Luppo Kuillman

Summarizing Discussion and Future Research Directions 133 6 The research presented in this doctoral thesis is relevant because the included respondents concern a representative sample given the average socio-demographic characteristics like age and gender of the two national occupational groups of both the PA and NP professionals (Aalbers, Van de Leemkolk, & Van der Velde, 2019; Van de Leemkolk & Van der Velde, 2019). To a certain extent, it can therefore, be stated that the results of the studies performed and presented in this doctoral thesis can be generalized to the two professional groups at large. Even though the representative sample is based on a rather moderately acceptable response rate, a certain degree of selection bias can never be ruled out. Furthermore as to whether the results can be applicable to other independent health professionals is also open to further research. The relevancy and practical implication for both education and practice will be summarized in paragraph 6.3. With respect to consistent use of the collected data the outcomes have a solid theoretical foundation derived from established theories regarding ethical decision- making, moral disengagement, and behavioral aspects (Ajzen, 1991; Bandura, 1999; Rest, Thoma, & Bebeau, 1999). All the validated, translated, and self- developed questionnaires are appropriately selected indicators of constructs of the aforementioned theories. Furthermore, research outcomes contributed to the explanation of (un)ethical conduct. Initially, i.e., upfront of this doctoral research, the idea existed to analyze all FCM components in a process-based manner since James Rest posited his model as the composition of logically and chronologically evolving variables during the ethical decision-making process. However, advancing insights made us decide to deviate from that linear, logical approach and zoom in to the separate constructs (M. J. Bebeau, Rest, & Narvaez, 1999). Especially so because empirical evidence strongly advises against such approaches (M. Bebeau, 2002), and some even propose the necessity of remodelling the FCM (Curzer, 2014). It is also worth mentioning that a few close colleagues of James Rest, in a later study, have refuted the initial assumption of the logical and chronological order in the ethical decision-making by proving the FCM components’ independence, which in the end also may explain the absent to low correlations between the constructs found in our work (You & Bebeau, 2013). Regarding the methodological rigor, in this thesis, there is a deliberate use of different analytical approaches ranging from regression analysis to path analysis and