Journal List > J Korean Acad Nurs Adm > v.19(3) > 1051689

Lee: Changes in Nursing Students' Moral Judgment and Ways to Evaluate the Effect of Ethics Education



This study was done to investigate changes in nursing students' moral judgment throughout their professional education, and to identify more suitable ways to evaluate ethics education by using P (%) scores only and P (%) scores with 4th scores.


The study consisted of cross-sectional and longitudinal surveys as well as a study using a nonequivalent control group pre-post experimental design. The participants were nursing students attending a university in Gyeongju, Korea. The data were collected from September 1, 2006 to October 31, 2009 using the Korean version of the Defining Issues Test.


In the cross-sectional survey, there was no significant difference in the nursing students' moral judgment scores according to their school grades. In the longitudinal survey, nursing students' moral judgment scores did not change significantly over the duration of their education. In the nonequivalent control group study, the effectiveness of nursing ethics education was identified by P (%) scores only.


The evidence indicates that nursing professional education does not influence the development of nursing students' moral judgment, and using P (%) scores only seems to be a better way compared to other ways to evaluate the effects of nursing ethics education.

Figures and Tables

Figure 1
Participants' moral judgment scores (2006) (N=156).
Figure 2
Changes of moral judgment scores with school years (2006~2009).
Table 1
Contents of Ethical Education

DNR=do not resuscitation.

Table 2
Homogeneity of the Participants' General Characteristics (N=83)

Exp.=experimental group; Cont.=control group.

Population≤1,000,000; 100,000≤population<1,000,000.

Table 3
Analysis of Effects of Nursing Ethics Education (2008) (N=83)

Exp.=experimental group; Cont.=control group.


1. Ahn SH, Han SS, Kim CH. A study of moral reasoning by the defining issues test among medical students. J Korean Acad Nurs Adm. 1996. 2(2):85–95.
2. Bebeau MJ. The defining issues test and the four component model: Contributions to professional education. J Moral Educ. 2002. 31:271–295.
3. Cameron ME, Schaffer E, Park HA. Nursing students' experience of ethical problems and use of ethical decision-making models. Nurs Ethics. 2001. 8:432–447.
4. Elisie B, Bertram B. Nursing ethics through the life span. 2002. 4th ed. New Jersey, NJ: Prentice Hall.
5. Han SS, Ahn SH. Moral reasoning and ethical decision making among student nurses in moral dilemmas. J Korean Acad Nurs Adm. 1995a. 1:5–21.
6. Han SS, Ahn SH. Effects and nursing ethics education on moral reasoning and ethical decision making for student nurses. J Korean Acad Nurs Adm. 1995b. 1:268–284.
7. Hong SH. A study on the development of medical ethics education program. 2000. Seoul, Korea: Seoul National University;Unpublished doctoral dissertation.
8. Kim IJ, Sung NJ, Jung KH, Bae GR, Park KU, Kim JP, et al. Effect of the medical ethics education evaluated by DIT. Korean J Med Ethics Educ. 2005. 8:95–104.
9. Kim JY. A study on the relationship of college education. 2004. Seoul, Korea: Seoul National University;Unpublished doctoral dissertation.
10. Kim MK. Comparative study on the moral identity development of dentists in two countries. 2007. Seoul, Korea: Seoul National University;Unpublished doctoral dissertation.
11. Kim YS. Effect of ethics education on nurse's moral judgement. 1999. Seoul, Korea: Yonsei University;Unpublished doctoral dissertation.
12. Kim YS, Park JW, Son YJ. A longitudinal study on moral judgment development in nursing and medical students. J Korean Acad Nurs. 2003. 33:820–828.
13. Kim YS, Park JW, You MA, Seo YS, Han SS. Sensitivity to ethical issues confronted by Korean hospital staff nurses. Nurs Ethics. 2005. 12:595–605.
14. King PM, Mayhew MJ. Moral judgement development in higher education: Insights from the defining issues test. J Moral Educ. 2002. 31:247–270.
15. Kohlberg L. The development of modes of moral thinking and choice in the years ten to sixteen. 1958. Chicago: University of Chicago;Unpublished doctoral dissertation.
16. Krawczyk RM. Teaching ethics: Effect on moral development. Nurs Ethics. 1997. 4:57–65.
17. Lee MA. A study of an effect of ethics education being provided to nursing students: Using the DIT (Defining Issues Test). J Korean Acad Nurs Adm. 2008a. 14:26–34.
18. Lee MA. Longitudinal DIT study of the moral judgment of students nurses at one university in Korea. Korean J Med Ethics Educ. 2008b. 11:139–152.
19. Lee MA. The effect of ethics of education on the moral judgment of nursing students. Korean J Med Ethics. 2009. 12:177–188.
20. Lee MA, Ahn SH, Kang YS, Seomun GA, Shin MJ. An evaluation of the level of moral development of clinical nurses in Korea. Korean J Med Ethics Educ. 2006a. 9:73–84.
21. Lee MA, Ahn SH, Kang YS, Seomun GA, Shin MJ. Evaluation of the level of moral development of Korean nursing students. Korean J Med Ethics Educ. 2006b. 9:157–168.
22. Lee MA, Kim IJ, Hong SH. A study of moral judgment of nursing student: Using DIT test. Korean J Med Ethics Educ. 2005. 8:105–115.
23. Moon YL. Cross-cultural studies on moral judgment development using the defining issues test. 1984. Minneapolis, MN: University of Minnesota;Unpublished manuscript.
24. Park M, Kjervik D, Crandell J, Oermann MH. The relationship of ethics education to moral sensitivity and moral reasoning skills of nursing students. Nurs Ethics. 2012. 19:568–580.
25. Peter E, Lunardi VL, Macfarlane A. Nursing resistance as ethical action: Literature review. J Adv Nurs. 2004. 46:403–416.
26. Rest JR. Development in judging moral issues. 1979. Minneapolis, MN: University of Minnesota.
27. Rest JR. Moral development: Advances in research and theory. 1986. New York, NY: Praeger Publisher.
28. Rest JR, Naravez D. Moral development in the professions: Psychology and applied ethics. 1994. New Jersey, NJ: Lawrence Erlbaum.
Similar articles