Measuring moral judgment in nursing dilemmas.

Based on cognitive theory of moral development, this research investigated the difference between nurses' responses to general, hypothetical moral dilemmas and their responses to real-life nursing dilemmas. The purpose of the research was to: identify recurrent moral dilemmas experienced by staff nurses; develop an instrument (Nursing Dilemma Test [NDT]) to measure nurses' responses to nursing dilemmas and the importance given to moral issues and practical considerations; relate staff nurses' responses to nursing dilemmas in the NDT and responses to hypothetical moral dilemmas in the Defining Issues Test to two subject variables (level of nursing education and length of clinical nursing experience); and compare moral judgments, both hypothetical general and nursing specific, of five subject groups (N = 225): staff nurses with associate degrees (57) and baccalaureate degrees (85) in nursing, nurses with masters degrees in nursing (10), college junior prenurses (36), and graduate level nonnurses (37). Findings verified the significance of formal education and previous involvement with similar dilemmas in enhancing principled thinking and raised questions about the relative strength of practical considerations in the hospital milieu.