Moral reasoning explained by personality traits and moral disengagement: A study among Dutch nurse practitioners and physician assistants

An Evaluation of Cross-Cultural Adaptations of Social Cognition Testing: A Systematic Review

Social cognition remains one of the most difficult cognitive domains to assess in diverse populations due to a lack of culturally appropriate tools. This study systematically reviewed literature on neuropsychological tests for social cognition that have been translated, adapted, are cross-cultural, or are assembled for diverse, specifically "Global South," populations. The aim was to identify assessments appropriate for diverse populations, outline and evaluate their methodological approaches, and provide procedural recommendations for future research. The PRISMA systematic review search strategy produced 10,957 articles, of which 287 were selected for full-text screening. The study had to include a neuropsychological assessment of social cognition. The full text of the resulting 287 articles was then screened; the study had to include a translated, adapted, cross-cultural test, or an assembled test for Global South populations. Eighty-four articles were included in this study: 24 for emotion recognition, 45 for theory of mind, 9 for moral reasoning, and six for social cognition in general. Overall, there were 31 translations, 27 adaptations, 14 cross-cultural tests, and 12 assembled tests for Global South populations. Regarding quality, 35 were of low quality, 27 were of moderate quality, and 22 were high quality. This study provides an overview of social cognition tests modified or assembled for diverse populations and gives examples of methodological procedures. It highlights the variability in procedure quality and provides possible reasons for this variability. Finally, it suggests a need to report rigorous modification and assembly procedure in order to have modified and assembled social cognition tests appropriate for diverse populations.

Oncology nurse competency in chimeric antigen receptor T-cell therapy: A qualitative study

BACKGROUND

Chimeric antigen receptor (CAR) T-cell therapy is a promising therapeutic method in the field of tumor immunotherapy. An increasing number of patients are beginning to select CAR T-cell therapy in mainland China. It is characterized by a complex process, a long period of treatment, high individualization, quick disease status changes and unique side effects. Oncology nurses play a crucial role in the provision of CAR T-cell therapy.

OBJECTIVE

To explore oncology nurses' competency in CAR T-cell therapy with guidance from the iceberg model.

DESIGN

A descriptive qualitative study.

SETTINGS

This study was conducted with nurses on lymphoma wards in three tertiary hospitals in China.

PARTICIPANTS

A total of 13 nurses and 2 nursing managers were approached, and all of them took part in this study.

METHODS

Data were collected face-to-face or via online video using a semistructured interview guide between November 2022 and February 2023 by the first author. The study was performed and reported following the Consolidated Criteria for Reporting Qualitative Research. Content analysis was used to analyze the data.

RESULTS

Nursing competency in CAR T-cell therapy was identified as including four main categories encompassing 12 subcategories and 40 codes. The main categories were theoretical knowledge, operation skills, personality traits and motives. The subcategories were basic knowledge of chemotherapy, professional knowledge of CAR T-cell therapy, basic skills, professional skills, relevant discipline skills, communication/coordination ability, critical thinking, basic traits, professional personality, enthusiasm for the nursing profession, empathy with patients and motivation to promote professional development.

CONCLUSIONS

Medical staff can develop a competency-based nurse training program to improve the professional competencies of oncology nurses in CAR T-cell therapy and meet patients' supportive needs for optimal care. Additionally, the findings may be helpful for building measurement standards to assess oncology nurses' performance.

How the COVID-19 pandemic affects the moral reasoning of pediatric residents and the general population

BACKGROUND

Kohlberg's theory of moral development asserts that people progress through different stages of moral reasoning as their cognitive abilities and social interactions mature. Individuals at the lowest stage of moral reasoning (preconventional stage) judge moral issues based on self-interest, those with a medium stage (conventional stage) judge them based on compliance with rules and norms, and those at the highest stage (postconventional stage) judge moral issues based on universal principles and shared ideals. Upon attaining adulthood, it can be considered that there is stability in the stage of individuals' moral development; however, the effect of a global population crisis such as the one experienced in March 2020, when the World Health Organization (WHO) declared the COVID-19 pandemic, is unknown. The purpose of this study was to evaluate the changes in the moral reasoning of pediatric residents before and after one year of the COVID-19 pandemic and compare them with a general population group.

METHODS

This is a naturalistic quasi-experimental study conducted with two groups, one comprised 47 pediatric residents of a tertiary hospital converted into a COVID hospital during the pandemic and another group comprised 47 beneficiaries of a family clinic who were not health workers. The defining issues test (DIT) was applied to the 94 participants during March 2020, before the pandemic initiated in Mexico, and later during March 2021. To assess intragroup changes, the McNemar-Bowker and Wilcoxon tests were used.

RESULTS

Pediatric residents showed higher baseline stages of moral reasoning: 53% in the postconventional group compared to the general population group (7%). In the preconventional group, 23% were residents and 64% belonged to the general population. In the second measurement, one year after the start of the pandemic, the group of residents had a significant decrease of 13 points in the P index, unlike the general population group in which a decrease of 3 points was observed. This decrease however, did not equalize baseline stages. Pediatric residents remained 10 points higher than the general population group. Moral reasoning stages were associated with age and educational stage.

CONCLUSIONS

After a year of the COVID-19 pandemic, we found a decrease in the stage of moral reasoning development in pediatric residents of a hospital converted for the care of patients with COVID-19, while it remained stable in the general population group. Physicians showed higher stages of moral reasoning at baseline than the general population.

Awareness impairment in Alzheimer's disease and frontotemporal dementia: a systematic MRI review

This review aims to define awareness impairment and related disturbances in neurodegenerative diseases, including Alzheimer's disease (AD) and frontotemporal lobar degeneration (FTLD) spectrum of disorders. An update of the available scientific literature on the use of magnetic resonance imaging (MRI) in the study of awareness in these disorders is also offered. MRI plays an important role in the characterization of neurodegenerative signatures and can increase our knowledge on brain structural and functional correlates of awareness. In the reviewing process, we established a-priori criteria and we searched the scientific literature for relevant articles on this topic. In summary, we selected 36 articles out of 1340 publications retrieved from PubMed. Based on this selection, this review discusses the multiple terms used to define different or overlapping aspects of awareness impairment, and specifically summarizes recent application of MRI for investigating anosognosia, social cognition, including theory of mind and emotional processing, free will, and autonoetic awareness alterations in different neurodegenerative disorders, with most of these studies focused on AD and FTLD. This systematic review highlights the importance of awareness impairment and related domains in neurodegenerative disorders, especially in AD and FTLD, and it outlines MRI structural and functional correlates in these populations.

The predictive values of a deliberative and a paternalistic attitude towards two situations of moral conflict: A study among Dutch nurse practitioners and physician assistants

Background

In this study, we examined the predictive values of a moral deliberate and paternalistic attitude on the propensity of yielding to pressure. In these hypothesised positive and negative relationships, we further sought to ascertain whether moral disengagement plays a pivotal role when individuals deviate from ethical standards, rules and regulations when yielding to pressure.

Aim(s)

This study's primary aim was to assess the predictive value of a moral deliberative and paternalistic attitude for yielding to pressure when physician assistants (PAs) and nurse practitioners (NPs) face moral conflicts.

Method

This validation study was cross‐sectional and based on a convenience sample of Dutch PAs and NPs. The MSQ‐DELIB and MSQ‐PATER scales indicate a moral deliberate or paternalistic attitude. These scales were assumed to have a predictive value towards the degree of yielding to pressure by PAs and NPs. Yielding to pressure was measured by two vignettes in which respondents faced a moral conflict (vignette 1: prescribing unindicated antibiotics and vignette 2: discharging a difficult patient from the hospital).

Results

Only moral deliberation was a significant predictor of yielding to pressure. That is, we found a positive effect in vignette 1 (in which the pressure came from the patient). In contrast, we found a negative relationship in vignette 2 (in which pressure went from the working environment). Paternalism did not affect yielding to pressure in either vignette.

Conclusion

This study suggests that PAs and NPs having a moral deliberative attitude makes them receptive to pressure exerted by patients to break moral standards. On the other hand, they are more resilient against doing so when this pressure comes from different sources than the patient. Further research is needed to find more conclusive evidence for this differential effect.

Facilitating and motivating factors for reporting reprehensible conduct in care: A study among nurse practitioners and physician assistants in the Netherlands

RATIONALE, AIMS AND OBJECTIVES

The aims of this study are as follows: (a) to establish whether a relationship exists between the importance that healthcare professionals attach to ethics in care and their likelihood to report reprehensible conduct committed by colleagues, and (b) to assess whether this relationship is moderated by behavioural control targeted at preventing harm.

METHOD

In this cross-sectional study, which was based on a convenience sample (n = 155) of nurse practitioners (NPs) and physician assistants (PAs) in the Netherlands, we measured ethics advocacy (EA) as a motivating factor (reflecting the importance that healthcare professionals attach to ethics and care) and "behavioral control targeted at preventing harm" (BCPH) as a facilitating factor. "Reporting reprehensible conduct" (RRC) was measured as a context-specific indicator of whistleblowing intentions, consisting of two vignettes describing morally questionable behaviour committed by colleagues.

RESULTS

The propensity to report reprehensible conduct was a function of the interaction between EA and BCPH. The only group for which EA predicted RRC consisted of individuals with above-average levels of perceived BCPH.

CONCLUSION

The results suggest that the importance that healthcare professionals attach to ethical aspects in care is not sufficient to ensure that they will report reprehensible conduct. Such importance does not induce reporting behaviour unless the professionals also perceive themselves as having a high level of BCPH. We suggest that these insights could be helpful in training healthcare providers to cope with ethical dilemmas that they are likely to encounter in their work.

An aged life has less value: A qualitative analysis of moral disengagement and care failures evident in Royal Commission oral testimony

AIMS AND OBJECTIVES

To identify common themes about care failures in residential aged care as described from the perspectives of older people and their families in transcripts from hearings and submission to the Australian Royal Commission. These failures are explored through the lens of moral disengagement.

BACKGROUND

Previous inquiries into care failures have highlighted widespread harm from inhumane care, caused by staff carelessness, indifference and callousness. In health care, limited consideration has been given to the moral engagement or disengagement of staff and the relationship of moral engagement with care failures.

METHOD

Qualitative latent content analysis of 22 transcripts from the Royal Commission between March 2020-August 2020. Methods are reported using the SRQR.

RESULTS

This paper presents one theme, Dehumanisation of the care process: An aged life has less value, from a larger study. Care failures relating to morally disengaged staff were found to be widespread and influenced by the environments created by organisations.

CONCLUSION

This study highlights the need for further research to identify indicators of moral disengagement among staff and explore strategies to reduce or prevent moral disengagement within organisations trusted with providing care to older people.

RELEVANCE TO CLINICAL PRACTICE

Caregiving is necessarily associated with, and shaped by, moral dimensions. The erosion or disengagement of these moral dimensions among care staff reveals important aspects of residential aged care's lived experience. Studying dynamics within aged care facilities can provide a useful analytic lens for illuminating ways that residents and their family or those close to them, experience or are impacted by moral dimensions and behaviours.

Re-assessing the validity of the Moral Sensitivity Questionnaire (MSQ): Two new scales for moral deliberation and paternalism

RATIONALE, AIMS, AND OBJECTIVES

The current study and previous research have called the six-component model of Lützen's 30-item Moral Sensitivity Questionnaire (MSQ) into question. For this reason, we re-examined the construct validity of this instrument.

METHODS

In this cross-sectional study, which was based on a convenience sample of Dutch nurse practitioners (NPs) and physician assistants (PAs), we tested the validity of MSQ items using exploratory and confirmatory factor analyses (EFA and CFA, respectively).

RESULTS

The EFA revealed a two-component model, which was then tested as a target model with CFA and was found to have good model fit. Some items were correlated with two uncorrelated latent constructs, which we labelled as "paternalistic" and "deliberate" attitudes towards patients.

CONCLUSIONS

As in previous studies, the analyses in the current study, which was conducted among PAs and NPs, did not reveal six dimensions for the 30 items. Two new latent dimensions of moral sensitivity were psychometrically tested and confirmed. These two components relate to studies investigating ethical behaviour, and they can be used to describe the moral climate in healthcare organizations. The scales are indicators of the extent to which health professionals behave in a deliberate (sensitive) or paternalistic (insensitive) manner towards the opinions of patients within the context of medical decision-making.

Individual and Classroom Social-Cognitive Processes in Bullying: A Short-Term Longitudinal Multilevel Study

The aim of this study was to examine whether individual and classroom collective social-cognitive processes (moral disengagement and self-efficacy) were associated with bullying perpetration among schoolchildren. An additional aim was to examine whether changes in these processes from grade 4 (Time 1) to grade 5 (Time 2) were associated with a change in bullying perpetration. Self-reported survey data were collected from 1,250 Swedish students from 98 classrooms. Results of multilevel analysis indicated that individual and classroom collective moral disengagement (CMD) were positively associated with bullying, and defender self-efficacy (DSE) was negatively associated with bullying. The effect of changes in individual moral disengagement on changes in bullying was positive, and the effects of changes in DSE and classroom collective efficacy on changes in bullying were negative. Thus, the findings demonstrate the changeability of moral disengagement, DSE and collective efficacy over time, and how these changes are linked to changes in bullying perpetration.