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Ethical reasoning of practising nurses: Does ethics education make a difference?

McAlpine, Heather F.N. (1998) Ethical reasoning of practising nurses: Does ethics education make a difference? PhD thesis, Murdoch University.

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Before researchers or educators can examine the effectiveness of various approaches to professional ethics education, there is need for reliable and valid tools to assess practitioners’ ethical reasoning. Instruments used in the past to measure moral reasoning of nurses have proven problematic. Empirical evidence indicates that moral development and ethical reasoning are complex, multidimensional processes. As such, they present a severe test to theory and instrument development.

This study’s overall intent was to ascertain the ethical reasoning of practising nurses in response to a practice dilemma, and whether that reasoning was affected by an ethics education course. The study was divided into two interlinked phases. Phase One focused on the development and pilot testing of an instrument, the Ethical Reasoning Tool (ERT), to measure unprompted ethical reasoning of nurses as demonstrated in written responses to a case study. Phase Two involved use of the ERT to ascertain nurses’ ethical reasoning before (pre-test) and following (post-test) an ethics course. Quantitative and qualitative methods were used to explore specific questions guiding each of the study’s two phases.

The instrument’s theoretical framework (and the content of the educational intervention) represented integration and synthesis of an extensive body of interdisciplinary theory and research. The ERT’s design was rooted in the hypotheses that there are levels of professional ethical reasoning, and key influential factors/components involved in nursing contemplation of ethical issues.

Participants of Phases One (n=30) and Two (n=41) were enrolled in a required ethics course in a university nursing programme. Results of quantitative and qualitative analyses in both phases found traditional/unreflective ethical reasoning, as measured by the ERT, to be the norm in pre-test responses. Statistically significant changes in reasoning were found in quantitative analyses of post-test results. No significant differences in ethical reasoning were found according to demographic variables of age, years of nursing experience. previous ethics education exposure, or level on the career structure.

The ERT was found to meet pre-set criteria for content and construct validity, demonstrated inter-rater reliability, and demonstrated internal consistency reliability as measured by a standardised Cronbach’s Coefficient Alpha of .84 at pre-test and .91 at post-test. Thematic analysis of respondent written pre and post-test responses supported the accuracy of the ERT’s hypothesised components and levels of nurses’ ethical reasoning. Respondents’ written data concerning their own pre and post-test responses indicated perceptions of significant differences in reasoning which they attributed to the ethics course. The ERT demonstrates a promising way to measure professional responses to ethical issues. Further research is required to demonstrate validity and reliability.

Item Type: Thesis (PhD)
Murdoch Affiliation(s): Division of Social Sciences, Humanities and Education
Notes: Note to the author: If you would like to make your thesis openly available on Murdoch University Library's Research Repository, please contact: Thank you.
Supervisor(s): Hill, Brian
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