Luppo Kuillman

Chapter 5 114 Indicator of Yielding to pressure  In this study, we used two vignettes as indicators of “yielding to pressure”. These vignettes, as exhibited in Appendix 1, are regarded as two separate indicators as they tap two distinct dimensions of moral conflict that occurs during1) provider-patient interaction (vignette 1), and 2) provider-colleagues interaction (vignette 2). They both indicate degrees to which healthcare professionals yield to pressure during a moral conflict. On a scale from 0 to 100, we asked the respondents to indicate how likely they are to act in the following ways a) prescribe antibiotics without a medical indication to a demanding patient (vignette 1), and b) discharge a schizophrenic patient from the hospital with oral antibiotics, pressured by the demanding nursing staff to restore calm and order in the nursing ward (vignette 2). A higher score on both vignettes indicated a higher likelihood to yield to pressure at the cost of adherence to rules and regulations.   Indicators of moral deliberation and paternalism  In an earlier study, we validated the two scales MSQ-DELIB and MSQ-PATER, as measures of moral deliberate and paternalistic attitude, respectively. Both scales have a good internal consistency, as indicated by Cronbach’s alpha of 0.70 (L. Kuilman et al., 2020). The 4-item MSQ-DELIB contains items like: “As a PA/NP, I must always know how individual patients in my ward should be respectfully approached” and “What is most important in my clinical practice is my relationship with the patients”. The 7-item MSQ-PATER scale contains items like: “I always base my actions on the medical knowledge of what is the best treatment, even if the patient protests” and “When I need to make a decision contrary to the will of a patient, I do so accordingly to my opinion about what is good care”. Moral disengagement scale  To measure propensity to morally disengage, we modified the moral disengagement scale of Bandura et al. (Bandura, Barbaranelli, Caprara, & Pastorelli, 1996b) to fit the perspective of general healthcare. For example, item number 32 in Bandura’s scale: “Children are not at fault for misbehaving if their parents force them too much”, was replaced by: “Medical professionals cannot be held accountable for their mistakes when the government puts them under heavy pressure” . We invited the respondents to answer 32 statements on a Likert-type scale (1= completely disagree to 5= completely agree). The scale’s Cronbach’s alpha of 0.85 in our study was consistent with the findings by