Moral Sensitivity, Empathy and Perceived Ethical Climate of Psychiatric Nurses Working in the National Mental Hospitals

Hyekyung Jo; Sunah Kim

doi:10.12934/jkpmhn.2017.26.2.204

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Jo and Kim: Moral Sensitivity, Empathy and Perceived Ethical Climate of Psychiatric Nurses Working in the National Mental Hospitals

Original Article

J Korean Acad Psychiatr Ment Health Nurs 2017;26(2):204-215.

Published online: 7 June 2017

DOI: https://doi.org/10.12934/jkpmhn.2017.26.2.204

Moral Sensitivity, Empathy and Perceived Ethical Climate of Psychiatric Nurses Working in the National Mental Hospitals

Hyekyung Jo¹, Sunah Kim²

¹National Center for Mental Health ․ Graduate School, Yonsei University, Seoul, Korea

²College of Nursing, Yonsei University, Seoul, Korea

Corresponding author: Kim, Sunah College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel: +82-2-2228-3210, Fax: +82-2-364-5027, E-mail: PSY0962@yuhs.ac

Received 4 April 20172 June 2017 Accepted 9 June 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to identify the relationships between Moral Sensitivity, Empathy and Perceived Ethical Climate for nurses working in national mental hospitals and to provide basic data for the development of interventions that enhance Moral Sensitivity and help psychiatric hospital nurses in Ethical Decision-making.

Methods

This descriptive cross-sectional study was conducted with 182 psychiatric nurses working in the national mental hospitals. Data were collected through self-report questionnaires which included the Moral Sensitivity Questionnaire (MSQ), Interpersonal Reactivity Index (IRI), and Hospital Ethical Climate Survey (HECS).

Results

The mean score for MSQ was 5.19, for IRI, 2.49, and for HECS, 3.73. There was a significant positive correlation between moral sensitivity and empathy (r=.24, p=.001), between moral sensitivity and perceived ethical climate (r=.17, p= .025) and between empathy and perceived ethical climate (r=.17, p=.025).

Conclusion

Findings indicate that moral sensitivity can be enhanced by improving empathy, a personal factor, and ethical climate, an organization factor. Further identification of the relationship between moral sensitivity and personal and organizational factors will be useful in the development of interventions to enhance moral sensitivity of nurses working in psychiatric wards.

Keywords: Moral sensitivity, Empathy, Ethical climate, Psychiatric nurses

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Figure 1.

The conceptual framework of this study.

Table 1.

Levels of Participants’ Moral Sensitivity, Empathy and Perceived Ethical Climate according to Participant's General Characteristics (N=182)

Characteristics	Categories	n (%)	Moral sensitivity		Empathy		Perceived ethical climate
Characteristics	Categories	n (%)	M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p)
Gender	Male	17 (9.3)	5.13±0.48	−0.49	2.29±0.22	−3.93	3.68±0.37	−0.47
Gender	Female	165 (90.7)	5.19±0.48	(.623)	2.51±0.30	(.001)	3.74±0.49	(.639)
Age (year)	<30^a	17 (9.3)	5.01±0.48	3.04	2.44±0.21	2.64	3.82±0.58	4.49
	30~40^b	44 (24.2)	5.07±0.51	(.030)	2.43±0.26	(.051)	3.53±0.40	(.005)
	40~50^c	77 (42.3)	5.22±0.45	a, b<d	2.48±0.34		3.74±0.16	b<a, c, d
	≥50^d	44 (24.2)	5.32±0.46		2.60±0.30		3.89±0.50
Marital status	Single	33 (18.1)	5.06±0.52	1.50	2.48±0.30	0.49	3.58±0.56	2.85
	Married	144 (79.1)	5.22±0.47	(.227)	2.50±0.31	(.614)	3.77±0.46	(.061)
	Etc.	5 (2.7)	5.16±0.22		2.37±0.20		3.49±0.48
Religion	Have	114 (62.6)	5.19±0.47	−0.09	2.48±3.11	−0.51	3.75±0.46	0.63
Religion	None	68 (37.4)	5.19±0.49	(.932)	2.51±0.30	(.614)	3.70±0.51	(.529)
Years of nursing experience	<10^a	42 (23.1)	5.01±0.47	3.18	2.43±0.24	2.79	3.62±0.48	2.86
	10~20^b	38 (20.9)	5.15±0.52	(.015)	2.39±0.28	(.028)	3.64±0.42	(.025)
	20~25^c	35 (19.2)	5.24±0.43	a<c, d, e	2.56±0.35	a<e	3.67±0.43	a, b, c<e
	25~30^d	45 (24.7)	5.23±0.44		2.52±0.31	b<c, d, e	3.84±0.52
	≥30^e	22 (12.1)	5.41±0.48		2.61±0.31		3.95±0.52
Years of psychiatric nursing experience	1~5^a	29 (15.9)	5.00±0.50	2.02	2.43±0.21	4.39	3.70±0.49	4.12
	5~10^b	30 (16.5)	5.17±0.50	(.093)	2.44±0.26	(.002)	3.67±0.43	(.003)
	10~15^c	18 (9.9)	5.15±0.52		2.29±0.29	a, b, c<e	3.35±0.35	a, b, d, e＞c
	15~20^d	25 (13.7)	5.34±0.46		2.50±0.29		3.79±0.49
	≥20^e	80 (44.0)	5.22±0.44		2.58±0.33		3.83±0.49
Education	Diploma^a	69 (37.9)	5.23±0.44	4.38	2.51±0.32	0.15	3.70±0.48	0.73
level	Bachelor^b	61 (33.5)	5.05±0.49	(.014)	2.48±0.28	(.861)	3.71±0.49	(.482)
level	≥Master's course^c	52 (28.6)	5.30±0.50	b<c	2.48±0.31		3.80±0.48
Qualification	PMHN^a	152 (83.5)	5.17±0.48	0.84	2.52±0.31	4.08	3.71±0.49	1.03
	PMHNP^b	16 (8.8)	5.28±0.51	(.436)	2.35±0.15	(.019)	3.89±0.47	(.358)
	GPN^c	14 (7.7)	5.30±0.47		2.34±0.28	a＞b, c	3.75±0.46
Position	Staff^a	124 (68.1)	5.12±0.47	5.97	2.46±0.29	4.48	3.65±0.46	5.89
	Charge^b	20 (11.0)	5.19±0.40	(.003)	2.47±0.31	(.013)	3.84±0.42	(.003)
	≥Unit manager^c	38 (20.9)	5.41±0.48	a<c	2.62±0.31	a<c	3.94±0.52	a<c

PMHN=Psychiatric mental health nurse; PMHNP=Psychiatric mental health nurse practitioner; GPN=General psychiatric nurse.

Table 2.

Participant's Moral Sensitivity, Empathy and Perceived Ethical Climate (N=182)

Variables	Items	Range of score	Range of total score	M±SD (average score)	M±SD (total score)
Moral sensitivity	30	1~7	30~210	5.19±0.48	154.07±14.77
Relation	3		3~21	6.16±0.68	18.49±2.04
Autonomy	3		3~21	5.90±0.76	17.70±2.28
Rules	7		7~49	5.41±0.63	37.85±4.41
Benevolence	5		5~35	5.24±0.62	26.20±3.12
Conflict	5		5~35	4.91±0.90	24.54±4.52
Meaning	6		6~42	4.49±0.81	26.92±4.88
Empathy	28	0~4	0~112	2.49±0.30	67.79±8.52
Cognitive empathy	14		0~56	2.61±0.39	36.55±5.48
–Perspective-taking	7		0~28	2.85±0.47	19.94±3.28
–Fantasy	7		0~28	2.37±0.55	16.61±3.87
Affective empathy	14		0~56	2.37±0.33	33.24±4.58
–Empathic concern	7		0~28	2.79±0.49	19.54±3.42
–Personal distress	7		0~28	1.96±0.43	13.70±3.02
Perceived ethical climate	26	1~5	26~130	3.73±0.48	97.01±12.55
Peers	4		4~20	3.93±0.49	15.70±1.97
Patients	4		4~20	3.84±0.51	15.37±2.03
Managers	6		6~30	3.75±0.68	22.52±4.06
Hospital	6		6~30	3.64±0.54	21.86±3.24
Physicians	6		6~30	3.59±0.60	21.55±3.62

Table 3.

Correlations of Moral Sensitivity, Empathy and Perceived Ethical Climate (N=182)

	Moral sensitivity							Empathy							Ethical climate
	1	1-1	1-2	1-3	1-4	1-5	1-6	2	2-1	2-1-1	2-1-2	2-2	2-2-1	2-2-2	3	3-1	3-2	3-3	3-4	3-5
1. Moral sensitivity	1
1-1. Relation	.58^∗∗	1
1-2. Meaning	.63^∗∗	.13	1
1-3. Benevolence	.67^∗∗	.50^∗∗	.16^∗	1
1-4. Autonomy	.64^∗∗	.58^∗∗	.21^∗∗	.50^∗∗	1
1-5. Conflict	.70^∗∗	.22^∗∗	.34^∗∗	.28^∗∗	.26	1
1-6. Rules	.81^∗∗	.41^∗∗	.37^∗∗	.51^∗∗	.41^∗∗	.55	1
2. Empathy	.24^∗∗	.23^∗∗	.00	.25^∗∗	.30^∗∗	.18^∗	.15^∗	1
2-1. Cognitive empathy	.24^∗∗	.23^∗∗	.00	.28^∗∗	.33^∗∗	.17^∗	.11	.87^∗∗	1
2-1-1. perspective-taking	.24^∗∗	.30^∗∗	−.02	.32^∗∗	.39^∗∗	.06	.11	.60^∗∗	.72^∗∗	1
2-1-2. fantasy	.13	.07	.02	.12	.14	.19^∗∗	.06	.73^∗∗	.81^∗∗	.17^∗	1
2-2. Affective empathy	.16^∗	.16^∗	−.00	.14	.17^∗	.12	.14	.81^∗∗	.43^∗∗	.25^∗∗	.40^∗∗	1
2-2-1. empathic concern	.20^∗∗	.32^∗∗	.02	.23^∗∗	.27^∗∗	.02	.10	.77^∗∗	.57^∗∗	.47^∗∗	.41^∗∗	.75^∗∗	1
2-2-2. personal distress	.02	−.12	−.03	−.05	−.06	.16^∗	.10	.37^∗∗	.01	−.15^∗	.14	.67^∗∗	.01	1
3. Perceived ethical climate	.17^∗	.25^∗∗	.03	.17^∗	.25^∗∗	−.07	.20^∗∗	.17^∗	.16^∗	.23^∗∗	.03	.11	.30^∗∗	−.17^∗	1
3-1. Peers	.14	.21^∗∗	−.06	.17^∗	.23^∗∗	−.06	.23^∗∗	.22^∗∗	.21^∗∗	.23^∗∗	.11	.15^∗	.31^∗∗	−.12	.84^∗∗	1
3-2. Patients	.26^∗∗	.37^∗∗	.06	.23^∗∗	.39^∗∗	−.03	.24^∗∗	.31^∗∗	.30^∗∗	.38^∗∗	.11	.22^∗∗	.34^∗∗	−.06	.76^∗∗	.67^∗∗	1
3-3. Managers	.12	.17^∗	.00	.09	.17^∗	−.02	.13	.07	.06	.08	.01	.06	.20^∗∗	−.13	.82^∗∗	.61^∗∗	.43^∗∗	1
3-4. Hospital	.15^∗	.22^∗∗	.02	.15^∗	.23^∗∗	−.05	.20^∗∗	.10	.12	.22^∗∗	−.02	.04	.20^∗∗	−.17^∗	.89^∗∗	.67^∗∗	.66^∗∗	.66^∗∗	1
3-5. Physicians	.09	.16^∗	.09	.11	.14	−.13	.09	.11	.11	.18^∗	.00	.08	.27^∗∗	−.17^∗	.87^∗∗	.69^∗∗	.65^∗∗	.55^∗∗	.72^∗∗	1

^∗ p<0.5

^∗∗ p<.01.

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