Moral Reasoning in College Students: Implications for Nursing Education
Authors: Mustapha Sherry L , Seybert Jeffrey A 
Published: April 2021

ABSTRACT

The purpose of this study was to investigate the moral reasoning levels of undergraduate students, freshman through senior (N = 266 ), in a liberal arts college. Three groups of students, two liberal arts, and one nursing participated in the study. All three groups had enrolled in one of two general education curricular tracks. Two of the groups, one liberal arts and one nursing, were enrolled in a traditional general education curriculum; the third group enrolled in an integrated general education curriculum which used decision-making as an organizational structure.

Moral reasoning levels were determined for the three groups via Rest's Defining issues Tèsi. Results revealed the liberal arts students in the integrated curriculum had significantly higher moral reasoning levels than those in the traditional curriculum. The nursing students were intermediate in moral reasoning levels to the two liberal arts groups. These results suggest that baccalaureate nursing educators should consider an approach similar to the integrated curriculum with a decision-making organizational structure to facilitate students' moral reasoning development.

Regardless of their area of clinical practice, today's professional nurses are increasingly confronted with ethical dilemmas and often required to make moral/ethical decisions. Nurses who reason at a high moral or ethical level are assumed to practice by a code of moral principles and thus more likely to make decisions which value others and respect their rights and dignity (Felton & Parsons, 1987).

In response to this relatively complex dimension in nursing practice, nursing educators have begun to discuss how best to prepare the nursing student to make these high-level ethical decisions. Nursing literature contains articles ranging from those espousing the need for teaching ethical content in nursing curricula (Benoliel, 1983; Clay, Povey, & Clift, 1983; Krawczyk & Kudzma, 1978), to those identifying methods of incorporating this content into nursing curricula and specific teaching strategies (Bridston, 1982; Clay, Povey, & Clift, 1983). In a survey of 86 National League for Nursing (NLN) accredited baccalaureate nursing programs, Aroskar (1977) reported that only six programs required a course in ethics. The Hastings Center (Aroskar & Veatch 1977) reported that these accredited baccalaureate nursing education programs included a median of six to ten hours per academic year of ethical content in nursing curricula.

Several researchers have studied the moral reasoning levels of baccalaureate nursing students (Munhall, 1979; Edgil, 1983; Awtrey, 1980; Krawczyk, 1982). For example, Krawczyk (1982) surveyed three baccalaureate nursing programs to determine ethical content and how it was addressed. Her findings revealed that students who had a required ethics course scored significantly higher on measures of moral reasoning than students who did not have an ethics course. Bridston (1982) described intervention studies with freshmen and junior level baccalaureate nursing students. She conducted seven 30-minute discussion sessions of ethical dilemmas over one semester with freshman nursing students. Results showed some increase in moral reasoning scores of students in the ethical discussion group as compared to a control group, but the differences were not statistically significant. Results of a second study with junior level students were inconclusive.

Results of nursing studies and others published in the non-nursing literature (Dortzbach, 1975) indicate that while level of education is one of the strongest correlates of advanced moral reasoning, nursing educators have not found a definitive way to facilitate students' acquisition of high levels of moral reasoning within current nursing curricula.