The psychometric properties of instruments measuring ethical sensitivity in nursing: a systematic review
Authors: Zhou Lu , Bi LiXiong , Wu YuMing , Wang Lei , Liu Gao , Cai EnLi 
Published: November 2024

Abstract
Background
Recognizing and appropriately responding to ethical considerations is a crucial element of ethical nursing practice. To mitigate instances of ethical incongruity in healthcare and to promote nurses’ comprehension of their professional ethical responsibilities, it is imperative for researchers to accurately evaluate ethical sensitivity. Conducting a systematic review of the available instruments would enable practitioners to determine the most suitable instrument for implementation in the field of nursing.

Aim
This review aims to systematically assess the measurement properties of instruments used to measure ethical sensitivity in nursing.

Methods
A systematic literature search was conducted in July 2022 in the following electronic databases: Scopus, CINAHL, APAPsycINFO, Embase, Web of Science, and PubMed. Two reviewers independently screened and assessed the studies in accordance with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. The updated criteria for good measurement properties are used to rate the result of measurement properties, and the modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to grade the quality of the summarized evidence.

Results
This review encompasses a total of 29 studies that describe 11 different instruments. Neither cross-cultural validity nor responsiveness was examined in any of the included studies. Whereas the majority of the instruments were conducted with at least some type of validity assessment, nearly all of the reliability results rated were indeterminate. Two instruments were recommended, the Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS) and the Ethical Awareness Scale for nurses in intensive care units. It is recommended that new self-administration instruments for special nursing settings be developed in accordance with the item response theory (IRT)/Rasch model.

Conclusion
The selection of ethical sensitivity measurement instruments in nursing, and further research on the development, psychometric, and cross-cultural adaptation of these instruments, could be conducted in accordance with the findings and suggestions of this systematic review.

Strengths and limitations
• This review was conducted to assess 11 instruments that were used to measure ethical sensitivity in nursing in 29 studies.
• The Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS) and the Ethical Awareness Scale for nurses in intensive care units can be recommended, but further reliability and cross-cultural validity testing are needed.
• The IRT/Rasch model is also recommended to measure ethical sensitivity in nursing.
• The potential limitation of utilizing the COSMIN checklist for assessing methodological quality is worth considering.
• Test–retest was considered inappropriate; thus, the reliability testing of ethical sensitivity measurement instruments still needs to be explored.