Maintaining Moral Sensitivity as an Inevitable Necessity in the Nursing Profession

To Editor,

Nursing is a discipline mixed with science, art and ethics. Nursing is not solely limited to technical skill and knowledge. Ethical values, believes, and orientations of nurses have a key role in judging and deciding in clinical environment. According to Lützén et al ethical decision-making comprises four components: (1) moral sensitivity; (2) moral judgment; (3) moral motivation; and (4) moral character. Of these four components, moral sensitivity is the most important, since it enables nurses to identify ethical problems in providing patient care, to make the most ethical decision and to achieve ethical sensitivity.¹

Lützén et al described Moral sensitivity as a contextual, intuitive grasp of the patients’ vulnerable status and an awareness of the moral repercussions of decisions made on their behalf. In the new decades It was acknowledged that, in addition to cognitive capacity, there were additional aspects of moral sensitivity, such as sensations, feelings, moral knowledge, and skills.² Moral sensitivity is defined as the awareness and attention to the existing moral values in a contradictory situation and individual self-awareness to the role and duty on that specific situation, in some studies moral sensitivity has the same meaning as “conscience”.³

Moreover, for providing ethical and effective nursing care to patients, nurses should develop moral sensitivity and moral reasoning in their profession. Nurses have to be sensitive to moral issues related to their career so that they can respect their client rights in decision making and manage ethical debates in their profession.⁴

Some experts in ethics call moral sensitivity the ability and capacity of a person to understand the reactions and feelings of others. This level of sensitivity is useful for detecting moral conflicts, emotional and intellectual assessment of vulnerable circumstances, and raising awareness of the moral ramifications of making judgments regarding others.⁵ Moral sensitivity is becoming more important, particularly in health, and especially in nursing.

Therefore, having moral sensitivity in the matter of care is considered being a fundamental concern in the nursing profession, and this made our research team, who have been working on ethical issues for a long time, decide to, besides review the meaning of moral sensitivity, moral sensitivity in the world and Iran, and finally, explain the consequences of neglecting moral sensitivity and providing solutions to increase moral sensitivity in nurses.

According to the great emphasis placed on the importance of paying attention to moral sensitivity in all phenomena, what is obvious is the moral dilemma regarding nurses’ professional competence for moral decision making, which has been criticized by the health system and other systems on numerous occasions.⁶

Based on the literature, till now, it is plausible to conclude that nurses also in new decades face ethical dilemmas in their work environments. Ethical issues are specific and defined issues of care practice that are viewed as a cause of conflict in the framework of values and ethical duties, enabling alternative courses of action to be resolved. To deal with these tensions, nurses must have acceptable sensitivity till recognize the situation as problematic and develop moral awareness, scenario analysis abilities, ethical reasoning, and the ability to act.^3,7,8

Milliken in an integrative review asserted, despite the many researches that have been conducted on the moral sensitivity of nurses in the world, nurses still do not have enough moral sensitivity when facing ethical issues in patient care.⁶

Filipova’s study in the United Statesacclaimed nurses did not have enough sensitivity in moral decision-making.⁹ Likewise, some studies in Iran stated nurses were weak in utilizing morals during decision-making and did not have enough sensitivity.^8,10 Public worries related to ethical problems in health areas are increasing and this growth makes the study of morality irrefutable.

According to the reports of Hajibabaee et al and Amiri et al in the Middle East, many nurses face ethical problems and challenges every day.^8,11 Most of these studies have shown that nurses in the face of moral problems, suffer from insufficient moral sensitivity.

The inability to face ethical problems causes 20% of professional nurses to quit their job or change their working environment.⁶ According to another study by Hakimi et al having nurses with high moral sensitivity is important in contexts where there may be pressure to ‘turn a blind eye’ or ignore poor care practices; Where bad behaviors become normalized, professionals become accustomed to this and cease to oppose the bad practices in the services.¹⁰ Nurses with low moral sensitivity have a negative impact on the workplace. Undesirable moral sensitivity can face nurses with moral conflicts and damage the process of patient care.¹¹ As low levels of moral sensitivity in nurses lead to inappropriate decision making it is necessary for us to do more study on following this issue and provide appropriate curriculum to enhance moral sensitivity in both groups of nurses and nursing students.¹² Moral sensitivity may be promoted through ethical education, consisting of educational methods, such as formal classes, conferences, seminars, analysis of cases, group discussions, and dramatization among others. Teaching needs to consider ways of helping/supporting the transition from the role of student to the role of nurse, emphasizing how to deal with ethical problems which can cause moral suffering.^4,12-14

Finally, we believe it is necessary to deal with and solve moral issues to provide high-quality nursing care and moral sensitivity is the prerequisite for solving moral issues. The development of moral sensitivity for decision-making in nursing improves the quality of care and the delivery of services based on best practices and scientific knowledge. The development of moral sensitivity in nurses not only leads to the development of moral care but also leads to care with wisdom and compassion. Moral sensitivity enhances attention, accurate understanding, and reviewing the needs of patients, which helps nurses establish proper clinical reasoning. The nursing framework entails a commitment to care as well as sensitivity to patients’ physical and emotional requirements. As a result, moral sensitivity is especially vital in persons who give morally based clinical care to their patients.

COI-statement

None.

Ethical Approval

Not applicable.