Ethical Decision-making Abilities Research Articles

Ethical Decision-Making Level of Intensive Care Nurses

Aim: A crucial skill for nurses is the understanding of ethics and ethical dilemmas, which enables them to make ethical decisions. This study aimed to assess the ethical decision-making abilities of intensive care nurses employed at a university hospital.
 Materials and Methods: 
 In this descriptive study, the population comprised 265 nurses employed in the hospital's intensive care units. The sample for the study, on the other hand, consisted of 56 intensive care nurses. Data were collected using a “Nurse Information Form” and the “Nursing Dilemma Test”.
 Results: Intensive care nurses scored above the moderate level in Principled Thinking (29.95±10.34) and Practical Considerations (17.79±4.73). The study indicated that these nurses were acquainted with dilemmas similar to those in the Nursing Dilemma Test (15.71±4.47).
 Conclusion: The most common ethical dilemmas faced by intensive care nurses included the conflict between true procedures that should be done and the physician's request, the decision not to perform cardiopulmonary resuscitation, and telling the truth to the patient. It was concluded that intensive care nurses tried to take ethical principles into account when making decisions about ethical dilemmas, but that they did not make use of ethical principles adequately and were affected by environmental factors. To increase intensive care nurses’ level of consideration of ethical principles when they make decisions about ethical dilemmas, it is necessary to determine the ethical dilemmas they encounter and to increase and develop the knowledge and skills of nurses about the ethical decision-making process by supporting ethics education with in-service training.

Development of the ethical decision-making competence scale.

Developing confident capacity for ethical decision-making is vital in nursing education. However, no tool examines nursing students' competence in ethical decision-making. This study aimed to develop an Ethical Decision-Making Competence Scale (EDM-CS) to assess ethical care decision-making competencies in nursing students. Original items were obtained by employing a focus group and the Delphi method. A cross-sectional design was used to confirm the items remained on the scale. Additionally, the scale's reliability and validity were assessed. The EDM-CS was completed by 498 nursing students. An exploratory factor analysis (EFA) was used to examine the factor structure based on data from group 1 (n = 250). A second-order confirmatory factor analysis (CFA) was used to examine the model's fitness based on data from group 2 (n = 248). This study was conducted between August 2022 and July 2023. The Institutional Review Board of OO Medical University Hospital approved this study's design and procedure. From the original 34 items, nine were deleted in the EFA. Thus, the EDM-CS had 25 items and a four-factor structure (ethical judgement, ethical sensitivity, ethical motivation, and ethical action), which explained 60.97% of the total variance. A second-order CFA identified a second-order factor termed 'ethical decision-making competence' with 18 items (root mean square residual = 0.052). The EDM-CS scores correlated significantly and positively with the scores on the Scale of Protective Factor-24 (r = 0.47, p < .001), which indicated good convergent validity. Cronbach's alpha coefficient of the final EDM-CS was 0.90 and ranged from 0.73 to 0.80 for the four subscales. The EDM-CS was validated to fit the data adequately. It can be used to evaluate clinical nursing students' ethical decision-making abilities and to develop education strategies to improve their ethical care competence.

Pros and Cons of Robotic Nursing

Robotic Nursing is using machines (robots) for the daily nursing activities in order to reduce the nurse’s burnout and errors in the nursing practice, assisting in daily nursing activities and doing physical work like lifting heavy instruments, transferring the patient, etc. It eases the burden on nurses, reduces the nurses' burnout, they socially and physically assistive, can be used during pandemic and used for video-conferencing for medical help (tele-health). In India, health-bots like Mitra, Maitri, TriCog, etc are being used for booking online consultations, health advices, medicine recommendations and for diagnosis of cardiac disorders. Challenges- High costs, lack of human touch and ethical decision-making abilities. Robots come with various advantages, but being technologically advanced doesn’t replace the qualities of humans like decision making abilities, critical thinking and warmth. Installing robots in Indian Hospitals can be a challenging task but in contrary to this Robots can reduce nurses’ overload, burnout and medical errors.

The role of deceptive advertisements and ethical decision outcomes in determining buying behavior

The study was conducted to identify the opinions of consumers’ regarding deceptive advertisements and the extent to which they considered it immoral. It aimed to collectively examine the impact of deceptive advertisements on consumers’ perceptions and their ability to make an ethical decision regarding buying behavior. A cross-sectional design is conducted in order to gather data from respondents. The digital advertisements were shown to 378 respondents through web survey designs. SEM (structural equational modelling) was used to analyze the data. The results depicted that advertiser make use of moral decoupling strategies in developing countries as it becomes easier for the consumers to get influenced by a transgressor. After identifying the deception in an advertisement, it becomes necessary to analyze the role of consumers’ ethical decision-making abilities in order to determine their buying behaviors. Moral intensity, perceived risks and moral judgements have a significant impact on consumers’ ethical decision-making abilities. However, consumers’ perception regarding a deceptive claim was not found to have any significant impact on their buying behavior. The relation only becomes significant in the presence of consumers’ ethical decision-making abilities.

Correlations between moral courage, moral sensitivity, and ethical decision-making by nurse interns: a cross-sectional study

BackgroundClinical decision-making involves ethical issues that become more and more complex. Nurse interns must be more skilled in making rational and timely decisions when facing ethical dilemmas. The contributing factors and their relationships that challenge ethical decision-making among nurse interns must be fully understood, as this level of knowledge can support the development of strategies and interventions that improve the ethical decision-making ability of nurse interns.ObjectiveThis study examined the relationships between moral courage, moral sensitivity, and ethical decision-making by nurse interns. In addition, we investigated whether moral sensitivity mediates the relationship between moral courage and ethical decision-making.DesignA descriptive cross-sectional study using an online questionnaire.SettingThe study sampled nurse interns from Class iii Grade A general hospitals in Sichuan Province, China.ParticipantsA convenience sampling method was used to select 1334 nurse interns from March 2022 to May 2022.MethodsA general information questionnaire, the Nurses’ Moral Courage Scale (NMCS), the Chinese Moral Sensitivity Questionnaire (MSQ), and the Judgement About Nursing Decision (JAND) were used for data collection. Data was processed and analysed using SPSS 26.0 and Amos 28.0. Data analysis included descriptive statistics, Pearson correlation analysis, and structural equation modelling.ResultsMoral courage was found to be positively correlated with ethical decision-making (P < 0.01). Moral sensitivity was also positively correlated with ethical decision-making (P < 0.01) and had a mediating effect on the relationship between moral courage and ethical decision-making (P < 0.01).ConclusionsThe moral courage and moral sensitivity of nurse interns are positively correlated with ethical decision-making ability. Moral sensitivity significantly mediates the relationship between moral courage and ethical decision-making ability. The knowledge gained from this study can inform educational strategies and interventions in supporting the development of nurse interns’ ethical decision-making ability.

The Relevance of Value-Based Leadership and Spirituality in the Workplace

In contemporary corporate settings, the pursuit and economic success has often overshadowed the significance of value-based leadership and spirituality in the workplace. Drawing from research and literature, this paper highlights the potential benefits of incorporating value-based leadership principles and spiritual practices into leadership strategies, fostering a harmonious and productive work environment. Value-based leadership emphasizes the integration of moral principles and values in decision-making processes and interactions with employees. Scholars argue that value-driven leaders are more likely to prioritize the well-being of their workforce, encouraging employee engagement and commitment (Brown &amp; Trevino, 2014). By demonstrating authenticity and ethical conduct, these leaders create a positive organizational culture, boosting employee morale and satisfaction. As a result, employees tend to be more motivated to contribute to the company’s success and collaborate in achieving organizational goals (Mayer et al., 2012). The interplay between value-based leadership and spirituality in the workplace is mutually reinforcing. Valued leaders often draw from spiritual practices to strengthen their ethical decision-making abilities (Fry &amp; Slocum, 2015). On the other hand, a spiritual orientation inspires leaders to adopt more compassionate and empathetic leadership styles, leading to higher levels of employee trust and job satisfaction (Dierendonck et al., 2019). The concepts of value-based leadership (VBL) and spirituality in leadership have both attracted a lot of interest in the workplace. Both strategies aid in developing a meaningful and mission-driven workplace. The definitions, advantages, and ramifications for executives and organizations are all examined in this article. The positive effects of these strategies on employee engagement, well-being, and organizational performance are clear. Additionally, leadership that is based on values and that is spiritual has the power to improve organizations.

The Ethical Decision-Making Ability of Nursing Students in China’s Universities

The Ethical Decision-Making Ability of Nursing Students in China’s Universities

Influence of empathy and professional values on ethical decision-making of emergency nurses: A cross sectional study

IntroductionEmergency nurses are likely to experience serious ethical dilemmas and conflicts because of the dangerous and unpredictable care situations. Nursing ethical decision-making ability is therefore a core competence. Empathy and professional values may be the important variables that influence ethical decision-making. However, for emergency nurses, there is a lack of empirical evidence to support presently. This study aimed to explore the influence of empathy and professional values on nursing ethical decision-making of emergency nurses. MethodsA convenience sample of 236 emergency nurses from 10 general hospitals in China were surveyed. Their ethical decision-making ability, empathy and professional values were measured using the Judgment About Nursing Decision scale, Jefferson Scale of Empathy-Health Professionals, and Nursing Professional Values Scale-Revised, respectively. Additionally, their sociodemographic data were collected. Univariate analysis, Pearson analysis, and multiple linear regression were performed. ResultsThe mean ethical decision-making score of emergency nurses was 295.06 ± 26.49, which was medium level. Their average ethical choice score was higher than that of ethical action (P < 0.001). The multiple linear regression results showed that professional values (Standardized coefficients (β) = 0.295, 95% confidence interval (CI): 0.618–1.618), empathy (β = 0.210, 95% CI: 0.620–1.613), job title (β = 0.253, 95% CI: 0.357–2.800) and number of forms of in-service training on ethical decision-making (β = 0.243, 95% CI: 0.254–3.942) were the independent factors significantly influencing the ethical decision-making ability. The multivariate linear regression model had an F statistic of 32.153 (P < 0.001) and an R2 = 0.588. ConclusionsStrengthening nurses’ empathy and professional values can help nurses make ethical decisions. More clinical experience and in-service training on ethical decision-making can help emergency nurses better handle ethical dilemmas and conflicts.

Development and application of an online learning platform for nursing ethics: A teaching practice research

BackgroundIt is crucial to diversify the methods for clinical nurses to continue learning nursing ethics in that ethical decision-making ability in nursing is regarded as one of the core competencies in nursing practice. ObjectiveIn response to nurses' learning needs for nursing ethics, this study built an online learning platform for the pertinent topic, and tested its effect on improving nurses' ethical decision-making ability and critical thinking ability. DesignA qualitative method was adopted to develop interventions, which were designed as a teaching practice research consisting of a study group and a control group. ParticipantsA total of 93 nurses, including 20 interviewees and 30 in the study group and 43 in the control group. MethodQualitative methods were employed to understand the learning needs of nurses. The judgment about nursing decisions and the critical thinking disposition inventory, learning effectiveness questionnaire and learning software quality evaluation scale were used as research tools in this teaching practice research. The SPSS 25.0 was adopted to analyze data by paired sample t-test and independent sample t-test. ResultsIn the measurement of the judgment about nursing decisions scale, the study group scored higher than the control group. The critical thinking disposition inventory scale identified a similar result in the total score incorporating the four dimensions, including analyticity, systematicity, critical thinking self-confidence, inquisitiveness. There is a correlation between learning software quality and learning effect, with a correlation coefficient of 0.640. ConclusionThe online learning platform of nursing ethics built in this study has positive learning effects, and it demonstrates effectiveness to improve nurses' abilities in nursing ethics, decision-making and critical thinking. It is expected to be a viable way to improve the continuity of nurses' study of ethics.

Moral dilemmas for moral machines

Autonomous systems are being developed and deployed in situations that may require some degree of ethical decision-making ability. As a result, research in machine ethics has proliferated in recent years. This work has included using moral dilemmas as validation mechanisms for implementing decision-making algorithms in ethically-loaded situations. Using trolley-style problems in the context of autonomous vehicles as a case study, I argue (1) that this is a misapplication of philosophical thought experiments because (2) it fails to appreciate the purpose of moral dilemmas, and (3) this has potentially catastrophic consequences; however, (4) there are uses of moral dilemmas in machine ethics that are appropriate and the novel situations that arise in a machine-learning context can shed some light on philosophical work in ethics.

Reliability and validity evaluation of the chinese version of the ethical sensitivity questionnaire for nursing students

BackgroundAdvances in technology and the expansion of nursing roles have led to complex ethical issues in nursing. Nursing students are the future clinical nursing workers and practitioners. The ethical sensitivity of nursing students is very important to the professional development of nursing students, which can strengthen the ethical cognition of nursing students, improve the ethical decision-making ability of nursing students, and is beneficial to the development of nursing students in the process of clinical practice and nursing education. However, there are no instruments to evaluate the ethical sensitivity of nursing students in China. Therefore, the purpose of this study is to evaluate the validity and reliability of the Chinese version of the Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS).MethodsAfter obtaining the authorization of the author of the original scale, the study used the Brislin back-translation method for translation. An exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) were performed to examine the underlying factor structure of the translated questionnaire. The Cronbach alpha coefficient, the test-retest reliability, and the corrected item-total correlation were calculated to verify the internal consistency of the scale.ResultsThe Chinese version of ESQ-NS retained 13 items. Exploratory factor analysis (EFA) extracts four common factors, and the cumulative variance contribution rate is 62.479%. The CFA reached the adaptive standard, and the discriminant validity of the scale was good. The Cronbach alpha coefficient of this scale was 0.821, and 4 dimensions were between 0.708 and 0.738. The results of the test-retest showed that Pearson’s correlation coefficient of the overall ESQ-NS was 0.814. Corrected item-total correlation ranged from 0.337 to 0.542.Conclusions The Chinese version of the ESQ-NS has good reliability and validity, which can be used to evaluate the level of ethical sensitivity of nursing students in China.

Ethical Decision-Making Ability and Cognitive Reasoning among Final Year Engineering Students in a Higher Education Institution in Malaysia: A Qualitative Study

Ethical decision-making is an important element in engineering profession. The objective of this study is to examine final year engineering students’ ethical decision-making ability and cognitive reasoning skills. The research questions aim to investigate the considerations and general steps that students go through in a decision-making process. This study gathered qualitative data through written decisions and interviews. Twelve engineering students in a Malaysian private engineering school were asked to read two ethical vignettes and write down their decisions. This was followed by semi-structured interview questions, in alignment with the steps in an ethical decision-making model, to gauge the students’ reasoning behind their decisions. The interview transcripts were analyzed and common themes that influence the ethical decision- making of students were identified. The analysis focused on ethical sensitivity and ethical judgement of students. Students demonstrated a decent level of ethical sensitivity emphasizing professional responsibility but their ethical judgment varied according to case study. In general, students were able to identify underlying issue and affected parties, but did not give much thought to potential course of action. This study draws reflection on engineering students’ flow of thinking and cognitive reasoning processes when given a situation to deal with. The findings of this study stress the importance of engineering schools integrating relevant case studies or true accounts of engineering practices to develop ethical decision-making ability and cognitive reasoning among future engineers. This would prepare the engineering students to face the ethical challenges in their profession.

The Implementation of the Right to Equality in the Care of a Vulnerable Medical Population: Pregnant and Postpartum Lesbians

Medical equality is a basic right for patients, and awareness of the need for friendly medical care is increasing alongside international trends of promoting gender equality. Whether clinical professionals are sufficiently enabled and motivated to maintain justice and protect their patients, especially those from vulnerable populations, is an issue that deserves greater attention. We examined the situation of pregnant and postpartum lesbian woman to assess the ethical abilities of clinical professionals. We reflect on whether these patients received appropriate medical care and treatment from the perspective of medical equality. To date, nursing education has placed significantly greater emphasis on protecting the autonomy of patients and on ethical decision-making abilities than on instituting medical equality. In clinical practice, the ethical responses of clinical professionals to equality directly impact vulnerable populations. How clinicians collect clinical data and judge individual cases may cause patients to feel neglected. To carry out friendly medical care effectively, steps must be taken to improve the quality of care. As clinical professionals provide medical treatment, they should be more empathetic toward lesbian postpartum women, maintain an attitude of equality, and refrain from judging the sexual tendencies of individual cases, and protect the privacy of their patients. Regarding the special needs of vulnerable populations, clinical professionals should continue learning and spending time reflecting on methods to improve quality of care.

THE EFFECTIVENESS OF OIDDE LEARNING MODEL IN THE IMPROVEMENT OF BIOETHICS KNOWLEDGE, ETHICAL DECISION, AND ETHICAL ATTITUDE OF BIOLOGY PRE-SERVICE TEACHERS

The aim of this research was to (1) compare the effectiveness of OIDDE (Orientation, Identify, Discussion, Decision, and Engage in Behavior) learning model and conventional learning models in improving bioethics knowledge; (2) compare the effectiveness of OIDDE learning model and conventional learning models in improving ethical decision-making abilities; (3) comparing the effectiveness of OIDDE learning model and conventional learning model in improving ethical attitudes. The research design was a quasi experimental non-equivalent control group design pre-test post-test. The research population was the second semester students of the biology pre-service teachers’ department of biology education of the FTTE Muhammadiyah University of Malang. Sampling was done by simple random sampling and obtained 76 students were devided into 37 students in the experimental group and 39 students in the control group. Data collecting is carried out through bioethical knowledge tests, and ethical decision- making, and scoring of ethical attitudes. Data were analyzed by ANCOVA, Kolmogorv-Smirnov, and unpaired T test. The results showed that there were significant differences in the effectiveness of achieving improved bioethics knowledge, ethical decision making, and ethical attitudes between OIDDE and conventional learning models, namely the effectiveness of OIDDE learning models higher than conventional learning models. Keywords: bioethics knowledge, biology pre-service teachers, ethical attitudes, ethical decisions, OIDDE learning model.

Types of Perception toward Ethical Issues in Perioperative Nurses: Q-Methodological Approach

This study was aimed at identifying the types of perceptions of ethical issues among perioperative nurses. Q-methodology focusing on individual subjectivity was used with data collected in November 2016. Thirty-four Q-statements were selected and scored by the 35 participants on a 9-point scale with normal distribution. Participants were perioperative nurses working in advanced general hospitals and general hospitals. The data were analyzed using the PC-QUANL program. total of 35 perioperative nurses were classified into 4 factors based on the following viewpoints: self-centered (type 1), onlooking and avoiding (type 2), patient-centered (type 3), and problem-centered (type 4). The 4 factors accounted for 57.84% of the total variance. Individual contributions of factors 1, 2, 3, and 4 were 41.80%, 7.18%, 5.20%, and 3.66%, respectively. The major contribution of this study is the clarification of perioperative nurses' subjective perceptions of ethical issues. These findings can be used in formulating effective strategies for nursing educators, professional nurses, and nursing administrators to improve ethical decision-making abilities and to perform ethical nursing care by the appropriate management of ethical issues in everyday nursing practice.

OIDDE Learning Model through Integrated Field Studies Abroad to Develop Ethical Decision Skills of Candidate Biology Teachers: Indonesian Perspective

This study aimed to describe the ethical problems, valuable experience, and ethical decision-making abilities about the environment by students through the application of OIDDE models on integrated field studies abroad. Descriptive data analysis techniques were used on existing data. Environmental ethical problems that arose are the use and exploitation of natural resources, pollution, lack of public facilities’ cleanliness, poaching, and environment arrangement problems. Valuable experiences gained by students were: 1) Malaysia Highway Rest Area: plants flourish and the birdlife is undisturbed; 2) Malacca River: transformed into a clean and beautiful area; 3) Putrajaya: concerns raised about environmental balance and sustainability; 4) Sentosa Island: various modern amusement rides prepared for enjoyment in line with environmental principles. Ethical decisions taken were: 1) environmental functions and sustainability should be referenced in development; 2) amusement rides developed in line with environmental consideration; 3) pattern of consumption and human activities to avoid resultant pollutants as much as possible; 4) use of environmentally friendly facilities should become a lifestyle choice; and 5) consistently implement environment regulations.

Effect of nursing ethics re-education for ethical cognitive and decision-making ability in practice nursing students

Objective To discuss the impact of nursing ethics reeducation for the level of ethical cognitive and decision-making ability in practice nursing students. Methods A total of 72 cases of practice nursing students from July 2015 were selected as intervention group and 68 cases of practice nursing students from July 2016 were as control group. The nurses in intervention group participated in two months, a total of 8 times of nursing ethics continuing education courses. The forms of course included flip classroom, case discussion, and scene simulation. The control group accepted routine nursing clinical teaching. The level of ethical cognitive and decision-making ability before and after the intervention were measured in the two groups. Results After the intervention, the scores of ethical cognitive of intervention group were (3.74±0.41) points, higher than the control group (3.20±0.45) points, the difference was significant (t=-7.440, P=0.000); and decision-making ability of intervention group were (283.58±30.38) points, higher than the control group (270.88±29.51) points, the difference was significant (t=-2.507, P=0.013). Conclusions The nursing ethics re-education can improve the cognition of practice nursing students in nursing ethics, at the same time improving the ability of making nursing ethical decisions, helping nursing students making nursing ethical decisions in clinical better. Key words: Students, nursing; Nursing care; Ethics; Education

St. Albans Family Enterprises

This case study can serve as an instrument to help students and practitioners develop their ethical decision-making ability, in particular practical wisdom (prudence) within a virtue ethics framework. St. Albans Family Enterprises is a group of companies with three business lines: petrol stations, flower exportation and women´s fashion retail establishments, with around 300 employees and 20 stores in London, Liverpool, Manchester, Edinburgh and Bristol. Apparently, an alleged leakage of sensitive information took place at the Head Office, involving several employees who found themselves in a delicate professional situation and who happened to be relatives. Senior management are facing ethical dilemmas with respect to these employees but also with respect to themselves who feel partly responsible for having generated such compromising situation for some employees.

Experiential Learning in Virtue Ethics Through a Case Study

Teaching business ethics effectively may prepare future leaders and managers to better deal with delicate situations that they might face in the workplace. However, such an aim is one of the biggest challenges that educators at universities are called on to solve. An increasing number of scholars are invoking the role of prudence in the virtue ethics context as a viable approach to teach students how to manage ethical dilemmas. In this regard, this paper presents the ‘St. Albans Family Enterprise’ case study that can serve as an instrument to help students and practitioners develop their ethical decision-making ability and to foster a disposition towards applying sound judgment or what can be called in classical terms, prudence. The paper also offers guidance to educators about how the case can be used for teaching purposes, and explains the implications of exercising practical wisdom (prudence) within a virtue ethics framework.

Research on ethical decision-making ability and its influencing factors in clinical nursing

Objective To investigate the ethical decision-making ability and its influencing factors in clinical nursing, in order to improve the ethical decision-making ability and nursing quality in clinical nursing. Methods Totally 338 clinical nurses in four tertiary comprehensive hospitals of Shenyang were selected as the research object, and the judgment about nursing decision (JAND, 2007 edition) was used to conduct the survey. Results The total JAND questionnaire score was (296.37±14.23) points; dimensions of ethical action and ethical selection were (162.23±8.02) points and (134.14±6.20) points. Multivariate regression analysis indicated that, the method to obtain professional knowledge among many factors affected the total score much more; the education and whether receiving the ethical decision-making ability training came the second. Conclusions Clinical nurses′ nursing ethical decision-making ability should be improved through professional knowledge learning and training, so as to improve the quality of clinical nursing. Key words: Nurses; Decision-making; Ethics, nursing; Influencing factors