Moral sensitivity in Primary Health Care nurses

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.

The Relationship of Intensive Care Nurses' Attitudes Towards Organ Donation With Their Attitudes Towards Euthanasia and Moral Sensitivity

Determination of the relationship between nurses' attitudes towards issues, such as end-of-life care that is specific to intensive care, euthanasia, and organ donation and their moral sensitivity levels is one of the important points for working out ethical problems encountered in intensive care units and increasing the quality of care. This study was conducted to determine the relationship between the attitudes of intensive care nurses towards organ donation, euthanasia, and terminal patients and their moral sensitivity. The study was completed with 175 nurses who agreed to participate in the study. Informed consent of the participants was obtained. While nurses' attitudes towards euthanasia, death, and caring for the dying patient did not correlate with their moral sensitivities, their attitudes towards organ donation did.

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.

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.

Responsible leadership and project citizenship behavior: A cross-level investigation

Project citizenship behavior (PCB) has an important positive impact on project success. Researching how to promote PCB is an important issue in project management. Based on social learning theory and social cognitive theory, this paper adopted the method of questionnaire survey and hierarchical linear model (HLM) to analyze the collected data derived from the sample of Chinese construction enterprises and verified this hypothesis. The results show that responsible leadership has a significant positive effect on PCB, moral identity mediates this relationship, and collective moral sensitivity positively moderates this mediating effect. The findings of the study systematically and deeply reveal the intrinsic mechanism of the cross-level influence of responsible leadership on PCB, and provide new enlightenment for the practice of project management.

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

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

Moral sensitivity and person-centered care among mental health nurses in South Korea: A cross-sectional study

AIM

To identify the predictors of mental health nurses' person-centered care, including moral sensitivity.

BACKGROUND

Person-centered care meets patients' ethical needs by protecting their autonomy and dignity, and respecting their choices; it is essential to enhance patient outcomes. Therefore, it is important to identify the predictors of the practice of advocating patients' rights and dignity, and providing person-centered care among mental health nurses to foster competency and ensure the highest quality of care.

METHODS

This cross-sectional study included 220 mental health nurses in South Korea. It measured their general and work-related characteristics, moral sensitivity, and person-centered care. Multiple regression analysis was conducted to identify the person-centered care predictors.

RESULTS

The most potent person-centered care predictor was moral sensitivity (β=.35, p<.001). Other predictors included prior biomedical ethics education (β=.15, p=.013) and marital status (β=.14, p=.025). The regression model had 28.0% explanatory power.

CONCLUSIONS

Mental health nurses' moral sensitivity must be increased to improve their person-centered care.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurses should receive continuous education to remain aware of and maintain a high level of moral sensitivity and be encouraged to continue the person-centered practice. Organizational and policy support is needed to promote the practice of person-centered care in the workplace.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

DISCUSSION

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

The relationship between moral sensitivity and professional values and ethical decision-making in nursing students

BACKGROUND

More researchers have paid attention to the ethical decision-making in nursing worldwidely due to the increasing complexity of ethical issues and dilemmas. Ethical decision-making ability is regarded as one of the core competences of nursing practice and has the potential to resolve ethical issues. It is important to identify the key variables related to ethical decision-making and understand their relationship between them respectively. It is also helpful to design interventions to promote nursing students' ability to resolve ethical dilemmas.

OBJECTIVE

This study aims to examine the relationship between moral sensitivity, professional values and ethical decision-making respectively, and to explore whether professional values have mediating effect on the relationship between moral sensitivity and ethical decision-making among nursing undergraduates in Chinese nursing education context.

DESIGN

This study is a cross-sectional descriptive correlational design.

METHODS

263 nursing undergraduates from Nursing and Health School, Zhengzhou University in Henan province of China participated in the study and received the investigation. Their ethical decision-making, moral sensitivity and professional values were measured through the following three questionnaires, including the Judgement About Nursing Decision (JAND), Chinese Moral Sensitivity Questionnaire-Revised Version (MSQ-R-CV) and Chinese Nurses' Professional Values Scale-Revised Version (NPVS-R-CV). The data were processed and analysed by SPSS 23.0 and AMOS 24.0. The statistical methods included descriptive statistics, independent-samples t-tests, one-way analysis of variance, Pearson's correlation analyses and structural equation modeling.

RESULTS

Moral sensitivity is positively correlated with ethical decision-making (P < 0.01). Professional values is positively correlated with ethical decision-making (P < 0.01) and also has a mediating effect on the relationship between moral sensitivity and ethical decision-making (P < 0.01).

CONCLUSION

The investigation contributes to a broader understanding of the factors that influence nursing students' ethical decision-making. Developing ethics education around nursing students' professional values and moral sensitivity can improve their ethical decision-making ability.

Ethical Problems and Moral Distress in Primary Care: A Scoping Review

Background: Since 1997, nursing ethics research has focused on solving ethical dilemmas, enhancing decision-making strategies, and introducing professional education. Few studies describe the triggers of ethical dilemmas among primary care nurses. The aim of this study was to explore the moral distress and ethical dilemmas among primary care nurses. Methods: A scoping review was performed following Arskey and O’Malley’s framework. PubMed, CINAHL, PsycINFO, Embase, and Scopus were searched systematically to retrieve relevant titles and abstracts. A temporal filter was applied to focus on the most recent literature (years of 2010–2020). The research was completed on 17 November 2020. Results: Of 184 articles retrieved, 15 were included in the review. Some (n = 7) studies had a qualitative design, and the most productive country was Brazil (n = 7). The total number of nurses involved in quantitative studies was 1137 (range: 36–433); the total number of nurses involved in qualitative studies was 144 (range: 7–73). Three main focus areas were identified: (a) frequent ethical conflicts and moral distress episodes among nurses working in primary care settings; (b) frequent moral distress measures here employed; (c) coping strategies here adopted to prevent or manage moral distress. Conclusion: Further research is needed to examine the differences between moral distress triggers and sources of ethical dilemmas among the different care environments, such as primary care and acute care settings.

Nurses' caring behaviour and its correlation with moral sensitivity

BACKGROUND

Different and contradictory results have been reported for nurses' caring behaviour and moral sensitivity.

AIMS

The present study aimed to examine the correlation between nurses' caring behaviour and moral sensitivity.

METHODS

The research was a descriptive, correlational study. Data were collected using moral sensitivity (range: 0-100) and caring behaviour (range: 24-144) questionnaires. A total of 250 nurses who worked in the clinical wards of Yasuj teaching hospitals in 2018, were selected by systematic random sampling. The collected data were analysed using SPSS version 19 for descriptive statistics and Pearson correlation tests.

RESULTS

Seventy-four percent of nurses had moderate moral sensitivity (50-74). Nurses' moral sensitivity and caring behaviour mean scores were reported to be 59.5 ± 11.1 (range: 31-87) (Potential range 0--100) and 110.99 ± 17.99 (range: 69-94) (Potential range 22-144), respectively. The Pearson test showed a positive correlation between nurses' caring behaviour and moral sensitivity at a 99% level (p = 0.001).

CONCLUSIONS

Nurses' moral sensitivity and caring behaviour were found to be moderate and good, respectively. Furthermore, there was a positive correlation between moral sensitivity and caring behaviour in nurses, that is, nurses provided better caring behaviour as levels of moral sensitivity increased.

CULTURAL ADAPTATION AND VALIDATION OF THE MORAL SENSITIVITY QUESTIONNAIRE AMONG BRAZILIAN NURSES

ABSTRACT Objective: cultural adaptation and validation of the Moral Sensitivity Questionnaire to assess moral sensitivity among Brazilian nurses. Method: methodological study with 106 nurses from two hospitals located in the south of Brazil. The instrument was culturally adapted according to international guidelines, following six steps: translation, reconciliation of translated versions, back translation, expert panel, pretest, and final review. The Brazilian version was validated in the Brazilian context using factor analysis and Cronbach’s alpha. Results: after the expert panel’s assessment, pretest, and verification of face and content validity, the instrument was considered satisfactory to be applied among Brazilian nurses. Six constructs were identified: Respect for patients’ autonomy, modified autonomy, experiencing moral conflict, having confidence in medical and nursing knowledge, structuring moral meanings, and teamwork. The instrument presented satisfactory internal consistency, with a Cronbach’s alpha equal to 0.62; the Cronbach’s alpha of the six constructs ranged from 0.60 to 0.67. Conclusion: the Brazilian version of the Moral Sensitivity Questionnaire is valid and reliable to be applied among Brazilian nurses and can improve understanding of factors involving decision-making when facing ethical conflicts.

The ethical dimension of problems faced in general medicine: relationship with moral sensitivity

Objective:

to identify the main ethical problems and how these relate to the moral sensitivity of nurses working in a general medicine ward.

Method:

this qualitative, exploratory, and descriptive study was conducted in a university hospital located in the south of Brazil. A total of 18 nurses working in a general medicine ward were interviewed. A semi-structured interview script was used, and data were analyzed using discursive textual analysis.

Results:

nurses considered the main ethical problems to include conflicts at the institutional level, situations involving conflicts with patients and/or family members, and conflicts within the staff. The perception of nurses and how they deal with these problems relate to moral sensitivity. Two categories emerged: experiencing ethical problems, and relationship with moral sensitivity.

Conclusion:

because of the multidimensional nature of moral sensitivity, it trains and enables nurses to recognize and deal with ethical problems faced in clinical practice so that nurses become able to make fair and prudent decisions, improving the quality of nursing care.

Professional practice of nurses and influences on moral sensitivity

OBJECTIVE

To understand the professional practice of nurses and their influence on the development of moral sensibility.

METHODS

A qualitative and descriptive study, conducted between November 2015 and February 2016 in the hospitalization units of the medical clinic of two large hospitals located in Belo Horizonte, Minas Gerais. 14 nurses participated. Data collection was done through interviews, guided by semi-structured scripts. The data were submitted to content analysis.

RESULTS

Two categories emerged: Professional practice of the nurse: internal and external goods and Moral sensitivity and the interface with the professional practice of nurses. The development of the moral sensitivity of nurses is influenced by factors related to professional practice, such as interpersonal relations, ethical education and management activities. Final considerations: In the professional practice, moral sensibility is an integral part of the ethical decision-making process in services, being essential for quality care.

Perception of care quality and ethical sensitivity in surgical nurses

BACKGROUND

It is stated that high ethical sensitivity positively affects the quality of nursing care. However, the relationship between nursing care quality and ethical sensitivity has not been clearly demonstrated in researches.

AIM

This study was carried out to determine the relationship between surgical nurses' care behaviors and their ethical sensitivity.

METHOD

The sample of this cross-sectional, descriptive-correlational study consists of 308 nurses who worked at the surgical departments in four Turkish hospitals. The data were collected using the "Nurse Description Form" developed by the researcher, "Caring Behaviours Inventory-24" and "Ethical Sensitivity Questionnaire." Data were evaluated by the Mann Whitney U test, Kruskal Wallis one-way analysis of variance and Spearman correlation analysis.

ETHICAL CONSIDERATIONS

The study was approved by the ethics committee. Verbal and written consent was received from the nurses.

RESULTS

It was found in the study that nurses' Caring Behaviours Inventory-24 total score median was 5.25 (4.83-5.58), nurses' perception level of caring quality was high, median of Ethical Sensitivity Questionnaire total score was 89.00 (75.00-101.00) and nurses' ethical sensitivity was moderate. A negative significant relation was found between nurses' Caring Behaviours Inventory-24 total score and Ethical Sensitivity Questionnaire total score (r = -0.162; p = 0.009). A negative relation was also detected between nurses' working period at the current clinic and providing benefit (r = -0.147; p = 0.012), holistic approach (r = -0.139; p = 0.018) and orientation (r = -0.175; p = 0.003) scores of Ethical Sensitivity Questionnaire sub-scales.

CONCLUSION

Nurses' perception levels of caring quality were high and their ethical sensitivity levels were moderate. It was found out that nurses' ethical sensitivity increased together with their perception of caring quality, and as their working period at the current clinic increased, the ethical sensitivity also increased in terms of the sub-scales of providing benefit, holistic approach, and orientation. The factors that adversely affect the quality of nursing care and ethical sensitivity should be examined and attempts should be made to improve the working environment.

ELEMENTS OF MORAL SENSITIVITY IN THE PRACTICE OF CLINICAL HOSPITAL NURSES

ABSTRACT Objective: to identify the elements of moral sensitivity held by nurses working in a medical clinic unit. Method: this exploratory-descriptive study with a qualitative approach addressed 18 nurses from a medical clinic of a university hospital located in southern Brazil using semi-structured interviews, which were analyzed using discursive textual analysis. Results: data were structured into six categories: relational orientation; experiencing moral dilemmas; following rules; benevolent motivation; structuring moral meaning; and autonomy. These categories enabled the identification of important elements of moral sensitivity, such as acknowledging the ethical dimension of one’s attitudes, acknowledging the uniqueness of each patient, dealing with conflict between workers and patients and/or their companions, adapting to the workplace, empathy, dialogue, clinical decision-making, meeting the needs of patients, understanding patients’ health condition, respect, welcoming patients’ desires and providing guidance that concerns patients’ requests and refusals. Conclusion: the elements of moral sensitivity identified in this study contribute to support nurses when making clinical decisions, especially when facing ethical issues arising in a medical clinic setting.

Experiências de cuidado dos enfermeiros às pessoas com hanseníase: contribuições da hermenêutica

Resumo Objetivo Estudo qualitativo fundamentado na hermenêutica filosófica que teve como objetivo analisar a experiência de cuidar de pessoas com hanseníase na pratica de enfermeiros do Município do Rio de Janeiro. Métodos Estudo qualitativo desenvolvido nas áreas programáticas de saúde do município do Rio de Janeiro, que apresentaram alto ou médio coeficiente de detecção de hanseníase em 2014. Foram selecionados serviços com os seguintes perfis: exclusivamente ESF, serviços com clínicas especializadas e unidades mistas que se caracterizam pela coexistência da ESF e do modelo tradicional de atendimento. Participaram da pesquisa dezenove enfermeiros que atuavam nos serviços de Atenção Primária e Secundária destas áreas. Os critérios de inclusão definidos foram possuir experiência de pelo menos cinco anos no acompanhamento de pessoas que receberam diagnóstico de hanseníase e, qualificação técnica por treinamento específico. Como critério de exclusão, estar em afastamento laboral durante toda a etapa de coleta de dados que ocorreu no período de fevereiro de 2015 a março de 2016. As entrevistas foram agendadas em comum acordo com os participantes e gravadas com autorização dos mesmos. Resultados Elaboraram-se duas categorias: Para os enfermeiros, o atendimento da pessoa com hanseníase perdeu em qualidade e os enfermeiros reconhecem o estigma como um problema que compromete o tratamento e a cura da hanseníase. Conclusão O atendimento às pessoas com hanseníase ficou reduzido à uma ação eventual, onde a relação profissional-usuário tem vínculo fragilizado. O estigma e a discriminação que comprometem o tratamento ainda estão presentes nas atitudes e no comportamento dos profissionais de saúde, e se constituem em obstáculo no restabelecimento da saúde.