The predictive values of a deliberative and a paternalistic attitude towards two situations of moral conflict: A study among Dutch nurse practitioners and physician assistants.
ethical decision-making
moral conflict
moral deliberation
moral disengagement
nurse practitioner
paternalism
physician assistant
yielding to pressure
Journal
Scandinavian journal of caring sciences
ISSN: 1471-6712
Titre abrégé: Scand J Caring Sci
Pays: Sweden
ID NLM: 8804206
Informations de publication
Date de publication:
Sep 2022
Sep 2022
Historique:
revised:
27
07
2021
received:
24
01
2021
accepted:
16
08
2021
pubmed:
27
8
2021
medline:
19
8
2022
entrez:
26
8
2021
Statut:
ppublish
Résumé
In this study, we examined the predictive values of a moral deliberate and paternalistic attitude on the propensity of yielding to pressure. In these hypothesised positive and negative relationships, we further sought to ascertain whether moral disengagement plays a pivotal role when individuals deviate from ethical standards, rules and regulations when yielding to pressure. This study's primary aim was to assess the predictive value of a moral deliberative and paternalistic attitude for yielding to pressure when physician assistants (PAs) and nurse practitioners (NPs) face moral conflicts. This validation study was cross-sectional and based on a convenience sample of Dutch PAs and NPs. The MSQ-DELIB and MSQ-PATER scales indicate a moral deliberate or paternalistic attitude. These scales were assumed to have a predictive value towards the degree of yielding to pressure by PAs and NPs. Yielding to pressure was measured by two vignettes in which respondents faced a moral conflict (vignette 1: prescribing unindicated antibiotics and vignette 2: discharging a difficult patient from the hospital). Only moral deliberation was a significant predictor of yielding to pressure. That is, we found a positive effect in vignette 1 (in which the pressure came from the patient). In contrast, we found a negative relationship in vignette 2 (in which pressure went from the working environment). Paternalism did not affect yielding to pressure in either vignette. This study suggests that PAs and NPs having a moral deliberative attitude makes them receptive to pressure exerted by patients to break moral standards. On the other hand, they are more resilient against doing so when this pressure comes from different sources than the patient. Further research is needed to find more conclusive evidence for this differential effect.
Sections du résumé
BACKGROUND
BACKGROUND
In this study, we examined the predictive values of a moral deliberate and paternalistic attitude on the propensity of yielding to pressure. In these hypothesised positive and negative relationships, we further sought to ascertain whether moral disengagement plays a pivotal role when individuals deviate from ethical standards, rules and regulations when yielding to pressure.
AIM(S)
OBJECTIVE
This study's primary aim was to assess the predictive value of a moral deliberative and paternalistic attitude for yielding to pressure when physician assistants (PAs) and nurse practitioners (NPs) face moral conflicts.
METHOD
METHODS
This validation study was cross-sectional and based on a convenience sample of Dutch PAs and NPs. The MSQ-DELIB and MSQ-PATER scales indicate a moral deliberate or paternalistic attitude. These scales were assumed to have a predictive value towards the degree of yielding to pressure by PAs and NPs. Yielding to pressure was measured by two vignettes in which respondents faced a moral conflict (vignette 1: prescribing unindicated antibiotics and vignette 2: discharging a difficult patient from the hospital).
RESULTS
RESULTS
Only moral deliberation was a significant predictor of yielding to pressure. That is, we found a positive effect in vignette 1 (in which the pressure came from the patient). In contrast, we found a negative relationship in vignette 2 (in which pressure went from the working environment). Paternalism did not affect yielding to pressure in either vignette.
CONCLUSION
CONCLUSIONS
This study suggests that PAs and NPs having a moral deliberative attitude makes them receptive to pressure exerted by patients to break moral standards. On the other hand, they are more resilient against doing so when this pressure comes from different sources than the patient. Further research is needed to find more conclusive evidence for this differential effect.
Identifiants
pubmed: 34435706
doi: 10.1111/scs.13029
pmc: PMC9545036
doi:
Types de publication
Journal Article
Langues
eng
Pagination
863-873Informations de copyright
© 2021 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.
Références
Psychol Sci. 2009 Mar;20(3):393-8
pubmed: 19254236
Scand J Caring Sci. 2022 Sep;36(3):863-873
pubmed: 34435706
J Med Ethics. 2008 Apr;34(4):262-7
pubmed: 18375677
J Clin Pharm Ther. 2002 Dec;27(6):431-40
pubmed: 12472983
J Adv Nurs. 2019 Jun;75(6):1252-1262
pubmed: 30575080
J Eval Clin Pract. 2020 Apr;26(2):659-669
pubmed: 31975512
J Eval Clin Pract. 2021 Aug;27(4):776-784
pubmed: 32816369
BMJ. 2004 Feb 21;328(7437):444
pubmed: 14966079
Pers Soc Psychol Rev. 1999;3(3):193-209
pubmed: 15661671
J Healthc Qual. 2000 Sep-Oct;22(5):41-3
pubmed: 11184029
Nurs Ethics. 1998 Jul;5(4):283-93
pubmed: 9782916
J Am Coll Dent. 2014 Summer;81(3):14-8
pubmed: 25951678
Med Educ. 2021 Jul;55(7):857-871
pubmed: 33386638
Behav Res Methods. 2009 Nov;41(4):1149-60
pubmed: 19897823
Nurs Health Sci. 2004 Sep;6(3):217-21
pubmed: 15291770
Bioethics. 2015 Feb;29(2):91-7
pubmed: 24602097
BMJ. 2012 Jan 27;344:e256
pubmed: 22286508
Nurs Ethics. 2015 Aug;22(5):608-15
pubmed: 25366998