Assessment of moral Reasoning Ability of the Nurses in dealing with moral dilemmas

Introduction : Increasing advances in medical science, diagnosis of various diseases, discovery of effective drugs in the treatment of incurable diseases, accurate diagnostic tests, prolonged death time, emergence of chronic diseases, and advanced and updated medical equipment have led to some moral issues in the treatment system. Since nurses constitute a major part of health care workers and have an effective role in the quality of care and patients’ treatment, awareness of moral principles can play an important role in helping them provide health care with a desired quality. Thus, in addition to clinical skills, nurses are in need of moral reasoning ability. Moral reasoning includes the nurses’ ability to judge and make the right decisions in the face of routinely encountered issues in clinical settings. Lack of moral reasoning ability can lead to making wrong decisions and taking subsequent wrong actions in complicated clinical situations, the consequences of which will affect the patient, his/her family, and even the nurse him/herself. Despite lots of information and insight on the side of the nurses concerning the condition of patients, evidence suggests that they often have a little role in decision making process due to lack of moral reasoning ability as one of the several reasons. Given that various studies have conflicting results about moral reasoning in nursing and various factors inn moral reasoning, and since lack of sufficient moral reasoning ability in nurses- especially when faced with ethical dilemmas- can lead to poor decision-making and stress in them, the present study was designed and conducted to determine the level of moral reasoning of the nurses working in the hospitals affiliated to Shahid Sadooqi University of Medical Sciences in Yazd. Methods : This cross-sectional study was carried out on 360 nurses working in the hospitals affiliated to Shahid Sadooqi University of Medical Sciences in Yazd, a city in central Iran. Having each hospital’s allocated, using the Nursing Dilemma Test questionnaire- which is designed based on Kohlberg level of moral reasoning- the data were collected through convenient sampling method. The questionnaire consists of six scenarios. In each scenario, a hypothetical moral dilemma is expressed for the nurses, and at the end of each scenario, three questions are raised. Scenario subjects are: a baby with birth deformities, forced drug administration, patient's request for death, new nurses entering the ward, wrong medication, and care at the end of patient’s life. The first question in each scenario asks what the nurses would do in such a situation. This question shows the decision-making based on moral reasoning. Each scenario’s options are “Yes”, “No”, and “Cannot decide”. The second question has six options where nurses’ moral reasoning is examined. This section of the questionnaire is designed based on stages 2-6 of Kohlberg's theory of moral development. Here the nurses are asked to sort six options correspondingly. The highest score in this section is 11 and the lowest score is 3; and the total score for the sum of the six scenarios is a minimum of 18 and a maximum of 66. The higher scores are at this stage are indicative of further development of moral reasoning. In the third section of each scenario, the nurses’ amount of exposure to the mentioned scenario is questioned. If the scores at this stage are from 6 to 17, it indicates the nurse’s previous exposure to the scenario; and any scores from 18 to 30 indicates the nurse’s lack of familiarity with similar conditions. Finally, the data were analyzed at the significance level of 0.05 using the SPSS statistical software (version 18). Ethical Considerations: The purposes of research and information confidentiality were explained to the participants and their verbal informed consent to participate in the study was also obtained. Results : The mean age of the participants (30.17 ± 6.63) was in the range of 22 to 47 years. As for the nurses’ answering to the first section of the questionnaire, the highest frequency in all six questions was for the correct answers. Concerning the second and third sections of the questionnaire, the nurses’ mean score of moral reasoning (44.1 ± 6.15) was obtained out of 60. No significant relationship was found between the nurses’ mean score of moral reasoning and the frequency of their exposure to any moral dilemmas (P>0.05, r = 0.013). There was also no significant relationship between the mean score of moral reasoning with age (P>0.05, r = 0.033) and work history (P>0.05, r= 0.038). In addition, no significant difference was found between the two genders’ mean score of moral reasoning (P>0.05, t = 0.46). Moreover, no significant difference was observed for different service places (P>0.05). Conclusion : According to the participant nurses’ observed mean of moral reasoning ability, it seems necessary to plan and implement such strategies as training- in order to improve the nurses’ ethical sensitivity, moral reasoning ability, and right decision-making when facing moral dilemmas - and improving the quality of nursing care based on human dignity. Please cite this article as: Fazljoo E, Borhani F, Abbaszadeh A, Dadgari A. Assessment of moral Reasoning Ability of the Nurses in dealing with moral dilemmas. Med Ethics J 2016; 10(36): 47-54.