The development of moral sensitivity of nursing students: A scoping review

Comparison of the correlation between moral sensitivity and clinical competence in emergency and intensive care nurses: A cross-sectional-correlation study

INTRODUCTION

Nurses' sensitivity to moral issues, especially in emergency and intensive care units is essential for providing complex nursing care. Therefore, the present study aimed to determine the correlation between moral sensitivity and clinical competence in emergency and intensive care nurses.

METHODS

The present multi-center cross-sectional correlational study was conducted in 2022 on 180 nurses in five emergency departments and four intensive care units of general hospitals affiliated to Semnan University of Medical sciences. The study tools include a demographic questionnaire, 25 item Lutzen Moral Sensitivity Questionnaire (MSQ), and a standardized Competency Inventory for Registered Nurses (CIRN). Data were analyzed by mean, standard deviation and MANOVA, Pearson's correlation coefficient test.

RESULTS

The two groups did not have significant differences in demographic characteristics (p < 0.05). Majority of two emergency department nurses (83.9%) and Intensive care nurses (81.8%) had a moderate level of moral sensitivity. Also, clinical competence of majority of emergency department nurses (73.3%) and Intensive care nurses (75.8%) were in moderate level. There was significant positive relationship between moral sensitivity with Clinical competence in emergency department nurses (p ≤ 0.01, r = 0.61). No significant relationship was observed between moral sensitivity and the clinical competence of intensive care nurses (p > 0.05, r = 0.15).

CONCLUSIONS

There is need for improving the level of knowledge of nurses about moral principles and increasing moral sensitivity which can expand the components of clinical competence, especially in intensive care units.

The influence of socio-cognitive mindfulness, moral sensitivity and dementia communication behaviors on dementia nursing performance of nurses in long-term care hospitals: a cross-sectional study

BACKGROUND

By incorporating socio-cognitive mindfulness which has been under-examined in the nursing field, this study investigated the relationships between socio-cognitive mindfulness, moral sensitivity, dementia communication behaviors, and dementia nursing performance of nurses in long-term care hospitals. This study also examined the factors influencing nurses' dementia nursing performance.

METHODS

A cross-sectional study was conducted with 209 nurses from long-term care hospitals in Korea. Data were collected between August 1 and August 31, 2022. Participants completed the questionnaire assessing their socio-cognitive mindfulness, moral sensitivity, dementia communication behaviors, and dementia nursing performance. Pearson's correlation and hierarchical multiple regression analysis were performed for data analysis.

RESULTS

Dementia nursing performance of the nurses in long-term care hospitals was positively related to their socio-cognitive mindfulness, moral sensitivity, and dementia communication behaviors. Furthermore, nurses' dementia communication behaviors, moral sensitivity, and total clinical career, in that order, were found to be the factors influencing their dementia nursing performance.

CONCLUSION

The findings indicate that the higher socio-cognitive mindfulness, moral sensitivity, and dementia communication behaviors, the higher dementia nursing performance, and that higher dementia nursing performance is associated with better dementia communication behaviors, greater moral sensitivity, and more extensive clinical experiences. This study provides a foundation for developing effective interventions to enhance dementia nursing performance in the future. To improve dementia nursing performance of nurses in long-term care hospitals, it is necessary to improve dementia communication behaviors and moral sensitivity, and prepare multilateral countermeasures to maintain nurses' clinical careers.

Clinical internship environment and caring behaviours among nursing students: A moderated mediation model

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.

Moral sensitivity of nursing students: a systematic review

BACKGROUND

Moral sensitivity is an essential criterion for nurses' professional competence, and it is effective in professional performance and the development of communication between nurse and patient. According to several definitions of moral sensitivity in nursing texts, each of them has examined moral sensitivity from a different aspect, and there are still uncertainties in the field of moral sensitivity of nursing students. Therefore, to clarify the characteristics and dimensions of the concept of moral sensitivity of nursing students, we used the method of concept analysis.

GOAL

To clarify and define moral sensitivity of nursing students.

METHOD

For this systematic review, ten databases (PubMed, Scopus, Science Direct, Emerald, Springer, Proquest (open access), ERIC, SID, Irandoc, Magiran) were searched. They were published between 1990 and 2020. Inclusion criteria were having access to the full text of the article, types of studies (quantitative, qualitative, concept analysis, systematic review, and meta-analysis) related to the attributes, antecedents, and consequences of nursing students' moral sensitivity, medical students' moral sensitivity and Ethics education, articles being published in scientific journals in English or Persian language, texts published in non-peer-reviewed journals and letters to the editor were excluded from the data analysis. The methodological quality of the studies was assessed using the Mixed Methods Appraisal Tool 2018 and Prisma ScR Checklist 2020. Rodger's evolutionary concept analysis was used to conduct this study.

RESULTS

From 361 articles, 38 were included. The results showed moral sensitivity in nursing students improves through specialized ethical knowledge and presence in educational and professional settings. The attributes consist of honest and benevolent communication, compassionate professional practice, intuitive perceiving moral challenges, awareness of the responsibilities and moral consequences of decisions. The moral sensitivity of nursing students improves the quality of nursing care and the effective management of ethical challenges.

CONCLUSION

Results can help develop nursing education theories and programs, design appropriate tools to evaluate this concept, and increase the quality of care and management of moral challenges in society and health systems.

LIMITATION

This research has only examined Persian and English texts; also, accessing all the international databases was impossible, and more investigation in this field is required.

Brave spaces in nursing ethics education: Courage through pedagogy

BACKGROUND

Nursing students must graduate prepared to bravely enact the art and science of nursing in environments infiltrated with ethical challenges. Given the necessity and moral obligation of nurses to engage in discourse within nursing ethics, nursing students must be provided a moral supportive learning space for these opportunities. Situating conversations and pedagogy within a brave space may offer a framework to engage in civil discourse while fostering moral courage for learners.

RESEARCH OBJECTIVE

The aim of this research is to explore the influence of a structured self-assessment tool called the ESA "Engagement Self-Assessment" on the alignment and creation of a brave space in a nursing ethics course.

RESEARCH DESIGN

This study used an exploratory, cross-sectional survey design.

PARTICIPANTS AND STUDY SETTING

Data from 39 undergraduate nursing students enrolled in a nursing healthcare ethics & law course using the ESA were recruited.

ETHICAL CONSIDERATIONS

Participation was voluntary and informed without coercion. Written consent was obtained prior to participation. Research ethics approval was obtained by the Institutional Research Ethics Board of the recruited participants (Ethics # 2022-23-03).

FINDINGS

The ESA provided structured self-reflection on the impact of shared vulnerability within a brave space. However, commitment to a brave space was not strongly influenced by the ESA, but rather by a mutual "commitment to others."

CONCLUSION

A teaching tool such as an ESA can be used to facilitate instructor expectations of civil discourse and discussion of difficult topics. Rules of engagement such as those found in brave spaces can help transform fear of vulnerability into authentic growth for learners. A morally supportive learning space can support critical opportunities for ethical development. This study provides insight into how self-assessment and the use of a brave space in nursing ethics education can facilitate a morally supportive learning space.

Promoting moral imagination in nursing education: Imagining and performing

Moral imagination is a central component of moral agency and person-centred care. Becoming moral agents who can sustain attention on patients and their families through their illness and suffering involves imagining the other, what moral possibilities are available, what choices to make, and how one wants to be. This relationship between moral agency, moral imagination, and personhood can be effaced by a focus on task-driven technical rationality within the multifaceted challenges of contemporary healthcare. Similarly, facilitating students' moral agency can also be obscured by the task-driven technical rationality of teaching. The development of moral agency requires deliberate attention across the trajectory of nursing education. To prepare nursing students for one practice challenge, workplace violence, we developed a multimodal education intervention which included a simulated learning experience (SLE). To enhance the realism and consistency of the educational experience, 11 nursing students were trained as simulated participants (SP). As part of a larger study to examine knowledge acquisition and practice confidence of learners who completed the SLE, we explored the experience of being the SP through interviews and a focus group with the SP students. The SP described how their multiple performances contributed to imagining the situation 'on both sides' prompting empathy, a reconsideration of their moral agency, and the potential to prevent violence in the workplace beyond technical rational techniques, such as verbal de-escalation scripts. The empirical findings from the SP prompted a philosophical exploration into moral imagination. We summarise the multimodal educational intervention and relevant findings, and then, using Johnson's conception of moral imagination and relevant nursing literature, we discuss the significance of the SP embodied experiences and their professional formation. We suggest that SLEs offer a unique avenue to create pedagogical spaces which promote moral imagination, thereby teaching for moral agency and person-centred care.

The Relationship between Moral Sensitivity and Professional Behaviour and Its Comparison in First- and Last-Year Undergraduate Nursing Students

Background

Nursing students should be equipped with ethical sensitivity and professional behaviour because they will face challenging ethical issues in their future work environment. This study aimed to determine the relationship between moral sensitivity and professional behaviour and compare it in first- and last-year undergraduate nursing students.

Methods

This study was a cross-sectional, correlational study that was conducted at Isfahan University of Medical Sciences in 2019. The sample size of this study was 238 nursing students. The tools used in this study were the Persian versions of the moral sensitivity questionnaire and the professional behaviour questionnaire. The data were analyzed using SPSS 18 software.

Results

Linear regression showed that the total score of moral sensitivity of nursing students had a significant relationship with their professional behaviour (p  <  0.05). The result of the univariate analysis showed that the mean total score of moral sensitivity and professional behaviour was significantly higher in the last year than in first-year students (p  <  0.05).

Conclusion

Considering the relationship between moral sensitivity and the professional behaviour of nursing students, the promotion of moral sensitivity can become the basis for the development of the professional behaviour of nursing students. Therefore, it is suggested to focus on teaching the principles of nursing ethics to develop the moral sensitivity of undergraduate nursing students.

Ethics education: Nurse educators' main concern and their teaching strategies

BACKGROUND

To practice nursing ethics, students must first understand the ethical concepts and principles of their profession, but despite this knowledge, students face challenges in implementing ethical principles in clinical settings. The educational performance of nurse educators is critical in resolving these challenges. This study focused on the lived experiences of nurse educators.

OBJECTIVE

To address the main concern of educators when teaching ethics to undergraduate nursing students and how they deal with it.

RESEARCH DESIGN

We conducted this qualitative content analysis in Iran in 2020. We used individual semi-structured interviews to collect, record, and transcribe data, as well as Graneheim and Lundman method to analyze them.

PARTICIPANTS

and research context: We used purposive sampling to select 11 nurse educators who either were currently in the position of ethics educators or had taught ethics from Iranian universities of medical sciences.

ETHICAL CONSIDERATIONS

The present study received the code of ethics No. IR.MODARES.REC.1399.036. Participants were aware of the study's purpose and signed a consent form to participate in the study. We considered data confidentiality and the voluntary principle in data collection.

FINDINGS

Nurse educators' main concern was how to sensitize students to ethical principles in clinical settings, so they tried to involve students in the teaching process, to repeat and practice ethical principles and concepts, simplify and simulate ethical principles and concepts, and provide opportunities for students to gain clinical experiences.

DISCUSSION

To sensitize students to ethical nursing care, nurse educators try to institutionalize ethical principles using different teaching methods, including students' involvement in teaching, experiential learning through simulated situations, practice, repetition, and provision of opportunities for practice and experience.

CONCLUSION

Improving students' cognitive ability and objectifying moral concepts and principles for students will institutionalize moral values in them that are fundamental for their moral sensitization.

The relationship between professional values, ethical sensitivities and caring behaviors among nursing students: A structural equation modeling approach

AIM

To examine the relationship between professional values, ethical sensitivity and caring behaviors among nursing students and determine whether professional values play a moderator role in the relationship between ethical sensitivity and caring behaviors among nursing students.

BACKGROUND

Developing professional nursing values, ethical sensitivity and caring behaviors is critical in nursing programs from the first year to graduation to prepare students for increasingly complex and diverse work environments.

DESIGN

A cross-sectional study using structural equation modeling. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used.

METHODS

This study was conducted with 189 undergraduate nursing students. The study was conducted in a four-year nursing faculty in the Mediterranean region of Turkey from February to June 2022. Data were collected using a personal information form, the Nurses' Professional Values Scale, the Moral Sensitivity Questionnaire and the Caring Behaviors Assessment Tool Nursing Version-Short Form.

RESULTS

We found that nursing students' perceptions of professional values and caring behaviors were high and their ethical sensitivity was moderate. Nursing students who are successful in high school have higher professional values. In addition, it was determined that nursing students who chose the nursing profession because of altruism had higher perceptions of caring behaviors. A positive relationship exists between professional values, ethical sensitivity (r = -0.258, p < 0.001) and caring behaviors (r = 0.431, p < 0.001) (p < 0.05). Professional values have a positive effect on ethical sensitivity and caring behaviors.

CONCLUSION

Professional values, ethical sensitivity and caring behaviors are relationships and professional values positively predict nursing students' ethical sensitivities and caring behaviors. As the professional value perceptions of nursing students increase, their ethical sensitivity and caring behaviors increase. Improving the curricula in a way that will improve professional values may enable nursing students to increase their ethical sensitivity and caring behaviors. The research contributes to a broader understanding of nursing education curriculum content.

Legal Regulations and the Anticipation of Moral Distress of Prospective Nurses: A Comparison of Selected Undergraduate Nursing Education Programmes

Moral distress is commonly experienced by nurses in all settings. This bears the risk of a reduced quality of care, burnout and withdrawal from the profession. One approach to the prevention and management of moral distress is ethical competence development in undergraduate nursing education. Profession-specific legal regulations function as a foundation for the decision on the educational content within these programmes. This theoretical article presents the extent to which legal regulations may open framework conditions that allow for the comprehensive preparation of prospective nurses to manage moral distress. The legal frameworks and the immediate responsibilities regarding their realisation in the context of undergraduate nursing education vary slightly for the three chosen examples of Switzerland, Austria and Germany. While an increased awareness of ethics’ education is represented within the nursing laws, no definite presumption can be made regarding whether undergraduate nursing students will be taught the ethical competencies required to manage moral distress. It remains up to the curriculum design, the schools of nursing and instructors to create an environment that allows for the realisation of corresponding learning content. For the future, the establishment of professional nursing associations may help to emphasise acutely relevant topics, including moral distress, in undergraduate nursing education.

Can a structured model of ethical reflection be used to teach ethics to nursing students? An approach to teaching nursing students a tool for systematic ethical reflection

BACKGROUND

Nurses encounter many ethical dilemmas in their practice. The ability to make good ethical decisions is a necessary competence in healthcare professions. International studies call for development and research on various methods to teach healthcare professionals ethics. This article describes an approach for learning how to be aware of and discover ethical dilemmas. By applying experienced narratives from healthcare practice and using question guidelines from a structured ethical model, nursing students learn to discover and find possible solutions for ethical problem in their practice.

AIM

The aim of this study was to describe second- and third-year nursing students' experiences by using structured ethical reflection as an approach to increase ethical awareness and deal with ethical decisions.

DESIGN

This study has a descriptive exploratory design. A three-day ethics seminar was carried out to help students learn how to recognize and explore ethical dilemmas in their practice.

MATERIALS AND METHODS

The data are collected from questionnaires used to evaluate the ethics seminar where 52 nursing students participated. The questionnaire contained open-ended and closed questions and was analysed using Braun and Clarke's reflexive thematic analysis. The empirical data were collected by 52 nursing students answering an evaluation questionnaire after the ethics seminar.

FINDINGS

Four themes were developed: Becoming aware of ethical dilemmas, Learning ethics by discussing knowledge and experiences with other students, Increased curiosity about ethics as a subject and Understanding the importance of critical ethical reflection work in clinical practice.

DISCUSSION

The process of learning how to understand the ethical principles in real-life nursing context continues progressing through the bachelor's program. Using group discussions and discussing examples of ethical dilemmas from practice help the students to a more comprehensive reflection process.

CONCLUSION

The nursing students experienced video lessons, group discussions and the use of a structured reflection model as a valuable approach in learning to recognize ethical dilemmas and how to deal with real-life ethical dilemmas.

The effects of an ethics laboratory program on moral sensitivity and professional values in nursing students: A randomized controlled study

BACKGROUND

Recently, moral sensitivity and professional values have become increasingly important in nursing education and have been tried to be improved.

OBJECTIVES

To investigate the effects of an ethics laboratory program integrated with the fundamentals of nursing course on the moral sensitivity and professional values of nursing students.

DESIGN

The present study was designed as a randomized controlled study. The 8-week ethics laboratory program was applied to the students in the intervention group. In the ethics laboratory program, interactive education methods, such as ethical scenarios, case studies, roleplay, group discussions, project papers and watching movies, were applied. Control group received the standard fundamentals of nursing curriculum.

PARTICIPANTS

The sample size was determined using stratified block randomization method, and 100 nursing students were assigned to intervention (n = 50) and control group (n = 50).

RESULTS

There was no baseline difference between the groups. The moral sensitivity average of the students in the intervention (82.66 ± 12.57) was lower than the average of the control group (85.64 ± 16.83) after the ethics laboratory program; however, the difference was not statistically significant (p > .05). Similarly, there were no significant differences between the intervention (132.32 ± 16.83) and the control group (131.81 ± 20.55) regarding the average score of professional values. In the responsibility sub-dimension of professional values, there was a statistically significant increase in the intervention group (p < .05).

CONCLUSION

The findings suggest that the ethics laboratory program for nursing students is effective in promoting responsibility sub-dimension of professional values. However, there was no significant effect on students' moral sensitivity and other dimensions of professional values. Further refinements of interventional research in ethics education and measurement of learning outcomes should be developed.

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.

The Effect of Transcultural Nursing Course on Students' Moral Sensitivity: A Quasi-Experimental Study

INTRODUCTION

The moral sensitivity of nurses positively affects the quality of patient care. For this reason, nursing students are expected to gain moral sensitivity skills during their education. The aim of the study is to examine the impact of transcultural nursing course (TNC) on the moral sensitivity levels of students.

METHODS

This study had a quasi-experimental design. The sample consisted of 100 nursing students (intervention: 36 and control: 64). The intervention group was composed of students who had enrolled in the TNC. The data were collected through the Sociodemographic Information Form and the Moral Sensitivity Questionnaire. Independent samples t-test and analysis of variance were used in data analysis.

RESULTS

The moral sensitivity levels of the students who received the TNC were significantly higher than those who did not.

DISCUSSION

The TNC is an effective teaching method in increasing the moral sensitivity levels of nursing students.