A Rasch analysis of nurses' ethical sensitivity to the norms of the code of conduct

To develop an instrument to measure nurses' ethical sensitivity and, secondarily, to use this instrument to compare nurses' ethical sensitivity between groups.

Professional codes of conduct are widely accepted guidelines. However, their efficacy in daily nursing practice and influence on ethical sensitivity is controversial.

A descriptive cross-sectional study was conducted.

One hundred and forty-three registered nurses from Barcelona (Spain) participated in the study, of whom 45.83% were working in primary health care and 53.84% in hospital wards.

A specifically designed confidential, self-administered questionnaire assessing ethical sensitivity was developed. Knowledge of the nursing code and data on ethical sensitivity were summarised, with the quality of the questionnaire assessed using Rasch analysis.

Item on knowledge of the code showed that one-third of nurses knew the contents of the code and two-thirds had limited knowledge. To fit the Rasch model, it was necessary to rescore the rating scale from five to three categories. Residual principal components analysis confirmed the unidimensionality of the scale. Three items of the questionnaire presented fit problems with the Rasch model. Although nurses generally have high ethical sensitivity to their code of conduct, differences were found according to years of professional practice, place of work and knowledge of the code (p<0.05).

The questionnaire showed acceptable psychometric properties to achieve the proposed objective. Nurses' ethical sensitivity to the norms of the code was high. However, many factors might influence the degree of ethical sensitivity. Further research to measure ethical sensitivity using invariant measures such as Rasch units would be valuable.

Other factors, such as assertiveness or courage, should be considered to improve ethical sensitivity to the code of conduct. Rigorous measurement studies and analysis in applied ethics are needed to assess ethical performance in practice.