Luppo Kuillman

Chapter 1 14 the 30 items of the MSQ. According to the authors, an exploratory factor analysis demonstrated that the six categories defined earlier (1994) could be retained. Despite the “relatively low Cronbach’s coefficient alpha for each category,” the total scale elicited a Cronbach’s alpha coefficient of 0.78. Furthermore, in this study, the authors maintained their position that the instrument was unidimensional, derived from their standpoint that “the total score can be seen as an indication of the respondent’s attitude towards moral issues in nursing practice.” Following the measurement of moral sensitivity among nurses, the first “doctor’s version” of themoral sensitivity questionnairewas developed and administered among psychiatrists (Lützén, Evertzon, & Nordin, 1997). This version of the MSQ was only slightly modified, for example, with the word “nurse” being replaced by “psychiatrist.” As in the nursing studies, the MSQ survey among psychiatrists maintained the assumed categories – 1) interpersonal orientation, 2) structuring moral meaning, 3) expressing benevolence, 4) modifying autonomy, 5) experiencing moral conflict, and 6) confidence in medical knowledge. Nevertheless, the outcome for the reliability and validity of the MSQ psychiatrist version was worrisome, with a Cronbach’s alpha of 0.64 for the scale. One plausible reason cited as justification for this lower internal consistency was ascribed to the fact that the MSQ initially had been developed on grounded theory effectuated through qualitative research and conducted among nurse samples and not among physicians. Key was the assumption of different levels of professional responsibility between nurses and physicians, thereby a different sensitivity to moral issues in daily practice. Despite the somewhat lower reliability and validity, it was opted to use this doctor’s version of the MSQ for this doctoral study. The reason for this is because we felt comfortable with the thought that the instrument measures what we purported to measure in terms of moral sensitivity among our sample, namely that of NPs and PAs. Also, the instrument aligned with the theorization of the concept, namely: “moral sensitivity is the contextual and intuitive understanding of the vulnerability of a person’s situation and insight into ethical consequences of decisions made on behalf of the person.” Therewith the instrument was deemed to fit as an appropriate indicator for one of the theoretical constructs within the “Four Component Model of Moral Behavior” as introduced by Rest and colleagues (J. R. Rest et al., 1999) and directional for the research as reported in Chapter 2 of this doctoral thesis.