Luppo Kuillman

Chapter 1 20 1.5 The concept of Behavioral Control targeted at Preventing Harm In this thesis the construct of Perceived Behavioral Control has been a construct of interest, because even though moral awareness/sensitivity and motivation can be very high, if an individual does not feel that the ability to behave morally (e.g. because the context does not allow it and / or because you feel powerless), then that does not result into moral behavior. For this we developed a healthcare context-specific indicator which roots from the Hippocratic principle of “First, do no harm” and measures a degree of behavioral control (Ajzen, 1991). This was operationalized by employing the concept of “Perceived Control of Preventing Harm.” The result was the development of the “Behavioral Control targeted at Preventing Harm” (BCPH) scale, consisting of five items: 1) “I always feel responsible for proper patient care, even if the resources are insufficient”; 2) “My skill in assessing the needs of the patient always helps me in my work”; 3) “I can always properly assess whether and when a patient should be told the truth”; 4) “I can easily sense when a patient is not receiving proper care”; and 5) “In patient care, I am always aware of the balance between performing the task well and the risk of harm to the patient.” Scoring high on the BCPH indicates that the respondent has a stronger behavioral control of abstaining from doing harm. In this doctoral thesis in Chapter 2 and Chapter 4 the indicator BCPH was used as an explanatory variable. 1.6 Outline of this doctoral thesis There is a two-fold aimof this PhD research doctoral thesis; first, to assess antecedents of ethical conduct among Physician Assistants and Nurse Practitioners, since this has never been done before, neither in the Netherlands nor globally. For being able to do so first, the necessary indicators of the aforementioned constructs had to be validated, i.e. indicators for the constructs of the FCM, moral disengagement and perceived behavioral control. All in order to address the second aim of this PhD research, namely, to assess them as appropriate antecedent, explanatory variables in respect of ethical conduct. Chapter 2 presents the outcomes of an attempt to validate the Moral Sensitivity Questionnaire which was translated into Dutch and adapted to the PA and NP professions. The six theoretical proposed dimensions as proposed by the developer of the MSQ (which was deemed as an appropriate indicator to measure the FCM’s