Table 4.

Final two-factor structure for EDMC.

Factor structure (reduced, unambiguous, German-speaking European countries and U.S.)
Factor 1: Ethical decision-making confidence subscale—“skill-related confidence dimension”
1. Recognize a genuine ethical dilemma in practice
2. Make a sound ethical decision
3. Explain your ethical decisions using correct ethical terminology and language
4. Provide a clear statement of the personal values that guide your EDM and practice
5. Articulate legal guidelines related to complex ethical issues in patient care
6. Articulate the difference between ethical dilemmas, moral distress, issues related to inter-professional collaboration and communication, difficult patients, etc.
7. Articulate the definition of moral distress and provide an example in your practice
8. Identify ethical issues in complex patient care
11. Recognize and manage moral distress in self and others
Factor 2: Ethical decision-making confidence subscale—“behavior-related confidence dimension”
13. Engage in preventative ethics initiatives to address the ethical environment in your practice area
14. Mentor others to develop ethical practice behaviors
15. Address barriers to ethical practice through systems changes
16. Use preventative ethics to decrease unit level moral distress
17. Engage in health policy initiatives supporting social justice
18. Provide leadership at the unit. Organizational, local, state and federal level for policy change initiatives to address social justice issues in health care

Excluded items: Apply ethical decision-making models or structured processes to complex clinical problems,” “Participate in and/or guide mediation related to complex clinical problems involving ethical dilemmas or moral distress,” “Role model collaborative problem solving in complex clinical problems involving ethical dilemmas or moral distress”

Notes: EDMC Ethical Decision-Making Confidence.