Luppo Kuillman

Chapter 6 130 6.1 Background of the conducted PhD research The studies being presented in this doctoral thesis concern research being completed in the context of a PhD track. The aims of the PhD research were to assess antecedents of (un)ethical conduct among Physician Assistants and Nurse Practitioners since this has not been attempted before, neither in the Netherlands nor globally. However, for doing so, first the necessary indicators for the constructs of the FCM, moral disengagement, and perceived behavioral control had to be both translated or developed and consequently validated. All in order to assess them as appropriate antecedent, explanatory variables towards ethical conduct. Regarding this (un)ethical conduct as examined in this doctoral research, two novel constructs are also introduced to the international pile of literature regarding (un)ethical decision- making, namely that of ‘reporting reprehensible conduct’ and ‘yielding to pressure.’ In this summarizing discussion, the main findings of the studies are made explicit and suggestions will be made for future research possibilities. Next to that, based on the main findings, the practical relevancies will be highlighted as an impetus for furthermore enriching PA and NP training regarding assumed ethical conduct and correspondingly the awareness of being confronted with moral issues after graduation. 6.2 Summary of main findings In this paragraph brief descriptions will be given regarding the main outcomes of the separate studies as reported in Chapter 2, Chapter 3, Chapter 4, and Chapter 5. In Chapter 2, the outcomes of a validation study are reported (L. Kuilman, Jansen, Mulder, Middel, & Roodbol, 2020-a). With the initial plan of modifying and validating a context-specific version of the Moral Sensitivity Questionnaire the findings turned out to be completely different from those anticipated at the start of the study. Whereas Lützén et al. maintained their claim of the MSQ measuring six dimensions of moral sensitivity (Lützén, Evertzon, & Nordin, 1997), in the study conducted for this Ph.D. research by both exploratory as also confirmatory factor analysis, there was no reason to maintain this theory for the instrument used among the included samples. Instead, I extracted and confirmed two novel scales that measure two types of attitude, namely those of a morally deliberate attitude (MSQ-DELIB) and that of a paternalistic attitude (MSQ-PATER). Both scales show good construct validity and