The development and validation of the Ethical Sensitivity Questionnaire for Nursing Students

BACKGROUND: Recent advances in medicine and an increasingly demanding healthcare environment are causing various complicated ethical problems. Nursing students need to prepare to deal with ethical issues in their future roles. Ethical sensitivity is a key aspect of the ethical decision-making process; however, there is no scale to measure nursing students’ ethical sensitivity. Therefore, we developed a scale and verified its reliability and validity. METHODS: The Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS) was developed in three phases. First, questionnaire items were formulated after a literature review and interviews with nursing students. Next, its face and content validity were examined by an expert panel and piloted among nursing university graduates. Then, a final draft questionnaire survey was administered to nursing university students from 10 Japanese universities in 2015 and an exploratory factor analysis was performed. Criteria-related relevance was examined to compare established scales (i.e. the Japanese version of the Moral Sensitivity Test (JMST) and the Japanese version of the revised Moral Sensitivity Questionnaire (JMSQ)) using single regression analysis. A second questionnaire survey was conducted in one of the 10 universities to examine reliability. RESULTS: Initially, 48 items including ethical conflict in clinical nursing practice were formulated, and 47 items were approved by the expert panel. Five-hundred and twenty-eight nursing students responded to the final draft questionnaire. Participants’ mean age was 20.4 (standard deviation = 3.1) years. The questionnaire was reduced to 13 items and three factor structures were determined by exploratory factor analysis: ‘respect for individuals’, ‘distributive justice’, and ‘maintaining patients’ confidentiality’. The Cronbach’s alpha values for items in each domain ranged from 0.77–0.81, and the Cronbach’s alpha for the entire ESQ-NS was 0.82. The ESQ-NS was significantly associated with specific domains: ‛Judgment of the care conflict’ from the JMST and ‘Sense of Moral Burden’ from the JMSQ. Pearson’s correlation coefficient of the ESQ-NS between the first and second survey was 0.42 (p < .01). CONCLUSIONS: The EAQ-NS, which was developed to evaluate the ethical susceptibility of nursing students, showed good validity, internal consistency, and reliability. This questionnaire can be used to evaluate nursing students’ ethics education by self-evaluation.