Developing the Concept of Moral Sensitivity in Health Care Practice

Factors associated with moral sensitivity among nurses in adult intensive care units: A cross-sectional study in China

BACKGROUND

Moral sensitivity may play a role in dealing with ethical issues in ICUs. However, the moral sensitivity of adult ICU nurses in China and its predictors have not been well investigated.

AIM

To analyse the moral sensitivity of intensive care unit (ICU) nurses and its predictors.

STUDY DESIGN

A cross-sectional study through convenience sampling was conducted in the ICUs of five hospitals in China between November and December 2022. A total of 331 ICU nurses were recruited. Data were obtained using a self-developed socio-demographic characteristic questionnaire, the Moral Sensitivity Questionnaire, the Jefferson Scale of Empathy-Health Professionals and the Organizational Climate Scale for Nursing. The participating institutions received a link to the tools used for online data collection, which they then forwarded to nursing staff.

RESULTS

The valid response rate was 96.98% (n = 321). The total mean moral sensitivity score of nurses was 43.04 ± 5.95. The mean scores for empathic ability and organizational climate for nursing were 91.97 ± 17.88 and 101.28 ± 14.77, respectively. Regression analyses revealed that the primary factors associated with moral sensitivity among critical care nurses included work tenure (p < .05), empathic ability (p < .001) and organizational climate (p < .001).

CONCLUSIONS

High levels of moral sensitivity were found in critical care nurses in China. Work tenure, empathic ability and organizational climate were significant predictors of moral sensitivity in critical care nurses.

RELEVANCE TO CLINICAL PRACTICE

To enhance the ethical sensitivity of ICU nurses, we suggest to strengthen the training of novice nurses so that they can better face the moral dilemma in clinical practice. In addition, organizational managers should also take measures to create a positive and harmonious working atmosphere, promote the application of moral knowledge in nursing practice and enhance their moral sensitivity.

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.

The impact of moral resilience on nurse turnover intentions: the mediating role of job burnout in a cross-sectional study

BACKGROUND

High nursing staff turnover is a critical issue that negatively impacts the quality of care and patient safety. Turnover intentions, a key predictor of actual turnover, reflect an individual's likelihood of leaving their current position. Understanding the underlying mechanisms driving nurse turnover intentions is crucial for developing targeted interventions to stabilize the nursing workforce globally.

OBJECTIVES

This study aims to explore the relationship between moral resilience, job burnout, and turnover intentions among nurses, focusing on the mediating role of job burnout in this relationship.

DESIGN

This study employed a quantitative, cross-sectional design.

METHODS

A convenience sample of 322 registered nurses was recruited from two tertiary hospitals in China between August and October 2023. Data were collected using the Chinese version of the Rushton Moral Resilience Scale (Chi-RMRS), the Maslach Burnout Inventory (MBI), and the Turnover Intention Scale. Data analyses were conducted using SPSS 26.0 and Amos 21.0. The study followed the STROBE guidelines for observational research.

ETHICAL CONSIDERATION

Before the commencement of data collection, the Institutional Review Board of Hunan Traditional Chinese Medical College (YXLL202401004) granted ethical approval.

RESULTS

The proposed model exhibited an excellent fit to the data, with fit indices as follows: χ2/df = 1.819, CFI = 0.977, TLI = 0.961, RMSEA = 0.072 (90% confidence interval [CI]: 0.033 to 0.107). The structural equation model revealed that moral resilience was inversely associated with job burnout and turnover intentions. Furthermore, job burnout fully mediated the relationship between moral resilience and turnover intentions (β = -0.473, p = 0.007). Further analysis indicated that the depersonalization component of job burnout was the sole mediator in the relationship between moral resilience and turnover intention (β = -3.934, 95% CI [-5.837, -1.932]).

CONCLUSION

The findings indicate that moral resilience among nurses is negatively associated with turnover intentions, with this effect fully mediated by the depersonalization dimension of job burnout. Enhancing moral resilience in nurses may be valuable strategy for healthcare administrators to mitigate job burnout and subsequently reduce turnover intentions.

Empathy, Moral Sensitivity, and Prosocial Behavior Among Medical Undergraduates in a South Indian Tertiary Care Teaching Institute: An Analytical Cross-Sectional Study

INTRODUCTION

 Empathy, moral sensitivity, and prosocialness are critical traits for medical professionals, as they affect patient care quality and ethical decision-making. These traits help address psychological complexities like stress and burnout in medical practice. Despite their importance, the relationships between these traits, especially among medical students, remain underexplored. This study aims to assess empathy, moral sensitivity, and prosocialness among medical students in South India, focusing on gender differences and their associations.

MATERIALS AND METHODS

 This cross-sectional study was conducted at Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Chennai, with 369 medical undergraduates. Data were collected using three standardized tools: the Interpersonal Reactivity Index for empathy, the Moral Sensitivity Questionnaire, and the Prosocialness Scale for Adults. The questionnaire, including demographic data, was administered online with anonymity and consent. Descriptive statistics summarized demographic data. Inferential analyses, including t-tests, chi-square tests, Pearson correlations, and multivariate regression, examined relationships between empathy, moral sensitivity, pro-social behavior, and demographics. Statistical significance was set at p < 0.05. Ethical approval was obtained from Saveetha Medical College's Ethics Committee.

RESULTS

 The mean age of participants was 20.5 ± 2 years, with 183 males (49.6%) and 186 females (50.4%). The majority were first-year students (29.8%), followed by second-year (19.5%) and final-year part I students (19.2%). Final professional part II students and interns comprised 15.4% and 16%, respectively. Females scored significantly higher in empathy domains like perspective-taking (15 ± 3.3 vs. 14 ± 3.4), fantasy (14.4 ± 4 vs. 13.6 ± 3.3), and empathetic concern (15.3 ± 3.5 vs. 14.2 ± 3.1), with p values <0.05. Overall, 186 females (50.4%) had a mean empathy score of 59 ± 9, compared to 183 males (49.6%) with 56.2 ± 7.1 (Cohen's d = 0.33). In moral sensitivity, females scored higher in modifying autonomy (7 ± 2.3 vs. 6.3 ± 2.2), structuring moral meaning (4.6 ± 2 vs. 4.15 ± 1.6), and expressing benevolence (16 ± 4 vs. 15 ± 4), with significant differences (p < 0.05). The total moral sensitivity score was higher in females (57 ± 10 vs. 54 ± 9), with a moderate effect size (Cohen's d = 0.3). Males scored higher in prosocialness, with 183 males (49.6%) scoring 54 ± 7, compared to 186 females (50.4%) with 51.5 ± 7.2 (Cohen's d = 0.3). Weak but significant correlations were found between empathy and prosocialness (r = 0.132, p = 0.011) and between moral sensitivity and prosocialness (r = 0.479, p < 0.001). Regression analysis identified gender, prosocial behavior, and specific moral sensitivity dimensions as significant predictors of empathy scores.

CONCLUSION

 This study revealed significant gender differences in empathy, moral sensitivity, and prosocialness among medical students. Females scored higher in empathy and moral sensitivity, whereas males showed greater prosocial behavior. The positive correlations between empathy and prosocialness and between moral sensitivity and prosocialness highlight their interconnectedness. Educational interventions that target empathy and moral sensitivity could help nurture more compassionate, ethical healthcare professionals. Future research should explore how these traits evolve throughout medical education.

The Relationship Between Moral Sensitivity, Missed Nursing Care and Moral Distress Among New Nurses: A Cross-Sectional Study

Moral sensitivity, missed nursing care and moral distress among healthcare professionals have received considerable attention in recent years. These factors represent important healthcare challenges for new nurses (graduation to 2 years of work experience). However, studies on the relationships among these variables in the context of new nurses in China remain lacking.

AIMS

To explore the relationships among moral sensitivity, missed nursing care and moral distress in the context of new nurses in China.

RESEARCH DESIGN

A cross-sectional descriptive survey was conducted.

PARTICIPANTS AND RESEARCH CONTEXT

A total of 228 new nurses were recruited from three tertiary hospitals in Qingdao, Shandong Province, China. Participants provided their sociodemographic and professional information and completed the Chinese Moral Sensitivity Questionnaire-Revised Version, the Chinese Missed Nursing Care Survey Version and the Chinese Moral Distress Scale-Revised Version. The data were analysed using Spearman's correlation analysis and multiple linear regression analysis.

RESULTS

The means and standard errors of moral sensitivity, missed nursing care and moral distress were 40.71 (0.39), 9.82 (0.78) and 34.87 (2.41), respectively. The variable of missed nursing care exhibited a significant negative relationship with moral sensitivity and a significant positive relationship with moral distress. Regression analysis revealed that the main factors influencing new nurses' moral distress were educational background, nature of job, current unit, frequency of night shifts and the dimensions of moral strength and responsibility. These factors can explain 14.9% of the total variation.

CONCLUSION

The findings revealed that higher rates of missed nursing care were associated with lower moral sensitivity and greater moral distress among new nurses. Therefore, developing interventions to reduce missed nursing care may be a promising strategy for improving moral sensitivity and preventing moral distress among new nurses.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

In hospitals, moral distress can be improved by focusing on modifiable factors such as staffing resources, leading to better promoting new nurses' health and improving the quality of care. This study can highlight practices accounting for moral sensitivity and missed nursing care in nursing research and training programmes.

REPORTING METHOD

Strengthening the reporting of observational studies in epidemiology (STROBE) statement.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

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.

Mediating effect of moral sensitivity and professional identity between moral courage and compassion fatigue among nursing interns: a cross-sectional study

BACKGROUND

Compassion fatigue in nursing interns contributes to career indecision and worsens the nursing shortage. While work environment and psychological factors are well-studied, the ethical dimension remains unexplored. Understanding these mechanisms, particularly the role of moral courage, is essential for designing interventions to combat compassion fatigue and address the workforce crisis. This study investigates the influence of moral courage on compassion fatigue among Chinese nursing interns, focusing on the mediating roles of moral sensitivity and professional identity.

METHODS

A quantitative, cross-sectional study was conducted in accordance with the STROBE guidelines. We used the convenience sampling method to recruit 467 nursing interns from four public junior colleges in Hunan Province, China in February, 2024. Data were collected using Compassion Fatigue Short Scale, Moral Courage Scale, Revised Moral Sensitivity Questionnaire, and Professional Identity Scale. Data analyses were conducted using SPSS 22.0 and Amos 21.0.

RESULTS

The modified model exhibited a good fit (χ2/df = 3.437, AGFI = 0.928, IFI = 0.984, TLI = 0.976, CFI = 0.984, NFI = 0.977, RMSEA = 0.072). Moral sensitivity positively influenced both moral courage and professional identity, while professional identity negatively impacted compassion fatigue. Importantly, the effect of moral courage on compassion fatigue was entirely mediated by moral sensitivity and professional identity (β = -0.114, P = 0.001).

CONCLUSION

This study suggests that moral courage in nursing interns mitigates compassion fatigue through the combined mediating effects of moral sensitivity and professional identity. Ethics education programs fostering moral courage, moral sensitivity, and professional values in nursing students could be crucial in alleviating compassion fatigue.

Moral sensitivity, moral courage, and ethical behaviour among clinical nurses

Background: Ethical behaviour in nursing practice is integral to establishing a harmonious nurse-patient relationship and improving the quality of care. A multitude of factors shapes such behaviour. Therefore, it is crucial to understand the interplay between these factors. Research objectives: This study aimed to explore the mechanisms underlying the influence of moral sensitivity on nurses' ethical behaviour and clarify the mediating role of moral courage. Research design: This cross-sectional quantitative study was conducted between July and August 2023. Participants and Research Context: The sample comprised 465 clinical nurses from three tertiary hospitals in Zhengzhou City, Henan Province, China. Data were collected using the Chinese version of the Moral Sensitivity Questionnaire-Revised Version, Nurses' Moral Courage Scale, and Ethical Behaviour Scale for Nurses. Data analysis was performed with SPSS 26.0 and AMOS 24.0, using descriptive statistics, Pearson correlation analysis, structural equation modelling, and bootstrapping methods. Ethical considerations: This study was approved by the Ethical Review Committee of Life Sciences of Zhengzhou University, China. Results: The participants were predominantly female (95.1%), with a mean age of 31.9 years. Moral courage and moral sensitivity were positively correlated with ethical behaviour. Moral sensitivity was positively associated with moral courage. Moral courage partially mediates the relationship between moral sensitivity and ethical behaviour. The indirect effect of nurses' moral sensitivity on ethical behaviour was quantified through moral courage (indirect effect = 0.290). Conclusion: Moral courage intermediates nurses' moral sensitivity and ethical behaviour. This conclusion provides nursing administrators with the insight that improving clinical nurses' moral sensitivity and courage can contribute to ensuring appropriate ethical behaviour.

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.

Applicants' success in the ethics entrance exam: A cross-sectional study

BACKGROUND

Student selection is the first step in recruiting future social and healthcare professionals. Ethically competent professionals are needed in social and healthcare. It is important to select applicants who have the best possible abilities to develop their ethical competence in the future. Values-based recruitment has been used to inform the recruitment and selection of higher education applicants. However, objective and valid tests in student selection are needed.

AIM

To assess social and healthcare applicants' success and related factors in the ethics section of the universities of applied sciences digital entrance examination (UAS Exam) to undergraduate degree programmes.

RESEARCH DESIGN

A cross-sectional design was used.

PARTICIPANTS AND RESEARCH CONTEXT

Social and healthcare applicants needed to identify ethical situations in the ethics section of a national digital entrance examination (UAS Exam) in autumn 2019 (between 29 October and 1 November) in 20 Finnish universities of applied sciences.

ETHICAL CONSIDERATIONS

The process for the responsible conduct of research was followed in the study. Ethics committee approval was obtained from the Human Sciences Ethics Committee in the Satakunta region (27 September 2019). Approval to undertake the study was obtained from the participating universities of applied sciences. Participation to the study was voluntary and based on informed consent.

RESULTS

The applicants' (n = 8971) mean scores were 7.1/20 (standard deviation 6.5), and 22.7% of the applicants failed the ethics section. Age, previous education, and place of birth (own/parent) explained the applicants' success in the ethics section (total score and failed exam results).

CONCLUSION(S)

Applicants' success in the ethics section varied indicating that future students may have a different basis to develop their ethical competence. This may impact on (new) students' learning, especially in practical studies.

Adaptation and validation of moral distress thermometer in Chinese nurses

BACKGROUND

Moral distress seriously affects professional nurses, and a number of instruments have been developed to measure the level of moral distress. The moral distress thermometer (MDT) is one of the commonly used instruments that can rapidly measure real-time moral distress; however, it remains unclear whether it is still useful in the Chinese cultural context.

AIM

This study aimed to adapt and validate the MDT among Chinese registered nurses.

RESEARCH DESIGN

An online, cross-sectional, survey study of adapting and validating Chinese version of MDT.

PARTICIPANTS AND RESEARCH CONTEXT

A total of 182 registered nurses effectively finished this survey. The correlation between MDT score and the score of the moral distress scale-revised version (MDS-R) was used for evaluating convergent validity, and MDT scores of registered nurses who working in different departments and who made different actions to the final question of the MDS-R were compared by using one-way ANOVA to evaluate construct validity.

ETHICAL CONSIDERATIONS

The Ethics Committee of Chongqing Traditional Chinese Medicine Hospital approved this study.

RESULTS

The Chinese version of MDT was described as relevant to measure moral distress, with a reported item-level content validity index (I-CVI) and scale-level CVI (S-CVI) of 1. The mean MDT score and mean MDS-R score were 2.54 and 38.66, respectively, and the correlation between these two scores was significantly moderate (r = 0.41). Nurses working different departments reported different levels of moral distress, and those working in intensive care unit reported the highest level of moral distress than those working in other departments (p = 0.04). The MDT scores between nurses who presented different actions to their position were also significantly different, and those who had ever left and those who had considered leaving but did not leave reported significantly higher moral distress.

CONCLUSION

The MDT is a reliable, valid, and easy-to-use instrument to rapidly measure the real-time moral distress of registered nurses in China.

Moral distress and moral sensitivity in clinical nurses

Health care providers are expected to have a certain moral sensitivity (MS) to make an ethical assessment. Moral distress (MD) is a common phenomenon in nursing. It can negatively affect nurses physically, psychologically, socially, and spiritually. This study aimed to investigate the relationship between MD and MS among nurses using a cross-sectional descriptive design. The study was conducted in two stages. The first stage was a methodological study that analyzed validity and reliability of the Measure of MD-Healthcare Professionals. The second stage was a descriptive- predictive analysis that investigated the relationship between MD and MS. The MD intensity and frequency scores of the participants were high and moderately high, respectively. There was no direct effect on the total score and frequency of MS and MD. However, a direct and significant negative effect of MS was seen on the intensity of MD. Based on the results of this study, MS should be considered as a measure in studies aimed at understanding MD among clinical nurses. Empowerment programs should be established to increase the awareness of health workers about ethical and moral situations and to support them to cope with the problems they experience in these areas.

Moral sensitivity and caring behavior in nursing interns: the mediating role of empathy

Background

The main purpose of this study is to analyze the relationship between moral sensitivity, empathy, and caring behaviors and to explore the mediating effect of empathy on moral sensitivity and caring behaviors of nursing interns.

Methods

A cross-sectional survey was conducted from August to September 2022 in which 261 nursing interns from two Grade 3A Hospitals in Xi'an participated. The questionnaires used in the survey include the General Information Questionnaire (GIQ), the Moral Sensitivity Questionnaire-Revised Version translated into Chinese (MSQ R-CV), the Chinese version of the Jefferson Empathy Scale (JSE), and the Chinese version of the Caring Behavior Inventory (C-CBI). The obtained data were analyzed through descriptive statistics, a one-way analysis of variance (ANOVA), and Pearson's correlation coefficient, and the mediating effect of empathy was tested through structural equations.

Results

The overall mean of moral sensitivity of nursing interns in two Grade 3A Hospitals in Xi'an is 40.84 ± 8.73, the overall mean of empathy is 100.51 ± 21.56, and the overall mean of caring behavior is (113.81 ± 21.05). Statistical analysis showed that there is a positive correlation between moral sensitivity and caring behavior of nursing interns (r = 0.376, p < 0.01), between their empathy and moral sensitivity (r = 0.336, p < 0.01), and between their empathy and caring behavior (r = 0.394, p < 0.01). The empathy of nursing interns has a mediated effect on the relationship between moral sensitivity and caring behavior. The mediated effect value was 0.14, accounting for 31.82% of the total effect.

Conclusion

The moral sensitivity of nursing interns can have a direct impact on predicting the caring behavior and indirect influences their caring behaviors mediated by empathy, with the latter effect being mediated by empathy. Therefore, nursing educators and hospital administrators should adopt targeted interventions to improve the moral sensitivity and empathy of nursing interns, which can further prove to be beneficial in improving their caring behaviors, leading to enhanced quality of nursing care and reduced nurse-patient conflicts and finally to a stabilized nursing team.

Moral resilience in registered nurses: Cultural adaption and validation study

BACKGROUND

Healthcare professionals, especially professional nurses, experience various types of moral suffering due to inevitable ethical conflicts. Moral resilience is recently proposed as a resource to address moral suffering. However, there is no tool to measure moral resilience in Chinese professional nurses.

AIM

This study aimed to translate the Rushton Moral Resilience Scale (RMRS) into Chinese and evaluate the psychometric properties of the Chinese version of RMRS (Chi-RMRS).

RESEARCH DESIGN

A methodological and descriptive research design.

PARTICIPANTS AND RESEARCH CONTEXT

A convenience sample of 411 Chinese professional nurses was recruited through an online survey platform between February and March 2023.

ETHICAL CONSIDERATIONS

This study was approved by the Research Ethics Committees of the University and hospitals involved.

RESULTS

The RMRS was translated and culturally adapted into a Chinese version. Neither floor nor ceiling effects were observed. The scale-level content validity index (CVI) was 0.922 with the item-level CVIs ranging from 0.833 to 1.000. The explanatory factor analysis (EFA) generated a three-factor structure for the Chi-RMRS, and the confirmatory factor analysis (CFA) demonstrated the three-factor structure with factor loadings for each item ranging from 0.42 to 0.80. The scale-level Cronbach's α coefficient was 0.811 with each dimension ranging from 0.717 to 0.821, and composite reliability (CR) coefficient for the overall scale was 0.920, with each dimension varying from 0.739 to 0.824. The standard error of measurement (SEM) and smallest detectable change (SDC) were 3.522 and 9.763, respectively.

DISCUSSION

The Chi-RMRS is able to measure moral resilience of Chinese professional nurses, and has good validity and reliability. It can be used in research and practice to determine the level of moral resilience, thus helping nursing managers to monitor the status of Chinese professional nurses, then develop interventions to maintain the well-being of professional nurses and to ensure quality of care.

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.

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.

Moral courage and its influencing factor among oncology specialist nurses: A multi-centre cross-sectional study

AIM

Moral courage among healthcare workers has been extensively studied. However, few studies have been conducted on oncology specialist nurses, who frequently encounter complex moral situations. This study aimed to describe the current situation regarding moral courage and explored its influence on oncology specialist nurses in China.

DESIGN

This was an exploratory, descriptive study.

METHODS

A convenience sample of 390 nurses was conducted from 15 hospitals in Sichuan Province, China, between March and May 2023. Participants were assessed using the Moral Distress Scale-Revised, Nurses' Moral Courage Scale and the Moral Sensitivity Questionnaire.

RESULTS

The results demonstrated that moral courage was negatively associated with moral distress, and positively associated with moral sensitivity. Having a master's degree or above, an intermediate title or senior title, medical ethics training, moral distress or moral sensitivity contributed to explaining 54.1% of the variance in moral courage.

CONCLUSIONS

Moral courage was associated with several factors. Developing clinical intervention strategies and effective teaching methods will be critical for improving moral courage. No Patient or Public Contribution.

Structural equation modeling for associated factors with patient safety behaviors among nursing interns: A cross-sectional study based on the capability opportunity motivation-behavior model

BACKGROUND

Nursing interns are one of the most crucial providers of nursing services. Their safety behaviors are closely associated with adverse events. Therefore, it is vital to explore the factors influencing nursing intern safety behavior to improve patient safety.

OBJECTIVE

To evaluate patient safety behavior among nursing interns and explore latent influencing mechanisms based on the capability opportunity motivation-behavior (COMB) model.

DESIGN

A cross-sectional study SETTINGS AND PARTICIPANTS: The participants were 422 nursing interns recruited through convenience sampling from a comprehensive teaching hospital.

METHODS

Data on general information, nursing interns' patient safety behavior, metacognitive ability, clinical internship environment, and moral sensitivity were collected. Nursing interns' patient safety behavior was described with means and standard deviations. The independent sample t-test, ANOVA, Pearson's correlation, and SEM were used to determine contributing factors to nursing interns' patient safety behavior.

RESULTS

The mean total score for patient safety behavior was 53.08 ± 6.22. The results indicated that metacognitive ability not only directly affects the patient safety behavior of nursing interns (β = 0.554, P < 0.001, 95 % CI = [0.446, 0.637]) but indirectly affects interns' safety behavior through professional identity (β = 0.009, P = 0.031, 95 % CI = [0.001, 0.019]). The clinical internship environment also has both direct (β = 0.258, P = 0.001, 95 % CI = [0.166, 0.349]) and indirect (β = 0.007, P = 0.029, 95 % CI = [0.001, 0.015]) effects on the patient safety behavior of nursing interns.

CONCLUSION

There are some specific areas where nursing interns' safety behaviors need to be improved. This study reveals that strong metacognitive ability and a clinical internship environment with rich opportunities might be essential for the development of patient safety behaviors. To promote nursing interns' patient safety behaviors, clinical teachers could use reflective teaching methods and provide a supportive clinical environment to nurture nursing interns' professional identities and patient safety behaviors.

Impacts of ethical climate and ethical sensitivity on caring efficacy

BACKGROUND

Caring practice begins with awareness of the suffering of patients in a given context. Understanding the interrelationship between the perceived ethical climate of the clinical environment and the ethical sensitivity and caring efficacy of nurses is crucial for strengthening the caring competency of nurses.

RESEARCH AIM

This study aimed to examine the associations between the ethical climate of the clinical environment and the ethical sensitivity and caring efficacy of nurses and to investigate the mediating effect of ethical sensitivity on the association between ethical climate and caring efficacy.

RESEARCH DESIGN

This was a quantitative study with a cross-sectional descriptive correlational design. The participants completed an online survey that measured the ethical climate, ethical sensitivity and caring efficacy using the Hospital Ethical Climate Survey, Moral Sensitivity Questionnaire-Revised and Caring Efficacy Scale, respectively.

PARTICIPANTS AND RESEARCH CONTEXT

The study recruited 293 nurses from two general hospitals that provided acute in-patient and extended care in Hong Kong.

ETHICAL CONSIDERATIONS

Ethical approval was obtained from the ethics committee of the university and the hospitals involved. Written consent was obtained from the participants.

RESULTS

Ethical climate was associated with caring efficacy (β = 0.340, p < .001) and ethical sensitivity (β = 0.197, p < .001). After adjusting for ethical climate, ethical sensitivity was associated with caring efficacy (β = 0.860, p < .001). Ethical sensitivity showed a significant mediating effect on the association between ethical climate and caring efficacy (indirect effect = 0.169, 95% confidence interval: 0.097 to 0.261), which accounted for 50% of the total effect.

CONCLUSIONS

The study reveals the complex and interwoven relationship between contextual and personal factors that affect nurses' caring efficacy from an ethical perspective. It provides insights into the significant roles of ethical climate and ethical sensitivity in strengthening caring efficacy. The results suggest theoretical and clinical implications for professionalisation.

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.

A new approach to stress of conscience's dimensionality: Hindrance and violation stressors and their role in experiencing burnout and turnover intentions in healthcare

AIMS

To identify a valid, longitudinally invariant factor model for stress of conscience and to investigate how stress of conscience dimensions associate with burnout and turnover intentions.

BACKGROUND

There has been a lack of consensus about the number and content of stress of conscience dimensions, and a lack of longitudinal studies on its development and outcomes.

DESIGN

A longitudinal, person-centred survey study using the STROBE checklist.

METHODS

Healthcare personnel (n = 306) rated their stress of conscience in 2019 and 2021. Longitudinal latent profile analysis was used to identify different subgroups based on the employees' experiences. These subgroups were then compared in terms of burnout and organisational/professional turnover.

RESULTS

Five subgroups were identified, where participants experienced: (1) hindrance-related stress (14%), (2) violation-related stress (2%), (3) both stress dimensions increasing over time (13%), (4) both high yet decreasing over time (7%), and (5) stable levels of low stress (64%). When both hindrance- and violated-related stress were high, it was a significant risk for burnout and turnover. Shortened, 6-item, two-dimensional scale for stress of conscience was found to be reliable, valid, and longitudinally invariant.

CONCLUSION

On its own, hindrance-related stress (e.g. lowering one's aspirations for high-quality work) is less detrimental to well-being than when it is combined with violation-related stress (e.g. being forced to do something that feels wrong).

IMPLICATIONS FOR THE PROFESSION PATIENT CARE

To prevent burnout and staff turnover in healthcare, different risk factors for stress of conscience need to be identified and addressed.

PUBLIC CONTRIBUTION

Data were collected among public sector healthcare workers.

RELEVANCE TO CLINICAL PRACTICE

If healthcare workers are forced to ignore their personal values at work, it poses a significant risk for their well-being and retention.

Physiotherapists' Ethical Climate and Work Satisfaction: A STROBE-Compliant Cross-Sectional Study

(1) Background: This study aimed to examine the relationship between Spanish physical therapists' perceptions of the ethical climate, their moral sensitivity (awareness of ethical issues), and job satisfaction. (2) Methods: the study analyzed descriptive correlational data on 104 physical therapists from three Spanish metropolitan hospitals. Respondents completed a demographic data form, an ethical climate questionnaire, a job satisfaction survey, and a moral sensitivity scale. This study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. (3) Results: With a mean score of 4.2, physical therapists are typically content with their jobs. The mean scores for the moral sensitivity and ethical climate questionnaires are high, at 40.1 (SD 6.3) and 96.8 (SD 17.1), respectively. There is a significant positive correlation between job satisfaction and ethical climate (r between 0.59 and 0.79) but only a weak correlation between job satisfaction and moral sensibility (r between 0 and 0.32 for the three aspects measured). (4) Conclusions: Generally speaking, physical therapists reported that they had high job satisfaction, a positive workplace environment, and excellent management support. Despite a weak relationship with moral sensibility, there is a strong association between ethical behavior, hospital organization, and higher levels of job satisfaction. It is important to encourage the development of moral sensibilities to boost psychological well-being and therapeutic decision-making.

Correlations between moral courage, moral sensitivity, and ethical decision-making by nurse interns: a cross-sectional study

BACKGROUND

Clinical decision-making involves ethical issues that become more and more complex. Nurse interns must be more skilled in making rational and timely decisions when facing ethical dilemmas. The contributing factors and their relationships that challenge ethical decision-making among nurse interns must be fully understood, as this level of knowledge can support the development of strategies and interventions that improve the ethical decision-making ability of nurse interns.

OBJECTIVE

This study examined the relationships between moral courage, moral sensitivity, and ethical decision-making by nurse interns. In addition, we investigated whether moral sensitivity mediates the relationship between moral courage and ethical decision-making.

DESIGN

A descriptive cross-sectional study using an online questionnaire.

SETTING

The study sampled nurse interns from Class iii Grade A general hospitals in Sichuan Province, China.

PARTICIPANTS

A convenience sampling method was used to select 1334 nurse interns from March 2022 to May 2022.

METHODS

A general information questionnaire, the Nurses' Moral Courage Scale (NMCS), the Chinese Moral Sensitivity Questionnaire (MSQ), and the Judgement About Nursing Decision (JAND) were used for data collection. Data was processed and analysed using SPSS 26.0 and Amos 28.0. Data analysis included descriptive statistics, Pearson correlation analysis, and structural equation modelling.

RESULTS

Moral courage was found to be positively correlated with ethical decision-making (P < 0.01). Moral sensitivity was also positively correlated with ethical decision-making (P < 0.01) and had a mediating effect on the relationship between moral courage and ethical decision-making (P < 0.01).

CONCLUSIONS

The moral courage and moral sensitivity of nurse interns are positively correlated with ethical decision-making ability. Moral sensitivity significantly mediates the relationship between moral courage and ethical decision-making ability. The knowledge gained from this study can inform educational strategies and interventions in supporting the development of nurse interns' ethical decision-making ability.

The relationship between teamwork, moral sensitivity, and missed nursing care in intensive care unit nurses

BACKGROUND

Teamwork, moral sensitivity, and missed nursing care are important healthcare challenges for Intensive Care Unit (ICU) nurses and the existence of a relationship between these variables can be useful for developing better care improvement strategies. This study aimed to determine the relationship between teamwork, moral sensitivity, and missed nursing care in ICU nurses.

METHODS

This is a descriptive cross-sectional study conducted on a total of 200 ICU nurses working at teaching hospitals affiliated to Semnan and Shahroud Universities of Medical Sciences, Semnan, Iran in 2022. Sampling was conducted using the census method. Data collection was conducted using a demographic checklist, the TeamSTEPPS Team Perception Questionnaire (T-TPQ), Lützén Moral Sensitivity Questionnaire (L-MSQ), and Kalisch and Williams Missed Nursing Care (MISSCARE) Survey. The examination of the relationship between the three variables was conducted using Pearson's correlation coefficient and multiple regression analysis.

RESULTS

The mean and standard deviation of teamwork, moral sensitivity, and missed nursing care was 3.47 ± 0.69, 64.19 ± 13.43, and 55.04 ± 34.10, respectively. The variable of teamwork had a significant positive relationship with moral sensitivity (p < .001) and a significant negative relationship with missed nursing care (p < .001). Teamwork was also a positive predictor of moral sensitivity (p < .001) and a negative predictor of missed nursing care (p < .001). The clinical experience of ICU nurses was a positive predictor of teamwork (p = .01) and a negative predictor of missed nursing care (p = .001). The age of ICU nurses was a positive predictor of moral sensitivity (p = .001) and a negative predictor of missed nursing care (p = .008).

CONCLUSION

The findings showed that a higher level of teamwork was associated with increased moral sensitivity and reduced missed nursing care among ICU nurses. Therefore, focusing on planning interventions on teamwork improvement can lead ICU nurses to improve moral sensitivity, lower missed nursing care, and promote the quality of patient care.

Problem-based learning versus reflective practice on nursing students' moral sensitivity

BACKGROUND

Moral sensitivity is one of the prerequisites for nurses' professional competency and patient care. It is critical to teach professional ethics in a student-centered manner in order to increase students' moral sensibility. This study evaluated the effects of professional ethics education via problem-based learning and reflective practice on nursing students' moral sensitivity.

METHODS

This experimental study was performed on 74 nursing students who were randomly divided into three groups of problem-based learning, reflective practice and control. Principles of professional ethics were presented for the two intervention groups in four 2-hour sessions using ethical dilemmas scenarios. Participants completed the Moral Sensitivity Questionnaire before, immediately, and three months after the intervention. Data were analyzed using SPSS₁₆.

RESULTS

Demographic characteristics of the three groups were similar (p > 0.05). The total moral sensitivity score significantly differed between the groups immediately and three months after the intervention (p < 0.001). The total mean score for moral sensitivity was significantly different between the two groups of problem-based learning and reflective practice, with the mean scores in the problem-based learning group being higher (p = 0.02). The mean score of moral sensitivity decreased statistically significantly in both experimental groups three months after the intervention as compared to immediately after the intervention (p < 0.001).

CONCLUSION

Nursing students' moral sensitivity can be increased through reflective practice and problem-based learning. While the results indicated that problem-based learning was more successful than reflective practice, additional research is recommended to confirm the influence of these two strategies on moral sensitivity.

Latent profiles of ethical climate and nurses' service behavior

BACKGROUND

Hospital ethical climate has important implications for clinical nurses' service behavior; however, the relationships are complicated by the fact that five types of ethical climate (caring, law and code, rules, instrumental, and independence) can be combined differently according to their level and shape differences. Recent developments in person-centered methods (e.g., latent profile analysis (LPA)) have helped to address these complexities.

AIM

From a person-centered perspective, this study explored the distinct profiles of hospital ethical climate and then examined the relationships of the profiles with clinical nurses' service behavior (both in-role and extra-role service behavior).

RESEARCH DESIGN

A quantitative study was conducted using cluster random sampling. Latent profile analysis and binary coded hexadecimal (BCH) analysis were conducted using Mplus 8.2.

PARTICIPANTS AND RESEARCH CONTEXT

A total of 871 clinical nurses in China were surveyed using the Ethical Climate Scale and Nurses' Service Behavior Questionnaire.

ETHICAL CONSIDERATIONS

Ethical approval was obtained from the IRB of the First Affiliated Hospital of Jinan University (No. KY-2020-090).

RESULTS

A four-profile hospital ethical climate model provided the best fit for the data. The four different profiles not only varied in level, but also in shape: high normative and low egoism (45.8%), high ethical climate (19.9%), low ethical climate (3.6%), and moderate ethical climate (30.8%). These profiles differentially predicted clinical nurses' overall, in-role, and extra-role service behaviors.

CONCLUSIONS

The results reveal new insights into the nature of hospital ethical climate and how different clinical nurses in these profiles can be best managed to accomplish different forms of service behavior.

Research note reliability and validity of Japanese version of the trauma-informed care provider survey (TIC provider survey)

OBJECTIVE

Robust instruments to evaluate the ability of trauma-informed care among healthcare workers need to be developed, as this would help the implementation of trauma-informed care to prevent re-traumatization of patients. This study aims to assess the reliability and validity of the Japanese version of the Trauma-Informed Care (TIC) Provider Survey. A total of 794 healthcare workers were surveyed using a self-administered questionnaire, including the TIC Provider Survey, and six measures that were considered to be correlated with it. We calculated the Cronbach's alpha coefficient to investigate the internal consistency of each category of the TIC Provider Survey (knowledge, opinions, self-rated competence, practices, and barriers). Spearman's rank correlation coefficients were used to investigate the correlation between each category of the TIC Provider Survey, and other measures of construct validity.

RESULTS

Cronbach's alpha coefficients of each category of the TIC Provider Survey were 0.40 (Knowledge), 0.63 (Opinions), 0.92 (Self-rated competence), 0.93 (Practices), and 0.87 (Barriers). The Spearman's rank correlation coefficients were small. We confirmed the reliability of the acceptable levels and examined the validity of modest or unacceptable levels of the Japanese version of the TIC provider survey among Japanese workers in a healthcare setting.

The Mindful Ethical Practice and Resilience Academy: Sustainability of Impact

BACKGROUND

Nurses face many ethical challenges, placing them at risk for moral distress and burnout and challenging their ability to provide safe, high-quality patient care. Little is known about the sustainability of interventions to address this problem.

OBJECTIVE

To determine the long-term impact on acute care nurses of a 6-session experiential educational program called the Mindful Ethical Practice and Resilience Academy (MEPRA).

METHODS

MEPRA includes facilitated discussion, role play, guided mindfulness and reflective practices, case studies, and high-fidelity simulation training to improve nurses' skills in mindfulness, resilience, and competence in confronting ethical challenges. A prospective, longitudinal study was conducted on the impact of the MEPRA curriculum at 2 hospitals in a large academic medical system. The study involved surveys of 245 nurses at baseline, immediately after the intervention, and 3 and 6 months after the intervention.

RESULTS

The results of the intervention were generally sustained for months afterward. The most robust improvements were in ethical confidence, moral competence, resilience, work engagement, mindfulness, emotional exhaustion, depression, and anger. Some outcomes were not improved immediately after the intervention but were significantly improved at 3 months, including anxiety and empathy. Depersonalization and turnover intentions were initially reduced, but these improvements were not sustained at 6 months.

CONCLUSIONS

Many MEPRA results were sustained at 3 and 6 months after conclusion of the initial foundational program. Some outcomes such as depersonalization and turnover intentions may benefit from boosters of the intervention or efforts to supplement the training by making organizational changes to the work environment.

Strategies and challenges in addressing ethical issues in the hospital context: A phenomenological study of nurse team leaders

Background

Nurse team leaders encounter considerable ethical challenges that necessitate using effective strategies to overcome them. However, there is a lack of research exploring the experiences of nurse team leaders in Indonesia who face ethical dilemmas in their professional duties.

Objective

This study aimed to explore nurse team leaders' experiences regarding strategies and challenges in dealing with ethical problems in hospital settings in Indonesia.

Methods

This qualitative study employed a hermeneutic phenomenology design. Online semi-structured interviews were conducted between November 2021 and February 2022 among 14 nurse team leaders selected using a snowball sampling from seven hospitals (three public and four private hospitals). Van Manen's approach was used for data analysis.

Results

The strategies for overcoming ethical dilemmas included (i) seeking the facts, (ii) stepping back, (iii) considering support, and (iv) standing by patients. The challenges for the nurse team leaders in resolving ethical problems consisted of (i) seniority, (ii) trust issue, and (iii) lack of reflection and ethics training.

Conclusion

Nurse team leaders recognize their specific roles in the midst of ethical challenges and seek strategies to deal with them. However, a negative working environment might impact ethical behavior and compromise the provision of quality care. Therefore, it is imperative for hospital management to take note of these findings and address issues related to seniority by providing regular ethics training and group reflection sessions to maintain nurses' ethical knowledge in hospital practice. Such interventions can support nurse team leaders in resolving ethical dilemmas and provide a conducive environment for ethical decision-making, ultimately improving patient outcomes.

Evaluation of moral sensitivity and moral courage in intensive care nurses in Turkey during the COVID-19 pandemic

BACKGROUND

During the COVID-19 pandemic, intensive care nurses may experience ethical issues related to fear of transmission, limited resources, and increased workload. Nurses' moral sensitivity and courage may have a role in dealing with these problems.

AIM

The purpose of this study was to assess intensive care nurses' moral sensitivity and moral courage during the COVID-19 pandemic.

DESIGN

Descriptive cross-sectional survey.

METHODS

A total of 362 nurses working in the intensive care units of pandemic hospitals in Turkey participated in the study between January and March 2021. Data were obtained using a personal information form, the Moral Sensitivity Questionnaire, and the Nurses' Moral Courage Scale. A link to the online data collection tools was sent to the management of participating institutions, who forwarded it to nurses. Reporting followed the CHERRIES guidelines.

RESULTS

In this study, the response rate of nurses was 89%. The nurses' total mean moral sensitivity score was 90.70 ± 28.89 and their mean moral courage score was 82.08 ± 13.51. A weak inverse correlation was found between the nurses' moral sensitivity and moral courage scores (r = -.176, p = .001). Total moral sensitivity score differed significantly according to years of Intensive care unit (ICU) experience (p = .007). Total moral courage scores increased significantly with education level (p = .012), years of nursing experience (p = .016), and willingness to work in the ICU (p < .001).

CONCLUSION

The study suggests that nurses working in the intensive care unit during the pandemic had moderate moral sensitivity and high levels of moral courage. Nurses' sociodemographic characteristics and ICU work conditions may affect their moral sensitivity and moral courage.

RELEVANCE TO CLINICAL PRACTICE

The results of this study can help guide efforts to improve moral courage and sensitivity and address ethical issues among ICU nurses.

Impact of ethical climate, moral distress, and moral sensitivity on turnover intention among haemodialysis nurses: a cross-sectional study

BACKGROUND

While several studies have been performed on turnover intention among nurses, limited studies have considered the ethical perspectives on turnover intention among haemodialysis nurses. The purpose of this study was to clarify the impact of ethical factors, namely ethical climate, moral distress, and moral sensitivity on turnover intention among haemodialysis nurses.

METHODS

This cross-sectional research was conducted between July and August 2017. A total of 148 haemodialysis nurses were invited to participate in the study by convenience sampling from 11 general and university hospitals in South Korea. Data were analysed using SPSS for t-test, one-way analysis of variance, Pearson's correlation coefficients, and multiple regression analysis.

RESULTS

In the final regression model, the adjusted R-squared significantly explained 34.6% of the variance in turnover intention (F = 22.534, p < .001) when moral distress related to physician practice (β = 0.310, p = .001) and ethical climate related to the hospital climate (β = - 0.253, p = .003) and manager (β = - 0.191, p = .024) were included. Following the stepwise multiple regression process, all subdomains related to moral sensitivity were excluded due to no statistical significance in the final regression model.

CONCLUSION

To reduce turnover intention among haemodialysis nurses, hospitals and managers should pay attention to haemodialysis nurses' moral distress originating from physicians' practice and improve their ethical climate. Additionally, it is required that the impact of moral sensitivity on turnover among nurses working in diverse care settings be examined further.

Physicians' Distress Related to Moral Issues and Mental Health In-Between Two Late Waves of COVID-19 Contagions

In addition to the sanitary constrains implemented due to the pandemic, frontline physicians have faced increased workloads with insufficient resources, and the responsibility to make extraordinary clinical decisions. In 108 physicians who were at the forefront of care of patients with COVID-19 during the first two years of the pandemic, mental health, moral distress, and moral injury were assessed twice, in between two late waves of COVID-19 contagions, according to their adverse psychological reactions, in-hospital experience, sick leave due to COVID-19, quality of sleep, moral sensitivity, clinical empathy, resilience, and sense of coherence. Three months after the wave of contagions, the adverse emotional reactions and moral distress decreased, while moral injury persisted. Moral distress was related to clinical empathy, with influence from burnout and sick leave due to COVID-19, and moral injury was related to the sense of coherence, while recovery from moral distress was related to resilience. The results suggest that measures to prevent physician infection, as well as strengthening resilience and a sense of coherence, may be helpful to prevent persistent mental damage after exposure to a sanitary crisis.

Technology moral sense: Development, reliability, and validity of the TMS scale in Chinese version

Introduction

The aggregation of intelligent technologies such as big data, algorithms, and biometrics poses new moral risks to humanity and has raised awareness of technology ethics. Based on the research on moral issues in the fields of ethics and psychology, we built the concept of technology moral sense (TMS) by investigating three dimensions-technology moral consensus, cognition, and emotion.

Methods

We focused on the field of intelligent surveillance technology, adopted a scale, and conducted a questionnaire survey with more than 1,000 respondents. We used exploratory and confirmatory factor analysis to test two different samples.

Results

First, by combining item analysis and Cronbach's alpha coefficient, we established that all three dimensions are reliable. Our results indicated a Cronbach's alpha coefficient of 0.944, 0.891 and 0.938 for technology moral consensus, emotion, and cognition. Second, exploratory factor analysis verified that there were three factors, the eigenvalues were all greater than one, and the cumulative variance explanation rate was 74.953%, and the factor loading coefficient of the 18 items are greater than 0.5. Finally, we used confirmatory factor analysis to test the fit of the model. The test shows that RMSEA = 0.078, CFI and TLI are greater than 0.9, which indicating the fit was suitable and the construct validity was good.

Discussion

Our findings demonstrated that the new scale is a reliable tool for assessing the technology moral sense in China. The results support the reliability and validity of the Technology Moral Sense (TMS) scale, and explain the existence of the concept of technology moral sense through three dimensions.

Sensemaking in the early stages of the COVID-19 pandemic: A narrative exploration of polarised morality in an NHS Trust

This article presents an analysis of personal diaries kept by health-care staff within a specialist NHS Trust in England during the initial 3 months of the COVID-19 pandemic. It adopts a moral sensemaking perspective to explore how NHS employees mobilised and reframed ideas of right and wrong in order to make sense of unprecedented uncertainty and displacement. By focussing on how the macro and micro politics of the pandemic were played out in the organisation, the study finds that polarised moral judgements were invoked in order to justify and rationalise a broad array of associated emergent emotions, intuitions, behaviours and practices. This polarisation of moral responses could be seen as a desire to bring order out of chaos and put matters back into place following displacement. This is inevitably an ongoing, complex and variegated enterprise whose results can be as often discomforting as they can be reassuring. Indeed, while moral sensemaking was partly beneficial for staff in that it promoted a greater sense of camaraderie and support for others, it also appeared to have darker consequences in terms of staff wellbeing and the development of more impermeable social boundaries across the organisation through processes of moral 'othering'.

Physical Therapists' Ethical and Moral Sensitivity: A STROBE-Compliant Cross-Sectional Study with a Special Focus on Gender Differences

(1) Background: Healthcare professionals´ clinical practice, their care of patients and the clinical decision-making process may be influenced by ethical and moral sensitivity. However, such outcomes have been scarcely studied in physical therapists. This study aimed to explore ethical sensitivity and moral sensitivity in practicing physical therapists, and to compare both variables by gender. (2) Methods: Cross-sectional study. 75 physical therapists (58.7% women; average age = 34.56 (8.68) years) were asked to fill in questionnaires measuring ethical sensitivity (Ethical Sensitivity Scale Questionnaire) and moral sensitivity (Revised-Moral Sensitivity Questionnaire). (3) Results: The sample showed high ethical sensitivity (116.14 ± 15.87 over 140) and high moral sensitivity (40.58 ± 5.36 over 54). When comparing by gender, women reported significantly higher ethical sensitivity than men (p = 0.043), as well as higher scores in the following dimensions: Caring by connecting with others (p = 0.012) and Working with interpersonal and group differences (p = 0.028). However, no differences were found in moral sensitivity (p = 0.243). (4) Conclusion: Physical therapists showed high levels of ethical and moral sensitivity, whilst women reported higher ethical sensitivity than men. Understanding physical therapists´ ethical and moral sensitivity is essential to design and implement integrated education programs directed to improve the quality of care of patients in their daily clinical practice.

How do ethically competent nurses behave in clinical nursing practice? A qualitative study

AIM

This study explored how ethically competent nurses behave in clinical nursing practice.

BACKGROUND

Nurses' ethical competency is crucial in nursing practice as it promotes patients' safety and quality of care.

METHODS

Using a purposive sampling technique, 20 clinical nurses in South Korea were interviewed via an online video platform. The data were analysed using a thematic analysis based on phenomenological approach.

RESULTS

The main theme found among the participating nurses' ethical competency was caring beyond egocentrism, with two subthemes: (1) patient-centred care based on compassion and (2) responsible behaviour based on nursing professionalism. Factors that enabled this included (1) reasonable work conditions, (2) interpersonal relationships, and (3) nurses' rich personal experiences.

CONCLUSIONS

Nurses' ethical competency depends on how far they can move away from their own egocentrism and act for their clients' benefit, wherein an appropriate workload and warm human relationships with one's colleagues are essential. Nurses should thus receive education on ethics and professionalism and participate in volunteer and leisure activities that cultivate their degree of empathy.

IMPLICATION FOR NURSING MANAGEMENT

Nursing leaders and managers should understand nurses' ethical competency and its enabling factors to devise effective strategies to promote it.

Reliability and Validity of the Japanese Version of the Attitudes Related to Trauma-Informed Care (ARTIC-10) Scale

BACKGROUND

Trauma-informed care is recommended to avoid the inadvertent retraumatization of patients by health care providers. Psychometric evaluation of trauma-informed care instruments is needed. The Japanese version of the Attitudes Related to Trauma-Informed Care (ARTIC-10) Scale has not yet been psychometrically validated.

OBJECTIVE

The study's objective was to examine the reliability and validity of the ARTIC-10.

METHODS

This psychometric study of the ARTIC-10 compared with five other scales associated with attitudes related to trauma-informed care used a cross-sectional survey design conducted in November 2020 with a convenience sample of Japanese physicians and nurses recruited from an internet research agency. Participants completed self-administered questionnaires including the (a) ARTIC-10; (b) the Japanese version of the Moral Sensitivity Questionnaire 2018; (c) Patient Health Questionnaire-9; (d) Generalized Anxiety Disorder-7; (e) Stress Underestimation Beliefs; and (f) Negative Acts Questionnaire-Revised. Cronbach's α measured reliability internal consistency, and construct validity was measured by Spearman's rank.

RESULTS

A total of 794 physicians and nurses completed the surveys. Cronbach's α value of ARTIC-10 was 0.56. Higher scores of ARTIC-10 were positively and significantly correlated with Moral Sensitivity Questionnaire 2018 and negatively and significantly correlated with other scales (r =-.12 to .30).

CONCLUSION

This study found only modest internal consistency and construct validity of the Japanese version of ARTIC-10 in physicians and nurses. Further study is needed to identify factors that affect the reliability and validity of this Japanese scale to improve its psychometric properties.

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.

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.

Impact of Service-Learning on Physiotherapy Students: Exercise Programs for Patients with Heart Transplantation and Acute Coronary Syndrome—A Randomized Clinical Trial

Introduction. Service-learning (SL) seems to be useful for healthcare students. This study aimed at comparing an SL program versus a traditional approach (TA) on moral sensitivity, ethical competences, knowledge, teaching quality, SL participation and performance, and satisfaction in physiotherapy students. Methods. Randomized clinical trial. A total of 32 physiotherapy students were allocated to an SL group (SLG, n = 16), or to a TA group (TAG, n = 16). Participants had to create an exercise program for patients with heart transplantation and acute coronary syndrome. The SLG performed the program with real patients, whilst the TAG performed a traditional collaborative approach. Moral sensitivity, ethical competences, knowledge and teaching quality were assessed pre- and post-intervention. SL participation and performance and satisfaction of the SLG were assessed post-intervention. Results. After the intervention, the SLG showed higher moral sensitivity, ethical competences, knowledge and reported better teaching quality than the TAG. The SL program was useful, addressed a real need, contributed to learning, helped to solve problems, facilitated better comprehension, increased motivation, and students would like to use SL in other subjects. Conclusions. The SL program had a positive impact on students, encouraging the implementation of similar SL interventions. SL may be considered a teaching–learning methodology of choice in physiotherapy students.

Factors affecting the formation of nurses' moral sensitivity in cardiopulmonary resuscitation settings: A qualitative study

Background: Certain factors may facilitate or inhibit the formation of moral sensitivity in nurses performing cardiopulmonary resuscitation (CPR). The identification of these factors in the context can help develop strategies to promote nurses' moral sensitivity and offer new insights into the consequences of their moral decisions.Objective: Taking into account the possibly multi-factorial nature of moral sensitivity, this study aimed to identify the factors affecting the formation of nurses' moral sensitivity in CPR settings.Research design and methods: This study performed a conventional qualitative content analysis. Twenty-one participants were selected via purposive and theoretical sampling. The data were collected through in-depth semi-structured interviews and simultaneously analyzed via content analysis.Participants and research context: In total, twenty-one participants (fourteen clinical care nurses, three head nurses, two educational supervisors, and two faculty members) from different cities of Iran were interviewed.Ethical considerations: The research was approved by the Ethics Committee of Urmia University of Medical Sciences in Iran (IR.UMSU.REC.1399.337).Findings: Four categories (underlying factors, professional factors, organizational inhibitors of ethics, and professional limitations) and 13 sub-categories were extracted.Discussion: The formation of moral sensitivity requires a range of ethical standards and their maintenance, not only at the individual level but also at the profession, organization, and community levels. So eliminating inhibitors of ethics in these contexts can improve nurse's ethical performance in CPR settings.Conclusion: Any measures taken or decisions made by nurses in CPR are driven by numerous ethical issues to which nurses must be morally sensitive. Some factors facilitate and some inhibit the formation of moral sensitivity in nurses.

Mindfulness, empathy and moral sensitivity in nurses: a structural equation modeling analysis

Background

Ethical issues may pose challenges to nurses; moral sensitivity can help them to overcome these challenges. Identifying variables related to moral sensitivity can help in planning to increase nurses’ moral sensitivity. This study aimed to investigate the relationship among mindfulness, empathy, and moral sensitivity in a sample of nurses.

Methods

In the present study, a cross-sectional design utilizing Structural Equation Modeling (SEM) was conducted. The nurses in a private hospital in Yazd, Iran, were invited to participate in the study (n=162) using simple random sampling. In order to gather the data, the Freiburg’s mindfulness inventory, moral sensitivity questionnaire, and revised Jefferson’s empathy scale were used. The hypothesized model was analyzed by SEM.

Results

The results show that Mindfulness (β=0.41, t=5.53, p<0.01) and empathy (β=0.52, t=6.77, p<0.01) had a significant direct effect on moral sensitivity. However, mindfulness had an indirect effect on nurses’ moral sensitivity via empathy improvement (z= 6.25, p<.01).

Conclusion

Empathy played a significant mediating role in the relationship between mindfulness and moral sensitivity, so mindfulness-based interventions with an emphasis on empathy may provide an opportunity to increase moral sensitivity in nurses.

Moral Sensitivity and Emotional Intelligence in Intensive Care Unit Nurses

Moral sensitivity helps individuals resolve moral dilemmas as a precursor to moral decision-making. Intensive care unit (ICU) nurses are at high risk for encountering moral dilemmas and should have the moral sensitivity to recognize moral issues. The activities of ICU nurses in moral decision-making are guided by moral sensitivity but are also based on emotional intelligence (EI). EI, be recognized as an integral part of moral sensitivity with long-standing theoretical foundations. It is necessary to explicate the true role of EI in moral sensitivity through empirical research. To measure the level of moral sensitivity of ICU nurses and determine the relationship between moral sensitivity and EI. We recruited 467 ICU nurses of ten hospitals from March to June 2021 in Hunan Province, China for a cross-sectional questionnaire survey. The moral sensitivity and EI were measured using the Moral Sensitivity Questionnaire-Revised Version into Chinese (MSQ-R-CV) and the Wong and Law Emotional Intelligence Scale-Version into Chinese (WLEIS-C). A self-report questionnaire covered sociodemographic characteristics. The average moral sensitivity score of ICU nurses was 39.41 ± 7.21. The average EI score was significantly positively correlated with the moral sensitivity score (p < 0.001). This study demonstrated that the moral sensitivities of ICU nurses were at medium levels. EI of ICU nurses can indeed affect their moral sensitivity, and the impact of each element of EI should be clarified for practical application.

Determinants of Moral Distress Among Mental Health Professionals

Background:

It is assumed that understanding moral distress and its correlated factors among mental health professionals would enhance understanding of the ethical dilemmas that mental health professionals are confronting.

Objectives:

To identify moral distress determinants among Jordanian mental health professionals working in psychiatric in-patient settings.

Methods:

A cross-sectional descriptive design was used, employing self-administered questionnaire.

Results:

Two- steps multiple hierarchical regression analysis showed that model 1 that includes the demographic characteristics, was significant with R2 = .151, while in model 2 that included demographics and the psychological characteristics of stress factors, it was found to be also significant R2 = .243.

Conclusion:

Morally distressing environments might diminish the quality of psychiatric care provided as well as the job satisfaction among healthcare providers.

Determinants of Moral Distress Among Mental Health Professionals

Background:

It is assumed that understanding moral distress and its correlated factors among mental health professionals would enhance understanding of the ethical dilemmas that mental health professionals are confronting.

Objectives:

To identify moral distress determinants among Jordanian mental health professionals working in psychiatric in-patient settings.

Methods:

A cross-sectional descriptive design was used, employing self-administered questionnaire.

Results:

Two- steps multiple hierarchical regression analysis showed that model 1 that includes the demographic characteristics, was significant with R2 = .151, while in model 2 that included demographics and the psychological characteristics of stress factors, it was found to be also significant R2 = .243.

Conclusion:

Morally distressing environments might diminish the quality of psychiatric care provided as well as the job satisfaction among healthcare providers.

Structural Equation Modeling of Person-Centered Nursing in Hospital Nurses

Background: This study aimed to develop and test a model of person-centered nursing (PCN) for hospital nurses using Structural Equation Modeling (SEM). Methods: This was a cross-sectional descriptive study. The subjects of this study were 340 clinical nurses in South Korea. A survey was conducted using an online questionnaire. Data were analyzed using SPSS 18.0 and AMOS 21.0. Results: Results of the validity test of the hypothesized model showed that goodness-of-fit indices satisfied the criteria (χ2 = 573.767 (df = 257, p < 0.001), TLI = 0.92, CFI = 0.93, SRMR = 0.02, RMSEA = 0.06), and 10 of the 15 paths established in the hypothesized model were statistically supported. The model’s explanatory power was 82%, which showed that empathy directly and indirectly affected PCN, and that nursing competency directly affected clinical nurse performance of PCN. In addition, nursing competency, interpersonal relationship ability, and moral sensitivity indirectly influenced PCN through empathy. Conclusions: In order to promote PCN for clinical nurses, it is desirable to develop in-hospital education programs that can improve nursing competency, interpersonal relationship ability, and moral sensitivities, emphasizing elements of empathy. Empathy was an important mediating factor that influenced the relationships between PCN and related variables.

Critical care nurses’ moral sensitivity during cardiopulmonary resuscitation: Qualitative perspectives

Background

Cardiopulmonary Resuscitation (CPR) is one of the areas in which moral issues are of great significance, especially with respect to the nursing profession, because CPR requires quick decision-making and prompt action and is associated with special complications due to the patients’ unconsciousness. In such circumstances, nurses’ ability in terms of moral sensitivity can be determinative in the success of the procedure. Identifying the components of moral sensitivity in nurses in this context can promote moral awareness and improve moral performance.

Objective

This study was conducted to explore and identify the experiences of critical care nurses about moral sensitivity components in CPR.

Research design and methods

This study was implemented with a qualitative approach. Data were collected via 22 in-depth semi-structured interviews held with 20 eligible participants with maximum variation. The data were then analyzed using the grounded theory approach.

Participants and research context

In total, thirteen clinical nurses, three head nurses, two educational supervisors, and two faculty members from different universities of Iran were interviewed.

Ethical considerations

This study was conducted with the ethical approval (IR.UMSU.REC.1399.337) of the Ethics Committee of Urmia University of Medical Sciences.

Findings

Four themes and 12 sub-themes were extracted from the analysis of the data, including “Consciously and compassionate attention to resuscitate the patient,” “Awareness of families’ anxiety,” “Understanding the teamwork and interactive guidance of the CPR process,” and “Compulsory violation of moral principles.”

Discussion

It is anticipated that this discussion will prompt further debate, raise awareness and help clarify the dimensions of moral sensitivity in unconscious patients especially during CPR, so that it can be more clearly named and defended as a moral authority in CPR.

Conclusion

identifying the components of moral sensitivity in nurses, facilitates their encounter with moral issues and can improve their moral performance and encourage right decisions.