Nursing students' responses to ethical dilemmas in nursing practice

In literature as well as in nursing practice a growing concern about nurses' ethical competence can be observed. Based on the cognitive theory of moral development by Kohlberg, this research examined nursing students' ethical behaviour in five nursing dilemmas. Ethical behaviour refers not only to the ethical reasoning of nursing students but also to the relationship between reasoning and behaviour. Kohlberg's definition of morality was refined by adding a care perspective. The results show that the majority of students can be located in the fourth moral stage according to Kohlberg's theory, that is, the conventional level of moral development. This finding implies that students are still guided by professional rules, norms and duties, and have not (yet) succeeded in making personal ethical decisions on the basis of their own principles and acting according to such decisions.     

Development of social-moral reasoning among Kibbutz adolescents: A longitudinal cross-cultural study.

Studied the development of social-moral judgments in 92 Israeli kibbutz adolescents (64 of whom were interviewed longitudinally over 2–9 yrs from ages 12 yrs to 24–25 yrs) from the perspective of L. Kohlberg's theory (1958, 1981) of moral judgment development. The study evaluated the validity of Kohlberg's model and moral judgment interview in a cross-cultural context. In addition, it assessed the cultural uniqueness of social-moral reasoning among kibbutzniks. Findings support the validity of Kohlberg's structural-developmental understanding of moral judgment. Stage change was found to be upward, gradual, and without significant regressions. Analyses showed internal consistency of the stages as operationally defined in the standardized scoring manual. The distribution of stage scores among Ss, overall, was unusually high when compared to the results of parallel studies in the US and Turkey. The most important cultural variation involved the use of Stages 4/5 and 5 (global stage and postconventional stage). While all the stages were present among Ss, not all elements of kibbutz postconventional reasoning were present in Kohlberg's model or scoring manual (e.g., the communal emphasis and collective moral principles). (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in moral reasoning: A comparison of the use of justice and care orientations.

Examined the adequacy of L. Kohlberg's (1971) cognitive-developmental model as a representation of female moral reasoning. Specifically, the claims of C. Gilligan (1982) that there are 2 conceptions of morality—one described as a morality of justice, on which Kohlberg's scheme is based, and one described as a morality of care, seen by Gilligan as more representative of female thinking about moral conflict—were studied. 101 male and 101 female undergraduates filled out a self-report questionnaire on moral dilemmas they had experienced. They then rated their use of both justice and care orientations in resolving those dilemmas. Ss also completed the Interpersonal Disposition Inventory and semantic differential items. The use of the 2 orientations was examined in relationship to S gender, sex role, and perceptions of the 2 orientations. Few significant differences were obtained, except that female Ss were more consistent in their use of a care orientation and male Ss were more consistent in their use of a justice orientation. More feminine males were more likely to report the use of a care orientation than less feminine males. Male and female reasoning about moral conflict is examined in the light of these 2 perspectives, and the relationship of sex roles to endorsement of each perspective is discussed. (23 ref) (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Moral development "versus" socialization: A critique.

Discusses L. Kohlberg's (1958, published 1969–1984) challenge to socialization theories of morality and counterchallenges to Kohlberg's moral state theory. Moral development and socialization theories differ, respectively, in whether the individual and cognition or society and affect are emphasized in the account of morality. It is argued that contemporary moral developmental and socialization theories should be viewed as providing complementary and interdependent analyses of human social interaction and the affective–cognitive unity of psychological events. (76 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family processes as predictors of adolescents' preferences for ascribed sources of moral authority: a proposed model

This paper develops a model of the family's role in the moralization of the adolescent. To achieve this aim, the Circumplex Model of Marital and Family Systems (Olson, Sprenkle, & Russell, 1979; Olson, 1983) provides the theoretical framework needed to identify levels of adaptability, cohesion, and communication within each family system. Once identified, these family processes are treated as possible predictors of certain moral preferences, in particular, the number and type of sources of moral authority held by the adolescent. The notion "source of moral authority" is based on Henry's (1983) reconceptualization of Kohlberg's stage theory of moral judgments. In light of this, a new measure, the Moral Authority Scale (MAS) has been developed to assess such adolescent preferences for different sources of moral authority. Overall, this unique approach identifies salient family processes as influencing adolescent moral reasoning by drawing together systems theory, cognitive developmental, and psychosocial approaches and generating testable predictions. In so doing, research needs and inadequacies of the current literature are highlighted and possible strategies to overcome such problems are explicated.     

Stage structure in objective moral judgments.

Analyzed the responses of 160 junior high, senior high, undergraduate, and graduate students to the Defining Issues Test, which measures Kohlbergian moral developments. The study was designed to investigate whether stage and item scores displayed the structure expected of variables that measure a hierarchical, personality-development sequence. Consistent with expectations, (a) the intercorrelations of stage scores displayed a simplex-like structure; (b) factor loadings for stage scores approximated a 2-factor, semicircular configuration with variables ordered by stage along the semicircle; and (c) along the 1st scaling dimension, variables were ordered by stage and persons were ordered by age. The pattern of the stage scores was consistent with the ordering of stages in L. Kohlberg's (1969) theory, except that Stage 2 reasons were assigned more importance by some Ss than would be expected from their position in the developmental sequence. The observed structure of the moral judgments is interpreted as evidence for a hierarchical sequence partially consistent with the one in Kohlberg's theory. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Moral reasoning and attitudes toward capital punishment.

Addressed 3 aspects of L. Kohlberg's (1981, 1984) theory of moral development, specifically the relationship between (1) levels of moral reasoning used to support opposing positions on a moral problem (the structure issue); (2) moral stage, conceptual complexity, and attitudes about capital punishment (the form/content issue); and (3) moral orientations and attitudes about capital punishment (the orientation/content issue). A sample of 72 students (aged 17–45 yrs) completed a paragraph completion test (assessing conceptual complexity), wrote an essay on capital punishment (assessing moral stage and orientations), and responded to a capital punishment questionnaire (assessing attitudes). Results indicate that Ss at higher moral stages were increasingly complex and tended to oppose capital punishment. Ss did not always use higher moral reasoning to substantiate their own position on capital punishment; rather they used higher reasoning to oppose capital punishment. Also, Ss expressed considerations reflecting different orientations when supporting opposite positions on this moral problem. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of the existential perspective on morality.

Comments on B. Vandenburg's (see record 1992-12211-001) article on epistemology and an existentialist consideration of development, taking exception to his assertion that existential consideration, described as crucial to moral development, is absent in Piaget (1965) and Kohlberg's (A. Colby and L. Kohlberg, 1984) cognitive model. It is argued that no such term as moral development exists in existentialism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The importance of 2,3-dimercaptopropinol (British anti-lewisite, BAL) in the trypanocidal activity of topical melarsoprol

The author agrees with the critiques of moral theory offered by such writers as Bernard Williams and Alasdair MacIntyre, and uses ideas from Heidegger and Levinas to argue that caring is an ontological structure of human existence which takes two forms: caring about on self (which he calls our "self-project") and caring-about-others. This dual form of caring is expressed on four Aristotelian levels of human living which the author describes and illustrates with reference to the phenomenon of pain. It is concluded from this analysis that traditional notions of morality as imposing obligations should give way to an understanding of ethics as the social forms given to our caring for ourselves and for others. A number of implications for ethical theory are sketched out with the conclusion that virtue theory should be preferred and that the model could be worked out more fully to show that virtue theory can be internalist, particularist, pluralist, personalist and objectivist.     

Moral development in Bahamian school children: A cross-cultural examination of Kohlberg's stages of moral reasoning.

Individually interviewed 7-14 yr old Bahamian schoolchildren, utilizing 3 of L. Kohlberg's (1958) moral dilemmas. An age trend in moral development was obtained, supporting previous cross-cultural research with Kohlberg's moral development stages. The only sex difference was among 13-14 yr olds. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The development of moral thought: Review and evaluation of Kohlberg's approach.

Evaluates the evidence supporting L. Kohlberg's theory on the development of moral thought. A systematic review of the literature suggests that there are several conceptual and methodological problems with the approach. The problems include the derivation, administration, and scoring of the model's primary measurement device (Moral Judgment Scale); the lack of evidence for both the reliability and validity of that device; and the absence of direct evidence for the basic assumptions of the theory. It is concluded that the empirical utility of the model has yet to be demonstrated. (40 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rationality, possibility and difference as bases of moral development.

Discusses the bases of moral development, based on a review of relevant literature. L. Kohlberg's (1981) cognitive structural theory of moral development prescribes abstract egalitarianism as the ideal form of moral reasoning. It is argued that this conceptualization represents an overly modernist, individualist reading of Platonic moral philosophy. H. G. Gadamer (1986), in contrast, sees Plato teaching that virtue is learned implicitly, through exemplifying a virtuous person. Belief that virtue must be justified rationally leads to the dissolution of social, communal bases of moral learning. His view suggests a more humanly relevant rendering of Platonic moral reasoning than that suggested by Kohlberg. This view suggests the possibility that virtue is irreducibly social, seen in the meaningful differences that acts have for others, and in implicit interpersonal relatedness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultivating a moral sense of nursing through model emulation

This paper reports part of a longitudinal research project, which sought to capture students' conceptualization of caring practice as they progressed to different levels of study in a nursing diploma programme in Hong Kong. Model emulation was found to be an effective means of focusing students' learning processes on the moral aspects of nursing practice. The theory of model emulation from a Chinese perspective and how it is applied to create a learning context to allow students to acquire a moral sense of nursing are discussed. The participating students are invited to be sincere enquirers in the pursuit of the good embedded in practice through introspective self-examination and dialogue. They are asked to describe and share their experience of positive and negative examples of nursing in written accounts. Van Kaam's phenomenological method was adopted to explicate the good and bad constituents of nursing from these examples, with the students assuming an active role in the explication process. The explication reveals that the students were able to articulate the good and bad practices in a variety of patient care situations.     

The role of logic in moral reasoning and development.

The frequently examined hypothesis proposed by L. Kohlberg (1969) that logical development is a necessary but insufficient condition of moral development was examined in cross-age analyses of approximately 225 adolescents and adults, aged 16–50 yrs. Two kinds of moral scores—one representing Kohlberg's system, and the other an interactional formulation—and 3 scores of formal operations based on Piagetian tasks were used. To explicate the logical/moral relation, controls for age, socioeconomic status, IQ, or educational levels were applied to correlational analyses within sex groups. Also, a sex-differentiated structural analysis was done. Neither set of results was consistent with Kohlberg's hypothesis. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between moral decision making and patterns of consolidation and transition in moral judgment development.

Following models that describe intraindividual correlates of stage transitions (S. S. Snyder & D. H. Feldman, 1984), this study assessed the relation between a measure of consolidation and transition in moral judgment development and the utility of moral concepts in sociomoral decision making. The study extends previous research in suggesting that individuals use moral concepts differently as they cycle through periods of consolidation and transition. With multiple cross-sectional and longitudinal samples, findings indicate that participants' reliance on a Kohlbergian moral framework as measured by the Defining Issues Test is highest during periods of consolidation and lowest during transitions. As participants move into periods of consolidation, the utility of moral stage information increases. Thus, this study indicates that the consolidation and transition model can be used to help identify individuals who are more or less likely to use Kohlberg's moral stages in their moral decision making. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Obsessional experience and compulsive behaviour: A cognitive-structural approach.

Reviews the book, Obsessional experience and compulsive behaviour: A cognitive-structural approach by G. F. Reed (1985). Reed's book is well worth reading by those interested in obsessive-compulsive disorders, particularly those unfamiliar with a phenomenological (or cognitive-structural) approach. In his discussion of definitional and diagnostic issues, Reed is thorough and he makes his thinking on the matter quite clean. His repeated case illustrations (both in this section and throughout the book) are very helpful, as is his distinction between the form, content, and modes of obsessional experiences. These observations will certainly help the novice in understanding these bewildering problems, and make the experienced researcher or clinician familiar with an alternative conceptualization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Moral judgment in delinquent and nondelinquent adolescents and their mothers.

Although considerable research effort has been devoted to the investigation of moral judgment in normal children, the relationship of the child's moral judgment to significant moral conduct as well as to parental antecedents has received scant empirical attention. In the current research, the level of moral judgment of 10 male 14-16 yr old delinquents and their mothers was compared to 10 nondelinquent males (matched on IQ and age) and their mothers, using L. Kohlberg's structured moral dilemmas. Mothers in both groups combined were higher in moral judgment than their sons. Nondelinquent adolescents used higher stages of moral judgment than delinquent adolescents. Similarly, mothers of nondelinquents manifested more mature moral judgment than did mothers of delinquents. Parental influences on the moral development of the child are discussed. (29 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Two moralities in action contexts: Relationships to thought, ego regulation, and development.

Six adolescent friendship groups (56 Ss aged 13–27 yrs), each group being sexually heterogeneous but all Black or White and all of lower or middle socioeconomic status, participated in moral games in an investigation of moral action constructed according to 2 different formulations. L. Kohlberg's (1969) theory of formal moral judgment, which is viewed as a process of deducing logical moral solutions from imperative rules, was contrasted with an interpersonal formulation that posits that moral solutions are achieved through dialogues that strive for balanced agreements among participants. Analyses focused on relationships between interview-based moral thought, action in the moral games, the coordination of action by coping and defensive processes used in these moral games, and changes in the level of thought after the game experiences. Although the levels of both the Kohlberg and interpersonal scores fluctuated between games, the interpersonal scores were more stable than the formal scores, particularly in stressful games. Black adolescents had higher interpersonal than formal levels; Whites reversed this pattern. All Ss used interpersonal more frequently than formal reasoning in the action situations. Predictions of action from test levels were markedly improved for the interpersonal moral scores when ego processing was taken into account. After the games the levels of both moral scores increased for the 6 experimental groups as compared to a control group of an additional 17 teenagers. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive and motivational parallels in moral development.

Two experiments examined parallels between L. Kohlberg's (1963, 1976) cognitive developmental stages and a hierarchy of incentives (motivations) based on Kohlberg's "motives for moral action" aspect. In Exp I, 134 undergraduates were simultaneously administered 2 perceptual motor tasks in 1 of 3 treatment conditions. In each treatment the opportunity for greater monetary reward on one task conflicted with one of the following incentives for performance on the other task: (a) interpersonal approval, (b) meeting the expectations of authority, and (c) choice in favor of distributive equality. As predicted by Kohlberg's moral judgment scale, Stage 3 Ss performed better for the interpersonal approval incentive, while Stage 4 Ss performed better to meet the expectations of authority. Postconventional Ss responded in favor of distributive equality to a greater extent than conventional (Stage 3 or Stage 4) Ss. Exp II included only Stage 3 and Stage 4 Ss and conflicted interpersonal approval directly with the expectations of authority. Results closely replicate those of Exp I. (French summary) (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender and dilemma differences in real-life moral judgment.

The authors investigated the effects of gender, gender role, and type of moral dilemma on moral maturity and moral orientation. Fifty-five female and 55 male university students were given the Personal Attributes Questionnaire (J. T. Spence & R. L. Helmreich, 1978), L. Kohlberg's test of moral judgment, and instructions to discuss a personal and impersonal real-life moral dilemma. Moral stage, moral orientation, and the relation between them varied across dilemmas. Females were more consistent than males in moral stage; males were more consistent in moral orientation. Females made higher stage and more care-based moral judgments than males made on personal real-life dilemmas. The observed variations occurred primarily because males reported more Stage 2, justice-pulling antisocial dilemmas than females, and females reported more Stage 3, care-pulling prosocial dilemmas than males. A more interactional model of moral judgment than the models of L. Kohlberg and C. Gilligan is recommended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)