Moral sensitivity as a personal and work attribute of emergency care nurses: a cross-sectional study.

OBJECTIVE: to analyze the moral sensitivity of Brazilian emergency care nurses according to their personal and work characteristics. METHOD: this is a quantitative, descriptive, cross-sectional study with a convenience sample. A total of 422 nurses from emergency care services in the five regions of Brazil took part. Sociodemographic and work-related information was collected, as well as the Brazilian version of the Moral Sensitivity Questionnaire. After approval by the Research Ethics Committee, the data was collected using a self-administered form on the Google Forms Platform, organized using Excel software and analyzed using the R language. RESULTS: nurses with longer experience in emergency care services showed higher levels in the interpersonal orientation, moral conflict and moral significance dimensions, while in the professional knowledge dimension, men showed higher levels, as evidenced by items that include confidence in nursing knowledge, intuition, experience and opinion. CONCLUSION: the differences in the nurses' moral sensitivity were due to their professional experience. It should be emphasized that valuing the sharing of intergenerational experiences in service could be a possible strategy for fostering moral competencies in the field of practice.

How people evaluate individuals who act morally prior to acting immorally: An examination of developmental change in moral evaluation, social preference, and prediction of moral behaviors.

Recent studies have enthusiastically examined the developmental origin of moral self-licensing, which is a tendency to act immorally after acting morally. However, it has not been considered enough how children evaluate personality traits of individuals who show moral licensing behavior and whether there is any developmental change in this evaluation. This study examined the developmental change in moral evaluation, social preference, and prediction of moral behaviors for moral licensing characters as well as moral or immoral characters. In total, 36 5- and 6-year-old children, 36 7- and 8-year-old children, and 58 university students participated in the study. The results revealed that 7- and 8-year-olds and adults evaluated moral licensing characters as more moral and likable than those who behave immorally, unlike 5- and 6-year-olds, who did not distinguish between the immoral and moral licensing characters. Importantly, 7- and 8-year-olds judged the moral licensing character as neutral in both moral evaluation and judgment of social preference, suggesting that they thought the immoral behavior was canceled out owing to prior moral behavior in the moral licensing character. However, adults still judged the moral licensing character as immoral and dislikable. Moreover, children's prediction of moral behavior for all characters showed the same tendency as moral evaluation, whereas adults' prediction was slightly different from their moral evaluation. Taken together, our findings revealed that the evaluation of individuals who show moral licensing behavior changed developmentally, and a moral licensing effect was found when evaluating others' moral traits from around 7 or 8 years of age.

A spiking neuron model of moral judgment in trolley dilemmas.

People will make different moral judgments in similar moral dilemmas where one can act to sacrifice some number of lives to save several more. Research has shown that although people can reason that an action would save more lives, automatic processes can overwrite deliberate reasoning. Having participants imagine hypothetical moral dilemmas, researchers have discovered that factors such as action/omission, means/side-effect, and personal/impersonal can affect judgment. Joshua Greene suggests that these features do not affect people's judgment because they are morally relevant but are instead a result of the myopic nature of the automatic moral process. Greene hypothesizes that there is some myopic module or domain-general process that attaches a negative emotional response to an action when one is contemplating violent actions. In the present research a model of this myopic automatic process is paired with an analytic system to replicate deontological and utilitarian responses to moral dilemmas. Our system, MERDJ, models this in simulated spiking neurons. The system takes in representations of specific moral dilemmas as inputs and outputs judgments of appropriate or inappropriate.

Posttraumatic Stress Disorder Symptom Clusters, Exposure to Potentially Morally Injurious Events, and Aggression Among Army Veterans.

OBJECTIVE: Very few studies have examined the association between posttraumatic stress disorder (PTSD) symptom clusters and aggression since the change in PTSD diagnosis criteria a decade ago. Furthermore, these studies have used measures based on PTSD criteria of the DSM-IV. The current study therefore examines the association between PTSD symptom clusters, exposure to potentially morally injurious events (PMIEs), and various types of aggression following the change in PTSD criteria and in accordance with the criteria of the DSM-5-TR. METHOD: A sample of 167 Israeli combat veterans completed validated self-report questionnaires tapping PTSD symptoms, exposure to PMIEs, and aggression levels. RESULTS: Our analysis revealed a significant positive relationship between the number of court-martials, betrayal-based PMIEs, all PTSD symptom clusters, and aggression. We also found that the arousal cluster, as well as the number of court-martials and age, predicted aggression, whereas the re-experiencing cluster predicted lower aggression levels. CONCLUSION: Besides an updated understanding of the association between all PTSD symptom clusters and various forms of aggression, these findings emphasize the importance of targeting arousal symptoms and especially anger in treatment of veterans with PTSD symptoms and those who report experiences of betrayal. The findings also suggest clinicians to consider arousal symptoms, age, and history of court-martials when conducting either clinical or actuarial risk assessments of veterans.

Moral distress related to paid and unpaid care among healthcare workers during the COVID-19 pandemic.

While there is growing literature on experiences of healthcare workers and those providing unpaid care during COVID-19, little research considers the relationships between paid and unpaid care burdens and contributions. We administered a moral distress survey to healthcare workers in Canada, in 2022, collecting data on both paid and unpaid care. There were no significant differences in the proportion of participants providing unpaid care by gender, with both genders equally affected by certain responsibilities such as reduced contact with family/loved ones. However, men were significantly more distressed about specific unpaid care responsibilities. Unpaid care was not significantly associated with differences in intention to leave work. At work, women were significantly more concerned about patients unable to see family, while men were distressed by others mistreating COVID patients. This study enhances understanding of paid and unpaid care relationships, particularly during crises, and proposes an innovative method for assessing unpaid care burdens.

Executive function as a mechanism for the emergence and expression of moral knowledge.

We outline two accounts by which executive function (EF) supports children's moral reasoning: an emergence and an expression account. The emergence account postulates that EF supports the development of moral concepts because it relates to how children navigate their early social environments and how well they can internalize moral messages. The expression account postulates that EF supports children's in-the-moment moral reasoning for complex moral situations. We present data from two studies with preschool children to assess each account. In support of the emergence account, EF longitudinally and positively predicted moral reasoning, but only for children who have experienced moderate forms of peer conflict. In support of the expression account, EF was only correlated with judgments that required the coordination of multiple pieces of information (i.e., retaliation and criterion judgments). We conclude that EF is an important cognitive mechanism of moral development and discuss various implications of these findings for both moral development and EF theory.

Does sense of coherence buffer the effects of moral dilemmas faced by psychiatric nurses in Japan? A cross-sectional study.

Psychiatric nurses face moral dilemmas that affect their mental health. We investigated whether sense of coherence (SOC) buffers psychiatric nurses' perceived effects of moral dilemmas on their psychological distress. A total of 418 nursing professionals in 6 psychiatric hospitals in Japan completed self-administered questionnaires. A negative correlation was observed between "patient rights" (r = -0.24, p < 0.001), "relationships other than patient" (r = -0.28, p < 0.001), "nursing care" (r = -0.25, p < 0.001) of moral dilemmas and "manageability" of SOC. Additionally, a negative correlation was observed between "patient rights" (r = -0.22, p < 0.001), "relationships other than patient" (r = -0.21, p < 0.001) of moral dilemmas and "comprehensibility" of SOC. Hierarchical multiple regression analysis used the Kessler Psychological Distress Scale-10 (K10), which assessed the degree of mental distress, as the dependent variable, and moral dilemmas and SOC as the independent variables, along with their interaction terms. The K10 scores significantly changed depending on the degree of moral dilemmas in the low SOC group, but not in the high SOC group. SOC buffers the effects of psychiatric nurses' perceived moral dilemmas on their psychological distress.

Cross-National Variations in Scientific Ethics: Exploring Ethical Perspectives Among Scientists in China, the US, and the UK.

This research explores the perspectives of academic physicists from three national contexts concerning their roles and responsibilities within the realm of science. Using a dataset comprised of 211 interviews with scientists working in China, the United States, and the United Kingdom, the study seeks to explain whether and in what manner physicists conceptualize scientific ethics within a global or national framework. The empirical findings bring to light disparities across nations in the physicists' perceptions of what constitutes responsible mentorship and engagement in public service. These cross-national variations underscore the moral agency of physicists as they navigate the ethical standards embraced by the global scientific community vis-à-vis those that are specific to their respective national contexts. The study's empirical insights may carry significant implications for both policymakers and ethicists, underscoring the imperative of soliciting and acknowledging the perspectives of academic scientists working and living in disparate national contexts when formulating comprehensive science ethics frameworks. Such inclusive and context-aware approaches to shaping ethics in science can contribute to the cultivation of a more robust and universally relevant ethical foundation for the scientific community.

Beyond Anthropocentrism: The Moral and Strategic Philosophy behind Russell and Burch's 3Rs in Animal Experimentation.

The 3Rs framework in animal experimentation- "replace, reduce, refine" - has been alleged to be expressive of anthropocentrism, the view that only humans are directly morally relevant. After all, the 3Rs safeguard animal welfare only as far as given human research objectives permit, effectively prioritizing human use interests over animal interests. This article acknowledges this prioritization, but argues that the characterization as anthropocentric is inaccurate. In fact, the 3Rs prioritize research purposes even more strongly than an ethical anthropocentrist would. Drawing on the writings of Universities Federation for Animal Welfare (UFAW) founder Charles W. Hume, who employed Russell and Burch, it is argued that the 3Rs originally arose from an animal-centered ethic which was however restricted by an organizational strategy aiming at the voluntary cooperation of animal researchers. Research purposes thus had to be accepted as given. While this explains why the 3Rs focus narrowly on humane method selection, not on encouraging animal-free question selection in the first place, it suggests that governments should (also) focus on the latter if they recognize animals as deserving protection for their own sake.

Culture shapes moral reasoning about close others.

Moral norms balance the needs of the group versus individuals, and societies across the globe vary in terms of the norms they prioritize. Extant research indicates that people from Western cultures consistently choose to protect (vs. punish) close others who commit crimes. Might this differ in cultural contexts that prioritize the self less? Prior research presents two compelling alternatives. On the one hand, collectivists may feel more intertwined with and tied to those close to them, thus protecting close others more. On the other hand, they may prioritize society over individuals and thus protect close others less. Four studies (N = 2,688) performed in the United States and Japan provide self-report, narrative, and experimental evidence supporting the latter hypothesis. These findings highlight how personal relationships and culture dynamically interact to shape how we think about important moral decisions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Travelling beyond time: shared brain system for self-projection in the temporal, political and moral domains.

Mental time travel (MTT), a cornerstone of human cognition, enables individuals to mentally project themselves into their past or future. It was shown that this self-projection may extend beyond the temporal domain to the spatial and social domains. What about higher cognitive domains? Twenty-eight participants underwent functional magnetic resonance imaging (fMRI) while self-projecting to different political, moral and temporal perspectives. For each domain, participants were asked to judge their relationship to various people (politicians, moral figures, personal acquaintances) from their actual or projected self-location. Findings showed slower, less accurate responses during self-projection across all domains. fMRI analysis revealed self-projection elicited brain activity at the precuneus, medial and dorsolateral prefrontal cortex, temporoparietal junction and anterior insula, bilaterally and right lateral temporal cortex. Notably, 23.5% of active voxels responded to all three domains and 27% to two domains, suggesting a shared brain system for self-projection. For ordinality judgement (self-reference), 52.5% of active voxels corresponded to the temporal domain specifically. Self-projection activity overlapped mostly with the frontoparietal control network, followed by the default mode network, while self-reference showed a reversed pattern, demonstrating MTT's implication in spontaneous brain activity. MTT may thus be regarded as a 'mental-experiential travel', with self-projection as a domain-general construct and self-reference related mostly to time. This article is part of the theme issue 'Elements of episodic memory: lessons from 40 years of research'.

Setting Expectations for Ethics Theory from the Standpoint of the User.

Ethics theory is highly valued to the point that some commentators have claimed that it has taken on a life of its own, with too much focus on the justification of moral judgment and not enough on the needs of users of such theory. Building from various personal experiences of interdisciplinary ethics collaborative developments and empirical research projects, the wisdom gleaned by others, as well as insights from pragmatist theory, this article offers five (non-exhaustive) expectations for ethics theory from the standpoint of a user. The article is intended to prompt broad reflection on expectations toward ethics theory and why user perspectives should be considered early in the development of ethics scholarship.

Moral Diversity for Medical Trainees.

While the proliferation of diversity, equity, and inclusion (DEI) initiatives among medical schools and residency training programs has provided important benefits of demographic and experiential diversity among medical trainees, there has not been a similar emphasis upon the importance of moral diversity in medical training. Enhanced attention to the importance of moral diversity and the centrality of conscience to medical practice might allow trainees to better interface with the morally diverse patients they serve, learn important virtues like humility, patience, and tolerance, and deepen their understanding of and appreciation for alternative moral viewpoints among their fellow practitioners.

Observers' motivated sensitivity to stigmatized actors' intent.

Does a harmful act appear more intentional-and worthy of opprobrium-if it was committed by a member of a stigmatized group? In two studies (N = 1,451), participants read scenarios in which an actor caused a homicide. We orthogonally manipulated the relative presence or absence of distal intent (a focus on the end) and proximal intent (a focus on the means) in the actor's mind. We also varied the actor's racial (Study 1) or political (Study 2) group. In both studies, participants judged the stigmatized actor more harshly than the non-stigmatized actor when the actor's level of intent was ambiguous (i.e., one form of intent was high and the other form of intent was low). These data suggest that observers apply a sliding threshold when judging an actor's intent and moral responsibility; whereas less-stigmatized actors elicit condemnation only when they cause the outcome with both types of intent in mind, more-stigmatized actors elicit condemnation when only one type, or even neither type (Study 2) of intent is in their mind. We discuss how these results enrich the literature on lay theories of intentionality.

Psychometric evaluation of a Spanish translation of the moral injury symptom scale for healthcare professionals.

BACKGROUND: Moral injury is prevalent among health care professionals, especially nurses. It can have negative personal consequences for clinicians, and indirectly impact the quality of patient care. Although nurses around the world experienced moral injury during the pandemic, it will continue to be a professional challenge. Thus, this study aimed to determine the psychometric properties of a scale measuring moral injury translated into Spanish. METHODS: A methodological study with a cross-sectional approach was conducted. After translating the Moral Injury Symptom Scale for Healthcare Professionals (MISS-HP) into Peruvian Spanish (MISS-HP-S) using International Test Commission methods, data were collected using online survey methods from a sample of 720 Peruvian nurses. Analytical methods included exploratory and confirmatory factor analysis, and invariance by age were examined. The corrected homogeneity index, ordinal alpha, and McDonald's omega allowed the evaluation of internal reliability. RESULTS: Findings from this sample of nurses who were mostly female (92%), from coastal Peru (57%), and averaged 39 (± 11) years of age, provided support for the validity and reliability of the MISS-HP-S. Structural validity was endorsed by findings indicating consistent factorial structure and adequate invariance among different age groups. In this study, three factors were observed: guilt/shame, condemnation, and spiritual strength. Internal consistency values included an ordinal alpha of 0.795 and McDonald's omega of 0.835. CONCLUSION: These findings differ from those reported from previous studies in other cultural contexts, suggesting the influence of cultural and sample-specific factors in the perception of moral injury among Peruvian nurses. Because this evidence supports the validity of the MISS-HP-S, it can be used in professional practice and in future research to identify and address situations that contribute to nurse moral injury.

Modular morals: Mapping the organization of the moral brain.

Is morality the product of multiple domain-specific psychological mechanisms, or one domain-general mechanism? Previous research suggests that morality consists of a range of solutions to the problems of cooperation recurrent in human social life. This theory of 'morality as cooperation' suggests that there are (at least) seven specific moral domains: family values, group loyalty, reciprocity, heroism, deference, fairness and property rights. However, it is unclear how these types of morality are implemented at the neuroanatomical level. The possibilities are that morality is (1) the product of multiple distinct domain-specific adaptations for cooperation, (2) the product of a single domain-general adaptation which learns a range of moral rules, or (3) the product of some combination of domain-specific and domain-general adaptations. To distinguish between these possibilities, we first conducted an anatomical likelihood estimation meta-analysis of previous studies investigating the relationship between these seven moral domains and neuroanatomy. This meta-analysis provided evidence for a combination of specific and general adaptations. Next, we investigated the relationship between the seven types of morality - as measured by the Morality as Cooperation Questionnaire (Relevance) - and grey matter volume in a large neuroimaging (n = 607) sample. No associations between moral values and grey matter volume survived whole-brain exploratory testing. We conclude that whatever combination of mechanisms are responsible for morality, either they are not neuroanatomically localised, or else their localisation is not manifested in grey matter volume. Future research should employ phylogenetically informed a priori predictions, as well as alternative measures of morality and of brain function.

"Working within broken systems": Social workers bridge the fractures of U.S. healthcare: A qualitative inquiry on moral injury.

Healthcare social workers (HSWs) in the United States are integral to interdisciplinary teams and health services. HSWs have a unique role in healthcare, as they care for their patients' psychosocial needs, through case management and clinical services. There is a gap in understanding how HSWs are impacted by their healthcare work. This study aims to understand the experience of moral injury, a marker of well-being, amongst HSWs in one state in the United States. Moral injury is the moral transgression (or boundary breaking) by oneself or someone in a position of power in high stakes situations and the negative outcomes of those experiences. Using a qualitative approach, semi-structured interviews were conducted with 24 HSWs in August of 2022. Thematic analysis was used to understand the lived experience of moral injury for HSWs. Three themes emerged: 1) HSWs' definition and examples of moral injury; 2) HSWs situated in the "in-between" of policy and practice; and 3) upholding social work values within the medical model. These findings impact healthcare practice and policy, in delineating what falls within the bounds of social work, changing the workflow of health services, and creating further opportunities for interdisciplinary training, well-being initiatives, and systems-level changes. The findings from this work highlight the importance of understanding the moral impact of healthcare work on social workers, which should be further examined in depth not only amongst HSWs but also across the healthcare workforce.