The development and validation of the Ethical Sensitivity Questionnaire for Nursing Students

Ethical sensitivity and compassion competence in nursing students: Two-center study/comparison of two different cultures

BACKGROUND

Although the literature includes studies on nursing students' ethical sensitivity and compassion competence, no study has examined and compared these skills among nursing students from different cultures.

AIM

This research determined and compared the ethical sensitivity and compassion competency levels of nursing students in two different geographies, one in Turkey (Group I) and one in the Turkish Republic of Northern Cyprus (Group II), which hosts students with different cultural characteristics.

DESIGN

Quantitative and cross-sectional research.

METHOD

The research was conducted with 201 nursing students in Group I and Group II, who were studying in the English Nursing program at the Nursing Faculties, received clinical practice training, took ethics in nursing courses, and agreed to participate. "Sociodemographic Form," "Moral Sensitivity Questionnaire," and "Compassion Competence Scale" were used to collect data. Frequency, percentage, mean, standard deviation, and Pearson correlation analysis were used to evaluate the data.

RESULTS

The mean "Moral Sensitivity Questionnaire" scores of nursing students in Group I and Group II are 149.52 (SD 21.13) and 155.63 (SD 25.21), respectively. The mean scores of the nursing students in Group I and Group II on the "Compassion Competence Scale" are 3.88 (SD 0.47) and 4.29 (SD 0.50), respectively. It was determined that the "Moral Sensitivity Questionnaire" and "Compassion Competency Scale" mean scores of the nursing students in Group II were higher than those of the nursing students in Group I, and this difference was statistically significant (p < 0.05).

CONCLUSION

The moral sensitivity and compassion competence of nursing students at the two universities were high. When the scores of the groups were compared, it was observed that the moral sensitivity and compassion competence levels of the nursing students in Group II were statistically significantly higher than those of the nursing students in Group I. The predictors of this were evaluated as to why students chose the nursing department, the country, and the department they liked.

A survey of ethical sensitivity among nursing students and its influencing factors

BACKGROUND

Nurses frequently experience ethical issues in their area of practice. In the challenging reality of today's healthcare environment, nursing students need to be prepared to deal with ethical issues in their future roles. Nevertheless, Chinese nursing students' ethical sensitivity status and the factors influencing it have not been described.

OBJECTIVE

This study aims to explore the level of ethical sensitivity and its influencing factors among Chinese nursing students.

RESEARCH DESIGN

This was a cross-sectional study. We firstly cross-culturally adapted the Japanese version of the Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS) into a Chinese version. Then, we administered the Chinese version of ESQ-NS, the Caring Ability Inventory (CAI), and general information questionnaire to nursing undergraduates.

PARTICIPANTS AND RESEARCH CONTEXT

The invitations were sent to 600 nursing undergraduates from four universities in Hunan, China.

ETHICAL CONSIDERATIONS

The study was supported by the Institutional Review Board (IRB) of the lead university. The Approval No. was E202092.

RESULTS

A total of 489 undergraduate nursing students participated in the study. The mean score for ethical sensitivity of the samples was 36.34 ± 4.90, and 187.99 ± 22.64 for their humanistic care ability. Pearson's correlation coefficient test indicated a meaningful and positive relationship between the ethical sensitivity and humanistic care ability (r = 0.576 and p < .01). And regression analysis showed that age, school year, experience in studying nursing ethics, how much you like nursing major, and humanistic care ability were of relevance to nursing students' ethical sensitivity.

DISCUSSION

Our findings suggest that the mean ethical sensitivity score of Chinese nursing students is 36.34 (13-52). The humanistic caring ability of Chinese nursing students is still at a low level.

CONCLUSION

Future interventions for improving the ethical sensitivity of the nursing students should consider general information of participants and their humanistic care ability.

Correlation between ethical sensitivity and humanistic care ability among undergraduate nursing students: a cross-sectional study

BACKGROUND

In nursing practice, a high level of ethical sensitivity and humanistic care ability must always be maintained. A limited number of studies have investigated the correlation between the level of ethical sensitivity and humanistic care ability of nursing students.

METHODS

A survey study was conducted from November 2023 to January 2024 among 656 undergraduate nursing students using the General Information Questionnaire, Ethical Sensitivity Questionnaire For Nursing Students, and Humanistic Care Ability Inventory.

RESULTS

The total ethical sensitivity score of nursing students (36.01 ± 6.31) was positively correlated with the total humanistic care ability score (r = 0.426, P < 0.01), and the results of the multivariate linear regression analysis showed that grade, relationship with parents, liking of the nursing major, willingness to work in nursing, experiences in learning nursing ethics, experience of caring for patients, and humanistic care ability are the main influencing factors of nursing students' ethical sensitivity.

CONCLUSION

The ethical sensitivity of undergraduate nursing students is at a moderate level, which shows a moderate and significant correlation with their humanistic care ability. College nursing educators and administrators should focus on integrating humanistic care ability education while increasing ethical education to cultivate excellent nursing students with comprehensive abilities.

Validation of the Santa Clara Ethics Scale (SCES) in Nursing Students: The Role of Ethics as a Protector of Student Compassion

BACKGROUND

Ethics is one of the essential concepts associated with professional nursing practice, and can play a part in the development of compassion. Although a number of instruments have been developed for the measurement of ethics, most are context-specific or excessively lengthy. The Santa Clara Ethics Scale (SCES) overcomes these problems. The goal is to translate, adapt, and validate the Spanish version of the Santa Clara Ethics Scale and to study the role of ethics, as a moral resource, in the prediction of the levels of compassion of nursing students.

METHODS

This study is a translation, adaptation, and validation study, with a cross-sectional design. A total of 924 Spanish nursing students participated in this study. Ethics and compassion for others were measured. Analyses included a confirmatory factor analysis, reliability estimates, and a structural equation model in which ethics explained the five correlated dimensions of compassion for others.

RESULTS

The confirmatory factor analysis had an adequate fit: χ2(35) = 173.56 (p < 0.01), CFI = 0.94, TLI = 0.92, RMSEA = 0.07 [90% CI = 0.06, 0.08], and SRMR = 0.05. Internal consistency was adequate (α = 0.74; ω = 0.83). The predictive model pointed to positive and statistically significant relationships between ethics and all dimensions of compassion for others.

CONCLUSIONS

The SCES can be considered a suitable instrument for the assessment of ethics in the Spanish nursing population and, thus, can be used as a tool for the measurement of key ethical competencies during the nursing degree. Moreover, the development of ethics is likely to improve the compassion levels of students. Ethics is, then, a key internal resource for both nursing students' compassionate care skills and, consequently, must be taken into account when redefining nursing students' curricula.

The psychometric properties of instruments measuring ethical sensitivity in nursing: a systematic review

BACKGROUND

Recognizing and appropriately responding to ethical considerations is a crucial element of ethical nursing practice. To mitigate instances of ethical incongruity in healthcare and to promote nurses' comprehension of their professional ethical responsibilities, it is imperative for researchers to accurately evaluate ethical sensitivity. Conducting a systematic review of the available instruments would enable practitioners to determine the most suitable instrument for implementation in the field of nursing.

AIM

This review aims to systematically assess the measurement properties of instruments used to measure ethical sensitivity in nursing.

METHODS

A systematic literature search was conducted in July 2022 in the following electronic databases: Scopus, CINAHL, APAPsycINFO, Embase, Web of Science, and PubMed. Two reviewers independently screened and assessed the studies in accordance with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. The updated criteria for good measurement properties are used to rate the result of measurement properties, and the modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to grade the quality of the summarized evidence.

RESULTS

This review encompasses a total of 29 studies that describe 11 different instruments. Neither cross-cultural validity nor responsiveness was examined in any of the included studies. Whereas the majority of the instruments were conducted with at least some type of validity assessment, nearly all of the reliability results rated were indeterminate. Two instruments were recommended, the Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS) and the Ethical Awareness Scale for nurses in intensive care units. It is recommended that new self-administration instruments for special nursing settings be developed in accordance with the item response theory (IRT)/Rasch model.

CONCLUSION

The selection of ethical sensitivity measurement instruments in nursing, and further research on the development, psychometric, and cross-cultural adaptation of these instruments, could be conducted in accordance with the findings and suggestions of this systematic review.

STRENGTHS AND LIMITATIONS

• This review was conducted to assess 11 instruments that were used to measure ethical sensitivity in nursing in 29 studies. • The Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS) and the Ethical Awareness Scale for nurses in intensive care units can be recommended, but further reliability and cross-cultural validity testing are needed. • The IRT/Rasch model is also recommended to measure ethical sensitivity in nursing. • The potential limitation of utilizing the COSMIN checklist for assessing methodological quality is worth considering. • Test-retest was considered inappropriate; thus, the reliability testing of ethical sensitivity measurement instruments still needs to be explored.

Assessment of ethical sensitivity in nursing students: Tools, trends, and implications

BACKGROUND

Rapid advances in medical technology, changing healthcare policies, and increasing patient diversity have exacerbated the ethical challenges. As nursing students are an integral part of the future nursing workforce, ethical sensitivity has a critical impact on their future careers.

PURPOSE

This study aims to promote research in related fields by systematically reviewing the origin and development of the concept of ethical sensitivity in nursing students, comparing currently available tools for assessing ethical sensitivity in nursing students, and exploring their applicability and reliability.

METHODS

A literature review method was used in this study. A literature search was conducted for assessment tools published between 1995 and 2024. A total of six articles focusing on assessment tools they developed to measure ethical or moral sensitivity were included and analyzed.

RESULTS

Our analysis revealed significant variations in the reliability and applicability of these assessment tools, particularly when used in diverse cultural settings. The study also identified a need for localized modifications of these tools to ensure their accuracy and relevance in different regions.

CONCLUSION

The findings provide valuable guidance for nursing educators in selecting appropriate assessment tools and offer a foundation for developing new tools that are more contextually relevant. This study contributes to the advancement of ethical sensitivity education for nursing students worldwide, ultimately enhancing patient care and professional development.

A New Construct in Undergraduate Medical Education Health Humanities Outcomes: Humanistic Practice

Proposed educational outcomes for the health humanities in medical education range from empathy to visual thinking skills to social accountability. This lack of widely agreed-upon high-level curricular goals limits humanities educators' ability to design purposeful curricula toward clear, common ends and threatens justifications for scarce curricular time. We propose a novel approach to the hoped-for outcomes of health humanities training in medical schools, which has the potential to encompass traditional health humanities knowledge, skills, and behaviors while also being concrete and measurable: humanistic practice. Humanistic practice, adapted from the concept of ethical sensitivity, is an intentional process of applying humanities knowledge and skills to a clinical scenario by 1) noticing that the scenario requires humanities knowledge or skills, 2) informing one's clinical and interpersonal strategy and behavior with humanities knowledge or skills, 3) reflecting on the effectiveness of the strategy and behavior, and 4) reorienting to develop new approaches for future practice. The construct of humanistic practice may help address some of the foundational problems in health humanities outcomes research since it transcends the traditional diverse content domains in the health humanities, can link patient and provider experiences, and may bridge the divide among the additive, curative, and intrinsic epistemic positions of humanities to medical education.

Development and validation of Adaptability to Return-to-Work Scale (ARTWS) for cancer patients

Introduction

The research on cancer patients returning to work in China is still in its infancy, and there is no research and discussion on the adaptability to return-to-work for cancer patients. It is critical to develop the Adaptability to Return-to-Work Scale (ARTWS) for cancer patients and evaluate its psychometric properties.

Methods

The items of the initial scale were compiled based on the theoretical model and literature review results. Through two rounds of Delphi expert consultation (N = 15) and a pilot survey (N = 40), the initial scale was further checked and revised. Conduct a large sample survey (N = 376) and the construct validity and reliability of the ARTWS were assessed by confirmatory factor analysis (CFA) and exploratory factor analysis (EFA).

Results

The final ARTWS consisted of 24 items. "Focusing on rehabilitation," "Rebuilding Self-efficiency," and "Adjusting plans" as common factors in determining adaptability to return to work for cancer patients, and the cumulative variance contribution rate for these three factors was 66.6%. The S-CVI of the total scale was 0.979. The Cronbach's α coefficient was 0.937 and the 2-week test-retest reliability was 0.814.

Discussion

ARTWS has good correlation validity and can be used as a tool to measure the adaptability of cancer patients' return to work. The presentation of the manuscript in Research Square (https://doi.org/10.21203/rs.3.rs-2323264/v1).

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.

Effect of empathy competence on moral sensitivity in Chinese student nurses: the mediating role of emotional intelligence

BACKGROUND

Ethical issues may pose challenges to nursing students entering clinical practice. Moral sensitivity can assist them in recognising existing moral situations and then taking adequate action. Identifying the variables associated with moral sensitivity may be useful in preparing to improve nursing students' moral sensitivity.

OBJECTIVES

This study investigated empathy, emotional intelligence, and moral sensitivity in Chinese student nurses to explore the association among these three factors and to verify the mediating function of emotional intelligence in determining the connection between empathy and moral sensitivity.

DESIGN

This study used a cross-sectional correlational design.

SETTING AND PARTICIPANTS

Through convenience sampling, 239 fourth-year nursing undergraduates at a university in Western China were enrolled in this study.

METHODS

Nursing students who volunteered to participate in the study completed self-reported scales on empathy, emotional intelligence, and moral sensitivity between September and October 2022. The potential mediating effect was explored using the Process Macro and bootstrap method.

RESULTS

The nursing students' average scores were 39.62 ± 5.27 on moral sensitivity, 108.21 ± 15.49 on empathy, and 124.41 ± 13.66 on EI. Moral sensitivity was positively correlated with emotional intelligence (r = 0.454, p < 0.001) and empathy (r = 0.545, p < 0.001). Furthermore, empathy exerted a substantial direct effect on nursing students' moral sensitivity (B = 0.1424, p < 0.001). Emotional intelligence could mediate the indirect path from empathy to moral sensitivity. (B = 0.0372, p < 0.001).

CONCLUSION

Emotional intelligence mediated the association between empathy and moral sensitivity. Thus, educational activities and programmes placing an emphasis on empathy and emotional intelligence may offer an alternative way to promote moral sensitivity in Chinese student nurses.

IMPLICATIONS

Nursing educators can organise programmes to improve nursing students' emotional competence and professional values. Early exposure to clinical practice benefits nursing students a lot in terms of building interactions with patients and increasing emotional resonance. In addition, nursing educators should develop situational teaching in nursing ethics courses to help students cope with ethical issues.

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.

Assessing the psychometric properties of the Arabic version of the Nursing Practice Readiness Scale among Saudi nursing students

Readiness to practice nursing is essential for nursing students to ensure that they are conscientious, have a sense of responsibility, and are rational in performing their clinical practice. This study tested the psychometric properties of the "Nursing Practice Readiness Scale" Arabic version (NPRS-A) to assess Saudi nursing students' readiness to practice nursing in clinical settings. This study used a methodological design to examine the psychometric properties of the NPRS-A among 373 nursing students in Saudi Arabia. The findings provide evidence of the NPRS-A's good content validity. The PCA revealed five distinct components with a "cumulative variance explained" of 69.2%. The test of difference on the nursing practice preparedness between students from different levels showed that students in the 2nd year were less prepared than junior and senior nursing students. The correlation test showed that a higher GPA and higher self-reported readiness are more ready to practice nursing in clinical settings. The research showed an overall Cronbach's alpha of 0.957. The establishment of the NPRS-A is significant, not only in Saudi Arabia but other Arabic-speaking countries. Nurse educators and nursing education policymakers can use this version to assess nursing students' learning needs to be prepared to practice nursing.

Knowledge of the Patients' Bill of Rights and Influencing Factors Among University Nursing Students

Background Nursing students, the future nursing workforce, are expected to be exposed to ethically challenging situations in their workplaces, and they must be knowledgeable about patients' rights to provide holistic care. However, limited research was cited on the knowledge of nursing students regarding the Bill of Rights and the factors influencing their knowledge. Purpose This study aimed to assess nursing students' knowledge of the patients' bill of rights and determine what factors influence this knowledge in Saudi Arabia. Methods A descriptive cross-sectional research study was conducted with a convenience sample of nursing students (N = 210) in a Saudi nursing college. Data were collected using a questionnaire that consists of three parts: demographic characteristics, knowledge of the patients' bill of rights, and six open-ended and reflective questions. Descriptive statistics and response analysis are used. Results The statistics showed that the total knowledge score about patients' rights ranged from 19 to 34, with a mean of 26.11 ± 2.32, among nursing students. About two-thirds of students reported adequate knowledge (n = 118, 65.5%), compared to those who had inadequate knowledge (n = 62, 34.5%). In addition to academic level and age, students reflected on many factors that shape their ethical knowledge, such as integrated, interprofessional learning experiences, workshops, a supportive and ethical learning environment, and the presence of an ethical committee. Conclusion Continuous efforts to foster ethics education with inspiring learning content and innovative instructional material are vital to improving nursing students' knowledge and readiness. Interprofessional education (IPE) sessions and awareness programs are effective strategies to improve their ethical awareness and knowledge.

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.

Moral sensitivity of nursing students. Adaptation and validation of the moral sensitivity questionnaire in Spain

Ethical sensitivity is a requirement for people care as well as for decision-making in everyday practice. The aim is to present an adaptation and transcultural validation -in Spanish- of the Moral Sensitivity Questionnaire by Lützén et al. in Spain. In addition to that, we provide a practical implementation analysing the degree of moral sensitivity of nursing students. The data used for data collection were moral Sensitivity Questionnaire, socio-demographic data and a self-report questionnaire. The psychometric properties of the questionnaire were assessed, including validity and reliability. Fit indices of the overall model were computed. The fit indices of the Confirmatory Factor Analysis (CFA) indicate a poor fit, although the Exploratory Factor Analysis (EFA) revealed two dimensions that show a better fit of its indices. Women and those women with more experience in the clinical setting have a higher mean score, as well as those who study in centers where the strategic lines are the humanization of care. Female nursing students with more experience in the clinical setting and with more educational training present higher sensitivity indexes, as well as those who study in centers where the strategic lines are the humanization of care. The findings confirm that the Lützén et al. questionnaire is multidimensional. In the Spanish sample, it was necessary to group the three initial factors into two: sense of moral burden and moral strength—grouping the moral responsibility items into the above items to make the instrument more resilient.

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.

Reliability and validity evaluation of the chinese version of the ethical sensitivity questionnaire for nursing students

BACKGROUND

Advances in technology and the expansion of nursing roles have led to complex ethical issues in nursing. Nursing students are the future clinical nursing workers and practitioners. The ethical sensitivity of nursing students is very important to the professional development of nursing students, which can strengthen the ethical cognition of nursing students, improve the ethical decision-making ability of nursing students, and is beneficial to the development of nursing students in the process of clinical practice and nursing education. However, there are no instruments to evaluate the ethical sensitivity of nursing students in China. Therefore, the purpose of this study is to evaluate the validity and reliability of the Chinese version of the Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS).

METHODS

After obtaining the authorization of the author of the original scale, the study used the Brislin back-translation method for translation. An exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) were performed to examine the underlying factor structure of the translated questionnaire. The Cronbach alpha coefficient, the test-retest reliability, and the corrected item-total correlation were calculated to verify the internal consistency of the scale.

RESULTS

The Chinese version of ESQ-NS retained 13 items. Exploratory factor analysis (EFA) extracts four common factors, and the cumulative variance contribution rate is 62.479%. The CFA reached the adaptive standard, and the discriminant validity of the scale was good. The Cronbach alpha coefficient of this scale was 0.821, and 4 dimensions were between 0.708 and 0.738. The results of the test-retest showed that Pearson's correlation coefficient of the overall ESQ-NS was 0.814. Corrected item-total correlation ranged from 0.337 to 0.542.

CONCLUSIONS

The Chinese version of the ESQ-NS has good reliability and validity, which can be used to evaluate the level of ethical sensitivity of nursing students in China.

Development of a questionnaire to measure the moral sensitivity of nursing students

Moral sensitivity is important for both, qualified nurses and nursing students. Currently, however, the instruments to measure moral sensitivity exist for qualified nurses only. The objective of this study is to develop a valid and reliable instrument to assess moral sensitivity of nursing students and to examine the development and differentiation of this sensitivity by school year, clinical training, and other educational variables. The study comprised semi-structured focus group interviews and a survey using a self-administered questionnaire. The questionnaire was developed using data obtained from the focus groups and distributed to 1,995 nursing students in three Bachelor of Science in Nursing programs (BScN) and eight Nursing Diploma programs. Completed questionnaires were obtained from 473 nursing students. An exploratory factor analysis indicated that 11 items and 3 factors were extracted: “Moral Strength,” “Sense of Moral Burden,” and “Moral Responsibility.” The factors each demonstrated acceptable content- and criterion-related validity with the Resilience Measurement Scale for University Students. This three-factor structure was consistent with that of the Japanese version of the revised Moral Sensitivity Questionnaire. The mean score of each item ranged from 2.75 to 4.74 (SD = 1.04 – 1.34). A comparison of inter-year scores showed that third-year students had significantly higher Moral Strength scores in both the BScN and Nursing Diploma programs. The 11-item questionnaire developed for this study was consistent with a three-factor structure of registered nurses’ moral sensitivity and successfully identified differences in moral sensitivity among nursing students. Using this type of questionnaire will allow nursing programs to improve the moral sensitivity of nursing students by allowing lecturers to develop tailored moral sensitivity programs.

Academic Ethical Awareness and Moral Sensitivity of Undergraduate Nursing Students: Assessment and Influencing Factors

Nursing students are exposed to ethically challenging conditions in their future workplaces; hence, they must be ethically knowledgeable and morally sensitive to provide patients with holistic care based on sound ethical decision-making skills. Objectives: This study aimed to assess nursing students' perception of their academic ethical awareness and moral sensitivity and determine the relationship between these variables. Methods: We conducted a descriptive correlational research study with a convenient sample of nursing students (N = 246) in a Saudi University nursing college. Data were collected using the Academic Ethical Awareness Questionnaire and Moral Sensitivity Questionnaire. We used descriptive statistics, ANOVA, and regression analyses. Results: Nursing students exhibited moderate academic ethical awareness and moral sensitivity. The regression analysis showed that academic ethical awareness can substantially predict 28.8% of the explained moral sensitivity variance (p < 0.001). Nursing students were aware that the violation of patients' respect or confidentiality and cheating in examinations were unethical behaviors. However, they showed low ethical awareness toward plagiarism behaviors. Furthermore, they reported higher moral sensitivity for patient-oriented care and professional responsibility and did not experience conflict. Academic level and integrated classroom and clinical learning experiences seemed to positively impact students' academic ethical awareness. Conclusion: The findings provide a basis for monitoring nursing students' professional misconduct so that they maintain integrity and adhere to academic ethics guidelines. Constant exertions for fostering nursing ethics courses with inspiring learning content and innovative instructional material are vital in improving nursing students' academic integrity and ethical care.

The role of undergraduate medical students training in respect for patient confidentiality

BACKGROUND

Encouraging professional integrity is vital for providing a standard of excellence in quality medical care and education and in promoting a culture of respect and responsibility. The primary objective of this work consisted of studying the relationship of medical students to the right to patient privacy in Spain, specifically by analysing the conditions for accessing patient clinical histories (CHs).

METHODS

A cross-sectional study was conducted based on a questionnaire sent by e-mail to final-year students at 41 Spanish universities. It had 14 multiple choice and closed questions framed in 3 large blocks. The first question addressed basic general knowledge issues on the right to privacy and the obligation for confidentiality. The two remaining blocks were made up of questions directed towards evaluating the frequency with which certain requirements and action steps related to students attending patients were performed and regarding the guarantees associated with accessing and handling patient CHs both on paper and in the Electronic Medical Record.

RESULTS

A total of 245 valid replies were considered. A total of 67.8 % of participants were women, with an average age of 24.05 ± 3.49 years. Up to 90.6 % were aware that confidentiality affected the data in CHs, although 43.3 % possessed non-anonymized photocopies of patient clinical reports outside the healthcare context, and only 49.8 % of the students were always adequately identified. A total of 59.2 % accessed patient CHs on some occasions by using passwords belonging to healthcare professionals, 77.2 % of them did not have the patients' express consent, and 71.9 % accessed a CH that was not anonymised.

CONCLUSIONS

The role of healthcare institutions and universities is considered to be fundamental in implementing educational measures regarding the risks and ethical and legal problems arising from the use of CHs among professionals and students. A thorough study of medical ethics is needed through the analysis of clinical cases and direct exposure to situations in which the patient's confidentiality is questioned.