The Relationship of Education and Moral Reasoning to Ethical Practice: A Meta-Analysis of Quantitative Studies

By Ketefian, Shaké EdD, Rn, Faan | Scholarly Inquiry for Nursing Practice, January 1, 2001 | Go to article overview

The Relationship of Education and Moral Reasoning to Ethical Practice: A Meta-Analysis of Quantitative Studies


Ketefian, Shaké EdD, Rn, Faan, Scholarly Inquiry for Nursing Practice


This meta-analytic article of quantitative studies is aimed at summarizing knowledge gained on ethical practice for the period of 1987 to 1997 and at suggesting directions for future research. It specifically investigated the relationships of education and moral reasoning to ethical practice, with ethical practice as the dependent variable. The sample consisted of eight studies that investigated the relationship between education and ethical practice, and five studies that addressed the relationship between moral reasoning and ethical practice. A small to medium relationship between education and ethical practice was found, with an overall mean for effect sizes, d= .44, p = .000. To test the relationship between moral reasoning and ethical practice the Pearson product moment coefficient r was used as the effect size estimate, as each of the studies in this group reported correlation analyses. A small but significant relationship was found between moral reasoning and ethical practice (overall r of .2, p = .000). These results are evaluated in comparison to those of a decade earlier and overall trends are identified. As before, the majority of the studies are in the form of dissertations, and few of their authors have published their work in the general scientific literature. Similarly, clarity has not yet been achieved with regard to the conceptual and operational definitions of ethical practice. Theoretical, measurement, and policy issues are discussed in highlighting the implications of the study.

Research in nursing ethics has assumed greater importance than ever as a result of developments within the profession and the society at large. Over the past two decades, an increasing number of investigators have studied various areas of ethical concerns, addressing moral reasoning or ethical competence in practice and the factors that might help understand and explain them.

Three previous summary reviews were identified in the literature on nursing ethics research. The first appeared in 1985 (Gortner), providing a broad examination of ethical inquiry and covering the period of 1968-1983. Gortner identified selected ethical issues related to the nurse, the patient, and the clinical environment, and discussed three additional issues that concern the clinical investigator's role as healer and scientist: protection of human subjects, and peer and institutional review. The second review (Ketefian & Ormond, 1988) dealt with empirical research on moral reasoning and ethical practice for the period of 1983 to 1987. This review utilized an integrative review method and included empirical studies only. In the third review (Cassidy, 1996), 38 research reports from articles and 31 dissertations were included, covering the period of 1987-1994. The studies were discussed in two groupings. One grouping involved the subjects studied (nurses and nursing students); the second grouping was discussed under the rubric of a moral competency model. The author included both qualitative and quantitative studies.

Unlike the earlier reports, this current review is more focused and employs metaanalytic methods. It includes studies that attempt to understand and explain ethical practice or other elements of ethical conduct in nursing practice. In the earlier phases of research in this domain, any attempt to be focused would have been doomed to failure, as the range of issues investigated was broad and varied. While the breadth of themes can still be noted, the volume of research currently is such that it is possible to identify one outcome variable, ethical practice, and report findings related to it. This focused approach promises to make results more meaningful and render recommendations for future research that are more useful to potential investigators. The fact that this is now possible also indicates that research in this area is maturing.

It is not unusual to find inconclusive, or even contradictory results derived from different studies on the same question. …

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