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Results for “Kohlberg Approach to Moral Development”

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PubMed1985

Ethical dilemmas in nursing: the role of the nurse and perceptions of autonomy.

This study investigated decision making in ethical dilemmas and attitudes toward professional autonomy. It was based on Murphy's identification of three nurse-patient relationship models. The model identification was the result of Murphy's investigation of the levels of moral reasoning of nurse practitioners, from Kohlberg's theory of moral development. Autonomy is necessary for patient advocacy in Murphy's highest order model of nurse-patient relationship. 109 freshmen, 103 seniors, and 82 graduates (baccalaureate nursing) were examined for model selection, risk-taking, restrictions, and anxiety in the decision-making process in specific situations. Autonomy was measured independently. The most significant results indicated that freshmen were less likely to select the autonomous model of relationship, had lower attitudes toward professional nursing autonomy, and were less willing to take risks. Graduates were lower than either student group in their perceptions of restrictions and anxiety. The responses to each dilemma itself varied by situation in relation to the model preferred.

Adolescent↗

PubMed2004

The development of moral judgment during nursing education in Finland.

This study describes moral judgment among first- and last-year nursing students in Finland and examines the effects of ethics teaching on the development of moral judgment. The data for this quantitative cross-sectional study were collected using the Defining Issues Test (DIT), which is based on Kohlberg's theory of moral reasoning stages. The questionnaires were sent to four polytechnics, which offer nursing education in southern Finland. A total of 52 first-year students and 54 last-year students participated. The results showed that students who had had to deal with ethical dilemmas in their practical training had higher moral judgment than students who did not. Last-year students had higher moral judgment than first-year students. Last-year students resorted to principle-based thinking more often than first-year students in resolving DIT dilemmas. The differences between the two groups were statistically significant. The results indicate that nursing education may has an effect upon students' moral judgment.

Adult↗

PubMed1992

Justice and care: the implications of the Kohlberg-Gilligan debate for medical ethics.

Carol Gilligan has identified two orientations to moral understanding; the dominant 'justice orientation' and the under-valued 'care orientation'. Based on her discernment of a 'voice of care', Gilligan challenges the adequacy of a deontological liberal framework for moral development and moral theory. This paper examines how the orientations of justice and care are played out in medical ethical theory. Specifically, I question whether the medical moral domain is adequately described by the norms of impartiality, universality, and equality that characterize the liberal ideal. My analysis of justice-oriented medical ethics, focuses on the libertarian theory of H.T. Engelhardt and the contractarian theory of R.M. Veatch. I suggest that in the work of E.D. Pellegrino and D.C. Thomasma we find not only a more authentic representation of medical morality but also a project that is compatible with the care orientation's emphasis on human need and responsiveness to particular others.

Adolescent↗

PubMed1996

The relationship between education and ethical behavior of nursing students.

Based on the cognitive theory of moral development of Kohlberg, refined by the addition of the dimension "ethics of care" and the educational theory of Janssen, the relationship of education and ethical behavior of nursing students was examined. Ethical behavior referred not only to the ethical reasoning of students but also to the relationship between this reasoning and their behavior. This study examined the responses of 2,624 nursing students to five ethical nursing dilemmas included in the Ethical Behavior Test by relating them to four educational variables: students' level of education, level of enrollment, school, and students' perceptions of the educational process. A significant relationship between education and ethical behavior was found.

Adolescent↗

PubMed2003

Changes in students' moral development during medical school: a cohort study.

INTRODUCTION: The requirements of professionalism and the expected qualities of medical staff, including high moral character, motivate institutions to care about the ethical development of students during their medical education. We assessed progress in moral reasoning in a cohort of medical students over the first 3 years of their education. METHODS: We invited all 92 medical students enrolled at the University of Sherbrooke, Que., to complete a questionnaire on moral reasoning at the start of their first year of medical school and at the end of their third year. We used the French version of Kohlberg's Moral Judgment Interview. Responses to the questionnaire were coded by stage of moral development, and weighted average scores were assigned according to frequency of use of each stage. RESULTS: Of the 92 medical students, 54 completed the questionnaire in the fall of the first year and again at the end of their third year. The average age of the students at the end of the third year was 21 years, and 79% of the students included in the study were women. Over the 3-year period, the stage of moral development did not change substantially (i.e., by more than half a stage) for 39 (72%) of the students, shifted to a lower stage for 7 (13%) and shifted to a higher stage for 8 (15%). The overall mean change in stage was not significant (from mean 3.46 in year 1 to 3.48 in year 3, p = 0.86); however, the overall mean change in weighted average scores showed a significant decline in moral development (p = 0.028). INTERPRETATION: Temporal variations in students' scores show a levelling process of their moral reasoning. This finding prompts us to ask whether a hidden curriculum exists in the structure of medical education that inhibits rather than facilitates the development of moral reasoning.

Adult↗

PubMed1998

Self-perception and value system as possible predictors of stress.

This study was directed towards personality-related, value system and sociodemographic variables of nursing students in a situation of change, using a longitudinal perspective to measure their improvement in principle-based moral judgement (Kohlberg; Rest) as possible predictors of stress. Three subgroups of students were included from the commencement of the first three-year academic nursing programme in 1993. The students came from the colleges of health at Jönköping, Växjö and Kristianstad in the south of Sweden. A principal component factor analysis (varimax) was performed using data obtained from the students in the spring of 1994 (n = 122) and in the spring of 1996 (n = 112). There were 23 variables, of which two were sociodemographic, eight represented self-image, six were self-values, six were interpersonal values, and one was principle-based moral judgement. The analysis of data from students in the first year of a three-year programme demonstrated eight factors that explained 68.8% of the variance. The most important factors were: (1) ascendant decisive disorderly sociability and nonpractical mindedness (18.1% of the variance); (2) original vigour person-related trust (13.3%) of the variance); (3) orderly nonvigour achievement (8.9% of the variance) and (4) independent leadership (7.9% of the variance). (The term 'ascendancy' refers to self-confidence, and 'vigour' denotes responding well to challenges and coping with stress.) The analysis in 1996 demonstrated nine factors, of which the most important were: (1) ascendant original sociability with decisive nonconformist leadership (18.2% of the variance); (2) cautious person-related responsibility (12.6% of the variance); (3) orderly nonvariety achievement (8.4% of the variance); and (4) nonsupportive benevolent conformity (7.2% of the variance). A comparison of the two most prominent factors in 1994 and 1996 showed the process of change to be stronger for 18.2% and weaker for 30% of the variance. Principle-based moral judgement was measured in March 1994 and in May 1996, using the Swedish version of the Defining Issues Test and Index P. The result was that Index P for the students at Jönköping changed significantly (paired samples t-test) between 1994 and 1996 (p = 0.028), but that for the Växjö and Kristianstad students did not. The mean of Index P was 44.3% at Växjö, which was greater than the international average for college students (42.3%) it differed significantly in the spring of 1996 (independent samples t-test), but not in 1994, from the students at Jönköping (p = 0.032) and Kristianstad (p = 0.025). Index P was very heterogeneous for the group of students at Växjö, with the result that the paired samples t-test reached a value close to significance only. The conclusion of this study was that, if self-perception and value system are predictors of stress, only one-third of the students had improved their ability to cope with stress at the end of the programme. This article contains the author's application to the teaching process of reflecting on the structure of expectations in professional ethical relationships.

Adult↗