Moral Reasoning and Moral Behavior Among Selected Groups of Practicing Nurses
Abstract
This study examined the relationship between moral reasoning and moral behavior in 79 practicing nurses. Moral reasoning was measured by Rest's Defining Issues Test. Judgments about Nursing Decisions (JAND), developed by the investigator, was used to measure moral behavior. JAND is compromised of seven stories, each depicting a nurse in an ethical dilemma, with a total of 48 items. It measures two components of moral behavior: knowledge and valuation of ideal moral behavior and perception of realistic moral behavior. The hypothesis that moral reasoning would be positively related to knowledge and valuation of ideal moral behavior was tested by Pearson product moment correlation; the obtained coefficient of .28 was significant at the .01 level. The hypothesis that moral reasoning would be positively related to nurses' perception of realistic moral behavior was also tested by Pearson product moment correlation; the obtained coefficient of .19 was significant at the .05 level. Additional analyses showed significant differences in the knowledge and valuation component of JAND between educational groups, ethnic groups, age groups, and years of practice in nursing; but, there were no differences between these groups with respect to the perception of realist moral behavior component of JAND. Implications of the findings for nursing practice, education, and research are discussed.
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Moral reasoning decreases with increasing nurses' work experience.
“In line with previous research [53–55], the findings of this study showed that moral reasoning decreases with increasing nurses’ work experience.”
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Kuiper, R. A., & Pesut, D. J. (2004) · Journal of Advanced Nursing · doi:10.1046/j.1365-2648.2003.02921.x · Cited by 405 · see citing works
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Kelly, B. (1998) · Journal of Advanced Nursing · doi:10.1046/j.1365-2648.1998.00810.x · Cited by 264 · see citing works
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Daly, W. M. (2001) · Journal of Advanced Nursing · doi:10.1046/j.1365-2648.2001.01949.x · Cited by 132 · see citing works
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Myrick, F. (2002) · Journal of Nursing Education · doi:10.3928/0148-4834-20020401-05 · Cited by 119 · see citing works
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Georges, J., & Grypdonck, M. H. F. (2002) · Nursing Ethics · doi:10.1191/0969733002ne495oa · Cited by 116 · see citing works
Being a Good Nurse and Doing the Right Thing: a qualitative study
Smith, K. V., & Godfrey, N. S. (2002) · Nursing Ethics · doi:10.1191/0969733002ne512oa · Cited by 114 · see citing works
Brooks, K. L., & Shepherd, J. M. (1990) · Journal of Nursing Education · doi:10.3928/0148-4834-19901101-05 · Cited by 103 · see citing works
Kim, W.-J., & Park, J. (2019) · Nurse Education Today · doi:10.1016/j.nedt.2019.08.018 · Cited by 102 · see citing works
Antecedents of Managers Moral Reasoning
Forte, A. (2004) · Journal of Business Ethics · doi:10.1023/b:busi.0000032501.59580.33 · Cited by 102 · see citing works
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Robichaux, C., & Clark, A. P. (2006) · American Journal of Critical Care · doi:10.4037/ajcc2006.15.5.480 · Cited by 97 · see citing works
Principled Thinking: A Comparison of Nursing Students and Experienced Nurses
Ham, K. (2004) · The Journal of Continuing Education in Nursing · doi:10.3928/0022-0124-20040301-08 · Cited by 87 · see citing works
The Role of Caring in a Theory of Nursing Ethics
Fry, S. T. (1989) · Hypatia · doi:10.1111/j.1527-2001.1989.tb00575.x · Cited by 84 · see citing works
Critical Thinking and Nursing Education
Gross, Y. T., Takazawa, E. S., & Rose, C. L. (1987) · Journal of Nursing Education · doi:10.3928/0148-4834-19871001-05 · Cited by 81 · see citing works
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Numminen, O., & Leino‐Kilpi, H. (2006) · Nurse Education Today · doi:10.1016/j.nedt.2006.10.013 · Cited by 73 · see citing works
Zurmehly, J. (2008) · The Journal of Continuing Education in Nursing · doi:10.3928/00220124-20081001-10 · Cited by 72 · see citing works
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Cerit, B., & Dinç, L. (2012) · Nursing Ethics · doi:10.1177/0969733012455562 · Cited by 68 · see citing works
Penticuff, J. H., & Walden, M. (2000) · Nursing Research · doi:10.1097/00006199-200003000-00002 · Cited by 65 · see citing works
Berger, M. C., Seversen, A., & Chvatal, R. (1991) · Western Journal of Nursing Research · doi:10.1177/019394599101300407 · Cited by 62 · see citing works
Luo, Z., Tao, L., Wang, C. C., Zheng, N., Ma, X., Quan, Y., Zhou, J., Zeng, Z., Chen, L., & Chang, Y. (2023) · BMC Nursing · doi:10.1186/s12912-023-01428-0 · Cited by 59 · see citing works
Johnson, J. H. (1988) · Research in Nursing & Health · doi:10.1002/nur.4770110307 · Cited by 58 · see citing works
The Impact of Nursing Education on Ethical/Moral Decision Making
Felton, G., & Parsons, M. A. (1987) · Journal of Nursing Education · doi:10.3928/0148-4834-19870101-04 · Cited by 55 · see citing works
Gaul, A. L. (1987) · Journal of Nursing Education · doi:10.3928/0148-4834-19870301-08 · Cited by 52 · see citing works
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Bužgová, R., & Sikorová, L. (2012) · Nurse Education Today · doi:10.1016/j.nedt.2012.06.016 · Cited by 49 · see citing works
Clarifying the Concept of Critical Thinking in Nursing
Pless, B. S., & Clayton, G. M. (1993) · Journal of Nursing Education · doi:10.3928/0148-4834-19931101-09 · Cited by 48 · see citing works
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Hilbert, G. A. (1988) · Journal of Professional Nursing · doi:10.1016/s8755-7223(88)80133-9 · Cited by 46 · see citing works
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Du, J., Huang, S., Lu, Q., Ma, L., Lai, K., & Li, K. (2022) · International Emergency Nursing · doi:10.1016/j.ienj.2022.101186 · Cited by 45 · see citing works
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Khaghanizadeh, M., Koohi, A., Ebadi, A., & Vahedian-Azimi, A. (2023) · BMC Medical Ethics · doi:10.1186/s12910-023-00938-5 · Cited by 40 · see citing works
Kl, B., & Shepherd, J. M. (1992) · Journal of Professional Nursing · doi:10.1016/8755-7223(92)90068-a · Cited by 37 · see citing works
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Kelly, B. (1992) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.1992.tb01812.x · Cited by 24 · see citing works
Su, Z., Qin, M., & Hu, D. (2024) · Asian Journal of Ethics in Health and Medicine · doi:10.51847/ibvpmrjsle · Cited by 23 · see citing works
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Miya, P. A., Boardman, K. K., Harr, K. L., & Keene, A. (1991) · The Journal of Clinical Ethics · doi:10.1086/jce199102409 · Cited by 23 · see citing works
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Cassidy, V. R., & Oddi, L. F. (1988) · Journal of Nursing Education · doi:10.3928/0148-4834-19881101-07 · Cited by 22 · see citing works
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Ketefian, S. (1989) · Nursing Clinics of North America · doi:10.1016/s0029-6465(22)01503-1 · Cited by 21 · see citing works
Self-citationZhen, C., Zong-hua, W., Luo, Y., Ma, H., Tan, J., Suofei, Z., & Lei, Z. (2022) · Nurse Education Today · doi:10.1016/j.nedt.2022.105336 · Cited by 20 · see citing works
Nurses Involvement in Ethical Decision-Making with Severely Ill Newborns
Martin, D. A. (1989) · Issues in Comprehensive Pediatric Nursing · doi:10.3109/01460868909026850 · Cited by 20 · see citing works
Yung, H. H.-P. (1997) · International Journal of Nursing Studies · doi:10.1016/s0020-7489(96)00046-6 · Cited by 19 · see citing works
Borhani, F., Abbaszadeh, A., Bahrampour, A., Ameri, G. F., & Aryaeenezhad, A. (2021) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_891_20 · Cited by 19 · see citing works
Moral Reasoning in College Students: Implications for Nursing Education
Mustapha, S. L., & Seybert, J. A. (1989) · Journal of Nursing Education · doi:10.3928/0148-4834-19890301-05 · Cited by 19 · see citing works
Raines, D. A. (1994) · Nursing Forum · doi:10.1111/j.1744-6198.1994.tb00144.x · Cited by 18 · see citing works
Reasons Registered Nurses Report Serious Wrongdoings in a Public Teaching Hospital
King, G., & Scudder, J. N. (2013) · Psychological Reports · doi:10.2466/21.13.pr0.112.2.626-636 · Cited by 18 · see citing works
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Chally, P. S. (1992) · Journal of Obstetric, Gynecologic & Neonatal Nursing · doi:10.1111/j.1552-6909.1992.tb01768.x · Cited by 18 · see citing works
The Moral Reasoning of Nurse Practitioners
Viens, D. (1995) · Journal of the American Academy of Nurse Practitioners · doi:10.1111/j.1745-7599.1995.tb01152.x · Cited by 16 · see citing works
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Haddad, A. M. (1988) · American Journal of Occupational Therapy · doi:10.5014/ajot.42.5.300 · Cited by 15 · see citing works
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Garritson, S. H. (1988) · Journal of Psychosocial Nursing and Mental Health Services · doi:10.3928/0279-3695-19880401-11 · Cited by 15 · see citing works
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Wang, X., Gao, H., & Jia, Y. (2025) · Nursing Ethics · doi:10.1177/09697330251333371 · Cited by 14 · see citing works
Claxton, G. L. (2014) · Journal for the Study of Education and Development Infancia y Aprendizaje · doi:10.1080/02103702.2014.929863 · Cited by 14 · see citing works
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McAlpine, H. (1996) · Journal of Nursing Education · doi:10.3928/0148-4834-19960301-07 · Cited by 13 · see citing works
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Borhani, F., Abbaszadeh, A., Bahrampour, A., Ameri, G. F., & Aryaeenezhad, A. (2021) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_875_20 · Cited by 12 · see citing works
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Cassidy, V. R. (1991) · Journal of Professional Nursing · doi:10.1016/8755-7223(91)90095-3 · Cited by 12 · see citing works
Hospital ethical climate mediates moral sensitivity and ethical decision-making ability
Xu, F., Wang, H., Tang, S., & Sun, M. (2025) · Nursing Ethics · doi:10.1177/09697330251350387 · Cited by 11 · see citing works
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Frederick, W. C., Wasieleski, D. M., & Weber, J. (2000) · HEC Forum · doi:10.1023/a:1008984531283 · Cited by 11 · see citing works
Xu, F., Wang, H., Tang, S., & Sun, M. (2025) · Nurse Education Today · doi:10.1016/j.nedt.2025.106697 · Cited by 9 · see citing works
Teaching Moral Reasoning to Student Nurses
Weber, J. R. (1992) · Journal of Holistic Nursing · doi:10.1177/089801019201000309 · Cited by 9 · see citing works
Evaluation of School of health students' ethics position in Turkey
Şen, E., Dal, N. A., Üstün, Ç., & Okursoy, A. (2015) · Nursing Ethics · doi:10.1177/0969733015594666 · Cited by 9 · see citing works
Measuring Nurses' Moral Reasoning
Oberle, K. (1995) · Nursing Ethics · doi:10.1177/096973309500200405 · Cited by 9 · see citing works
ALTERNATIVE APPROACHES TO MEASURING NURSING: GILLIGANS AND KOHLBERG'S MORAL DEVELOPMENT SCALES
Miller, L. H. (1984) · Rehabilitation Nursing · doi:10.1002/j.2048-7940.1984.tb02447.x · Cited by 9 · see citing works
Enhancing nursing ethics education: comparing the PAD model and traditional lecture-based learning
Wen, H., Huang, Z. Y., Zhang, R., Jiang, Y., Peng, L., & Chen, Y. (2025) · BMC Medical Ethics · doi:10.1186/s12910-025-01319-w · Cited by 8 · see citing works
Åkerlund, B. M. (1990) · Cited by 8 · see citing works
Relationship of Ethical Knowledge to Action in Senior Baccalaureate Nursing Students
Moe, C. S. (2018) · Nursing Education Perspectives · doi:10.1097/01.nep.0000000000000319 · Cited by 6 · see citing works
The Relationship Between Role Conception and Ethical Behaviour of Student Nurses in Hong Kong
Yung, H. H.-P. (1997) · Nursing Ethics · doi:10.1177/096973309700400202 · Cited by 7 · see citing works
Fry, S. T. (2004) · Springer eBooks · doi:10.1007/1-4020-2127-5_21 · Cited by 7 · see citing works
The JAND as a measure of nurses' perception of moral behavior
Oddi, L. F., & Cassidy, V. R. (1994) · International Journal of Nursing Studies · doi:10.1016/0020-7489(94)90005-1 · Cited by 7 · see citing works
Wang, K., Mi, Y., Wu, Y., & Sun, H. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1512533 · Cited by 6 · see citing works
Business Ethics: Implications for Continuing Education/Staff Development Practice
Pearson, G. A. (1987) · The Journal of Continuing Education in Nursing · doi:10.3928/0022-0124-19870101-08 · Cited by 6 · see citing works
SUPPORTING NURSES IN ETHICAL DECISION MAKING
de Casterlé, B. D. (1998) · Nursing Clinics of North America · doi:10.1016/s0029-6465(22)02617-2 · Cited by 5 · see citing works
Ethical Dilemmas in Occupational Health Nursing
Rogers, B. (1988) · AAOHN Journal · doi:10.1177/216507998803600301 · Cited by 5 · see citing works
Åkerlund, B. M. (1990) · KTH Publication Database DiVA (KTH Royal Institute of Technology) · Cited by 5 · see citing works
Zheng, M., Zhao, J., & Zhang, X. (2024) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph21060712 · Cited by 4 · see citing works
Vahidi, H., & Shafaroodi, N. (2020) · Clinical Ethics · doi:10.1177/1477750920971799 · Cited by 4 · see citing works
Gender, Industries, And The Moral Reasoning Of Managers
Forte, A. (2008) · Journal of Diversity Management (JDM) · doi:10.19030/jdm.v3i1.4980 · Cited by 4 · see citing works
Nursing Ethics: Essential Component of Continuing Education
Cragg, C. E. (1988) · The Journal of Continuing Education in Nursing · doi:10.3928/0022-0124-19881101-09 · Cited by 4 · see citing works
Hartranft, S. R. (2009) · Digital Commons - University of South Florida (University of South Florida) · Cited by 4 · see citing works
Ethical voices of pediatric mental health nurses
Twomey, J. G. (2000) · Journal of Pediatric Nursing · doi:10.1016/s0882-5963(00)80022-6 · Cited by 3 · see citing works
Ellis, R. (1984) · Springer eBooks · doi:10.1007/978-3-662-40453-9_9 · Cited by 3 · see citing works
Nursing Ethics Education in Finland from the Perspective of Codes of Ethics
Numminen, O. (2010) · UTUPub (University of Turku) · Cited by 3 · see citing works
Liu, S., Xu, D., Wen, S., Liu, X., & Wu, D. (2026) · BMC Nursing · doi:10.1186/s12912-026-04450-0 · Cited by 2 · see citing works
Cerebellum and Emotion in Morality
Han, H. (2022) · Advances in experimental medicine and biology · doi:10.1007/978-3-030-99550-8_12 · Cited by 2 · see citing works
Nurses' emotions and oral care for hospitalised adults
Johnson, I. G. (2013) · ORCA Online Research @Cardiff (Cardiff University) · Cited by 2 · see citing works
Tang, Y., Yang, Y., Zhang, L., Yang, Y., & Li, G. (2026) · BMC Medical Ethics · doi:10.1186/s12910-026-01441-3 · Cited by 1 · see citing works
Liu, K. M., Wang, X., Li, Q., Wang, J., Qin, L., Jiang, L., Yang, M., & Li, Y. (2026) · Nurse Education Today · doi:10.1016/j.nedt.2026.107281 · Cited by 1 · see citing works
Wu, W., Huang, X., Ntim, S. Y., Shen, Y., Li, X., & Wang, G. (2024) · KSII Transactions on Internet and Information Systems · doi:10.3837/tiis.2024.06.009 · Cited by 1 · see citing works
Philpott, D. W. (2000) · Language arts journal of Michigan · Cited by 1 · see citing works
Teaching Basic Ethical Concepts and Decision-Making: A Staff Development Application
O'Neil, J. A. (1991) · The Journal of Continuing Education in Nursing · doi:10.3928/0022-0124-19910901-04 · Cited by 1 · see citing works
Dr. Rogers was Invited to Reply
Rogers, B. (1989) · AAOHN Journal · doi:10.1177/216507998903700210 · Cited by 1 · see citing works
Ethical Decision-Making among Critical Care Unit Nurses
Bowen, M. E. (1996) · doi:10.22371/07.1996.002 · Cited by 1 · see citing works
Gerstle, D. S. (2001) · University Microfilms International eBooks
Nurses' Resolutions of Six Ethical Dilemmas.
Lawrence, J. A., & Crisham, P. (1983)
Keehne, J. A. (1993) · ScholarWorks - GVSU (Grand Valley State University)
Ethical issues encountered by nurses
Hollands, D. (2009) · cIRcle (University of British Columbia) · doi:10.14288/1.0087382
- Authors
- KETEFIAN, S.
- Venue
- Nursing Research
- Published
- 1981-05
- Volume
- 30
- Issue
- 3
- Pages
- 171???176
- ISSN
- 0029-6562 (ISSN-L)
- OpenAlex
- W197499387
- Cited by
- 112
- References
- 0
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 5 · 2023: 2 · 2022: 3 · 2021: 3 · 2020: 2 · 2019: 2 · 2018: 1 · 2015: 1 · 2014: 1 · 2013: 2 · 2012: 2
- FWCI
- 6.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Nursing Research (publishedVersion)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Ethics in medical practice
- Social Sciences › Decision Sciences › Information Systems and Management › Ethics in Business and Education
- Life Sciences › Neuroscience › Cognitive Neuroscience › Psychology of Moral and Emotional Judgment
- Keywords
- moral reasoning, moral behavior, nurses, ethical dilemmas, nursing ethics, nursing education, ethnic differences, age differences, years of practice
- MeSH terms
- Decision Making, Ethics, Nursing, Humans, Judgment, Morals, Surveys and Questionnaires, Moral Development
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