The Relationship between Nurses' Moral Sensitivity and Patients' Satisfaction with the Care Received in the Medical Wards

Moral sensitivity of nurses in a university hospital in southern Brazil

OBJECTIVE

to analyze the moral sensitivity of nurses while facing ethical conflicts at the professional practice and verify their association with sociodemographic and labor-related variables.

METHOD

cross-sectional study, carried out with 115 nurses from a university hospital of southern Brazil. The Moral Sensitivity Questionnaire - Brazilian Version was applied from April to May 2023. Descriptive and analytical statistics were used to analyze the data.

RESULTS

the mean of the nurse's total moral sensitivity score was 3.49 (SD=0.36). The lowest score levels of moral sensitivity were related to the constructs "modified autonomy" (2.48; SD=1.08) and "meaning of the moral structure" (3.46; SD=0.66), while the highest levels were associated with the constructs "respect for patient autonomy" (3.90; SD=0.85) and "experiencing moral conflict" (3.59; SD=1.02). The constructs "modified autonomy" and "meaning of moral structure" were statistically significant regarding the association with the number of employment contracts, work shift and weekly hours worked (p=0.045, p=0.034, and p=0.044, respectively).

CONCLUSION

nurses exhibit moderate levels of moral sensitivity, and aspects of work are related to the ability to recognize and act on ethical problems.

The Nexus of Emotional Intelligence, Empathy, and Moral Sensitivity: Enhancing Ethical Nursing Practices in Clinical Settings

Background: Moral sensitivity is crucial for ethical decision-making in nursing, enabling nurses to respond appropriately to ethical dilemmas in clinical settings. Emotional intelligence and empathy have been identified as key factors influencing moral sensitivity. However, limited research examines the interplay between these variables, particularly in nursing practice. Objective: This study explores the relationships between emotional intelligence, nursing empathy, and moral sensitivity among nurses in Mosul teaching hospitals and examines empathy's mediating role in these relationships. Methods: This study employed a descriptive cross-sectional design. It involved 300 nurses from Mosul teaching hospitals in Iraq. Data collection occurred from July 1, 2024, to October 1, 2024. Validated measurement tools were used, including the Emotional Intelligence Scale (EIS), the Jefferson Scale of Empathy, and the Moral Sensitivity Questionnaire. Statistical analyses, including Pearson's correlation, multiple regression, and mediation analysis, were conducted to examine the relationships among emotional intelligence, empathy, and moral sensitivity. Results: Emotional intelligence and nursing empathy were significantly positively correlated with moral sensitivity (r = 0.58 and r = 0.66, respectively; p < 0.01). Multiple regression analysis revealed that both emotional intelligence (β = 0.30, p < 0.01) and nursing empathy (β = 0.52, p < 0.01) significantly predicted moral sensitivity, explaining 39% of the variance. Mediation analysis indicated that empathy partially mediated the relationship between emotional intelligence and moral sensitivity (p < 0.01). Conclusion: This study highlights the significant roles of emotional intelligence and empathy in enhancing nurses' moral sensitivity, with empathy acting as a partial mediator. Interventions that promote emotional intelligence and empathy development in nursing education and clinical practice could improve ethical decision-making and patient care quality. Further research is needed to explore these relationships longitudinally and in diverse healthcare settings.

The level of moral sensitivity among nurses: a systematic review and meta-analysis

BACKGROUND

Nurses, the largest frontline healthcare group in the world, experience a high incidence of moral distress. Enhancing moral sensitivity (MS) can effectively alleviate this distress. However, MS levels among nurses have not been clearly defined. Therefore, this study aimed to assess the level of MS among nurses and provide evidence-based insights to improve their moral practices.

METHODS

This review searched multiple databases, including PubMed, Cochrane Library, Embase, Web of Science, CINAHL, Scopus, Medline, China Knowledge Resource Integrated Database, Wanfang Database, VIP Database, Chinese Biomedical Database, Chinese Medical Journal Full Text Database, Google Scholar, and OpenGrey, from inception to December 31, 2024. Two reviewers (Ting Zhao and Shi Chen) independently screened the literature and extracted data. Their quality was assessed using the Joanna Briggs Institute's Critical Appraisal Tool. Data were analyzed using Stata software (version 17.0) to synthesize the mean scores of the moral sensitivity questionnaire (MSQ). Subgroup and meta-regression analysis were performed to identify the sources of heterogeneity, and a sensitivity analysis was conducted to assess the robustness of the results.

RESULTS

A total of 99 studies involving 29,387 nurses were included. The pooled mean score for MS was 4.49 [95% CI (4.29, 4.70)], indicating a moderate level. Meta-regression revealed the assessment instrument, country, and department as potential sources of heterogeneity. The mean scores by country were as follows: China (5.22), Korea (4.82), Iran (4.44), and Turkey (3.28). The scores for the different assessment instruments varied, with the MSQ-revised version (5.46) having the highest scores.

CONCLUSION

Nurses demonstrated moderate MS levels, indicating opportunities for further improvement. This review offers useful insights for nurse managers and educators in shaping strategies to improve moral training.

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.

Moral sensitivity and attitudes towards patient safety among critical care nurses

INTRODUCTION

Patient safety is essential for healthcare quality and a global concern. The rapid advancement of medical technology presents ethical challenges for critical care nurses, who navigate complex decision-making processes. Given their close relationships with patients, nurses are uniquely positioned to address patient safety issues. Thus, enhancing nurses' moral sensitivity and ethical values is increasingly important.

OBJECTIVE

This study aims to explore the relationship between moral sensitivity and attitude towards patient safety in critical care nurses.

METHODS

This cross-sectional, descriptive-correlational study was conducted from June to September 2022 in three hospitals affiliated with Hamadan University of Medical Sciences in Iran. Participants were nurses in intensive care units (ICUs), selected via convenience sampling. A total of 382 nurses completed questionnaires assessing demographic information, moral sensitivity, and patient safety attitudes. Data analysis was performed using descriptive statistics, t-tests, ANOVA, Pearson's correlation, and multiple regression in SPSS 26.Ethical considerations: This research received ethical approval from the Ethics Committee of Hamadan University of Medical Sciences. Participants provided informed consent regarding the study's objectives, and their confidentiality was strictly upheld throughout the research.

RESULTS

The nurses' average age and work experience were 38.6 years and 12.4 years, respectively. Mean scores for moral sensitivity and patient safety attitude were 81.65 ± 2.69 and 51.47 ± 2.21, indicating high levels and a significant positive correlation. Factors such as increasing age, work experience, fewer working hours, and completion of ethics training were linked to more positive attitudes towards patient safety (p < .05). Regression analysis showed that 42.8% of the variability in attitudes towards patient safety could be explained by moral sensitivity and demographic characteristics.

CONCLUSION

This study highlights the relationship between moral sensitivity and patient safety attitudes among critical care nurses, emphasizing the importance of education, experience, and training in shaping ethical values. Enhancing moral sensitivity is vital for reducing risky behaviors and improving patient safety outcomes in critical care settings.

The Relationship Between Perceived Comfort Level with Moral Sensitivity and Moral Distress Among Oncology Nurses: A Descriptive Correlational Study

OBJECTIVE

This study aimed to investigate the relationship between perceived comfort level with moral distress and moral sensitivity among oncology nurses METHODS: This is a descriptive-correlational study on 210 oncology nurses. The samples were selected through the convenience method from September 2020 to February 2022 in the oncology centers of Ahvaz, Iran. Data were collected via a demographic form, Lutzen's Modified Moral Sensitivity Questionnaire, Corley's Moral Distress Scale, and Kolcaba's Nurses Comfort Questionnaire (NCQ). Data were analyzed using SPSS V24, descriptive statistics, Independent t, Mann-Whitney-U, Kruskal-Wallis, Pearson's correlation coefficient, ANOVA, and linear regression tests.

RESULTS

Nurses experienced a moderate level of perceived comfort (67.91 ± 8.75), moral sensitivity (58.4 ± 13.3), and moral distress (57.54.8 ± 8.9). Moral sensitivity was significantly inversely related to the intensity of moral distress (P < .001). A statistically significant relationship was found between nurses' perceived comfort level with frequency of distress (P < .001) and moral sensitivity (P = .046). Moral distress explained 13.8% of changes in perceived comfort level (R2 = 0.138, F = 6.51, sig < 0.001, R = 0.371).

CONCLUSION

Nurses' perceived comfort level, moral sensitivity, and moral distress were at a moderate level and intercorrelated. It is suggested that factors contributing to moral distress should be eliminated. Also, moral sensitivity should be refined as a decisive factor.

IMPLICATION FOR NURSING PRACTICE

Oncology nurses are exposed to morally distressing situations that may be a source of discomfort. This study guides nurses, managers, planners, and policymakers to identify the contributing factors and use strategies and solutions to enhance nurses' perceived comfort level.

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.

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.

Nurse's Spiritual Sensitivity Scale (NSSS): A Validity and Reliability Study in Turkey

Nurses carry out spiritual care based on ethical principles, and they must have spiritual sensitivity to meet spiritual care needs. Seen from this angle, it is important to determine nurse's spiritual sensitivity in order to meet patient's spiritual care needs, to increase patient-nurse communication and to adopt a holistic approach to care. For this reason, the aim of this study was to test the validity and reliability of the Turkish Nurse's Spiritual Sensitivity Scale. In the present study, a sample size of 207 nurses was reached in the data collection stage. The Turkish Nurse's Spiritual Sensitivity Scale (NSSS) is a Likert-type scale consisting of 20 items and a single factor. There are no reverse-scored statements on the scale. A score of zero shows no spiritual sensitivity, and four shows higher spiritual sensitivity. The minimum score on the scale is zero, and the maximum score is 80. It was seen in this study that the Nurse's Spiritual Sensitivity Scale is a valid and reliable measurement instrument for a Turkish sample. This scale can be used by professionals to determine the spiritual sensitivity of Turkish nurses.

Moral sensitivity as a personal and work attribute of emergency care nurses: a cross-sectional study

OBJECTIVE

to analyze the moral sensitivity of Brazilian emergency care nurses according to their personal and work characteristics.

METHOD

this is a quantitative, descriptive, cross-sectional study with a convenience sample. A total of 422 nurses from emergency care services in the five regions of Brazil took part. Sociodemographic and work-related information was collected, as well as the Brazilian version of the Moral Sensitivity Questionnaire. After approval by the Research Ethics Committee, the data was collected using a self-administered form on the Google Forms Platform, organized using Excel software and analyzed using the R language.

RESULTS

nurses with longer experience in emergency care services showed higher levels in the interpersonal orientation, moral conflict and moral significance dimensions, while in the professional knowledge dimension, men showed higher levels, as evidenced by items that include confidence in nursing knowledge, intuition, experience and opinion.

CONCLUSION

the differences in the nurses' moral sensitivity were due to their professional experience. It should be emphasized that valuing the sharing of intergenerational experiences in service could be a possible strategy for fostering moral competencies in the field of practice.

Components related to ethical decision making in medical science students: A structural equation model

BACKGROUND

Evaluating moral principles in the Society of Medical Sciences and health care workers (HCWs) is imperative due to their direct contact with the community and the significant impact of their attitudes and decisions on people's lives. This study aimed to determine the components related to ethical decisions in medical sciences students.

METHODS

One thousand two hundred thirty-five eligible students in the Alborz University of Medical Sciences participated in this descriptive study. We gathered their socio-demographic information, assessed their moral reasoning, and used the ethical decisions questionnaire, Lutsen moral sensitivity questionnaire, and general health questionnaire (GHQ) for data gathering. The data were analyzed with SPSS software version 25 and LISREL version 8.8.

RESULTS

According to the path analysis test findings, ethical reasoning significantly correlated with ethical decision-making (B = 0.40). The number of clinical courses passed, moral sensation (moral sensitivity), and the total number of passed academic semesters had the greatest positive and negative association with ethical decision-making, respectively. (B = 0.54), (B = 0.524) and (B = -0.11).

CONCLUSION

Based on the findings of the moral reasoning test, the moral sensation was associated with ethical decision-making, which indicates the necessity of attending to ethical aspects, promoting moral reasoning, sensitivity, and students' accuracy.

Missed nursing care and its relationship with nurses' moral sensitivity: a descriptive-analytical study

BACKGROUND

Missed care rates are an indicator of healthcare quality. Missed nursing care can reduce patient safety and lead to adverse events. Moral sensitivity enables nurses to interpret and respond to clients' needs according to ethical principles. Despite the importance of moral sensitivity and its role in the quality of care, the relationship between nurses' moral sensitivity and missed nursing care has not been extensively studied. This raises the question of whether there is an association between nurses' moral sensitivity and missed care. This study was conducted to investigate the relationship between nurses' moral sensitivity and missed nursing care in the medical and surgical departments of Imam Khomeini Hospital in Urmia, Iran.

METHODS

A cross-sectional study was conducted in 2022, on 202 nurses working in the medical and surgical departments of Imam Khomeini Medical Education Center, Urmia, Iran. Stratified random sampling was used to select the participants. A questionnaire on demographic characteristics, Kalisch's missed care questionnaire, and Lutzen's moral sensitivity questionnaire were used to collect data. Data were analyzed using the Pearson correlation test and linear regression analysis.

RESULTS

Most participants (52.97%) showed moderate moral sensitivity. Nurses' mean moral sensitivity and total missed care scores were 149.07 ± 21.60 and 59.45 ± 4.87, respectively. Pearson correlation test showed no significant correlation between moral sensitivity scores and the total missed care scores (r = 0.041, p = 0.152). However, in the regression analysis, moral sensitivity (β = 0.213, p < 0.001), age (β = 0.131, p < 0.001), working in rotating shifts (β = 0.183, p < 0.001), monthly income (β = 0.079, p = 0.004), work experience (β = 0.030, p = 0.010), and monthly work hours (β = 0.247, p = 0.010) influenced missed care. Approximately, 0.98% of the variance in the missed care was explained by these variables.

CONCLUSION

Our nurses reported moderate levels of moral sensitivity and a concerning level of missed care. Missed care can have detrimental effects on patient safety. Therefore, nursing managers must address this issue promptly.

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

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.

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.

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.

A Study of How Moral Courage and Moral Sensitivity Correlate with Safe Care in Special Care Nursing

Background

Nursing is a caring profession, and nurses who have moral sensitivity and moral courage presumably can provide safe and better care for patients. This study aims at investigating how moral courage and moral sensitivity correlate with safe care in special care nursing.

Methods

This study is a descriptive work of research. The participants consisted of 524 nurses who were in practice in the ICU (intensive care unit), CCU (C\coronary care unit), post-CCU (postcoronary care unit), and dialysis of four hospitals located in the south of Iran selected via census sampling. Data were collected from April to September 2020 using the moral sensitivity questionnaire (MSQ), professional moral courage questionnaire (PMCQ), and the assessment of safe nursing care questionnaire (ASNCQ). The collected data were analyzed using descriptive statistics, t-test, chi-square, multiple regression analysis, and Pearson's correlation coefficient in SPSS v. 22.

Results

The mean ± SD of the nurses' age was 33.89 ± 6.91 years, and the mean ± SD of their work experience was 9.16 ± 4.67 years. The total mean score ± SD of the nurses' moral sensitivity was found to be 93.41 ± 2.68, the total mean score ± SD of their moral courage was found to be 96.38 ± 3.63, and the total mean score ± SD of their safe care scores was found to be 321.80 ± 9.76. The values of Pearson's correlation coefficients showed significant correlations between moral courage and safe care (r = 0.54, p < 0.001), moral sensitivity and safe care (r = 0.59, p < 0.001), and moral sensitivity and moral courage (r = 0.52, p < 0.001).

Conclusion

There is a positive correlation between moral sensitivity and moral courage. Both positively correlated with special care nursing. Accordingly, through effective planning, education, and giving their support, nurse administrators can promote the abovementioned ethical virtues in the nursing staff, thereby improving the quality of care.

Relationship between moral sensitivity and the quality of nursing care for the elderly with Covid-19 in Iranian hospitals

BACKGROUND

The quality of care has a significant impact on the condition of elderly patients. Many factors affect the quality of care, including ethical considerations. Ethical considerations, such as moral sensitivity, change in times of crisis. The present study was conducted to assess the relationship between moral sensitivity and the quality of nursing care for the elderly with Covid-19 in Iranian hospitals.

METHODS

This was a cross-sectional descriptive correlational study. The participants included 445 nurses that were selected by quota sampling method from hospitals admitting COVID-19 patients. The data were collected using the Moral Sensitivity Questionnaire (MSQ) and Quality Patient Care Scale (QUALPAC) as self-reports. We used the SPSS software v.16 for statistical analysis.

RESULTS

The total score of moral sensitivity and quality of care was 52.29 ± 16.44 and 2.83 ± 0.23, respectively. Moral sensitivity negatively correlates with psychological, social, and physical aspects (P < 0.05). Modifying autonomy, interpersonal orientation, and experiencing moral conflict predicted β = 0.10 of the psychosocial aspect of quality of care. Structural moral meaning and expressing benevolence predicted the changes in the physical dimension of quality of care (β = 0.02).

CONCLUSION

The quality of care had a significant inverse correlation with moral sensitivity. Multiple regression analysis showed that modifying autonomy, interpersonal orientation, and experiencing moral conflict could predict the psychosocial dimensions. Structuring moral meaning could predict the physical dimension. The communication aspects were not related to any of the dimensions of moral sensitivity.

Moral distress and moral resilience of nurse managers

BACKGROUND

Moral distress is a phenomenon that can lead to an imbalance of the mind and body. There are many coping strategies to overcome the obstacles that lead the subject to this condition. Some coping strategies are capable of being achieved through the cultivation of moral resilience.

AIM

The aim is to identify the strategies of moral resilience in the nursing management of University Hospitals in Brazil.

RESEARCH DESIGN

The research design is the qualitative study with discursive textual analysis.

PARTICIPANTS AND RESEARCH CONTEXT

: 44 nurse managers and nurses in leadership positions participated in a total of 30 University Hospitals in Brazil. Data were collected online, using a questionnaire with open questions.

ETHICAL CONSIDERATIONS

The Ethics Committee approved the study. Participants received information about the research, agreed to respond to the questionnaire, and were guaranteed anonymity.

FINDINGS

Personal adaptive strategies (intrapersonal and interpersonal) and organizational collaborative strategies (intrinsic and transformational management) emerged from this process. The intrapersonal strategies involved elements of rationality, flexibility, rebalancing practices, moral courage, and detachment. The interpersonal strategies addressed support networks, team involvement, and dialog. Organizational strategies dealt with actions which reorient ethical infrastructure, ethical education, and psychological protection, as well as fostering dialogical relationships, empowerment, and cooperation.

CONCLUSION

From the perspective of social historical construction, it is understood that developing personal and organizational strategies is essential to cultivating moral resilience.

Electrophysiological Markers of Fairness and Selfishness Revealed by a Combination of Dictator and Ultimatum Games

Individual behavior during financial decision making is motivated by fairness, but an unanswered question from previous studies is whether particular patterns of brain activity correspond to different profiles of fairness. Event Related Potentials (ERPs) were recorded from 39 participants who played the role of allocators in a Dictator Game (DG) and responders in an Ultimatum Game (UG). Two very homogeneous groups were formed by fair and selfish individuals. At fronto-central cortical sites, the latency of ERP early negativity (N1) was 10 ms shorter in selfish participants than in fair participants. In fair DG players, the subsequent positive wave P2 suggested that more cognitive resources were required when they allocated the least gains to the other party. P2 latency and amplitude in the selfish group supported the hypothesis that these participants tended to maximize their profit. During UG, we observed that medial frontal negativity (MFN) occurred earlier and with greater amplitude when selfish participants rejected less favorable endowment shares. In this case, all players received zero payoffs, which showed that MFN in selfish participants was associated with a spiteful punishment. At posterior-parietal sites, we found that the greater the selfishness, the greater the amplitude of the late positive component (LPC). Our results bring new evidence to the existence of specific somatic markers associated with the activation of distinct cerebral circuits by the evaluation of fair and unfair proposals in participants characterized by different expressions of perceived fairness, thus suggesting that a particular brain dynamics could be associated with moral decisions.

The relationship between moral sensitivity and caring behavior among nurses in iran during COVID-19 pandemic

Background

Caring for patients during a pandemic can be difficult for healthcare workers, the patients themselves, and healthcare systems. Nurses are expected to recognize ethical dilemmas and make sound judgments when confronted with them. Sensitizing nurses to ethical issues strengthen their ability to identify ethical dilemmas and make ethical choices. As a result, this study aimed to determine a relationship between moral sensitivity and caring behavior among nurses during the coronavirus (COVID-19) pandemic.

Method

The current study is a cross-sectional study of 406 nurses who worked in a single hospital during the COVID-19 epidemic. We used a demographic questionnaire and the caring behavior inventory (CBI) tool to collect data online. The data were analyzed using descriptive and correlational statistics.

Findings

Eighty-three point seven percent of participants in this study were female, and 71.9% were married. 47.5% reported caring for a COVID-19 patient for longer than a month; their average work experience was 13.1 years. Additionally, Moral Sensitivity correlated positively with caring behavior and its dimensions (r = 0.164, P = 0.001). However, a significant and inverse link existed between the dimension "following the rules" and the nurse's caring conduct (r = -0.117, P = 0.019).

Conclusion

During the pandemic, nurses' moral sensitivity was moderate and significantly connected with their caring behavior. Because nurses encounter numerous obstacles while caring for patients in critical conditions, they require ethical empowerment to perform correctly, as caring behavior improves with increased moral sensitivity.

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.

Moral courage, moral sensitivity and safe nursing care in nurses caring of patients with COVID-19

AIM

Evaluation the moral courage, moral sensitivity and safe nursing care in nurses caring of infected patients by the COVID-19.

DESIGN

This study employed cross-sectional research.

METHODS

520 nurses caring for COVID-19 patients in 5 hospitals were selected via convenience sampling. They completed questionnaires online. Data were analysed by SPSS software version 22.

RESULTS

Findings showed that moral courage has a strong and direct correlation with moral sensitivity (p < .001, r = 0-.70) and safe nursing care (p < .001, r = 0-.74). Variables of moral sensitivity, safe nursing care, work experience, age and employment status can predict 64.76% of the variance in moral courage in these nurses. Nursing care of patients with COVID-19 have reported high moral courage in recent months, and in spite of the numerous tensions and stresses in terms of caring these patients during this relative long period, they are still diligent in providing safe and high sensitive care to these patients.

Does heavy mental workload affect moral sensitivity among critical care unit nursing professionals? a cross-sectional study

Background

Moral sensitivity creates the basic attitude in providing effective ethical care to patients. Heavy mental workload is a major concern of critical care nursing professionals, which could adversely affect nursing staff and patients. The present study aimed to investigate the effects of mental workload and some demographic variables on the moral sensitivity of critical care nursing professionals.

Methods

This cross-sectional, descriptive-correlational study was performed on 181 nursing professionals working in the critical care units of Shahid Rajaei Cardiovascular Medical and Research Center in Tehran, Iran. Data were collected using a demographic questionnaire, the moral sensitivity questionnaire, and the NASA-task load index to assess mental workload. Data analysis was performed in SPSS version 22 using descriptive statistics, independent t-test, Pearson’s correlation-coefficient, and regression analysis.

Results

The results of regression analysis yielded no statistical significant relationship between heavy mental workload and moral sensitivity of the critical care nursing professionals, while clinical experience had a positive, significant association with moral sensitivity.

Conclusions

Although care nursing professionals experience a heavy mental workload in critical care units, it does not decrease their moral sensitivity. In addition, experienced nurses have higher moral sensitivity and lower mental workload. Therefore, it seems that nursing managers should pay special attention to the importance of employing experienced nurses along with younger nurses.

Effect of Ethics Seminar on Moral Sensitivity and Ethical Behavior of Clinical Nurses

While nursing is an ethical profession, unethical behavior among nurses is increasing worldwide. This study examined the effects of an ethics seminar on nurses’ moral sensitivity and ethical behavior. A total of 35 nurses (17 experimental, 18 control) were recruited. The ethics seminar was held over a six-month period from May to October 2018 and comprised six sessions held once a month for two hours. Moral sensitivity and unethical behavior were measured at the start and end of the seminar. Moral sensitivity and unethical behavior showed a negative correlation (r = −0.400, p < 0.05). After the ethics seminar, the experimental group’s moral sensitivity was not significantly increased (t = −1.039, p = 0.314). The experimental group’s mean scores of unethical behavior at pre- and posttest were 12.59 and 9.47, respectively, indicating a statistically significant difference (t = 3.363, p = 0.004). There was no statistically significant difference in the mean score in both moral sensitivity and unethical behavior at pre- and posttest in the control group. Thus, ethics seminars can reduce the risk of unethical behavior among nurses. Regular ethics seminars and training must be provided to nurses as part of their curriculum/practice.