in nursing were analysed from a hypothetical-deductive approach. The findings indicate that moral stress is independent of context-given specific preconditions: (1) nurses are morally sensitive to the patient’s vulnerability; (2) nurses experience external factors preventing them from doing what is best for the patient; and (3) nurses feel that (...) they have no control over the specific situation. The findings from this analysis are supported by recent research on stress in the workplace but differ in that the imperatives directing work are moral in nature. Stress researchers have found that persons who experience that they have no control over their work situation and at the same time experience high demands may be prone to cardiovascular diseases. An important question raised by this study is whether moral stress should be recognized as a health risk in nursing. Further research is required in order to generate intervention models to prevent or deal with moral stress. (shrink)

The aim of this Swedish study was to develop the concept of moral sensitivity in health care practice. This process began with an overview of relevant theories and perspectives on ethics with a focus on moral sensitivity and related concepts, in order to generate a theoretical framework. The second step was to construct a questionnaire based on this framework by generating a list of items from the theoretical framework. Nine items were finally selected as most appropriate and consistent with the (...) research team’s understanding of the concept of moral sensitivity. The items were worded as assumptions related to patient care. The questionnaire was distributed to two groups of health care personnel on two separate occasions and a total of 278 completed questionnaires were returned. A factor analysis identified three factors: sense of moral burden, moral strength and moral responsibility. These seem to be conceptually interrelated yet indicate that moral sensitivity may involve more dimensions than simply a cognitive capacity, particularly, feelings, sentiments, moral knowledge and skills. (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)

Every day situations arising in health care contain ethical issues influencing care providers' conscience. How and to what extent conscience is influenced may differ according to how conscience is perceived. This study aimed to explore the relationship between perceptions of conscience and stress of conscience among care providers working in municipal housing for elderly people. A total of 166 care providers were approached, of which 146 (50 registered nurses and 96 nurses' aides/enrolled nurses) completed a questionnaire containing the Perceptions of (...) Conscience Questionnaire and the Stress of Conscience Questionnaire. A multivariate canonical correlation analysis was conducted. The first two functions emerging from the analysis themselves explained a noteworthy amount of the shared variance (25.6% and 17.8%). These two dimensions of the relationship were interpreted either as having to deaden one's conscience relating to external demands in order to be able to collaborate with coworkers, or as having to deaden one's conscience relating to internal demands in order to uphold one's identity as a `good' health care professional. (shrink)

Stress in health care is affected by moral factors. When people are prevented from doing ‘good’ they may feel that they have not done what they ought to or that they have erred, thus giving rise to a troubled conscience. Empirical studies show that health care personnel sometimes refer to conscience when talking about being in ethically difficult everyday care situations. This study aimed to construct and validate the Stress of Conscience Questionnaire (SCQ), a nine-item instrument for assessing stressful situations (...) and the degree to which they trouble the conscience. The items were based on situations previously documented as causing negative stress for health care workers. Content and face validity were established by expert panels and pilot studies that selected relevant items and modified or excluded ambiguous ones. A convenience sample of 444 health care personnel indicated that the SCQ had acceptable validity and internal consistency (Cronbach’s alpha exceeded 0.83 for the overall scale). Explorative factor analysis identified and labelled two factors: ‘internal demands’ and ‘external demands and restrictions’. The findings suggest that the SCQ is a concise and practical instrument for use in various health care contexts. (shrink)

In order to prepare bioethics and clinical ethics courses for clinicians in Turkey, we needed to know the attitudes of physicians when placed in ethically difficult care situations. We presented four cases to 207 physicians who are members of the Physicians’ Association in Kocaeli, Turkey. Depending on the decisions they made in each case, we determined whether they were aware of the ethical aspects of the cases and the principles they chose as a basis for their decisions. We aimed to (...) gain information about their ethical tendencies and moral sensitivity. A small number of physicians stated that they would ‘show respect for a patient’s living will’ in the first case, but more stated that they would ‘let the patient refuse the treatment’ in the second. In the third case, where medical confidentiality was the significant ethical issue, most of the physicians said that they would act in order to maintain confidentiality. For the last case, more than half the physicians chose to ‘tell the truth’ to the patient. The paternalism shown in the doctors’ decisions on the first two cases was no longer observed in those made for the last two cases. We concluded that the physicians who participated in our study have low sensitivity to living wills (or advance directives) and patients refusing treatment. However, when issues of medical confidentiality and truth-telling are concerned, they take care to protect the autonomy of the individual and are relatively more aware of the ethical aspects of these cases. (shrink)

Book reviewed in this article: Principles of Biomedical Ethics. By Tom L. Beauchamp and James F. Childress.

In this paper, I present a general profile of individuals with psychopathy, autism, and acquired sociopathy as well as look specifically at the abilities of these individuals with respect to the moral domain. These individuals are individually and collectively interesting because of their significant affective and social impairments. I argue that none of these individuals should be considered full moral agents based on a proposed account of moral agency consisting of the following two necessary conditions: the capacity for moral judgment (...) and the capacity for moral motivation. Since each of these groups of individuals fails to satisfy the criteria in a different way, these arguments help to distinguish three primary ways in which emotion contributes to moral motivation. I conclude with a suggested general implication of this discussion for related debates in moral theory. (shrink)

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)

Over the course of its first seven editions, Principles of Biomedical Ethics has proved to be, globally, the most widely used, authored work in biomedical ethics. It is unique in being a book in bioethics used in numerous disciplines for purposes of instruction in bioethics. Its framework of moral principles is authoritative for many professional associations and biomedical institutions-for instruction in both clinical ethics and research ethics. It has been widely used in several disciplines for purposes of teaching in the (...) classroom, during conferences, etc. (shrink)

In a Different Voice is the little book that started a revolution, making women's voices heard, in their own right and with their own integrity, for virtually the first time in social scientific theorizing about women. Its impact was immediate and continues to this day, in the academic world and beyond.

This edition continues the debate on bioethical issues in nursing and health care. Revised chapters include discussions on transcultural ethics in nursing practice, and homophobia and the moral entitlement of AIDS and HIV-positive patients.

Ethics has been discussed largely in the language of the father, Nel Noddings believes: in principles and propostions, in terms such as _justification,_ _fairness,_ and _equity._ The mother's voice has been silent. The view of ethics Noddings offers in this book is a feminine view. "This does not imply," she writes, "that all women will accept it or that most men will reject it; indeed there is no reason why men should not embrace it. It is feminine in the deep (...) classical sense—rooted in receptivity, relatedness, and responsiveness. It does not imply either that logic is to be discarded or that logic is alien to women. It represents an aternative to present views, one that begins with the moral attitude or longing for goodness and not with moral reasoning." What is at the basis of moral action? An altruism acquired by the application of rule and principle? Or, as Noddings asserts, caring and the memory of being cared for? With numerous examples to supplement her rich theoretical discussion, Noddings builds a compelling philosophical argument for an ethics based on natural caring, as in the care of a mother for her child. The ethical behavior that grows out of natural caring has at its core as care-filled receptivity to those involved in any moral situation, and leaves behind the rigidity of rule and principle to focus on what is particular and unique in human relations. "The hand that steadied us as we learned to ride our first bicycle did not provide propositional knowledge, but it guided and supported us all the same, and we finished up 'knowing how.'" Noddings's discussion is far-ranging, as she considers whether organizations, which operate at a remove from the caring relationship, can truly be called ethical. She discusses the extent to which we may truly care for plants, animals, or ideas. Finally, she proposes a realignment of education to encourage and reward not just rationality and trained intelligence, but also enhanced sensitivity in moral matters. (shrink)

Finally, they describe the key elements for the successful implementation of a fully functioning health care organization ethics program and what it can mean to the patients and the community."--BOOK JACKET.

ACKNOWLEDGMENTS. Among Those Who helped greatly in the initial stages of this project by making constructive suggestions on my first "caring" papers are Nick Burbules, William Doll, Bruce Fuller, Brian Hill, William Pinar, Mary Anne ...

What do corporations look like when they have integrity, and how can we move more companies in that direction? Corporate Integrity offers a timely, comprehensive framework- and practical business lessons - bringing together questions of organizational design, communication practices, working relationships, and leadership styles to answer this question. Marvin T. Brown explores the five key challenges facing modern businesses as they try to respond ethically to cultural, interpersonal, organizational, civic and environmental challenges. He demonstrates that if corporations are to meet (...) the needs of civil society, they must facilitate inclusive communication patterns based on mutual recognition and civic cooperation. Corporate Integrity is essential reading for professionals in organizational ethics, business leaders, and graduate students looking for practical and reflective insights into doing business with integrity and purpose. (shrink)

Shaftesbury's philosophy combined a powerfully teleological approach, according to which all things are part of a harmonious cosmic order, with sharp observations of human nature (see section 2 below). Shaftesbury is often credited with originating the moral sense theory, although his own views of virtue are a mixture of rationalism and sentimentalism (section 3). While he argued that virtue leads to happiness (section 4), Shaftesbury was a fierce opponent of psychological and ethical egoism (section 5) and of the egoistic social (...) contract theory of Hobbes (section 6). Shaftesbury advanced a view of aesthetic judgment that was non-egoistic and objectivist, in that he thought that correct aesthetic judgment was disinterested and reflected accurately the harmonious cosmic order (section 7). Shaftesbury's belief in an harmonious cosmic order also dominated his view of religion, which was based on the idea that the universe clearly exhibits signs of perfect divine design (section 8). According to Shaftesbury, the ultimate end of religion, as well as of virtue, beauty, and philosophical understanding (all of which are turn out to be one and the same thing), is to identify completely with the universal system of which one is a part. (shrink)

Nel Noddings argues that hers is not an ethics of agape. I want to argue, on the contrary, that it is, and that this is a problem. My central thesis is that the unidirectional nature of the analysis of one-caring reinforces oppressive institutions.