Evidências de validade da Escala RASH - Relação, Autonomia, Separação e Heteronomia em uma amostra de brasileiros e norte americanos / Evidenced of validity of the RASH Scale - Relation, Autonomy, Separation and Heteronomy in a sample of brazilians and north americans / Evidencias de validez de la Escala RASH - Relación, Autonomía, Separación y Heteronomía en una muestra de brasileños y norteamericanos

A Escala RASH (relação, autonomia, separação e heteronomia) foi desenvolvida para investigar padrões de self em estudos transculturais. No presente estudo, foi realizada uma análise fatorial da escala RASH em amostras brasileiras e norte-americanas, com o objetivo de fornecer uma medida de quatro fatores com bons índices de ajuste. Buscou-se confirmar o padrão de self autônomo-relacionado nas duas amostras e também a relação entre o nível de escolaridade dos pais e tipos de valores que desejam para seus filhos. Coletou-se dados de 756 participantes (EUA, n = 519, Brasil, n = 237), pais ou responsáveis por alunos de 7 a 14 anos. Foram realizadas análise fatorial exploratória e confirmatória, medidas de invariância e estatísticas básicas como média, desvio padrão e correlação. Os resultados corroboram uma estrutura de quatro fatores do instrumento e os padrões autorrelatados nas duas culturas. O instrumento pode auxiliar em pesquisas transculturais sobre o desenvolvimento de valores e captar diferenças entre culturas.(AU)

The RASH scale (which stands for relation, autonomy, separation, and heteronomy) was developed to investigate patterns of self in cross-cultural studies. In the present study, a factor analysis of the RASH scale was conducted in Brazilian and North American samples, with the aim of providing a four-factor measure with good fit indices. The aim was to confirm the pattern of autonomous-relational self in the two samples and also the relationship among the parents' level of education and the types of values they want for their children. We collected data from 756 participants (n = 519, USA; n = 237, Brazil), parents or guardians of students aged 7 to 14 years. Exploratory and confirmatory factor analyses, invariance measures and basic statistics such as mean, standard deviation, and correlation were performed. The results confirmed the four-factor structure of the instrument and self-reported patterns in the two cultures. The instrument can help in cross-cultural research on the development of values and capture differences between cultures.(AU)

La escala RASH (relación, autonomía, separación y heteronomía) se desarrolló para investigar patrones del self en estudios transculturales. En el presente estudio, se realizó una validación de la escala RASH en muestras brasileñas y norteamericanas, con el objetivo de proporcionar una medida de cuatro factores con buenos índices de ajuste. Se buscó confirmar el patrón de self autónomo-relacionado en ambas muestras, así como la relación entre el nivel educativo de los padres y los tipos de valores que desean para sus hijos. Se recopilaron datos de 756 participantes (n = 519 en EE. UU.; N = 237 en Brasil), padres o tutores de estudiantes de 7 a 14 años. Se llevaron a cabo análisis factoriales exploratorios y confirmatorios, seguidos de medidas de invarianza y cálculos de estadísticas básicas como media, desviación estándar y correlación. Los resultados respaldaron la estructura de cuatro factores del instrumento y los patrones autoinformados en ambas culturas. El instrumento puede ser útil para investigaciones interculturales sobre el desarrollo de valores y para capturar las diferencias entre culturas.(AU)

The effect and comparison of training in ethical decision-making through lectures and group discussions on moral reasoning, moral distress and moral sensitivity in nurses: a clinical randomized controlled trial.

BACKGROUND: Ethical decision­making and behavior of nurses are major factors that can affect the quality of nursing care. Moral development of nurses to making better ethical decision-making is an essential element for managing the care process. The main aim of this study was to examine and comparison the effect of training in ethical decision-making through lectures and group discussions on nurses' moral reasoning, moral distress and moral sensitivity. METHODS: In this randomized clinical trial study with a pre- and post-test design, 66 nurses with moral reasoning scores lower than the average of the community were randomly assigned into three equal groups (n = 22) including two experimental groups and one control group. Ethical decision-making training to experimental groups was provided through the lectures and group discussions. While, the control group did not receive any training. Data were collected using sociodemographic questionnaire, the nursing dilemma test (NDT), the moral distress scale (MDS) and the moral sensitivity questionnaire (MSQ). Unadjusted and adjusted binary logistic regression analysis was reported using the odds ratio (OR) and 95% confidence intervals. RESULTS: Adjusted regression analysis showed that the probability of increasing the nursing principle thinking (NPT) score through discussion training was significantly higher than lecture (OR: 13.078, 95% CI: 3.238-15.954, P = 0.008), as well as lecture (OR: 14.329, 95% CI: 16.171-2.005, P < 0.001) and discussion groups compared to the control group (OR: 18.01, 95% CI: 22.15-5.834, P < 0.001). The possibility of increasing moral sensitivity score through discussion training was significantly higher than lecture (OR: 10.874, 95%CI: 6.043-12.886, P = 0.005) and control group (OR: 13.077, 95%CI: 8.454-16.774, P = 0.002). Moreover, the moral distress score was significantly reduced only in the trained group compared to the control, and no significant difference was observed between the experimental groups; lecture group vs. control group (OR: 0.105, 95% CI: 0.015-0.717, P = 0.021) and discussion group vs. control group (OR: 0.089, 95% CI: 0.015-0.547, P = 0.009). CONCLUSIONS: The results of this study indicate that ethical decision-making training is effective on empowerment of ethical reasoning. Whereas the group discussion was also effective on increasing the ethical sensitivity, it is recommended the training plan provided in this study to be held as workshop for all nurses in health and treatment centers and placed in curricular plan of nursing students. REGISTRATION: This randomized clinical trial was registered in Iranian Registry of Clinical Trials under code (IRCT2015122116163N5) in 02/07/2016.

Measuring moral development in the pharmacy profession from undergraduate to established practitioner: a decadal longitudinal study.

The aim of this study is to measure and evaluate the moral reasoning of undergraduate pharmacy students as they progress through a British university, and onward through the early years of their professional practice. This study utilizes version 2 of Rest's Defining Issues Test in a longitudinal design, evaluating a single cohort of future pharmacists, which started a 4-year Master of Pharmacy degree program in 2008-09, completed their preregistration training, and progressed through their early careers. The final dataset was collected in 2019. Both descriptive and inferential statistical analysis was subsequently carried out. The cohort experienced significant moral growth during the 4 years of their undergraduate degree, where they were exposed to an ethical education designed to engage students at the "plus one" level of moral reasoning. There is also evidence for work-based augmentation of moral development between graduation from university and qualification as pharmacists. The subjects underwent a marked increase in moral development as they progressed through their undergraduate studies, followed by another sizeable, though not statistically significant developmental progression during the preregistration year. The retrograde step in moral development observed between newly qualified level and established practitioner level requires further investigation: structured interviews with participants, which focus on changes to their experiences in practice and how these affected their moral agency are already underway.

Human infants are aroused and concerned by moral transgressions.

Humans reason and care about ethical issues, such as avoiding unnecessary harm. But what enables us to develop a moral capacity? This question dates back at least to ancient Greece and typically results in the traditional opposition between sentimentalism (the view that morality is mainly driven by socioaffective processes) and rationalism [the view that morality is mainly driven by (socio)cognitive processes or reason]. Here, we used multiple methods (eye-tracking and observations of expressive behaviors) to assess the role of both cognitive and socioaffective processes in infants' developing morality. We capitalized on the distinction between moral (e.g., harmful) and conventional (e.g., harmless) transgressions to investigate whether 18-mo-old infants understand actions as distinctively moral as opposed to merely disobedient or unexpected. All infants watched the same social scene, but based on prior verbal interactions, an actor's tearing apart of a picture (an act not intrinsically harmful) with a tool constituted either a conventional (wrong tool), a moral (producing harm), or no violation (correct tool). Infants' anticipatory looks differentiated between conventional and no violation conditions, suggesting that they processed the verbal interactions and built corresponding expectations. Importantly, infants showed a larger increase in pupil size (physiological arousal), and more expressions indicating empathic concern, in response to a moral than to a conventional violation. Thus, infants differentiated between harmful and harmless transgressions based solely on prior verbal interactions. Together, these convergent findings suggest that human infants' moral development is fostered by both sociocognitive (inferring harm) and socioaffective processes (empathic concern for others' welfare).

How the COVID-19 pandemic affects the moral reasoning of pediatric residents and the general population.

BACKGROUND: Kohlberg's theory of moral development asserts that people progress through different stages of moral reasoning as their cognitive abilities and social interactions mature. Individuals at the lowest stage of moral reasoning (preconventional stage) judge moral issues based on self-interest, those with a medium stage (conventional stage) judge them based on compliance with rules and norms, and those at the highest stage (postconventional stage) judge moral issues based on universal principles and shared ideals. Upon attaining adulthood, it can be considered that there is stability in the stage of individuals' moral development; however, the effect of a global population crisis such as the one experienced in March 2020, when the World Health Organization (WHO) declared the COVID-19 pandemic, is unknown. The purpose of this study was to evaluate the changes in the moral reasoning of pediatric residents before and after one year of the COVID-19 pandemic and compare them with a general population group. METHODS: This is a naturalistic quasi-experimental study conducted with two groups, one comprised 47 pediatric residents of a tertiary hospital converted into a COVID hospital during the pandemic and another group comprised 47 beneficiaries of a family clinic who were not health workers. The defining issues test (DIT) was applied to the 94 participants during March 2020, before the pandemic initiated in Mexico, and later during March 2021. To assess intragroup changes, the McNemar-Bowker and Wilcoxon tests were used. RESULTS: Pediatric residents showed higher baseline stages of moral reasoning: 53% in the postconventional group compared to the general population group (7%). In the preconventional group, 23% were residents and 64% belonged to the general population. In the second measurement, one year after the start of the pandemic, the group of residents had a significant decrease of 13 points in the P index, unlike the general population group in which a decrease of 3 points was observed. This decrease however, did not equalize baseline stages. Pediatric residents remained 10 points higher than the general population group. Moral reasoning stages were associated with age and educational stage. CONCLUSIONS: After a year of the COVID-19 pandemic, we found a decrease in the stage of moral reasoning development in pediatric residents of a hospital converted for the care of patients with COVID-19, while it remained stable in the general population group. Physicians showed higher stages of moral reasoning at baseline than the general population.

Piagetian's principles on moral development and its influence on the oral hygiene practices of Indian children: An embedded mixed-method approach.

BACKGROUND: Moral principles in children can influence their oral hygiene practices and can be beneficial in providing better oral health care. AIM: To assess the consistency of Piaget's moral development principles in Indian children aged 7 to 11 years and evaluate its influence on their oral hygiene practices. DESIGN: The first phase of the embedded mixed-method approach included telephone interviews of 50 children on eight situations of moral development as suggested by Jean Piaget. Children were categorised into heteronomous and autonomous moralities based on the content analysis. The second phase of the study included a semi-structured qualitative interview on knowledge and practice behaviour of children on oral hygiene maintenance. RESULTS: There was no significant difference in the overall moral development of children aged 7 to 9 years and 9 to 11 years (p = .57). Only 4.8% of girls had heteronomous morality, and a significant difference was noted between boys and girls (p = .014). There was a significant difference in the oral hygiene practices observed between heteronomous morality and autonomous morality children. CONCLUSION: Children were autonomous in their morality at 7 to 9 years of age. Children with autonomous morality performed better oral hygiene practices than children with heteronomous morality.

Making psychiatry moral again: the role of psychiatry in patient moral development.

Psychiatric involvement in patient morality is controversial. If psychiatrists are tasked with shaping patient morality, the coercive potential of psychiatry is increased, treatment may be unfairly administered on the basis of patients' moral beliefs rather than medical need, moral disputes could damage the therapeutic relationship and, in any case, we are often uncertain or conflicted about what is morally right. Yet, there is also a strong case for the view that psychiatry often works through improving patient morality and, therefore, should aim to do so. Our goal is to offer a practical and ethical path through this conflict. We argue that the default psychiatric approach to patient morality should be procedural, whereby patients are helped to express their own moral beliefs. Such a procedural approach avoids the brunt of objections to psychiatric involvement in patient morality. However, in a small subset of cases where patients' moral beliefs are sufficiently distorted or underdeveloped, we claim that psychiatrists should move to a substantive approach and shape the content of those beliefs when they are relevant to psychiatric outcomes. The substantive approach is prone to the above objections but we argue it is nevertheless justified in this subset of cases.

Fair sharing is just caring: Links between justice sensitivity and distributive behavior in middle childhood.

Justice sensitivity (JS), the tendency to perceive and adversely respond to injustice, was related to prosocial behavior in different age groups and to distributive preferences in adults. To test influences of JS on sharing and distributive preferences, middle childhood as an important phase for moral development may be particularly interesting. We asked 1320 5- to 12-year-old children (M = 8.05 years, SD = 1.02; 51.2 % girls, 1.3 % transgender and gender-nonconforming) to read five vignettes that made salient the different principles of distributive justice (equality, merit, and need) and to distribute imaginary sweets between themselves and one described child (sharing) or between two described children (distributing). Children also rated their JS, and parents rated children's theory of mind (ToM) abilities and empathy. More concerns for justice for the self (victim JS) predicted distributions following the merit principle and a preference for need over equality and merit when forced to choose among the three. Caring for justice for others (altruistic JS) predicted more sharing, equal distributions, less distributions according to the merit principle, and a preference for equal distributions over merit and need when forced to choose among the three. These associations prevailed when ToM and empathy were included as control variables. The findings underline the importance of justice-related personality traits, such as JS, for moral development in middle childhood.

Telas na infância: postagens de especialistas em grupos de cuidadores no facebook / Screens in childhood: posts of specialists in caretakers' groups in the facebook / Pantallas en la infancia: las publicaciones de expertos en grupos de cuidadores en facebook

Apesar das crescentes investigações sobre uso de telas na infância, essa é uma temática complexa e ainda recente, que traz diversos desafios para pesquisadores e cuidadores. Comunidades virtuais em redes sociais são utilizadas por mães e pais para esclarecer dúvidas e receber conselhos acerca da parentalidade e saúde infantil, podendo, simultaneamente, assumir uma função prescritiva e normativa quanto ao seu modo de agir. Sendo assim, este artigo pretende compreender como o uso de telas na infância vem sendo abordado por especialistas em grupos de mães e pais no Facebook. Foi realizado um estudo qualitativo envolvendo 49 postagens de especialistas, sobretudo psicólogos e educadores, extraídas de cinco grupos públicos de mães e pais nessa rede social. Os textos das publicações foram verificados por meio de análise temática e discutidos com base no referencial teórico psicanalítico. Os resultados mostraram que os especialistas destacam os possíveis prejuízos do uso de telas na infância, além de fornecer orientações aos pais sobre como lidar com sua presença no cotidiano das crianças e de suas famílias. Concluiu-se que apesar dos grupos de cuidadores no Facebook serem uma ferramenta de divulgação de informações acerca do uso de telas na infância, cabe não naturalizar a presença de especialistas nesses espaços virtuais criados por pais e mães, interpondo-se nos saberes e nas trocas horizontalizadas entre os cuidadores.(AU)

Although investigations on the use of screens in childhood are increasing, this is a complex and recent topic, which poses several challenges for researchers and caregivers. Virtual communities in social networks are used by mothers and fathers to clarify doubts and receive advice regarding parenting and child health, at times, simultaneously, assuming a prescriptive and normative role on their way of acting. Therefore, this study aimed to understand how the use of screens in childhood has been approached by experts in groups of mothers and fathers on Facebook. A qualitative study was carried out involving 49 posts from specialists, mainly psychologists and educators, extracted from five public groups of mothers and fathers in this social network. The publications' texts were verified via thematic analysis and discussed based on the psychoanalytical theoretical framework. The results showed that experts highlight the possible damage of the use of screens in childhood, in addition to providing guidance to parents on how to deal with the presence of digital technology in the daily lives of children and families. It was concluded that, although caregivers' groups on Facebook are a tool for disseminating information about the use of screens in childhood, it is important not to naturalize the presence of specialists in these virtual spaces created by fathers and mothers, interposing in the horizontally interchanges that occur between the caregivers.(AU)

A pesar de las crecientes investigaciones sobre el uso de pantallas en la infancia, este es un tema complejo y aún reciente, que plantea varios desafíos para investigadores y cuidadores. Las comunidades virtuales en las redes sociales son utilizadas por madres y padres para aclarar dudas y recibir consejos sobre educación y salud infantil, pudiendo, al mismo tiempo, asumir un rol prescriptivo y normativo sobre su forma de actuar. Por lo tanto, este estudio tuvo como objetivo comprender cómo el uso de las pantallas en la infancia ha sido abordado por especialistas en grupos de madres y padres en Facebook. Se realizó un estudio cualitativo a partir de 49 publicaciones de especialistas, principalmente de psicólogos y educadores, extraídas de cinco grupos públicos de madres y padres en esta red social. Se realizó en los textos de las publicaciones un análisis temático y se utilizó el marco teórico psicoanalítico. Los resultados mostraron que los expertos destacan posibles daños que provoca el uso de pantallas en la infancia, además de orientar a los padres sobre cómo afrontar esta presencia de la tecnología digital en el día a día de los niños y sus familias. Se concluyó que, a pesar de que los grupos de cuidadores en Facebook son una herramienta de difusión de información sobre el uso de pantallas en la infancia, es importante no naturalizar la presencia de especialistas en estos espacios virtuales creados por padres y madres que se interpone entre los saberes e intercambios horizontales de los cuidadores.(AU)

Um capítulo esquecido na história da psicologia? sexualidades desviantes, psicopatologia e normalidade / A forgotten chapter in the history of psychology? deviant sexualities, psychopathology, and normality / ¿Un capítulo olvidado en la historia de la psicología? sexualidades desviadas, psicopatología y normalidad

Este artigo tem como objetivo produzir uma análise histórica sobre as intersecções entre Psicologia e sexualidade desviantes da norma no Brasil, de fins do século XIX a meados da década de 1980. Esta temporalidade foi escolhida por abarcar o surgimento das pesquisas científicas sobre sexualidade e desvios sexuais, a consolidação dos estudos psicológicos sobre a temática e o processo mais recente de despatologização da homossexualidade. Em termos teóricos e metodológicos, foram adotados os pressupostos da História Social da Psicologia e da historiografia das homossexualidades no Brasil. Desse modo, buscou-se compreender como as ideias, concepções e práticas psicológicas foram mudando ao longo do tempo, em conexão com as transformações socioculturais e políticas que ocorreram durante o século XX. Para isto, foram utilizadas fontes primárias e secundárias de pesquisa com vistas à produção de interpretações sobre as conexões entre as ideias, os atores e os eventos narrados. Argumenta-se, ao longo do artigo, que as ideias e práticas psicológicas estão intrinsecamente conectadas aos contextos socioculturais e políticos de seu tempo, sendo os movimentos dinâmicos e os conflitos presentes nesses contextos fatores determinantes para a sua constituição.(AU)

This article aims to produce a historical analysis of the intersections between Psychology and sexualities that deviate from the norm in Brazil, from the late 19th century to the mid-1980s. This period was chosen because it encompasses the emergence of scientific research on sexuality and sexual deviations, the consolidation of psychological studies on the subject and the most recent process of de-pathologization of homosexuality. Theoretically and methodologically, the assumptions of the Social History of Psychology and the historiography of homosexualities in Brazil were adopted. Therefore, we sought to understand how psychological ideas, conceptions and practices have changed over time, in connection with the sociocultural and political transformations that occurred throughout the 20th century. For this, primary and secondary sources of research were used to produce interpretations about the connections between the ideas, the actors and the narrated events. It is argued, throughout the article, that the psychological ideas and practices are intrinsically connected to the sociocultural and political contexts of their time, being the dynamic movements and conflicts present in these contexts determining factors for their constitution.(AU)

Este artículo tiene como objetivo realizar un análisis histórico de las intersecciones entre la Psicología y las sexualidades desviadas de la norma en Brasil desde finales del siglo XIX hasta mediados de la década de 1980. Esta temporalidad fue elegida por abarcar el surgimiento de las investigaciones científicas sobre sexualidad y desvíos sexuales, la consolidación de los estudios psicológicos sobre el tema y el más reciente proceso de despatologización de la homosexualidad. En el marco teórico y metodológico, se adoptaron los presupuestos de la Historia Social de la Psicología y de la historiografía de las homosexualidades en Brasil. De esta manera, se pretende comprender cómo las ideas, concepciones y prácticas psicológicas han cambiado a lo largo del tiempo, en conexión con las transformaciones socioculturales y políticas ocurridas durante el siglo XX. Para ello, se utilizaron las fuentes de investigación primarias y secundarias con miras a generar interpretaciones sobre las conexiones entre las ideas, los actores y los eventos narrados. Se argumenta, a lo largo de este artículo, que las ideas y las prácticas psicológicas están intrínsecamente conectadas a los contextos socioculturales y políticos de su tiempo, y los movimientos dinámicos y los conflictos presentes en estos contextos fueron los factores determinantes para su constitución.(AU)

Resolução de conflitos familiares por adolescentes e defesa do domínio pessoal / Adolescents' family conflict resolution and defense of personal domain / Resolución de conflictos familiares por adolescentes y defensa del dominio personal

Compreender as estratégias de resolução de conflitos utilizadas por adolescentes na relação com seus pais é fundamental para entender como ocorre seu desenvolvimento saudável. Este artigo investigou a resolução de conflitos de adolescentes em situações de confronto entre o seu domínio pessoal e o controle parental. 36 adolescentes com idades entre 15 e 17 anos, divididos igualmente conforme o sexo, responderam a uma entrevista semiestruturada, que continha quatro situações de conflito hipotéticas. Os dados foram submetidos à análise de conteúdo semântica e a testes não paramétricos. Os resultados foram categorizados em sete estratégias: Assunção de culpa, Submissão, Mentira, Hostilidade, Diálogo/Explicação, Negociação e Outra. A forma predominante de resolução utilizada foi o Diálogo/Explicação, considerada como uma forma recorrente de defender o domínio pessoal. Foram encontradas diferenças em relação ao sexo dos participantes e à situação hipotética. Por fim, os resultados são discutidos em termos de grau de autonomia e tipo de defesa do domínio pessoal.(AU)

Understanding the conflict resolution strategies used by adolescents in their relationship with their parents is fundamental to understanding how their healthy development occurs. This article investigated the resolution of conflicts by adolescents in confrontation situations between their personal domain and parental control. A total of 36 adolescents, aged 15 to 17 years, divided equally according to sex, answered a semi-structured interview that contained four hypothetical conflict situations. Data were subjected to semantic content analysis and non-parametric tests. The results were categorized into seven strategies: Assumption of Guilt, Submission, Lie, Hostility, Dialogue/Explanation, Negotiation, and Other. The predominant form of resolution used was Dialogue/Explanation, considered a recurrent form of defense of the personal domain. Differences were found depending on the participants' gender and the hypothetical situation. Finally, the results are discussed regarding the degree of autonomy and type of defense of the personal domain.(AU)

Enterarse de las estrategias de resolución de conflictos que los adolescentes utilizan en la relación con sus padres es fundamental para comprender cómo ocurre el desarrollo saludable de los adolescentes. A partir de una entrevista semiestructurada, presentamos cuatro situaciones hipotéticas de conflicto que fueron analizadas y respondidas por 36 adolescentes de entre 15 y 17 años, divididos según el género. Los datos se sometieron a un análisis de contenido semántico y a pruebas no paramétricas. Los resultados se categorizaron en siete estrategias de resolución de conflictos: Asunción de culpa, Sumisión, Mentira, Hostilidad, Diálogo/Explicación, Negociación y Otros. La forma de resolución más utilizada fue Diálogo/Explicación, y esta categoría fue una forma de defensa del dominio personal. Asimismo, se encontraron diferencias en función del género de los participantes y conforme la situación hipotética. Los resultados se discuten en términos de grado de autonomía y tipo de defensa del dominio personal.(AU)

Links Between Adolescents' Moral Mindsets and Narratives of their Inconsistent and Consistent Moral Value Experiences.

Past work on moral mindsets has largely overlooked the adolescent developmental period, a time when adolescents are navigating the complexities of moral life and experiencing tensions between important moral principles and their own actions. This study investigated how moral incrementalism and essentialism are linked to how adolescents construct meanings about their moral experiences. The sample included 96 Canadian adolescents (12-15-years of age; M = 13.5 years). Adolescents generated written narratives of times when they acted inconsistently and consistently with a moral value, and completed a vignette-based measure of moral mindsets. Moral incrementalism was associated with references to the psychological and emotional facets of experiences and engaging in meaning-making processes in narratives. Adolescents who endorsed incrementalism disengaged less only when narrating a self-discrepant experience, indicating some context-specificity across moral event types. Overall, results contribute to scholarship on moral mindset and narrative identity construction. Findings illuminate how individual differences in youth's views of moral traits and behavior may be associated with important aspects of moral identity development such as delving into the psychological and emotional aspects of their experiences and engaging in meaning-making processes.

Competência moral e formação médica na contemporaneidade: estudo brasileiro / Moral competence and medical education in contemporary times: a Brazilian study / Competencia moral y educación médica en la contemporaneidad: un estudio brasileño

Resumo A fim de avaliar a competência moral de estudantes de medicina, este artigo compara diferentes momentos do curso, identificando aspectos sociodemográficos e acadêmicos relacionados a essa competência e discutindo a ferramenta de avaliação. Trata-se de estudo quantitativo observacional transversal, com aplicação da versão estendida do Teste de Competência Moral, de Lind, e questionário sociodemográfico-acadêmico. Identificaram-se escores médios baixos nos períodos avaliados - com média do primeiro período superior aos demais - e comportamento destoante do "dilema do médico" em relação aos demais, independentemente do período. Detectaram-se escores de competência moral baixos em todos os períodos avaliados, com declínio ou estagnação no decorrer do curso e "fenômeno de segmentação" do teste, e não se identificou correlação relevante das variáveis sociodemográficas e acadêmicas. Por fim constatou-se que escores dos períodos iniciais inferiores aos descritos na literatura prévia podem sugerir tendência geracional.

Abstract To evaluate the moral competence of medical students, this article compares different moments of medical training, identifying sociodemographic and academic aspects related to this competence, then discussing the evaluation tool. This is a quantitative, cross-sectional and observational study, with application of the extended version of Lind's Moral Competence Test and a socio-demographic and academic questionnaire. Low mean scores were identified in the periods evaluated—the first period's mean was higher than the others—and behavior that deviates from the "physician's dilemma" in relation to the others, regardless of the period. Low moral competency scores were detected in all periods evaluated, with decline or stagnation over the course and "segmentation phenomenon" of the test. No relevant correlation of sociodemographic and academic variables was identified. Finally, this study found scores for the initial periods lower than those described in the literature, suggesting a generational trend.

Resumen Este artículo evalúa la competencia moral de estudiantes de medicina desde comparaciones de diferentes momentos del curso, identificando los aspectos sociodemográficos y académicos y discutiendo el instrumento de evaluación. Este estudio es cuantitativo observacional, transversal, que aplicó la versión extendida de la Prueba de Competencia Moral, de Lind, y el cuestionario sociodemográfico y académico. Se identificaron las puntuaciones medias bajas en los períodos evaluados -un promedio del primer período superior a los demás- y los comportamientos que diferían del "dilema del médico" con relación a los demás, independientemente del período. Resultaron bajas las puntuaciones de la competencia moral en todos los períodos evaluados, con descenso o estancamiento durante el curso y un "fenómeno de segmentación" de la prueba, además, no hubo correlación significativa entre las variables sociodemográficas y académicas. Las puntuaciones de los períodos iniciales fueron más bajas a las descritas en la literatura, lo que supone una tendencia generacional.

Educar para a bioética: desafio em enfermagem / Educating for bioethics: a challenge in nursing / Educar en bioética: desafío en la enfermería

Resumo Educar para a bioética é um desafio na atualidade. Ainda maior se torna este desafio, quando pensamos no ensino da bioética a estudantes de enfermagem, que irão desempenhar uma profissão que tem como expoente máximo o cuidar da outra pessoa. Tratando-se de uma profissão que implica a relação com o outro e a prestação de cuidados humanizados e adequados a cada situação específica, torna-se importante desenvolver ferramentas de ensino que promovam não só o desenvolvimento técnico e o conhecimento de como fazer, mas essencialmente o desenvolvimento de competências morais, pessoais e profissionais que conduzam a cuidados de saúde de excelência. Este artigo pretende apresentar uma reflexão sobre o ensino da bioética e a sua relação com o desenvolvimento da competência moral dos estudantes de enfermagem, assim como sugerir algumas estratégias no ensino da Bioética que potenciem a formação de enfermeiros cada vez mais competentes.

Abstract Educating for bioethics is a challenge today. This challenge is even greater when we think of the teaching of bioethics to nursing students, who will perform a profession that has as its maximum target the care of other people. Because it is a profession that implies the relationship with the other and the provision of humanized and appropriate care to each situation, it is important to develop teaching tools that promote not only technical improvement and knowledge of how to do a task, but also the development of moral, personal and professional skills that lead to excellent health care. This article presents a reflection on the teaching of bioethics and its relationship with the development of moral competence of nursing students, suggesting some strategies that enhance the teaching of bioethics and the education of increasingly competent nurses.

Resumen Educar en bioética es un desafío en la actualidad. Esto se vuelve más grande cuando pensamos en la enseñanza de bioética a estudiantes de enfermería, quienes desempeñarán una profesión que tiene la máxima expresión la asistencia a las personas. Por ser una profesión que involucra la relación con el otro y la prestación de una asistencia humanizada y adecuada a cada situación específica, es importante desarrollar herramientas didácticas que promuevan no solo el desarrollo técnico y el conocimiento de cómo hacerlo, sino fundamentalmente el desarrollo de competencias morales, personales y profesionales que promuevan una excelente atención en salud. Este artículo reflexiona sobre la enseñanza de la bioética y su relación con el desarrollo de la competencia moral de los estudiantes de enfermería, así como sugiere algunas estrategias para la enseñanza de la Bioética que promueva una formación de profesionales cada vez más competentes.

Differences in moral reasoning among medical graduates, graduates with other degrees, and nonprofessional adults.

BACKGROUND: Reasoning and moral action are necessary to resolve day-to-day moral conflicts, and there are certain professions where a greater moral character is expected, e.g., medicine. Thus, it is desirable that medical students develop skills in this field. Some studies have evaluated the level of moral reasoning among medical students; however, there are no comparative studies involving other types of populations. Therefore, the objective of this study was to compare the moral reasoning among medical graduates with that of a group of young graduates with other degrees and of a group of nonprofessional adults. METHODS: An exploratory cross-sectional study was conducted. Pediatric residents and pediatric subspecialty residents at a pediatric hospital were invited to participate, forming the group of "medical graduates". A group of young people from a social program and students with a master's degree in a science from the same pediatric hospital were also invited to participate, comprising the group of "graduates with other degrees". Finally, a group of beneficiaries of a family clinic was invited to participate, which we categorized as "nonprofessionals". To evaluate the differences in moral reasoning between these 3 groups, we applied the Defining Issues Test (DIT), a moral reasoning questionnaire designed by James Rest using Kohlberg's theory of moral development. RESULTS: The moral reasoning of 237 subjects-88 from the "medical graduates" group, 82 from the "graduates with other degrees" group and 67 from the "nonprofessionals" group- was evaluated. We found differences in the profiles of moral development of the groups. The profile of the "nonprofessionals" showed a very high predominance of subjects at the preconventional level, 70%, but only 4.5% at the postconventional level. Among the "medical graduates", we observed 37.5% at the preconventional level and 34% at the postconventional level (X2 p < 0.001); this group had the highest percentage in this category. This large difference could be because the differences in the ages and socioeducational levels of nonprofessionals are much wider than those among medical graduates. However, significant differences were also found when the profiles of medical graduates were compared with those of graduates with other degrees, since the latter demonstrated 56% at the preconventional level and 18% at the postconventional level (X2 test, p = 0.02). CONCLUSIONS: Significant differences were found in moral reasoning among the groups that we evaluated. Among the group of medical graduates, there was a higher percentage of subjects at the postconventional level than among the group of graduates with other degrees and a much higher percentage than among the group of nonprofessionals. Our conclusions give the first evidence that studying medicine seems to influence the development of moral reasoning in its students. Therefore, we consider it relevant to develop educational strategies where the student is involved in simulated but realistic decision-making situations, where there are moral dilemmas to resolve from their early years of training.

Disagreement, justification, and equitable moral judgments: A brief training study.

Although theorists agree that social interactions play a major role in moral development, previous research has not experimentally assessed how specific features of social interactions affect children's moral judgments and reasoning. The current study assessed two features: disagreement and justification. In a brief training phase, children aged 4-5.5 years (N = 129) discussed simple moral scenarios about issues of fairness (how to allocate things between individuals) with a puppet who, in a between-participants factorial design, either agreed or disagreed with the children's ideas and either asked or did not ask the children to justify their ideas. Children then responded to another set of moral scenarios in a test phase that was the same for all children. Children in the "agree and do not justify" baseline condition showed an inflexible equality bias (preferring only equal allocations regardless of context), but children who had experiences of disagreement or experiences of being asked to justify themselves shifted toward making equitable decisions based on common ground norms and values. Furthermore, false belief competence was related to children's decisions and justifications. These findings support the classic Piagetian hypothesis that social interactions are a catalyst of cognitive disequilibrium and moral development.

False belief understanding and moral judgment in young children.

Although the influence of intent understanding on children's moral development has been long studied, little research has examined the influence of belief understanding on that development. In two studies we presented children with morally relevant belief vignettes to examine the extent to which they incorporate both intent and belief information in their moral judgments. In Study 1 (N = 64), 5-year-olds with higher false belief understanding (FBU) rated agents with false beliefs as more positively intentioned in good intent trials (even though the outcome was bad) than in bad intent trials (even though the outcome was good). In contrast, 4-year-olds with higher FBU were generally unable to integrate their belief understanding with their moral evaluations, performing no better on intention questions than children with lower FBU. Neither age group significantly differentiated reward and punishments as a function of intent when a false belief was involved. In Study 2 (N = 109 children, N = 42 adults), we found that by simplifying our study design and reducing the task demands, 4-year-olds with higher FBU were able to make appropriate intent judgments. Yet, as in Study 1, all children had difficulty assigning punishment/reward based on intent. For both moral intentions and moral consequences, 4- and 5-year-olds with higher FBU differed from those of adults in several respects, indicating that moral reasoning develops substantially beyond the preschool years. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

From distress to detachment: exploring how providing care for stigmatized patients influences the moral development of medical trainees.

In acute hospital settings, medical trainees are often confronted with moral challenges and negative emotions when caring for complex and structurally vulnerable patients. These challenges may influence the long term moral development of medical trainees and have significant implications for future clinical practice. Despite the importance of moral development to medical education, the topic is still relatively under-explored. To gain a deeper understanding of moral development in trainees, we conducted a qualitative exploration of how caring for a stigmatized population influences their moral development. Data were collected from 48 medical trainees, including observational field notes, supplemental interviews, and medical documentation from inpatient units of two urban teaching hospitals in a Canadian context. Utilizing a practice-based approach which draws on constructivist grounded theory, we conducted constant comparative coding and analysis. We found that caring for stigmatized populations appeared to trigger frustration in medical trainees, which often perpetuated feelings of futility as well as avoidance behaviours. Additionally, hospital policies, the physical learning environment, variability in supervisory practices, and perceptions of judgment and mistrust all negatively influenced moral development and contributed to apathy and moral detachment which has implications for the future. Recognizing the dynamic and uncertain nature of care for stigmatized patients, and addressing the influence of structural and material factors provide an opportunity to support moral experiences within clinical training, and to improve inequities.

Fostering Nursing Students' Moral Decision-Making Through Use of an Affective Learning Module.

BACKGROUND: The emphasis on disciplinary and preventive approaches to combating academic misconduct does little to foster student professional identity and core nursing value formation. PROBLEM: There is a need for pedagogy designed to navigate moral decision-making within ambiguous areas of practice as nursing students integrate personal and professional values while becoming a nurse. APPROACH: Rest's theory of moral development offers a framework for constructing purposeful affective learning activities that operationalize moral sensitivity, judgment, motivation, and character, whereas Krathwohl's theory provides a means to identify affective learning objectives. Offering prelicensure nursing students an opportunity to discuss, reflect on, and consider actions and consequences associated with academic and practice-based situations forms the basis for this affective learning module that fosters connections between academic and professional behaviors of integrity. CONCLUSION: Rest's theoretical model provides a viable structured approach to moral development. Curriculum designed to engage moral decision-making offers an innovative approach to cultivating student integrity.

Distinctions between moral and conventional judgments from early to middle childhood: A meta-analysis of social domain theory research.

Understanding distinctions between morality and conventions is an important milestone in children's moral development. The current meta-analysis integrated decades of social domain theory research (Smetana, 2006; Turiel, 1983) on moral and conventional judgments from early to middle childhood. We examined 95 effect sizes from 18 studies (2,707 children; Mage = 7.30 years; 51% females; 42% Whites). Along with these, effects from additional 28 studies were estimated with imputed correlations in a secondary analysis of 248 effect sizes from 46 studies (4,469 children; Mage = 7.34 years; 46% females; 32% Whites). Across all judgments, moral/conventional distinction effects were significant, positive, and moderate. Consistent with social domain theory definitions of morality, children evaluated moral transgressions as more wrong independent of authorities' commands or rules than conventional transgressions and moral rules as more generalizable and inalterable than conventional rules. Moral transgressions also were seen as more unacceptable and more deserving of punishment than conventional transgressions. The aggregated effects were also significant for each type of judgment. However, effects were stronger for criteria considered definitional of the domains than for acceptability or punishment judgments, which are not considered criteria. Moreover, children made greater domain distinctions with age across all types of judgments. When examined separately, age moderated effects only for criterion judgments, not for acceptability or punishment judgments. Effects for distinctions also were moderated by the types of moral and conventional rules assessed. Thus, moral/conventional distinctions were found across early and middle childhood, but there was variability in children's developing understanding. (PsycInfo Database Record (c) 2022 APA, all rights reserved).