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PubMed2000

Should moral reasoning serve as a criterion for student and resident selection?

The aim of medical school and residency training is to produce well-trained physicians. One problem has been in knowing which applicants to select. Academic criteria have not correlated well with clinical performance. The current study suggests consideration of an important variable that has been found to be associated with exemplary clinical performance. In recent studies a significant relationship between moral reasoning skills and clinical performance has been found for medical students and residents and dental and nursing students. A similar relationship has been found between levels of moral reasoning and malpractice claims among practicing orthopaedic surgeons. Rest has developed the Defining Issues Test, as a paper and pencil, objective test for assessing moral reasoning. With it being deemed appropriate to assess applicants' scientific reasoning, the authors support the development of an assessment of moral reasoning as a selection criterion for medical school and residency training. More research is required. If additional research confirms the relationship of moral reasoning and superior clinical performance, then the results of moral reasoning tests might legitimately be used in the selection process.

Humans↗
PubMed1994

Moral-emotional responsiveness: a two-factor domain of conscience functioning.

OBJECTIVE: The purpose of this study was to assess the progression in development of moral-emotional responsiveness in children and adolescents and to examine the relationship of this progression with previously identified stages of conceptualization of conscience. METHOD: Using three semistructured questions from the Stilwell Conscience Interview, 132 normal volunteers between the ages of 5 and 17 years were assessed regarding comprehension of their emotional responses to moral stimuli. RESULTS: Rational analysis of the responses identified six items; each item was scaled for complexity into five stages. Factor analysis of the six items revealed two factors: moral-emotional responsiveness 1 contained items relating to external anxiety, internal anxiety, and mood; more-emotional responsiveness 2 contained items relating to the restoration of psychophysiological equilibrium through the processes of reparation and healing. Differences between conceptualization stages, with the moral-emotional responsiveness factors serving as dependent variables, were accounted for by stage differences in age and the positive correlations between the moral-emotional responsiveness factors and age. CONCLUSIONS: Moral-emotional responsiveness is a two-factor domain of the conscience. The findings provide additional developmental guidelines for assessing conscience development and functioning both in clinical practice and in research.

Adolescent↗
PubMed1996

Moral valuation: a third domain of conscience functioning.

OBJECTIVE: To assess development of moral valuation in normal children and adolescents, that is, how moral rules for living are derived and justified, and to examine the relationship of this progression with previously identified stages of conceptualization of conscience. METHOD: Using three semistructured questions from the Stilwell Conscience Interview, 132 normal volunteers between the ages of 5 and 17 years were assessed. All moral valuation responses were examined within three aspects of social reference: authority-derived, self-derived, and peer-derived. Each aspect was scaled for complexity into six anchored levels. RESULTS: The levels of all three aspects correlated positively with conceptualization stages as well as with each other. When the covariate, age, was taken into consideration, peer-derived valuation was significantly correlated with both age and stage. CONCLUSIONS: Moral valuation is a domain of conscience functioning in which moral rules and their justifications are socially referenced in relationship to authority, self, and peers. Anchored levels of these three aspects of moral valuation provide developmental guidelines for mental status examinations in patients between 5 and 17 years of age as well as providing criteria for future comparative studies in various diagnostic categories of psychopathology.

Adolescent↗
PubMed2005

The effects of staff nurses' morale on patient satisfaction.

This study, designed by descriptive and inferential methods, study aimed to examine staff nurses' morale and its effect on patient satisfaction, the most commonly used variable to measure patient outcomes. Data were collected with structured questionnaires from 332 nurses and 265 inpatients in 21 medical-surgical units of a medical center in Taiwan. All registered nurses (RN) among the 21 sample units were recruited and administered with Litwin and Stringerm's (1968) Work Morale Scale, which was modified by Hsu in 1981. A convenience sampling was implemented to select those patients who had been admitted for at least 3 days and were ready to be discharged. Yang's (1997) Nursing-Sensitive Patient Satisfaction Scale was used to measure patient outcomes. The results showed that job position and pay had a significant effect on nurses' work morale. Nurses' work morale may not necessarily be an impact factor on patient satisfaction, but it accounts for 66.7 percent of the discriminate power to predict nursing-sensitive patient satisfaction. In view of the findings, every attempt should be made to highlight the nature of a caring profession. Nursing leaders should put effort into improving nurses' involvement and identification with their organizations, both of which are significant factors associated with nursing unit morale. The findings of this study may contribute to a body of knowledge regarding nurses' work morale and nursing-sensitive patient outcomes.

Adolescent↗
PubMedDate not supplied

Parent and peer contexts for children's moral reasoning development.

This study addressed the polarization among theoretical perspectives in moral psychology regarding the relative significance of parents and peers in children's developing moral maturity. The sample was composed of 60 target children from late childhood and midadolescence, 60 parents, and 60 friends who participated in parent/child and friend/child dyadic discussions of a series of moral conflicts. The quality of parents' and friends' verbal interactions, ego functioning, and level of moral reasoning in these discussions was used to predict the rate of children's moral reasoning development over a 4-year longitudinal interval. Results revealed that interactions with both parents and peers were predictive of children's development but that these two types of relationships influence development in rather different ways. Implications of the findings for the understanding of these socialization agents' roles in moral development are discussed.

Adolescent↗
PubMedDate not supplied

Hierarchical structure of moral stages assessed by a sorting task.

Following criticism of Kohlberg's theory of moral judgment, an empirical re-examination of hierarchical stage structure was desirable. Utilizing Piaget's concept of reflective abstraction as a basis, the hierarchical stage structure was investigated using a new method. Study participants (553 Dutch university students and 196 Russian high school students) sorted statements in terms of moral sophistication. These statements were typical for the different stages of moral development as defined in Colby and Kohlberg. The rank ordering performed by participants confirmed the hypotheses. First, despite large individual variation, the ordering of the statements that gave the best fit revealed that each consecutive Kohlbergian stage was perceived to be more morally sophisticated. Second, the lower the stage as represented by the items, the higher the agreement among the participants in their ranking; and the higher the stage as represented by the items, the lower the agreement among the participants in the rankings. Moreover, the pivotal point depended on the developmental characteristics of the sample, which demonstrated a developmental effect: The ordering of statements representative of moral stages below one's own current stage was straightforward, whereas the ordering of statements above one's own stage was difficult. It was concluded that the Piagetian idea of reflective abstraction can be used successfully to operationalize and measure the hierarchical nature of moral development.

Adolescent↗
PubMed1983

Moral reasoning and the student nurse.

The traditional curriculum in nurse education has tended to emphasize the acquisition of knowledge and practical skills and to ignore, for the most part, close examination of the social and moral dimensions of the nurse's role. The authors suggest that we ought to include a much more substantial consideration of moral issues in the nurse education and, in particular, they argue that Kohlberg's model of moral development could provide a theoretical framework. This model is based on a cognitive-developmental approach in which an individual's level of reasoning is assessed by the use of a variety of hypothetical dilemmas. Kohlberg claims to identify six qualitatively distinct stages and argues that the transition from one stage to the next results from the individual's active attempts to resolve conflicts arising from moral dilemmas. Some suggestions are made about the ways in which discussion of moral dilemmas might be incorporated within a moral reasoning module in the nurse education curriculum and proposals are made for methods of teaching such a module.

Cognition↗
PubMed2006

Nurses' lived experiences of moral stress support in the intensive care context.

The aim of this study was to analyse and describe lived experiences of support in situations characterized by critical care situations and moral stress in intensive care nursing. An exploratory interpretative study was conducted. Data consisted of interviews with 36 nurses from different types of intensive care units. The first level of analysis of data identified contextual factors, such as type and purpose of support and working conditions. On the next level of analysis five tentative interpretations were identified: (1) receiving organized support is a matter of self-determination, (2) whether to participate in organized support or to be off duty are experienced as mutually exclusive, (3) dealing with moral stress is experienced as a private matter, (4) colleagues managing moral stress serve as models in stress support and (5) not being able to deal with moral stress urges one to seek outside support. A comparison of these interpretations identified three major themes: availability, accessibility and receptivity of support. The main interpretation and conclusion were: lived experience of moral stress support involves an interconnectedness between structural and existential factors. Thus, adequate moral stress support presupposes an allowable professional climate and access to caring supervision.

Adaptation, Psychological↗
PubMed1998

Indigenous health: a special moral imperative.

The provision of health services to Indigenous people is not perceived by many Australians to be a moral issue. Indigenous health, however, is not only a moral issue, it is a moral issue that deserves special consideration. In many sectors of society, the correct moral path is unclear, but the circumstances of Indigenous health warrant special consideration which policy makers and health care administrators are uniquely placed to render. The setting of Australia was at the expense of Indigenous flourishing. There is little doubt that many of the current poor health outcomes of Indigenous Australians result from their past impoverishment. We argue that each member of Australian society has inherited a collective moral responsibility, along with the social assets accrued at the expense of Indigenous Australians, irrespective of their personal complicity. Government, as representatives of the people, has a responsibility to repay some of this society's accrued moral debt through the allocation of resources independent of issues of equity.

Australia↗
PubMedDate not supplied

Ethical dilemma and moral distress: proposed new NANDA diagnoses.

PURPOSE: To propose two NANDA diagnoses--ethical dilemma and moral distress--and to distinguish between the NANDA diagnosis decisional conflict and the proposed nursing diagnosis of ethical dilemma. SOURCES USED: Journal articles, books, and focus group research findings. DATA SYNTHESIS: Moral/ethical situations exist in health care. Nurses' experiences of ethical dilemmas and moral distress are extrapolated to the types and categories of ethical dilemmas and moral distress that patients experience and are used as the basis for development of two new nursing diagnoses. CONCLUSION: The two proposed NANDA diagnoses fill a void in current standardized terminology. PRACTICE IMPLICATIONS: It is important that nurses have the ability to diagnose ethical or moral situations in health care. Currently, NANDA does not offer a means to document this important phenomenon. The creation of two sets of nursing diagnoses, ethical dilemma and moral distress, will enable nurses to recognize and track nursing care related to ethical or moral situations.

Conflict, Psychological↗
PubMed2001

Examining the foreseeable: assisted suicide as a herald of changing moralities.

After her intense battle for the decriminalization of assisted suicide in the Supreme Court of Canada, Sue Rodriguez committed suicide with medical assistance in 1994. Following her suicide, government and law representatives remained silent and no criminal charges were ever brought against the person(s) who presumably assisted Ms Rodriguez in her death. This apparent non-intervention of criminal law is examined in view of the useful role that the Rodriguez event may have played in a possible shift in the dominant morality. It is argued that the Rodriguez assisted suicide may have been a useful 'crime' (in the Durkheimian sense) in that it brought to the fore the possibility that social conditions--which made the 'crime' possible--may no longer be in harmony with conventional morality. Similarly to Socrates' crime, the Rodriguez case can be seen as an anticipation of a new morality. It can be analyzed as a prelude to alterations, as directly preparing the way for changes in the dominant morality. The role of criminal law as a preferred mode of moral regulation is also examined in relation to the moral demands and expectations that arose during as well as after the judicial saga.

Canada↗
PubMed2003

Moral stress: synthesis of a concept.

The aim of this article is to describe the synthesis of the concept of moral stress and to attempt to identify its preconditions. Qualitative data from two independent studies on professional issues in nursing were analysed from a hypothetical-deductive approach. The findings indicate that moral stress is independent of context-given specific preconditions: (1) nurses are morally sensitive to the patient's vulnerability; (2) nurses experience external factors preventing them from doing what is best for the patient; and (3) nurses feel that they have no control over the specific situation. The findings from this analysis are supported by recent research on stress in the workplace but differ that the imperatives directing work are moral in nature. Stress researchers have found that persons who experience that they have no control over their work situation and at the same time experience high demands may be prone to cardiovascular diseases. An important question raised by this study is whether moral stress should be recognized as a health risk in nursing. Further research is required in order to generate intervention models to prevent or deal with moral stress.

Attitude of Health Personnel↗
PubMed1999

Moral concerns of different types of patients in clinical BRCA1/2 gene mutation testing.

PURPOSE: Implementing predictive genetic testing for a severe and common chronic disease such as breast cancer may raise unique ethical problems. Here we report on moral concerns experienced by patients in the setting of genetic counseling based on BRCA1/2 gene testing. PATIENTS AND METHODS: Patients were members of breast or breast/ovarian cancer families in a consecutive series of 100 families who received counseling at a familial cancer clinic. The patients' moral concerns were identified using the grounded theory approach in the qualitative analysis of verbal transcripts of 45 counseling sessions. Included were sessions with patients who had breast and ovarian cancer, as well as their male and female relatives, before and after the specific BRCA1/2 gene mutation was identified in the family, and before and after those who opted for mutation analysis were informed of their carrier status. RESULTS: There is an association of BRCA1/2 gene mutation carrier status and specific topics of moral concern. The moral preoccupations of patients with breast and ovarian cancer (probable carriers) related to their being instrumental in the detection of the specific mutation segregating in the family. The preoccupations of possible carriers concerned their own offspring. Individuals who tested positive (proven carriers) were concerned with issues of confidentiality. Patients who tested negative (proven noncarriers) were concerned with helping siblings and other relatives. CONCLUSION: Knowledge of the moral concerns of subjects in the study sample may help health care providers be aware of the moral concerns of their own patients. This report may also contribute to the debate on predictive testing for familial adult-onset diseases from the patient's perspective.

BRCA2 Protein↗
PubMed1995

Common morality as an alternative to principlism.

Unlike the principles of Kant, Mill, and Rawls, those of principlism are not action guides that stem from an underlying, integrated moral theory. Hence problems arise in reconciling the principles with each other and, indeed, in interpreting them as action guides at all, since they have no content in and of themselves. Another approach to "theory and method in bioethics" is presented as an alternative to principlism, though actually the "alternative" predates principlism by about 10 years. The alternative's account of morality stays close to ordinary, common morality with its rules and ideals, which in turn are grounded in aspects of human nature. As such, morality must be understood to be a rational, impartial, and public system that is incumbent on everyone. Morality is a unified and integrated system. The moral rules and ideals are also "culture-" and "profession-sensitive" in that they are interpreted more specifically within these various contexts.

Altruism↗
PubMed2003

Consistency, common morality, and reflective equilibrium.

Biomedical ethicists often assume that common morality constitutes a largely consistent normative system. This premise is not taken for granted in general normative ethics. This paper entertains the possibility of inconsistency within common morality and explores methodological implications. Assuming common morality to be inconsistent casts new light on the debate between principlists and descriptivists. One can view the two approaches as complementary attempts to evade or transcend that inconsistency. If common morality proves to be inconsistent, then principlists might have reason to prefer a less pluralist theory, thereby moving closer to descriptivism. Descriptivists, by contrast, might want to qualify their claim to accommodate all of people's basic moral convictions. Finally, both camps might wish to adopt a more revisionist posture, accepting that an adequate ethical theory occasionally will contradict some of people's deepest moral convictions. Proper application of the method of reflective equilibrium, to which both descriptivists and principlists claim allegiance, may entail greater openness to revisionism than either camp admits.

Bioethics↗
PubMed2001

Plato's conception of the relations between moral philosophy and medicine.

The first part of this article construes crucial passages from the Platonic dialogues as evidence that Plato takes medicine as a model for moral philosophy and as one of the organizing principles for his writing of the dialogues. The second part reflects upon the significance of one of the most debatable implications of the model: the comparison between health and illness, on the one hand, and moral virtue and moral vice, on the other. It articulates 10 illuminating aspects of this comparison and two potentially serious objections to it. The third part of this article examines what the model implies about the roles of medicine and moral philosophy in the political community and about the natures of doctor-patient and philosopher-interlocutor relationships. It highlights Socrates' criticisms of a kind of politics that covers over moral causes of social disorders by means of Band-Aid legislation, and emphasizes that according to the model, both the doctor and the moral teacher confront agents who must cooperate in the process of reform and accept whatever responsibility they have for their conditions.

Ethics, Medical↗
PubMed2005

Moral maturity and delinquency after prenatal alcohol exposure.

OBJECTIVE: Prenatal exposure to alcohol is associated with cognitive, behavioral and social deficits, including delinquency. Although delinquent populations and those with intellectual and behavioral deficits exhibit impaired moral judgment and reasoning, this area remains unexplored in alcohol-exposed individuals. METHOD: Moral maturity and delinquency were evaluated in 27 participants with prenatal alcohol exposure (ALC group) and 29 nonexposed controls (CON group) matched on age (range: 10-18), gender, handedness, socioeconomic status and ethnicity. Moral maturity was evaluated using the Sociomoral Reflection Measure-Short Form, and delinquency was evaluated with the Conduct Disorder (CD) Questionnaire. Additional measures included social desirability and inhibition. RESULTS: The ALC group performed at a lower level of moral maturity than the CON group. Whereas Verbal IQ primarily predicted this difference, a deficit on the moral value judgment having to do with relationships with others was specific to prenatal alcohol exposure. Furthermore, delinquency was higher in the ALC group, and specific sociomoral values were predictive of delinquent behavior. Finally, half of the children and adolescents with a history of prenatal alcohol exposure but without fetal alcohol syndrome had probable CD. CONCLUSIONS: The results of this study indicate that interventions aimed at reducing delinquency in those with prenatal alcohol exposure are necessary, and targeting moral judgment for this purpose may be beneficial.

Adolescent↗
PubMed1985

Differences in the morale of older, rural widows and widowers.

The purpose of the study was to determine the effect of sex differences on the morale of older widowed individuals. It was hypothesized that when the direct and indirect effects of several background and intervening variables were isolated, sex would have a significant association with morale and that widowers would be more adversely affected. The sample (N = 257) included rural widows and widowers aged sixty-five to ninety-four years who were selected by a compact cluster sampling technique. Sex of respondent was not found to affect morale; however, perceived financial status and self-rated health had significant direct effects. Widows and widowers reporting higher morale were those who had higher perceived financial status and rated their health as good. Education had a significant positive effect on morale via health and financial status. Economic and physical resources appear to be more influential determinants of the widowed older adults' morale than sex differences.

Aged↗