Development of ethical dilemmas and resolution of ethical dilemmas scales in nursing practice
Aranya Chaowalit, Assoc. Prof., D. of Medical Nursing, F. of Nursing, PSU.
Wandee Suttharangsee, D. of Psychiatric Nursing, F. of Nursing, PSU.
Thanomsri Inthanont, Asst. Prof., D. of Psychiatric Nursing, F. of Nursing, PSU.
Corresponding e-mail : caranya@ratree.psu.ac.th
Published : Research Report
Key words : instrument development, ethical dilemmas, resolution of ethical dilemmas,
nursing practice
The purpose of this methodologic research was to develop the Ethical Dilemmas Scale and the Resolution of Ethical Dilemmas Scale in nursing practice of professional nurses.
An item pool of the two scales was developed from focus group interviews of 40 professional nurses working in regional and medical centers and general hospitals. Data from the interviews were analyzed by content analysis to develop themes reflecting ethical dilemmas and resolution of ethical dilemmas. Sixty items to measure the frequency of ethical dilemmas and 19 items to measure the frequency of resolution of the ethical dilemmas were developed. Content validity of the scales was determined by three experts. Then, pre-testing on 20 professional nurses were performed which yielded reliability of the Ethical Dilemmas Scale and the Resolution of the Ethical Dilemmas Scale with standardized alphas of .92 and .75 respectively.
Data were collected on a proportional stratified random sample of 508 professional nurses. The reliability of the Ethical Dilemmas Scale and the Resolution of the Ethical Dilemmas Scale on the
508 nurses were 096 and .76 respectively. Five factors of the Ethical Dilemmas Scale were identified using principal components analysis with varimas rotation, and a loading cut off point of .30. It con-sisted of 50 items and explained a total of 43.83% of variance with the reliability of .95. Two factors of the Resolution of the Ethical Dilemmas Scale contained 18 items and explained a total of 31.58% of variance with the reliability of .78.
The five factors of the Ethical Dilemmas Scale were : (1) Lack of Cooperation to Maintain Standard of Care (16 item, a=.89). (2) Neglect of Patient and Family Involvement and Self-Determination (10 items, a=.87). (3) Withholding the Truth, Maintaining Confidentiality/Information Disclosure (10 items, a=.83). (4) Professional Obligation and Duty to Self (8 items, a=.78), and (5) Prolonging Life vs. Ending Life (6 items, a=.78). The two factors of the Resoluation of the Ethical Dilemmas Scale were : (1) Doing for Patients and Comforting Self (9 items, a=.74), and (2) Talking and Discussing (9 items, a=.71).
The findings from this study resulted in reliable and valid instruments to measure the frequency of ethical dilemmas and the resolution of ethical dilemmas which can be used for research in the area of ethics in the futher.
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