Luppo Kuillman

The predictive values of a Deliberative and a Paternalistic Attitude 121 5 3. Paternalism did not affect yielding to pressure in either vignette, therefore rejecting hypotheses 2.   Although moral deliberation regresses positively on yielding to pressure in vignette 1 (unindicated antibiotics), it is quite remarkable that it regresses negatively on yielding to pressure in vignette 2 (the schizophrenic patient). A possible interpretation of this may lie in the different sources of pressure in both scenarios. In vignette 1, it is the patient himself who exerts pressure on the healthcare professional. In that sense, the patient is the subject of the story in vignette 1, whereas, in vignette 2, it is the nursing staff who puts pressure on the clinician to dismiss the patient to restore calm and order. Since a healthcare professional with a high degree of moral deliberation attitude is entirely focused on the patient, it makes sense that (s)he is more likely to yield to pressure when a patients exerts pressure (e.g., in vignette 1). In contrast, (s)he is less likely to yield to pressure when this pressure is exerted by someone who chooses side against the patient (e.g., in vignette 2). Whether the source of the pressure (patient, colleagues, administration, or the patients’ family) influences the direction of moral deliberation is an interesting avenue for further research.  Furthermore, we expected a negative relationship between paternalism and yielding to pressure since individuals with a paternalistic stance will adhere to the rules and the own professional standards at all times and thus would be less likely to yield to pressure to deviate from these rules and standards. However, the results show no relation between paternalism and yielding to pressure. Thus, at this moment, there is no credible evidence to support our hypothesis (H2). Looking at the results, we also see no reason to expect that a significant relationship will be found when retesting the hypothesis among a larger sample. Apparently, adherence to one’s decision, rules and guidelines, as measured by our paternalism scale, is unrelated to “yield to pressure”. It may be more fruitful in further research to focus on other personality traits that measure persistence more directly and are not necessarily related to the specific medical context.   Strengths and limitations  One strength of this study is that a representative sample was used in terms of gender and age, reflecting the demographics of both the NP and PA workforces in the Netherlands (Laurant, van de Camp, Boerboom, & Wijers, 2014). For this reason, the results of moral deliberation being a predictor of yielding to pressure when