Luppo Kuillman

General Introduction 13 1 setting, that is, knowing the regulations, codes of conduct, and how one applies one’s professional values and norms, whereas, the alternative perspective of moral sensitivity is rather a pure intra-personal concept. This alternative perspective was introduced by Lützén and colleagues, grounded in a healthcare and nursing perspective (Lützén, Nordström, & Evertzon, 1995). As part of her doctoral research, Lützén conducted a qualitative study (Lützén, Nordin & Brolin, 1994) as an impetus to generate items for the conceptualization and instrumentation of measuring moral sensitivity. Six categories were defined for the moral sensitivity construct. In their aforementioned 1994 study, Lützén, Nordin, and Brolin reported their first findings on the conceptualization and instrumentation of moral sensitivity. In this early stage of their work, the tested instrument was known as the moral sensitivity test (MST). The MST was administered among 79 nurses working in psychiatric practice. The MST included 35 pre-coded items covering the categories: interpersonal orientation, structuring moral meaning, expressing benevolence, modifying autonomy, experiencing conflict, and reliance on physician knowledge. Items were phrased as statements and answers, in Likert-type format, from totally disagree (=1) to totally agree (=7). The uneven distribution of items per category was assumed to be inevitable because of the theoretical overlap in statements. The latter supported the authors’ assumption of the uni-dimensionality of the instrument. Five of the 35 items were excluded because they either correlated negatively or correlated low with the total score. The reliability, expressed by Cronbach’s alpha, for the total scale was 0.64. To support the uni-dimensionality of the instrument, the items of the six categories were clustered into a subscale A and a subscale B, eliciting near equal estimates of reliability (subscale A: α=0.62 and subscale B: α=0.60). Even though a weak positive correlation was found between the subscales, a Pearson’s correlation analysis for the subscales and the total score of the instrument revealed high positive correlation scores of 0.83 and 0.73, respectively. This positive correlation was not found in all categories and was therefore viewed as contradictory vis-à-vis the assumption of uni-dimensionality, in addition to the small sample size mentioned. After the first study in 1994, Lützén and colleagues followed up with another study by measuring moral sensitivity among nurses working at two psychiatric clinics and two medical-surgical clinics. (Lützén, Nordstrom, & Evertzon, 1995) In this study, the test previously known as MST was baptized the “Moral Sensitivity Questionnaire” (MSQ). The final number of participants was 215, and there were no missing values among