Moral sensitivity and critical thinking disposition of nursing students in Korea

The effect of simulated problem learning in nursing ethics on moral sensitivity, empathy and critical thinking of nursing students: A quasi-experimental study

AIM

Compare the effects of Simulation with problem-based learning (SPBL) and Problem-based learning (PBL) in nursing ethics education on nursing students' moral sensitivity, empathy, critical thinking, test scores and teaching satisfaction.

BACKGROUND

Promoting nursing students' individual and ethical and abilities through education is an essential way to improve their ethical performance and build trustful relationship with patients. Despite significant efforts in this area, few have evaluated the effectiveness of Simulation with problem-based learning and Problem-based learning as applied to nursing ethics education.

DESIGN

A quasi-experimental design based on a non-equivalent control group pre-test/post-test.

METHODS

A quasi-experimental design was used. Participants were 161 undergraduate nursing students from two levels of a university, 88 subjects in the experimental group were taught using Simulation with problem-based learning and 73 subjects in the control group were taught using Problem-based learning. A pre-test, post-test and questionnaire were used to assess the effectiveness of student nursing ethics education. χ2 test was used to examine group differences in students' characteristics and satisfaction with teaching post-intervention. Student's t-test was used to assess group differences in scale scores and test scores.

RESULTS

Compared to the pre-test, empathy as well as critical thinking were significantly higher in the PBL group (P<0.05), but there was no significant change in moral sensitivity (P>0.05); moral sensitivity, empathy and critical thinking were significantly higher in the SPBL group (P<0.05). Moreover, this study also showed that improvement in moral sensitivity, empathy, critical thinking and grades was more significant in the SPBL group of nursing students compared to the PBL group (P<0.05) and no statistically significant difference was found between the two groups in terms of teaching satisfaction (P>0.05).

CONCLUSION

The use of Simulation with problem-based learning in nursing ethics education has a positive impact on nursing students' competency development and knowledge acquisition. Nurse educators should consider this teaching method and promote change to increase the effectiveness of nursing ethics education.

Nurse's Spiritual Sensitivity Scale (NSSS): A Validity and Reliability Study in Turkey

Nurses carry out spiritual care based on ethical principles, and they must have spiritual sensitivity to meet spiritual care needs. Seen from this angle, it is important to determine nurse's spiritual sensitivity in order to meet patient's spiritual care needs, to increase patient-nurse communication and to adopt a holistic approach to care. For this reason, the aim of this study was to test the validity and reliability of the Turkish Nurse's Spiritual Sensitivity Scale. In the present study, a sample size of 207 nurses was reached in the data collection stage. The Turkish Nurse's Spiritual Sensitivity Scale (NSSS) is a Likert-type scale consisting of 20 items and a single factor. There are no reverse-scored statements on the scale. A score of zero shows no spiritual sensitivity, and four shows higher spiritual sensitivity. The minimum score on the scale is zero, and the maximum score is 80. It was seen in this study that the Nurse's Spiritual Sensitivity Scale is a valid and reliable measurement instrument for a Turkish sample. This scale can be used by professionals to determine the spiritual sensitivity of Turkish nurses.

Moral sensitivity and academic ethical awareness of nursing and medical students: A cross-sectional survey

BACKGROUND

Moral sensitivity and academic integrity discernment hold paramount importance for healthcare professionals. Owing to distinct undergraduate educational backgrounds, nurses and physicians may exhibit divergent moral perspectives, academic integrity cognisance, and moral sensitivity within clinical environments. A limited number of studies have investigated the disparities and congruencies pertaining to moral sensitivity and academic ethical awareness among nursing and medical students.

OBJECTIVE

The study compares moral sensitivity and academic ethical awareness of undergraduate nursing and medical students with and without clinical exposure.

RESEARCH DESIGN

A self-administered cross-sectional survey conducted from January to February 2022 was used to collect data from a medical school in Hong Kong.

PARTICIPANTS AND RESEARCH CONTEXT

A total of 545 respondents, including 137 nursing students and 408 medical students, completed the questionnaire.

ETHICAL CONSIDERATION

Ethics approval of the study was obtained. Written consent was waived to maintain anonymity because completing the questionnaire was considered implied consent.

FINDINGS

Both groups of undergraduates demonstrated a high level of bioethics knowledge. In terms of academic integrity, medical students were found to have a less concerned attitude towards punctuality, attendance, and skipping classes. Regarding moral sensitivity, senior medical students with clinical experience put less emphasis on decision-making involving patient participation, while senior nursing students were more hesitant in withholding treatment for incompetent patients who refused treatment. Both nursing and medical students showed decreased moral sensitivity in the 'conflicts' domain with increased clinical exposure.

CONCLUSION

Study findings contribute to the discussion comparing the ethical attitudes of nursing and medical students. More effort should be made in nursing and medical education to promote practices in line with high academic integrity and to develop the ability to be morally sensitive in professional settings.

The Effect of Burnout and Moral Sensitivity Levels of Surgical Unit Nurses on Job Satisfaction

PURPOSE

This study was carried out to determine the effect of burnout and moral sensitivity levels of surgical unit nurses on their job satisfaction.

DESIGN

A descriptive and correlational design study.

METHODS

The population consisted of 268 nurses working in health institutions in the Eastern Black Sea Region of Turkey. The data were collected online between 1 and 30 April, 2022 using a sociodemographic data form, the Maslach Burnout Inventory, the Minnesota Job Satisfaction Scale, and the Moral Sensitivity Scale. Pearson correlation analysis and logistic regression analysis were used to evaluate the data.

FINDINGS

The nurses' moral sensitivity scale mean score was 105.2 ± 18.8, and the Minnesota job satisfaction scale mean score was 3.3 ± 0.7. The participants' mean emotional exhaustion score was 25.4 ± 7.3, the depersonalization score average was 15.7 ± 4.6, and the personal accomplishment mean score was 20.5 ± 6.7. The factors affecting the job satisfaction of nurses were found to be moral sensitivity, personal accomplishment, and satisfaction with the unit they worked.

CONCLUSIONS

Nurses had high levels of burnout due to emotional exhaustion, one of the subdimensions of burnout, and moderate levels of burnout due to depersonalization and personal accomplishment. The moral sensitivity and job satisfaction of nurses are moderate. As the nurses' accomplishment and ethical sensitivity levels increased and their emotional exhaustion levels decreased, their job satisfaction levels increased.

The effect of durability of knowledge transfer through reminiscence on the moral sensitivity of nurses

BACKGROUND

Nursing is a moral attempt and endeavor. Moral sensitivity training is one of the most important ways to strengthen nursing moral decision making. Thus, the purpose of this study was to determine the effect of durability of knowledge transfer through reminiscence on nurses' moral sensitivity.

METHODS

The present study is a controlled randomized clinical trial conducted in pre- and post- interventional forms. The research population consisted of all nurses working at Bushehr Persian Gulf martyrs training hospital in 2017, 68 nurses participated as samples in the study selected by available sampling method and then randomly assigned to two groups of intervention and control groups. In this study, Morphological Sensitivity Questionnaire of Lautzen was used. Validity and reliability of the questionnaire have been confirmed. The pre-test was obtained from the control and intervention group. An 8-hour reminiscence training session was held for the intervention group. In order to study, the durability of training, posttest was obtained from both groups. Data were analyzed by SPSS software version 19 and using t-test, Chi-square, paired t-test.

RESULTS

The mean moral sensitivity score in nurses before intervention in both groups was not statistically different (P = 0.42). The comparison of the mean scores of nurses' moral sensitivity after intervention in the control and intervention groups, which in fact, indicates the durability of education, showed a significant difference. (P < 0.001).

CONCLUSION

The results of this study showed that the transfer of knowledge and education through reminiscence has a lasting effect on enhancing the moral sensitivity of nurses. Therefore, its inclusion in nursing educational programs as a training strategy can be considered as a step toward facilitating the training of nurses' moral sensitivity.

TRIAL REGISTRATION

This study is registered by Iranian Registry of Clinical Trials with decree code: IRCT2016021612830N18 on May 17, 2017. This study adheres to the CONSORT 2010 statement guidelines.

Moral awareness and its relationship with moral sensitivity among Iranian nursing students: A basis for nursing ethics education

AIM

This descriptive-analytical correlational study was carried out to examine moral awareness and its relationship with moral sensitivity among Iranian nursing students.

DESIGN

A descriptive-analytical correlational study.

METHODS

The present descriptive-analytical study was performed among 140 Iranian nursing students. The data collection tool was a three-part questionnaire including (1) Demographic Information Questionnaire, (2) Nurses' Awareness about the Iranian Nursing Code of Ethics by Mohajjel Aghdam and (3) Moral Sensitivity Questionnaire (MSQ) by Kim Lutzen. The data collected from these questionnaires were analysed in SPSS-26 using descriptive and inferential statistics.

RESULTS

The mean moral awareness (29.42 ± 4.01) was good, and the mean moral sensitivity (135.05 ± 18.79) was moderate among the students. A significant positive correlation was observed between the total score of moral awareness and moral sensitivity (r = .22, p = .009) in the nursing students.

Written and computer simulation on the moral sensitivity of nurses

Background: Moral sensitivity is the first step towards ethical decision-making. This sensitivity should form a basic attitude in healthcare team members, particularly nurses, toward providing effective and ethical care. This is highlighted in intensive care units (ICUs) where close attention should be paid to patient rights and moral or ethical decision-making.Objective: The present study aimed at determining and comparing the effect of written simulation and computer simulation of a virtual patient on the development of moral sensitivity of ICU nurses.Research design: Randomized controlled trial with one control arm and two experimental arms.Participants and content: This study involved 204 ICU nurses working in hospitals affiliated to Tehran University of Medical Sciences, Tehran, Iran, from 2019 to 2021 using a random allocation method. The participants were allocated to three groups comprising virtual patient computer simulation, written simulation, and the no simulation control group. After training based on a Patient Rights Charter, five scenarios, with themes reflecting the clauses of the Patient's Rights Charter, were written as a computer program and text for the computer simulation and written simulation groups, respectively. Finally, nurses' moral sensitivity was assessed using the Lützén moral sensitivity questionnaire as pre- and post-tests (immediately and 2 months after the intervention).Ethical considerations: Ethical permission was obtained for the study. All the participants signed the informed consent before the study onset.Results: The study results showed a significant difference in moral sensitivity among the three groups before the intervention (p = 0.003). Immediately after the intervention compared to pre-intervention, the three groups showed no significant differences in this regard (p = 0.056), however a significant difference among the three groups was found 2 months post-intervention (p < 0.001).

Relationship Between Emotional Intelligence and Ethical Sensitivity in Turkish Nursing Students

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(s) and perception of economic status affected the level of ethical sensitivity.

The relationship between moral sensitivity and caring behavior among nurses in iran during COVID-19 pandemic

Background

Caring for patients during a pandemic can be difficult for healthcare workers, the patients themselves, and healthcare systems. Nurses are expected to recognize ethical dilemmas and make sound judgments when confronted with them. Sensitizing nurses to ethical issues strengthen their ability to identify ethical dilemmas and make ethical choices. As a result, this study aimed to determine a relationship between moral sensitivity and caring behavior among nurses during the coronavirus (COVID-19) pandemic.

Method

The current study is a cross-sectional study of 406 nurses who worked in a single hospital during the COVID-19 epidemic. We used a demographic questionnaire and the caring behavior inventory (CBI) tool to collect data online. The data were analyzed using descriptive and correlational statistics.

Findings

Eighty-three point seven percent of participants in this study were female, and 71.9% were married. 47.5% reported caring for a COVID-19 patient for longer than a month; their average work experience was 13.1 years. Additionally, Moral Sensitivity correlated positively with caring behavior and its dimensions (r = 0.164, P = 0.001). However, a significant and inverse link existed between the dimension "following the rules" and the nurse's caring conduct (r = -0.117, P = 0.019).

Conclusion

During the pandemic, nurses' moral sensitivity was moderate and significantly connected with their caring behavior. Because nurses encounter numerous obstacles while caring for patients in critical conditions, they require ethical empowerment to perform correctly, as caring behavior improves with increased moral sensitivity.

Does the compassion level of nursing students affect their ethical sensitivity?

AIM

This study aims to determine the nursing students' levels of compassion and ethical sensitivity and reveal the effect of the level of compassion on their ethical sensitivity.

METHOD

A descriptive study was carried out with 328 nursing students studying at a state university. Data were collected through the "Personal Information Form", "The Compassion Scale", and "The Modified Moral Sensitivity Questionnaire for Student Nurses (MMSQSN)".

RESULTS

The average compassion scale score was 4.14 ± 0.57 and the students' MMSQSN score average was 4.72 ± 0.85. A low level of positive correlation was determined between the compassion level of the students and their ethical sensitivity. Students' compassion level was found to be high and their ethical sensitivity was found to be neutral.

CONCLUSION

The increase in the level of compassion positively affects ethical sensitivity. In order to increase the level of compassion of students to increase their ethical sensitivity, practices that improve compassion and ethical sensitivity are required during their education.

Nurses' caring behaviour and its correlation with moral sensitivity

BACKGROUND

Different and contradictory results have been reported for nurses' caring behaviour and moral sensitivity.

AIMS

The present study aimed to examine the correlation between nurses' caring behaviour and moral sensitivity.

METHODS

The research was a descriptive, correlational study. Data were collected using moral sensitivity (range: 0-100) and caring behaviour (range: 24-144) questionnaires. A total of 250 nurses who worked in the clinical wards of Yasuj teaching hospitals in 2018, were selected by systematic random sampling. The collected data were analysed using SPSS version 19 for descriptive statistics and Pearson correlation tests.

RESULTS

Seventy-four percent of nurses had moderate moral sensitivity (50-74). Nurses' moral sensitivity and caring behaviour mean scores were reported to be 59.5 ± 11.1 (range: 31-87) (Potential range 0--100) and 110.99 ± 17.99 (range: 69-94) (Potential range 22-144), respectively. The Pearson test showed a positive correlation between nurses' caring behaviour and moral sensitivity at a 99% level (p = 0.001).

CONCLUSIONS

Nurses' moral sensitivity and caring behaviour were found to be moderate and good, respectively. Furthermore, there was a positive correlation between moral sensitivity and caring behaviour in nurses, that is, nurses provided better caring behaviour as levels of moral sensitivity increased.

The importance of moral sensitivity in nursing education: A comparative study

BACKGROUND/AIM

This study aims to determine the importance of the "Ethics and Deontology in Nursing" course in nursing education for the purpose of revealing the level of moral sensitivity of nursing students.

MATERIALS AND METHODS

In our research, which is a descriptive study, data were collected from 461 nursing students who studied at the Faculty of Health Sciences. In the study, the Personal Information Form and Moral Sensitivity Questionnaire (MSQ) were used as data collection forms. The findings from the study were evaluated with SPSS 22.00 package software, and the level of significance in all analyses was accepted as p < 0.05.

RESULTS

The average age of the students participating in the study was 20.83 ± 1.55. Also, 51.8% of the students took the course "Ethics and Deontology in Nursing." The total mean score of the MSQ of students was determined as 83.32 ± 16.79. A statistically significant difference was found between the students' total scores of autonomy, benefit, holistic approach, conflict, practice, orientation, and moral sensitivity, depending on whether they took the course "Ethics and Deontology in Nursing."

CONCLUSION

It was concluded that moral sensitivity in nursing students was positively influenced by the ethical education they received.

The Relationship between Moral Sensitivity, Ethical Climate, and Job Strain with Patient Privacy from Viewpoint of Operating Room Staffs

BACKGROUND

The privacy of patients in the operating room is in particular importance. The results of previous studies have shown that various factors are affecting in this context. The aim of this study is to evaluate the relationship between moral sensitivity, ethical climate, and job strain with respect to patients' privacy in operating rooms.

MATERIALS AND METHODS

All of operating rooms nurses of teaching hospitals affiliated to Ardabil University of Medical Sciences were entered into this descriptive-analytical study with census sampling method in 2019. To collect data, standard surveys of moral sensitivity, ethical climate, job strain, and privacy were used. Data were analyzed by SPSS15 software using descriptive and analytical statistics methods (independent t-test, ANOVA, Pearson correlation, and regression analysis).

RESULTS

There was a positive significant relationship between moral sensitivity and privacy (r = 0.56, p < 0.001) and ethical climate and privacy (r = 0.60, p < 0.001), too. But, there was an inverse and significant correlation between job strain and privacy (r = -0.69, p < 0.001). The results also showed that moral sensitivity is the best predictor of patients' privacy.

CONCLUSIONS

Despite the predictability of all variables, results showed that moral sensitivity is the most important component in patients' privacy. In this regard, by increasing the moral sensitivity of nurses, the privacy of patients can be improved.

A scoping review of the integration of ethics education in undergraduate nursing high-fidelity human simulation-based learning

AIMS AND OBJECTIVES

To systematically assemble, examine and map the extant literature pertaining to the integration of ethics education in high-fidelity simulation-based learning experiences in nursing undergraduate programmes.

BACKGROUND

The value of ethics education for undergraduate nursing students is well established in the literature. Whether high-fidelity human simulation (HFHS) supports the development of ethical reasoning or positively impacts the acquisition of ethical knowledge and reasoning skills in undergraduate nursing students is inconsistently addressed.

DESIGN

A scoping review was conducted using the Arksey and O'Malley framework.

METHOD

CINAHL, ProQuest Nursing & Allied Health Source, ProQuest Dissertations & Theses A&I, MEDLINE, Web of Science, ERIC, Scopus, PsycINFO, and the Joanna Briggs Institute EBP databases were searched for English-language manuscripts published between 2012 and 2020. The PRISMA-ScR was used.

RESULTS

Eight papers that met the inclusion criteria were extracted for this review. Three broad categories were identified: the 'what' in ethics education, the 'how' of ethics education and the 'when' of ethics education in high-fidelity human simulation.

CONCLUSION

The integration of ethics education into simulation-based learning has the potential to positively promote nursing students' ability to develop knowledge of and skills in ethical practice. However, the inclusion of ethics education scenarios in HFHS is a relative new teaching innovation in undergraduate nursing education. As such, there continues to be no consensus on the 'what', 'how' or 'when' of ethics education for best practice in ethics education for undergraduate nursing programmes.

RELEVANCE TO CLINICAL PRACTICE

Quality improvement processes and research studies are needed to determine: the types of ethical dilemmas and debriefing sessions and optimal timing of HFHS ethics simulation in undergraduate nursing education, student support needed for running HFHS, and the learning needs of nurse educators seeking to incorporate ethics within HFHS.

Analysis of graduating nursing students' moral courage in six European countries

Background:

Moral courage is defined as courage to act according to one’s own ethical values and principles even at the risk of negative consequences for the individual. In a complex nursing practice, ethical considerations are integral. Moral courage is needed throughout nurses’ career.

Aim:

To analyse graduating nursing students’ moral courage and the factors associated with it in six European countries.

Research design:

A cross-sectional design, using a structured questionnaire, as part of a larger international ProCompNurse study. In the questionnaire, moral courage was assessed with a single question (visual analogue scale 0–100), the questionnaire also covered several background variables.

Participants and research context:

The sample comprised graduating nursing students (n = 1796) from all participating countries. To get a comprehensive view about graduating nursing students’ moral courage, the views of nurse managers (n = 538) and patients (n = 1327) from the same units in which the graduating nursing students practised were also explored, with parallel questionnaires.

Ethical considerations:

Ethical approvals and research permissions were obtained according to national standards in every country and all participants gave their informed consent.

Results:

The mean of graduating nursing students’ self-assessed moral courage was 77.8 (standard deviation 17.0; on a 0–100 scale), with statistically significant differences between countries. Higher moral courage was associated with many factors, especially the level of professional competence. The managers assessed the graduating nursing students’ moral courage lower (66.5; standard deviation 18.4) and the patients slightly higher (80.6; standard deviation 19.4) than the graduating nursing students themselves.

Discussion and conclusions:

In all countries, the graduating nursing students’ moral courage was assessed as rather high, with differences between countries and populations. These differences and associations between moral courage and ethics education require further research.

ELEMENTS OF MORAL SENSITIVITY IN THE PRACTICE OF CLINICAL HOSPITAL NURSES

ABSTRACT Objective: to identify the elements of moral sensitivity held by nurses working in a medical clinic unit. Method: this exploratory-descriptive study with a qualitative approach addressed 18 nurses from a medical clinic of a university hospital located in southern Brazil using semi-structured interviews, which were analyzed using discursive textual analysis. Results: data were structured into six categories: relational orientation; experiencing moral dilemmas; following rules; benevolent motivation; structuring moral meaning; and autonomy. These categories enabled the identification of important elements of moral sensitivity, such as acknowledging the ethical dimension of one’s attitudes, acknowledging the uniqueness of each patient, dealing with conflict between workers and patients and/or their companions, adapting to the workplace, empathy, dialogue, clinical decision-making, meeting the needs of patients, understanding patients’ health condition, respect, welcoming patients’ desires and providing guidance that concerns patients’ requests and refusals. Conclusion: the elements of moral sensitivity identified in this study contribute to support nurses when making clinical decisions, especially when facing ethical issues arising in a medical clinic setting.

Estratégias para o desenvolvimento da sensibilidade moral: perspectiva dos enfermeiros de unidades de terapia intensiva

Resumo Objetivo conhecer estratégias para o desenvolvimento da sensibilidade moral na perspectiva dos enfermeiros que atuam em unidades de terapia intensiva. Método pesquisa qualitativa, do tipo exploratório descritiva, realizada com 19 enfermeiros atuantes em três unidades de terapia intensiva de um hospitalfilantrópico do Sul do Brasil através de entrevistas semiestruturadas, analisadas mediante análise textual discursiva. Resultados emergiram duas categorias: desenvolvimento da sensibilidade moral a partir da formação acadêmica e desenvolvimento da sensibilidade moral a partir da experiência profissional. Entre as estratégias verificadas destacaram-se as discussões e reflexões acerca de problemas éticos, a vivência de atividades extracurriculares, a comunicação efetiva, o trabalho multidisciplinar, a realização de reuniões, a busca pelo conhecimento e a educação permanente em saúde. Conclusões e implicações para a prática o desenvolvimento da sensibilidade moral dos enfermeiros pode auxiliá-los no reconhecimento e enfrentamento de situações eticamente inadequadas, de modo a favorecer o exercício da autonomia e a capacidade de lidar com os conflitos éticos emergentes do contexto de trabalho. Neste estudo, foi possível conhecer ainda, que priorizar espaços para a reflexão e discussão coletiva nos ambientes de formação e atuação da enfermagem, oportuniza o fortalecimento de tomadas de decisões éticas, coerentes, autônomas e eficientes.

A comparison of inquiry-oriented teaching and lecture-based approach in nursing ethics education

BACKGROUND

With developing nursing ethics education, the traditional methods of teaching could not meet the learning needs of undergraduates. Improving ethical decision-making to undergraduates is necessary toward promoting nursing ethics.

OBJECTIVE

The aim of study is to compare the effect of inquiry-oriented teaching and lecture-based approach on nursing ethics education for undergraduates.

DESIGN

A quasi-experimental study was conducted for undergraduate nursing students.

SETTINGS

Two nursing schools participated in the study in mainland China.

PARTICIPANTS

A total of 97 undergraduate nursing students participated in the study.

METHODS

The study adopted a quasi-experimental design.

RESULTS

The inquiry-oriented teaching group was significantly higher on average scoring than the lecture-based group after intervention in 2 aspects including: professional relationship (P = 0.015) and ethical decision making (P = 0.021). Contrarily, this study also showed that in the lecture-based group the score of foundational theories of nursing ethics was higher than Inquiry-oriented group (P = 0.038). A statistically significant difference was not found between the two groups in 3 scenarios: ethics related to nursing practice, ethics related to nursing research and necessity of learning nursing ethics.

CONCLUSION

Combination of inquiry-oriented teaching and lecture-based approach is suggested as part of design for curriculum of nursing ethics education.

Moral sensitivity components identified among nurses from Intensive Care Units

OBJECTIVE

to identify ethical problems from the components of moral sensitivity among nurses of Intensive Care Units.

METHOD

qualitative, exploratory-descriptive study developed in a hospital in the South of Brazil with 19 nurses working in intensive care units through semi-structured interviews that were analyzed through discursive textual analysis.

RESULTS

ethical education, dialogue, relationships with other health team members, professional autonomy, knowledge, personal values, effective communication, leadership and patients' positive outcomes were identified as important components of nurses' moral sensitivity, and comprise the domains of moral consciousness, benevolent motivation, and spontaneous moral perception.

FINAL CONSIDERATIONS

the components of moral sensitivity identified in this study facilitate nurses' instrumentalization in the face of decision making and ethical problems in the intensive care setting.

Lecture-based versus problem-based learning in ethics education among nursing students

BACKGROUND

Moral reasoning is a vital skill in the nursing profession. Teaching moral reasoning to students is necessary toward promoting nursing ethics.

OBJECTIVES

The aim of this study was to compare the effectiveness of problem-based learning and lecture-based methods in ethics education in improving (1) moral decision-making, (2) moral reasoning, (3) moral development, and (4) practical reasoning among nursing students.

RESEARCH DESIGN

This is a repeated measurement quasi-experimental study.

PARTICIPANTS AND RESEARCH CONTEXT

The participants were nursing students in a University of Medical Sciences in west of Iran who were randomly assigned to the lecture-based (n = 33) or the problem-based learning (n = 33) groups. The subjects were provided nursing ethics education in four 2-h sessions. The educational content was similar, but the training methods were different. The subjects completed the Nursing Dilemma Test before, immediately after, and 1 month after the training. The data were analyzed and compared using the SPSS-16 software.

ETHICAL CONSIDERATIONS

The program was explained to the students, all of whom signed an informed consent form at the baseline.

FINDINGS

The two groups were similar in personal characteristics (p > 0.05). A significant improvement was observed in the mean scores on moral development in the problem-based learning compared with the lecture-based group (p < 0.05). Although the mean scores on moral reasoning improved in both the problem-based learning and the lecture-based groups immediately after the training and 1 month later, the change was significant only in the problem-based learning group (p < 0.05). The mean scores on moral decision-making, practical considerations, and familiarity with dilemmas were relatively similar for the two groups.

CONCLUSION

The use of the problem-based learning method in ethics education enhances moral development among nursing students. However, further studies are needed to determine whether such method improves moral decision-making, moral reasoning, practical considerations, and familiarity with the ethical issues among nursing students.

Validation of a Brazilian version of the moral sensitivity questionnaire

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.

Nurse ethical sensitivity: An integrative review

Background:

Ethical sensitivity has been identified as a foundational component of ethical action. Diminished or absent ethical sensitivity can result in ethically incongruent care, which is inconsistent with the professional obligations of nursing. As such, assessing ethical sensitivity is imperative in order to design interventions to facilitate ethical practice and to ensure nurses recognize the nature and extent of professional ethical obligations.

Aim:

To review and critique the state of the science of nurse ethical sensitivity and to synthesize findings across studies.

Research design:

Whittemore and Knafl’s revised framework for integrative reviews guided the analysis.

Research context and data sources:

A comprehensive, computer-assisted search of literature published in Cumulative Index of Nursing and Allied Health Literature and PubMed was performed. A systematic approach was used to extract, reduce, and synthesize the data.

Findings:

Four major conceptualizations of ethical sensitivity emerged from the literature. A sample of 25 reports met inclusion criteria, including 17 empirical reports and 8 theoretical reports.

Discussion:

Despite the existence of a concept analysis and a validated tool, ethical sensitivity remains a highly theoretical concept with multiple, and at times competing, conceptualizations. Ethical sensitivity has been assessed extensively in the context of ethical dilemmas; however, little attention has been paid to the way the concept operates in day-to-day practice.

Conclusion:

Future research should focus on better ways to operationalize and assess the concept, with particular attention to nurse awareness of the ethical content of everyday practice.

Demographic factors associated with moral sensitivity among nursing students

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.

Effects of ethics education on moral sensitivity of nursing students

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.

ELEMENTS AND STRATEGIES FOR ETHICAL DECISION-MAKING IN NURSING

ABSTRACT This study aimed to identify the elements and strategies that facilitate the ethical decision-making of nurses faced with ethical problems, from publications on the theme. An integrative literature review was carried out. Data collection was performed between the months of April and May 2014, in the databases: SciELO, CINAHL, LILACS and MEDLINE. Original, theoretical and case study articles, with a health team that included nurses, published in Portuguese, English and Spanish were included. A total of 19 studies were selected, the analysis of which resulted in three categories: external factors of ethical decision-making in nursing, individual factors of ethical decision-making in nursing and facilitating strategies of ethical decision-making in nursing. It was concluded that nurses need to use strategies that develop sensitivity, ability and ethical competence, in order to make prudent ethical decisions, contributing to the quality of health care.