Patient safety is essential for healthcare quality and a global concern. The rapid advancement of medical technology presents ethical challenges for critical care nurses, who navigate complex decision-making processes. Given their close relationships with patients, nurses are uniquely positioned to address patient safety issues. Thus, enhancing nurses’ moral sensitivity and ethical values is increasingly important.
Objective
This study aims to explore the relationship between moral sensitivity and attitude towards patient safety in critical care nurses.
Methods
This cross-sectional, descriptive-correlational study was conducted from June to September 2022 in three hospitals affiliated with Hamadan University of Medical Sciences in Iran. Participants were nurses in intensive care units (ICUs), selected via convenience sampling. A total of 382 nurses completed questionnaires assessing demographic information, moral sensitivity, and patient safety attitudes. Data analysis was performed using descriptive statistics, t-tests, ANOVA, Pearson’s correlation, and multiple regression in SPSS 26.
Ethical considerations: This research received ethical approval from the Ethics Committee of Hamadan University of Medical Sciences. Participants provided informed consent regarding the study’s objectives, and their confidentiality was strictly upheld throughout the research.
Results
The nurses’ average age and work experience were 38.6 years and 12.4 years, respectively. Mean scores for moral sensitivity and patient safety attitude were 81.65 ± 2.69 and 51.47 ± 2.21, indicating high levels and a significant positive correlation. Factors such as increasing age, work experience, fewer working hours, and completion of ethics training were linked to more positive attitudes towards patient safety (p < .05). Regression analysis showed that 42.8% of the variability in attitudes towards patient safety could be explained by moral sensitivity and demographic characteristics.
Conclusion
This study highlights the relationship between moral sensitivity and patient safety attitudes among critical care nurses, emphasizing the importance of education, experience, and training in shaping ethical values. Enhancing moral sensitivity is vital for reducing risky behaviors and improving patient safety outcomes in critical care settings.
KhoobiMAhmadiF. Maintaining moral sensitivity as an inevitable necessity in the nursing profession. J Caring Sci2024; 13(1): 1–2.
2.
NazariSPoortaghiSSharifiF, et al.Relationship between moral sensitivity and the quality of nursing care for the elderly with Covid-19 in Iranian hospitals. BMC Health Serv Res2022; 22(1): 840.
3.
KhodaveisiMOshvandiKBashirianS, et al.Moral courage, moral sensitivity and safe nursing care in nurses caring of patients with COVID‐19. Nurs Open2021; 8(6): 3538–3546.
4.
LützénKDahlqvistVErikssonS, et al.Developing the concept of moral sensitivity in health care practice. Nurs Ethics2006; 13(2): 187–196.
5.
HajiloPTorabiMEslami PanahM. Relationship between ethical reasoning and professional values among nursing students. Avicenna Journal of Nursing and Midwifery Care2022; 30(1): 1–11.
6.
BorhaniFKeshtgarMAbbaszadehA. Moral self-concept and moral sensitivity in Iranian nurses. J Med Ethics Hist Med2015; 8: 4.
7.
LützénKCronqvistAMagnussonA, et al.Moral stress: synthesis of a concept. Nurs Ethics2003; 10(3): 312–322.
8.
MohammadySborhaniFRoshanzadehM. Moral sensitivity and nurse’s attitude toward patients' rights. Iranian Journal of Medical Ethics and History of Medicine2017; 9(5): 52–62.
9.
OzgonulMLBademliKKircaN. The relationship between nurses' ethical sensitivity and attitudes towards medical errors. Int J Clin Pract2021; 75(12): e14972.
10.
JeongH-eNamK-hKimH-y, et al.Patient safety silence and safety nursing activities: mediating effects of moral sensitivity. Int J Environ Res Publ Health2021; 18(21): 11499.
11.
MohammadiFTehranineshatBGhasemiA, et al.A study of how moral courage and moral sensitivity correlate with safe care in special care nursing. Sci World J2022; 2022: 9097995.
12.
LeeEKimY. The relationship of moral sensitivity and patient safety attitudes with nursing students’ perceptions of disclosure of patient safety incidents: a cross-sectional study. PLoS One2020; 15(1): e0227585.
13.
GülnarEÖzverenHÖzdenD. The relationship between moral sensitivity and medical errors attitude in nursing students. J Forensic Leg Med2020; 73: 101981.
14.
MohammadiFTehranineshatBGhasemiA, et al.A study of how moral courage and moral sensitivity correlate with safe care in special care nursing. Sci World J2022; 2022(1): 9097995.
15.
IzadiAImaniHKhademiZ, et al.Moral sensitivity of critical care nurses in clinical decision making and its correlation with their caring behavior in teaching hospitals of Bandar Abbas in 2012. Iranian Journal of Medical Ethics and History of Medicine2013; 6(2): 43–56.
16.
BorhaniFAbbaszadehAMohamadiE, et al.Moral sensitivity and moral distress in Iranian critical care nurses. Nurs Ethics2017; 24(4): 474–482.
17.
NobaharMAmeriMGoliS. The relationship between teamwork, moral sensitivity, and missed nursing care in intensive care unit nurses. BMC Nurs2023; 22(1): 241.
18.
WaterfieldDBarnasonS. It kills your soul”: a mixed methods study of ethical sensitivity of critical care nurses. West J Nurs Res2024; 46(6): 404–415.
19.
KwonHSKimHKParkKS. Effects of the ethical values and willingness to report near miss on the perceptions of patient safety culture of nurses at general hospitals. Int J Appl Eng Res2017; 12(22): 11951.
20.
AhansazNAdib-HajbagheryMBaghaeiR. Missed nursing care and its relationship with nurses’ moral sensitivity: a descriptive-analytical study. BMC Nurs2024; 23(1): 169.
21.
DonaldsonL. The challenge of quality and patient safety. J R Soc Med2008; 101(7): 338–341.
22.
PernegerTV. A research agenda for patient safety. Int J Qual Health Care2006; 18(1): 1–3.
23.
KimLLyderCHMcNeese-SmithD, et al.Defining attributes of patient safety through a concept analysis. J Adv Nurs2015; 71(11): 2490–2503.
24.
CacciamaniGEMedinaLGSayeghAS, et al.Assessment and reporting of perioperative adverse events and complications in patients undergoing inguinal lymphadenectomy for melanoma, vulvar cancer, and penile cancer: a systematic review and meta-analysis. World J Surg2023; 47(4): 962–974.
25.
MamčenkovaitėESpirgieneL. Assessment of the attitude of intensive care units nurses of the dimensions of a safety culture. Slauga Mokslas ir praktika. 2023;4(7):1-7.
26.
YasinÇGülnurİ. Examination of nurses’ attitudes about patient safety according to sociodemographic characteristics. Sudan Journal of Medical Sciences (SJMS)2022; 17(4): 444–458.
27.
VaismoradiMTellaSPAL, et al.Nurses' adherence to patient safety principles: a systematic review. Int J Environ Res Publ Health2020; 17(6): 2028.
28.
KarlsenM-MWØlnesMAHeynLG. Communication with patients in intensive care units: a scoping review. Nurs Crit Care2019; 24(3): 115–131.
29.
BayatmaneshHZagheri TafreshiMManoochehriH, et al.Patient safety observation by nurses working in the intensive care units of selected hospitals affiliated to Yasuj University of Medical Sciences. Iranian South Medical Journal2019; 21(6): 493–506.
30.
LiuSIShikarMGanteE, et al.Improving communication and response to clinical deterioration to increase patient safety in the intensive care unit. Crit Care Nurse2022; 42(5): 33–43.
31.
FarziSMoladoostABahramiM, et al.Patient safety culture in intensive care units from the perspective of nurses: a cross-sectional study. Iran J Nurs Midwifery Res2017; 22(5): 372–376.
32.
Gouda MetwallyF and Abdeldayem Ata Hussein A. Moral and ethical sensitivity as predictors of nurses’ attitudes towards medication errors. Egyptian Journal of Health Care. 2022.
33.
PavlishCLHenriksenJBrown-SaltzmanK, et al.A team-based early action protocol to address ethical concerns in the intensive care unit. Am J Crit Care2020; 29(1): 49–61.
34.
WehkampKKuhnEPetzinaR, et al.Enhancing patient safety by integrating ethical dimensions to Critical Incident Reporting Systems. BMC Med Ethics2021; 22(1): 26.
35.
LützénKNordinCBrolinG. Conceptualization and instrumentation of nurses' moral sensitivity in psychiatric practice. Int J Methods Psychiatr Res1994; 4(4): 241.
36.
HassanpoorMHosseiniMFallahi KhoshknabM, et al.Evaluation of the impact of teaching nursing ethics on nurses' decision making in Kerman social welfare hospitals in 1389. Iranian Journal of Medical Ethics and History of Medicine2011; 4(5): 58–64.
37.
MadigoskyWSHeadrickLANelsonK, et al.Changing and sustaining medical students' knowledge, skills, and attitudes about patient safety and medical fallibility. Acad Med2006; 81(1): 94–101.
38.
ParkJParkM. Knowledge, attitude, and confidence on patient safety of undergraduate nursing students. J Korean Acad Soc Nurs Educ2014; 20(1): 5–14.
39.
OttosenMJSedlockEWAigbeAO, et al.Long-term impacts faced by patients and families after harmful healthcare events. J Patient Saf2021; 17(8): e1145–e1151.
40.
TorabiMEslamipanahM. Evaluating the level of ethical decision making of nurses and its relationship with the attitudes of end-of-life care of patients with COVID-19. Iranian Journal of Medical Ethics and History of Medicine2021; 14(0): 333–347.
41.
AljanabiHMaarmanRKehliniM, et al.Chapter 5 moral sensitivity, ethical experiences, and promotion of the civility of staff nurses. A Review2023: 58–66.
42.
AlanaziFKSimJLapkinS. Systematic review: nurses' safety attitudes and their impact on patient outcomes in acute-care hospitals. Nurs Open2022; 9(1): 30–43.
43.
LuoZTaoLWangCC, et al.Correlations between moral courage, moral sensitivity, and ethical decision-making by nurse interns: a cross-sectional study. BMC Nurs2023; 22(1): 260.
44.
JeongEJungM-RKimY. Influences of safety attitude for patient, and moral sensitivity in practice of standard precaution in small and medium hospital nurses. Journal of Digital Convergence2021; 19: 453–461.
45.
Annisa RahmiGRTutik SriHBardahD, et al.Faktor-faktor yang mempengaruhi sikap perawat dalam keselamatan pasien: systematic review: factors influencing nurse attitudes in patient safety: systematic review. Journal of Holistics and Health Sciences2023; 5(1): 16–25.
46.
SalsabilaANDhamantiI. Factors affecting nurses in implementing patient safety in hospitals: a literature review. J Health Sci2023; 16(1): 84–91.
47.
KhazaeiATorabiMShayganihonarM, et al.Exploring the challenges of emergency medical service providers in the initial phase of the COVID-19 pandemic: a qualitative content analysis. BMC Emerg Med2024; 24(1): 159.
48.
ZahednezhadHShokrollahiNGheshlaghRG, et al.Does heavy mental workload affect moral sensitivity among critical care unit nursing professionals? a cross-sectional study. BMC Nurs2021; 20(1): 140.
49.
AmiriEEbrahimiHNamdar AreshtanabH, et al.The relationship between nurses' moral sensitivity and patients' satisfaction with the care received in the medical wards. J Caring Sci2020; 9(2): 98–103.
50.
OhnishiKKitaokaKNakaharaJ, et al.Impact of moral sensitivity on moral distress among psychiatric nurses. Nurs Ethics2019; 26(5): 1473–1483.
51.
EomSKimS-S. Factors associated with nurses' moral sensitivity. J Korean Acad Psychiatr Ment Health Nurs2018; 27: 199–207.
52.
KavurmaciMTanM. Determining the moral sensitivities of intensive care nurses. Crit Care Nurs Q2019; 42(3): 278–284.
53.
AmiriEEbrahimiHVahidiM, et al.Relationship between nurses' moral sensitivity and the quality of care. Nurs Ethics2019; 26(4): 1265–1273.
54.
KusumawatiASHandiyaniHRachmiSF. Patient safety culture and nurses’ attitude on incident reporting in Indonesia. Enferm Clin2019; 29 Suppl 2(S2): 47–52.
55.
RobichauxCGracePBartlettJ, et al.Ethics education for nurses: foundations for an integrated curriculum. J Nurs Educ2022; 61(3): 123–130.
56.
JuandaHTahlilTUsmanS. The relationship between organizational culture and patient safety culture in hospitals in aceh province. International Journal of Nursing Education. 2024;16(3):37-43.
