Martine Kruijtbosch

19 I n t roduc t i on OUTLINE OF THE THESIS This thesis consists of five parts. The first part is the general introduction. In the second part we present two studies on Dutch community pharmacists’ moral sensitivity for the professional values in daily practice. For these studies moral dilemma narratives are investigated. In Chapter 2.1 we show which moral dilemmas early career Dutch pharmacists experience in daily community pharmacy practice and provide an overview of the themes of these dilemmas. Chapter 2.2 addresses which professional values (formulated in the Dutch Charter of Professionalism) and which other values could be identified in the moral dilemma narratives and present customised descriptions of the professional values for community pharmacists. In the third part we unveil three studies on moral reasoning of Dutch early career and community pharmacists. Chapter 3.1 contains the applicability testing of the Australian pharmacy-specific moral reasoning measure, the Professional Ethics in Pharmacy test (PEP test), among early career pharmacists practicing in Dutch community pharmacy. In the studies in Chapters 3.2 and 3.3 we further investigated the three moral reasoning perspectives (MRPs) (a business orientation perspective, a rules and regulation perspective and a professional ethics perspective) which are central to the design of the PEP test. We developed a new test for the context of Dutch healthcare and community pharmacy. We investigated to what extent the three MRPs play a role in community pharmacists’ handling situations of drug shortages. Chapter 3.2 presents the measurement of these MRPs in community pharmacists in the situation of three different drug shortage scenarios. Additionally, in Chapter 3.3 we describe whether these MRPs were associated with determinants and with the likelihood of intended handling options in relation to the three drug shortages. The fourth part covers one study about moral case deliberation (MCD) for community pharmacists. Chapter 4 explores whether community pharmacists’ moral reflectivity within the processes of moral sensitivity , moral reasoning and moral intention can be stimulated byMCD. Finally in the General discussion (Chapter 5), the results are discussed and put in a broader perspective. In the end recommendations are summarised for education, practice, policy and research.