Graduation Year

2009

Document Type

Dissertation

Degree

Ph.D.

Degree Granting Department

Nursing

Major Professor

Mary S. Webb, Ph.D.

Keywords

Moral development, Moral judgment, Patient safety, Responsibility, Moral distress

Abstract

Hospitals today focus on creating a culture of patient safety and reducing error. Registered nurses are mandated by the American Nurses Association's Code of Ethics to advocate for the patient at all times and to act accountably to ensure patient safety. There is a paucity of literature relating to how nurses' values and ethical ideology may affect their decision to act accountably. This study tested two hypotheses. Hypothesis 1 predicted that registered nurses who demonstrated a low relativistic ethical ideology would score higher on a measure of professional values than would registered nurses who demonstrate a high relativistic ethical ideology. Hypothesis 2 predicted an order of ethical ideology (absolutists then exceptionists, subjectivists and situationists) in scores on a measure of accountability. A descriptive non experimental design was used.

Registered nurses (n=215) employed on the west coast of Florida completed a demographic form, Ethical Position Questionnaire (EPQ), Nurses Professional Values Scale Revised (NPVSR) and an investigator developed accountability instrument. A median split on the scores of the relativism and idealism scales on the EPQ formed the four groups of ethical ideology; absolutists, exceptionists, subjectivists and situationists. The accountability instrument consisted of 2 hypothetical clinical vignettes involving a late antibiotic administration. Using a Likert type scale, the participants answered three questions regarding how likely they would be to record the actual time of medication administration, call the physician and complete an incident report. Hypothesis I was not supported. Idealism (p=.001) not relativism had a significant effect on professional values. Hypothesis II was not supported.

Absolutists scored highest on measures of accountability followed by exceptionists, situationists and subjectivists. When controlling for age, idealism not relativism had a significant effect on completing an incident report (p = .03). This is the first study to examine the effect of ethical ideology on professional values and a registered nurse's intention to act accountably. Previous studies described values held but did not link the descriptions to intentions to act. The information may be useful to hospitals as they build a culture of patient safety and develop a workforce that is accountable for its actions and decisions.

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