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Chen Q, Chen Q, Ma C, Zhang Y, Gou M, Yang W. Moral sensitivity, moral courage, and ethical behaviour among clinical nurses. Nurs Ethics 2024:9697330241259150. [PMID: 39105607 DOI: 10.1177/09697330241259150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
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.
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Nazari AM, Borhani F, Zare-Kaseb A, Zafarnia N. The relationship between nurses' moral competency and missed nursing care: a descriptive-correlational study. BMC Nurs 2024; 23:388. [PMID: 38844989 PMCID: PMC11155051 DOI: 10.1186/s12912-024-02058-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND When any aspect of patient care is overlooked or delayed, it is known as Missed Nursing Care (MNC), leading to adverse events such as medication errors, infections, increased mortality rates, and poor prognosis. Moral competence is crucial for clinical nurses as it guarantees high-quality patient care in nursing practice. Thus, this study aimed to investigate the correlation between moral competencies and MNC among nurses. METHODS This study was conducted with a descriptive-correlational design. The participants in the study were nurses who were currently enrolled at Shahid Beheshti University of Medical Sciences. In order to recruit nurses for the study, a convenience sampling method was implemented. The study tools were completed by a total of two hundred nurses. Research tools included a demographic questionnaire, the Moral Competence of Clinical Nurses Questionnaire, and the Kalisch and Williams Missed Nursing Care (MISSCARE) survey. ETHICAL CONSIDERATION This study was approved by the Medical Ethics and Law Research Center of Shahid Beheshti University of Medical Sciences. RESULTS The mean scores of moral competencies and MNC were 151.83 ± 12.60 and 42.71 ± 9.38, respectively. In other words, descriptive statistics showed that the moral competence score was more than 75%, and the MNC score was less than 50%. Also, there was a significant negative correlation between the total scores of moral competencies and MNC (r = -0.38, p < 0.001), indicating that more moral competence was correlated with lower levels of MNC. CONCLUSION The study revealed a negative correlation between nurses' moral competence and MNC, suggesting that enhancing moral competence could reduce MNC. To reduce MNC occurrences, hospitals, and organizations should prioritize moral competency, according to our research.
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Affiliation(s)
- Amir Mohamad Nazari
- Student Research Committee, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Borhani
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Akbar Zare-Kaseb
- Student Research Committee, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Niloofar Zafarnia
- Educational Development Center, Kerman University of Medical Sciences, Kerman, Iran
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Wiisak J, Stolt M, Igoumenidis M, Chiappinotto S, Gastmans C, Keogh B, Mertens E, Palese A, Papastavrou E, Mc Cabe C, Suhonen R. Factors contributing to the promotion of moral competence in nursing. Nurs Ethics 2024:9697330241235305. [PMID: 38504620 DOI: 10.1177/09697330241235305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Ethics is a foundational competency in healthcare inherent in everyday nursing practice. Therefore, the promotion of qualified nurses' and nursing students' moral competence is essential to ensure ethically high-quality and sustainable healthcare. The aim of this integrative literature review is to identify the factors contributing to the promotion of qualified nurses' and nursing students' moral competence. The review has been registered in PROSPERO (CRD42023386947) and reported according to the PRISMA guideline. Focusing on qualified nurses' and nursing students' moral competence, a literature search was undertaken in January 2023 in six scientific databases: CINAHL, Cochrane Library, PsycINFO, PubMed Medline, Scopus and Web of Science. Empirical studies written in English without time limitation were eligible for inclusion. A total of 29 full texts were retrieved and included out of 5233 citations. Quality appraisal was employed using Joanna Briggs Institute checklists and the Mixed Method Appraisal Tool. Data were analysed using inductive content analysis. Research about the factors contributing to the promotion of qualified nurses' and nursing students' moral competence is limited and mainly explored using descriptive research designs. The contributing factors were identified as comprising two main categories: (1) human factors, consisting of four categories: individual, social, managerial and professional factors, and ten sub-categories; and (2) structural factors, consisting of four categories: educational, environmental, organisational and societal factors, and eight sub-categories. This review provides knowledge about the factors contributing to the promotion of qualified nurses' and nursing students' moral competence for the use of researchers, nurse educators, managers, organisations and policymakers. More research about the contributing factors is needed using complex intervention, implementation and multiple methods designs to ensure ethically sustainable healthcare.
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Affiliation(s)
| | - Minna Stolt
- University of Turku; Wellbeing Services County of Satakunta
| | | | | | | | | | | | | | | | | | - Riitta Suhonen
- University of Turku; Turku University Hospital; Wellbeing Services County of Southwest Finland
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Khaghanizadeh M, Koohi A, Ebadi A, Vahedian-Azimi A. The effect and comparison of training in ethical decision-making through lectures and group discussions on moral reasoning, moral distress and moral sensitivity in nurses: a clinical randomized controlled trial. BMC Med Ethics 2023; 24:58. [PMID: 37542315 PMCID: PMC10403849 DOI: 10.1186/s12910-023-00938-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 07/25/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Ethical decision‑making and behavior of nurses are major factors that can affect the quality of nursing care. Moral development of nurses to making better ethical decision-making is an essential element for managing the care process. The main aim of this study was to examine and comparison the effect of training in ethical decision-making through lectures and group discussions on nurses' moral reasoning, moral distress and moral sensitivity. METHODS In this randomized clinical trial study with a pre- and post-test design, 66 nurses with moral reasoning scores lower than the average of the community were randomly assigned into three equal groups (n = 22) including two experimental groups and one control group. Ethical decision-making training to experimental groups was provided through the lectures and group discussions. While, the control group did not receive any training. Data were collected using sociodemographic questionnaire, the nursing dilemma test (NDT), the moral distress scale (MDS) and the moral sensitivity questionnaire (MSQ). Unadjusted and adjusted binary logistic regression analysis was reported using the odds ratio (OR) and 95% confidence intervals. RESULTS Adjusted regression analysis showed that the probability of increasing the nursing principle thinking (NPT) score through discussion training was significantly higher than lecture (OR: 13.078, 95% CI: 3.238-15.954, P = 0.008), as well as lecture (OR: 14.329, 95% CI: 16.171-2.005, P < 0.001) and discussion groups compared to the control group (OR: 18.01, 95% CI: 22.15-5.834, P < 0.001). The possibility of increasing moral sensitivity score through discussion training was significantly higher than lecture (OR: 10.874, 95%CI: 6.043-12.886, P = 0.005) and control group (OR: 13.077, 95%CI: 8.454-16.774, P = 0.002). Moreover, the moral distress score was significantly reduced only in the trained group compared to the control, and no significant difference was observed between the experimental groups; lecture group vs. control group (OR: 0.105, 95% CI: 0.015-0.717, P = 0.021) and discussion group vs. control group (OR: 0.089, 95% CI: 0.015-0.547, P = 0.009). CONCLUSIONS The results of this study indicate that ethical decision-making training is effective on empowerment of ethical reasoning. Whereas the group discussion was also effective on increasing the ethical sensitivity, it is recommended the training plan provided in this study to be held as workshop for all nurses in health and treatment centers and placed in curricular plan of nursing students. REGISTRATION This randomized clinical trial was registered in Iranian Registry of Clinical Trials under code (IRCT2015122116163N5) in 02/07/2016.
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Affiliation(s)
- Morteza Khaghanizadeh
- Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Aliakbar Koohi
- Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Sheykh bahayi Street, Vanak Square Tehran, Tehran, P.O. Box 19575-174, Iran
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Mrayyan MT, Abunab HY, Abu Khait A, Rababa MJ, Al-Rawashdeh S, Algunmeeyn A, Abu Saraya A. Competency in nursing practice: a concept analysis. BMJ Open 2023; 13:e067352. [PMID: 37263688 DOI: 10.1136/bmjopen-2022-067352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE Competency denotes the ability to execute a certain task or action with the necessary knowledge. Competency definitions and measurements are challenging for nursing and other professions due to their multidimensional aspects. This study aimed to clarify the concept of competency in nursing practice and propose an accurate definition. DESIGN Walker and Avant's approach was used to elucidate the concept of competency in nursing practice. DATA SOURCES ScienceDirect, PubMed, ProQuest, Scopus and CINAHL were searched from 1 January 2000 to 31 December 2021. ELIGIBILITY CRITERIA We included studies with the keywords: "concept analysis", "competence", "competency" and "nursing". The search was limited to full-text studies written in English that used theoretical and empirical approaches. DATA EXTRACTION AND SYNTHESIS We extracted the concept's uses, defining attributes, and the consequences and antecedents of the concept. RESULTS 60 articles were identified from the search process; after excluding duplicates and works unrelated to the study aim and context following the full-text screening, 10 articles were included in this concept analysis. The common defining attributes of competency were knowledge, self-assessment and dynamic state. Competency in nursing practice had many reported positive consequences that include but are not limited to improved patient, nurse and organisational outcomes. CONCLUSIONS Nurses can benefit from the result of this analysis in practice to implement professional care, in particular clinical contexts and situations to enhance patients' health.
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Affiliation(s)
- Majd T Mrayyan
- Department of Community and Mental Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | - Hamzeh Y Abunab
- Department of Basic Nursing, Faculty of Nursing, Isra University, Amman, Jordan
| | - Abdallah Abu Khait
- Department of Community and Mental Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | - Mohammad J Rababa
- Department of Adult Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Sami Al-Rawashdeh
- Department of Community and Mental Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | | | - Ahmed Abu Saraya
- Department of Adult Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
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Jantara RD, Barlem JGT, Jantara A, Rocha LP, Rocha SSD, Stigger DADS. Analysis of moral courage and related factors among undergraduate nursing students: a scoping review. Rev Bras Enferm 2023; 76Suppl 3:e20220225. [PMID: 37042930 PMCID: PMC10084776 DOI: 10.1590/0034-7167-2022-0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/10/2022] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVE to analyze scientific evidence on moral courage and related factors among nursing undergraduate students. METHOD the protocol of this scoping review was registered on Open Science Framework. A search was performed in five databases, according to the method provided by Joanna Briggs Institute Reviewers, the mnemonic strategy Population, Concept and Context, and a specific checklist. RESULTS a total of 2,812 results were identified, but only nine studies were eligible and presented three thematic approaches: Moral courage from the perspective of nursing students; Moral courage and related factors; and The teaching of moral courage in the training of nursing students. The factors related to moral courage include moral distress, moral sensitivity, age, and having a previous degree in the health field. FINAL CONSIDERATIONS few studies were found with a low evidence level. Most were performed in developed countries, indicating some gaps that need to be addressed in the future.
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Affiliation(s)
| | | | - Adrieli Jantara
- Universidade Federal do Rio Grande. Rio Grande, Rio Grande do Sul, Brazil
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Martin D, Mörch CM, Figoli E. The notion of moral competence in the scientific literature: a critical review of a thin concept. ETHICS & BEHAVIOR 2022. [DOI: 10.1080/10508422.2022.2067163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Dominic Martin
- Organization and Human Resources Department, School of Management Sciences, Université du Québec à Montréal
| | | | - Emmanuelle Figoli
- Organization and Human Resources Department, School of Management Sciences, Université du Québec à Montréal
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The Relationship between moral competence and cultural sensitivity levels of nurses working in primary healthcare institutions: A cross-sectional study in Turkey. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.977600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Hauhio N, Leino-Kilpi H, Katajisto J, Numminen O. Nurses' self-assessed moral courage and related socio-demographic factors. Nurs Ethics 2021; 28:1402-1415. [PMID: 34100317 DOI: 10.1177/0969733021999763] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nurses need moral courage to ensure ethically good care. Moral courage is an individual characteristic and therefore it is relevant to examine its association with nurses' socio-demographic factors. OBJECTIVE To describe nurses' self-assessed level of moral courage and its association with their socio-demographic factors. RESEARCH DESIGN Quantitative descriptive cross-sectional study. The data were collected with Nurses' Moral Courage Scale and analyzed statistically. PARTICIPANTS AND RESEARCH CONTEXT A total of 482 registered nurses from a major university hospital in Southern Finland completed the Finnish language version of Nurses' Moral Courage Scale in autumn 2017. ETHICAL CONSIDERATIONS Ethical approval was obtained from the university ethics committee and permission for the data collection from the participating hospital. Ethical principles and scientific guidelines were followed throughout the research process. FINDINGS Nurses' self-assessed level of moral courage was rather high. On Visual Analogy Scale (0-10), the mean value was 8.20 and the mean score of the four dimensional, 21-item Nurses' Moral Courage Scale was 4.09 on a 5-point Likert-type scale. Respondents' gender, present work role, ethical knowledge base, additional ethics education, self-study as a means to acquire ethical knowledge, and frequency of work situations needing moral courage were statistically significantly associated with nurses' moral courage. DISCUSSION Strongest association was found between nurses' higher moral courage level and formal and informal ethics education. Honesty and patient's humane and dignified encounter received the highest scores indicating respondents' internalization of the core values of nursing. CONCLUSION Although nurses were fairly morally courageous, moral courage should be a part of nurses' basic and continuing education thus covering its theoretical and practical learning. Since moral courage is a virtue that can be taught, learnt, and practiced, education is a relevant way to maintain and further strengthen nurses' moral courage.
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Hakimi H, Joolaee S, Ashghali Farahani M, Rodney P, Ranjbar H. Moral neutralization: Nurses' evolution in unethical climate workplaces. BMC Med Ethics 2020; 21:114. [PMID: 33203415 PMCID: PMC7672869 DOI: 10.1186/s12910-020-00558-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 11/04/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction Good quality of care is dependent on nurses’ strong clinical skills and moral competencies, as well. While most nurses work with high moral standards, the moral performance of some nurses in some organizations shows a deterioration in their moral sensitivity and actions. The study reported in this paper aimed to explore the experiences of nurses regarding negative changes in their moral practice. Materials and methods This was a qualitative study utilizing an inductive thematic analysis approach, which was conducted from February 2017 to September 2019. Twenty-five nurses participated in semi-structured interviews. Results The main theme that emerged from our analysis was one of moral neutralization in the context of an unethical moral climate. We found five sub-themes, including: (1) feeling discouraged; (2) normalization; (3) giving up; (4) becoming a justifier; and (5) moral indifference. Conclusions Unethical moral climates in health organizations can result in deterioration of morality in nurses which can harm both patients and health systems. Some unethical behaviors in nurses can be explained by this process.
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Affiliation(s)
- Hamideh Hakimi
- Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Soodabeh Joolaee
- UBC Centre for Health Evaluation and Outcome Sciences (CHÉOS), Vancouver, BC, Canada
| | - Mansoureh Ashghali Farahani
- Nursing Care Research Center (NCRC), School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Patricia Rodney
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Hadi Ranjbar
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Science, Tehran, Iran.
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Determination of Relationship Between Moral Sensitivity, Job Motivation and Hopelessness in Intensive Care Nurses. JOURNAL OF CONTEMPORARY MEDICINE 2020. [DOI: 10.16899/jcm.706285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Haghighat S, Borhani F, Ranjbar H. Is there a relationship between moral competencies and the formation of professional identity among nursing students? BMC Nurs 2020; 19:49. [PMID: 32536811 PMCID: PMC7288505 DOI: 10.1186/s12912-020-00440-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/01/2020] [Indexed: 11/16/2022] Open
Abstract
Background Moral competencies are essential for nursing work. Professional identity is a set of values and beliefs that a person has about her/his job, which includes moral values as well. The development of moral competencies and formation of professional identity in nursing students occurs mainly during their college years. The aim of this study was to investigate the relationship between moral competencies and the formation of professional identity among nursing students. Methods This study was designed as a descriptive-correlational study. The study population was consisted of nursing students who were enrolled in nursing schools at the time of the study. Two hundred and twenty-one nursing students completed the study tools. The research tools were a demographic questionnaire, Moral Development Scale for Professionals (MDSP), and Professional Identity Scale for Nursing Students (PISNS). Results The mean (SD) of MDSP and PISNS scores was 45.69 ± 5.90 and 55.61 ± 12.75, respectively. There was a significant statistical relationship between MSDP and PISNS scores (p < 0.05). A significant equation was found (f (2, 218) = 16.68, p < 0.001) with an R2 of 0.113. The MSDP scores increased 0.136 for each score of PISNS, and married students had 2.452 scores higher than single students. Conclusions The positive correlation between the formation of professional identity and development of morality in nursing students indicates that by strengthening students’ professional values, their moral competencies may develop positively.
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Affiliation(s)
- Sahar Haghighat
- School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Fariba Borhani
- Medical Ethics and Law Research Center of Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hadi Ranjbar
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Science, Shahid Mansouri st, Niyayesh St, Sattarkhan Ave, Tehran, 1445613111 Iran
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Wath A, Wyk N. A hermeneutic literature review to conceptualise altruism as a value in nursing. Scand J Caring Sci 2019; 34:575-584. [DOI: 10.1111/scs.12771] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/13/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Annatjie Wath
- Department of Nursing Science University of Pretoria Pretoria South Africa
| | - Neltjie Wyk
- Department of Nursing Science University of Pretoria Pretoria South Africa
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