Moral sensitivity of nursing students: a systematic review

Correlation between the Nurses, Moral Sensitivity and the Observance of Patients' Rights in ICUs

To provide care with high quality, nurses face a number of moral issues requiring them to have moral abilities in professional performance. Moral sensitivity is the first step in moral performance. However, its relation to the quality of care patients receive is controversial. This study aims to determine the relationship between the moral sensitivity of nurses and the quality of care received by patients in the medical wards. A descriptive correlational study using validated tools, including Moral Sensitivity Questionnaire and the Quality Patient Quality Scale. In total, 198 nurses and 198 patients in 17 medical wards of hospitals affiliated with Tabriz University of Medical Sciences, Iran. The study was reviewed and approved by the Ethics Committee of Tabriz University of Medical Sciences. The mean values of nurses' moral sensitivity and nurses' quality care were 136.47 ± 13.30 and 196.36 ± 44.10, respectively. There was no significant relationship between the patient care quality and nurses' moral sensitivity (r = -.14, p = .5). However, there was a significant inverse relationship between the dimension of "Experiencing moral conflicts" and the overall score of quality care (r = -.50, p = .04), the dimensions of "psychosocial (r = -.50, p = .04)" and "physical (r = -.50, p = .03)." Considering the significant inverse relationship between the score of patient quality care and the dimension of moral conflict experience, it seems when nurses make moral decisions, they experience a conflict between personal and professional values in their careers and thus experience moral tension. If this tension is not resolved properly, it can provide a way for them to distance themselves from patients, thereby making nurses indifferent to moral care.

The present research was carried out to look into the optimal interventions for raising moral sensitivity in nursing students. International electronic databases like Scopus, PubMed, and Web of Science were searched systematically from the earliest date to August 2, 2022, via keywords like "Morals", "Moral sensitivity", "Ethical sensitivity", and "Nursing students". Additionally, Iranian databases like Iranmedex were looked up. Randomized control trials (RCTs) and quasi-experimental studies' quality was evaluated using the Joanna Briggs Institute's (JBI) critical assessment checklist. A total of 756 nursing students were enrolled in nine studies. Of the nursing students, 54.87% were female and 70.63% were in the intervention group. The mean age of participants was 22.83 (SD=1.31) years. Mean study duration, intervention, and follow-up were 10, 5.41, and 6.68 weeks, respectively. It was shown that “education based on the visual, auditory, kinaesthetic (VAK) model”, “the spirituality training sessions”, “case-based method of education”, “the spirituality training sessions”, “nursing codes of ethics lecture”, and “the spiritual care training sessions” were enhanced moral sensitivity. Additionally, the “professional nursing practice course”, “nursing ethics education”, and “debate-based ethics education”, did not affect the nursing students' moral sensitivity. It is recommended that university administrators and policymakers plan and implement appropriate educational initiatives with moral and spiritual content in the form of educational workshops.

Nurses and nursing students increasingly confront ethical problems in clinical practice. Moral sensitivity, moral reasoning, and ethical decision-making are therefore important skills throughout the nursing profession. Innovative teaching methods as part of the ethics training of nursing students help them acquire these fundamental skills. This study investigated the effects and potential benefits of using standardized patients in ethics education on nursing baccalaureate students' moral sensitivity, moral reasoning, and ethical decision-making by comparing this method with in-class case analyses. This is a quasi-experimental study. The sample comprised 89 students in Hacettepe University's Faculty of Nursing. Following lectures describing the theoretical components of ethics, students were randomly assigned to two working groups, one using standardized patients and the other using in-class case analyses. Data were collected using the Moral Sensitivity Questionnaire, Rest's Defining Issues Test, and the Nursing Dilemma Test. All data were analysed using IBM SPSS Statistics Version 23. Ethical approval and official permission were obtained. All participating students completed informed consent forms. According to the results, the moral sensitivity of students in the standardized patient group significantly improved over time compared to those in the case analysis group, while the mean scores of students in both groups for moral reasoning and ethical decision-making were not statistically significant. Based on our results, we recommend the use of both standardized patients and case analysis as appropriate teaching methods in ethics education.

Moral Sensitivity and delivering Bad News Skills: A Study on Critical Care Unit Nurses

Based on Rest's Four Stage Model (moral sensitivity, moral judgement, moral intention and moral behaviour), we aim to compare the effects of dispositional moral sensitivity and contextual moral sensitivity on moral decision-making among nursing students. A cross-sectional study. The participants were from nursing colleges in Shijiazhuang, Guangzhou and Chongqing, China. A total of 354 nursing students were recruited via the convenience sampling method. Data were collected via the dispositional moral sensitivity scale and a scenario experiment. Structural equation modeling (SEM) was used to test the relationships among the variables in the structural model via Mplus. While dispositional moral sensitivity and contextual moral sensitivity both influence moral intention, they do so in opposite directions. Moral judgement has a positive impact on moral intention and acts as a mediator between dispositional moral sensitivity/contextual moral sensitivity and moral intention. This study compares the various influence paths and mechanisms of dispositional moral sensitivity and contextual moral sensitivity in moral decision-making, thereby advancing research on nursing ethics education. Our findings suggest that nursing colleges should adopt diverse strategies to cultivate the dispositional moral sensitivity of nursing students, thus facilitating their ability to make moral decisions. These insights have valuable implications for the advancement of nursing ethics education. We adhered to the STROBE guidelines. No patient or public contribution.

to identify ethical problems from the components of moral sensitivity among nurses of Intensive Care Units. qualitative, exploratory-descriptive study developed in a hospital in the South of Brazil with 19 nurses working in intensive care units through semi-structured interviews that were analyzed through discursive textual analysis. ethical education, dialogue, relationships with other health team members, professional autonomy, knowledge, personal values, effective communication, leadership and patients' positive outcomes were identified as important components of nurses' moral sensitivity, and comprise the domains of moral consciousness, benevolent motivation, and spontaneous moral perception. the components of moral sensitivity identified in this study facilitate nurses' instrumentalization in the face of decision making and ethical problems in the intensive care setting.

This study aims to determine the importance of the "Ethics and Deontology in Nursing" course in nursing education for the purpose of revealing the level of moral sensitivity of nursing students. In our research, which is a descriptive study, data were collected from 461 nursing students who studied at the Faculty of Health Sciences. In the study, the Personal Information Form and Moral Sensitivity Questionnaire (MSQ) were used as data collection forms. The findings from the study were evaluated with SPSS 22.00 package software, and the level of significance in all analyses was accepted as p < 0.05. The average age of the students participating in the study was 20.83 ± 1.55. Also, 51.8% of the students took the course "Ethics and Deontology in Nursing." The total mean score of the MSQ of students was determined as 83.32 ± 16.79. A statistically significant difference was found between the students' total scores of autonomy, benefit, holistic approach, conflict, practice, orientation, and moral sensitivity, depending on whether they took the course "Ethics and Deontology in Nursing." It was concluded that moral sensitivity in nursing students was positively influenced by the ethical education they received.

Introduction. The professional culture and competence of future military doctor encompasses professional, general-cultural, ethical values and is of great practical importance.Purpose. To analyze the scientific sources and publications of NATO and Western European scientists on the formation of the professional culture and competencies of future military doctors at NATO medical universities. The article reveals which areas of the professional culture of NATO military doctors are common and what are the differences.Research methods. Methods of theoretical, empirical analysis scientific literature, publications, comparison, classification, generalization and systematization of the material were used to solve the problems of the research.Results. The article covers aspects of the training of future military doctors at NATO and Northern European institutions of higher education. The example of the USA, Great Britain, Germany and Nordic countries shows the scientific experience and experience of forming the professional culture and competence of doctors. The pedagogical features of the process of educational and training of future military doctors are highlighted, with emphasis on the criteria of improving their professional competence and culture. The results of recent scientific studies of the North Atlantic countries in the field of the study of the professional culture and ethics of physicians in the course of their education and medical practice have been shown quite deeply.Scientific novelty and practical significance of research results. An attempt was made to show and analyze the amount of scientific work in NATO Western Europe on the formation of professional culture and ethics of the military doctor, his professional competence in the face of today`s global challenges related to the increasing military threats, increasing migration processes. The novelty of the study is the display analytical material based on the results and conclusions of studies on professional culture and competence, especially in countries such as United States and North European countries.It summarizes the similarity of experience, methodologies and approaches acquired in NATO`s medical universities in ethical education, professional competence, and highlights the existing differences. The author emphasizes the need to constantly study the experience of the countries the North Atlantic Alliance in matters of competence formation and professional culture of military doctors, taking into account the course of Ukraine on joining NATO. What is also important is that the process of reforming the military-medical service of the Armed Forces of Ukraine is continuing, and the work on achieving the goals of NATO partnerships and standards is increasing, which requires comprehensive scientific justification and recommendations in solving the set tasks.Conclusions and prospects for future research. Scientific research at NATO and Western Europe show that the growth of the professional culture and competence of future military doctors greatly improves the quality of provided medical care in the countries where doctors are trained, and enables them to perform peacefully peacekeeping missions.The experience of NATO countries in the training of military doctors is of practical importance for Ukraine, in view of the continuation of Russian – Ukrainian war in the eastern Ukraine, which required not only a sufficient number of highly qualified military doctors, but also the acquisition of appropriate professional competence and professional culture. Continuation of research on the enhancement of the professional culture and competence of military physicians is time consuming.Conclusions on the results of future research on the formation of professional culture in the processes of training future military doctors for the Armed Forces of Ukraine are of practical importance for the optimization of the educational process, the use in the daily work of doctors in part and medical institution of the Armed Forces and other security forces of Ukraine.

BackgroundDecision-making competence is a complex concept in the care for transgender and gender diverse adolescents, since this type of care concerns one’s developing gender identity and involves treatment options that often lack international consensus. Even despite competence assessments, moral challenges arise in the decision-making process. Here, traditional forms of clinical ethics support such as moral case deliberation might not fit as these do not provide thematic guidance. This study therefore aimed to develop a practice-oriented ethics support tool to assist care providers when dealing with moral challenges around decision-making competence in transgender adolescent care.MethodsThe study followed a participatory design to develop a tool in close collaboration with care providers; they had a say in all phases of development and dissemination. Firstly, nine care providers were interviewed about experienced moral challenges and needs for ethics support. Based on this, the structure and content of the tool was constructed and discussed in two focus group meetings, after which four care providers tested the tool and additional feedback was collected from the team and an advisory board. The final tool was presented to all Dutch care providers in transgender adolescent care.ResultsCare providers expressed a need for guidance in defining and assessing decision-making competence. Main moral challenges concerned discussing fertility options with young clients, dealing with co-occurring mental health difficulties and the decision-making role of parents. The final tool, named the Competence Consultant, is an interactive pdf containing four parts: (1) Clarify information; (2) Identify doubts and moral questions; (3) Guidance for conversations and (4) Overview and Conclusions.DiscussionDeveloping an ethics support tool in a controversial care setting is highly relevant as it aims to help individual care providers in defining, discussing and dealing with their moral challenges in actual practice. The ‘Competence Consultant’ for transgender care providers contributes to their moral sensitivity and moral competence. It is an example of the development of innovative and integrative forms of thematic ethics support.

Background and Purpose: Educators play a central role in enhancing students' moral competence by internalizing professional norms, values, attitudes, and skills. Moral sensitivity is a key competency for nursing educators and significantly influences their professional practice. Assessing this construct requires a valid and reliable measurement scale. This study aimed to design and psychometrically evaluate a questionnaire to measure moral sensitivity among nursing educators. Methods: This mixed-methods study used a sequential exploratory design for instrument development. In the qualitative phase, a hybrid concept analysis was conducted through a systematic literature review and in-depth, semistructured interviews with 10 purposively selected experts (8 nursing educators and 2 specialists in ethics and Islamic studies). Data were analyzed using conventional content analysis with MAXQDA 21. Based on the findings, an initial pool of questionnaire items was developed. In the quantitative phase, psychometric evaluation included face, content, and construct validity (exploratory factor analysis), as well as reliability testing through internal consistency and test-retest methods. Results: Qualitative findings identified attributes, antecedents, and consequences of moral sensitivity. Exploratory factor analysis revealed five factors: recognition of the situation, accuracy in decision-making, civic-benevolent behavior, student-centeredness, and attention to human dignity. The initial 80-item questionnaire was reduced to 31 items. The questionnaire showed excellent reliability (coefficient alpha = .92; intraclass correlation coefficient = .91). Conclusion: The Moral Sensitivity Questionnaire for educators demonstrates strong psychometric properties and provides a culturally grounded scale for assessing and promoting ethical sensitivity among nursing educators.

본 연구의 목적은 간호대학생의 비판적 사고성향, 전문직 자아개념과 도덕적 민감성에 대해 알아보고 관련성을 규명하기 위함이다. 연구 대상자는 일 지역 소재 간호학과에 재학 중인 280명으로 자료 수집은 2015년 3월 3일부터 3월 10일까지 진행되었다. 수집된 자료의 분석은 SPSS/WIN 18.0 프로그램을 이용하여 분석했다. 연구결과 도덕적 민감성은 생명윤리교육 경험 여부에 따라 유의한 차이가 있었다. 비판적 사고성향과 전문직 자아개념, 비판적 사고 성향과 도덕적 민감성 간에 양의 상관관계가 있었다. 본 연구결과를 토대로 추후 비판적 사고성향을 향상시킬 수 있는 방법이 필요하며, 전문직 자아개념의 확립을 위해 임상실습체계의 정비 및 구축이 필요하겠다. 또한 간호대학생의 도덕적 민감성을 향상시킬 수 있는 교육프로그램 개발 및 그 효과를 검증하는 연구를 제언한다. The aim of this study was to examine relations among critical thinking disposition, professional self-concept and moral sensitivity in nursing students. This study was conducted on 280 nursing students between March 3th 2015 and March 10th. 2015. The data was analyzed by using SPSS/WIN 18.0 program. Moral sensitivity significantly differed depending on one's experience in biomedical ethic education. Significant positive correlations were witnessed between critical thinking disposition and professional self-concept as well as between critical thinking disposition and moral sensitivity. Considering the results, the ways to develop critical thinking disposition and to ameliorate the current clinical training system are needed to firmly establish professional self-concept. Finally, I Suggest a study to develop and validate training program for the improvement of nursing students' moral sensitivity.

Kohlberg's theory of moral development explores the roles of cognition and emotion but focuses primarily on cognition. Contemporary post‐formal theories lead to the conclusion that skills resulting from cognitive‐affective integration facilitate consistency between moral judgement and moral behaviour. Rest's four‐component model of moral development delineates these skills specifically. The components, moral motivation, moral sensitivity, moral reasoning and moral character, operate as multidimensional processes that facilitate moral development and subsequently promote moral behaviour. The relationships between these components have been relatively unexplored, thereby missing the opportunity to unpack the processes underlying moral growth and development. In this study, moral motivation (spirituality), moral sensitivity (post‐formal skills) and moral reasoning are operationalized to examine the mediational effects of moral sensitivity of medical students. In the complex moral environment of medical students opportunities arise to question values and develop cognitive‐affective skills, among them spirituality and post‐formal thinking which are linked to increases in post‐conventional moral reasoning. The models tested indicate that moral sensitivity mediates the relationship between moral motivation and moral reasoning.

Moral sensitivity and moral reasoning are essential competencies biomedical researchers have to develop to make ethical decisions in their daily practices. Previous research has shown that these competencies can be developed through ethics education. However, it is unclear which underlying mechanisms best support the development of these competencies. In this article we argue that the development of moral sensitivity and moral reasoning can be fostered through teaching strategies that tap into students’ moral imagination. We describe how moral imagination can stimulate the development of these competencies through three different merits of moral imagination. Moral imagination can help students to 1) transfer and apply abstract moral concepts to concrete situations and contexts, 2) explore the perspective of others, 3) explore and foresee the moral consequences of different decisions and actions. We explain these three merits of moral imagination in the context of biomedical research and present a theoretical model for how these merits can be used to stimulate the development of moral sensitivity and moral reasoning. Furthermore, we describe multiple teaching strategies for biomedical curricula that tap into the three merits of moral imagination. These teaching strategies can inspire teachers to design ethics education that activates students’ moral imagination for the development of moral sensitivity and moral reasoning.

This systematic review aimed to update and explore the extant literature (2011-2020) regarding ethics knowledge in audiology and to compare the findings to an earlier study (2001-2010). This systematic review employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. MEDLINE, CINAHL, ERIC, MasterFILE Premier, E-Journals, Africa-Wide information and Academic Search Premier electronic databases, and non-peer-reviewed papers in Seminars in Hearing yielded a total of 63 papers. Following systematic screening using inclusion and exclusion criteria, a total of 12 full-text papers were included in this review. Pertinent data and findings from the review were tabulated and analyzed using a qualitative, deductive approach. Results showed that the 12 papers were published in nine peer-reviewed journals with a predominantly social scientific approach. This differs from the earlier review that reported only five papers with a predominantly philosophical approach. However, both the current and earlier studies focused on the rehabilitation/management role of the audiologist. In the earlier study, the focus was on moral judgment (as one of the components of moral behavior), whereas this was the focus of only half of the papers identified in this study, with the remaining papers focusing on moral sensitivity and moral motivation. The focus of papers had evolved and continued to include more elements related to the multiple perspectives used to analyze and describe ethics research. The body of knowledge of ethics in audiology specifically expanded in the area of social scientific research, focusing on beneficence and nonmaleficence, including moral motivation and basing research on moral judgment with the emphasis on the rehabilitation/management and education/research/administration role of audiologists.