Relationships between the moral perspectives of care and justice, selected individual and contextual factors, and nurse activism in a sample of practicing nurses

Abstract

The purpose of this descriptive study was to examine the use of the moral perspectives of care and justice, the level of nurse activism, and relationships between these variables and selected factors in practicing registered nurses (RNs). The study also evaluated the construct validity of a measure of care- and justice-based moral reasoning, the Care-Justice Inventory (CJI). Data were obtained via a questionnaire from 214 registered nurses at three southern hospitals (35% response rate). The sample consisted of 68 male RNs and 146 female RNs; 62 subjects were in advanced nursing practice roles and 152 were staff nurses. The CJI demonstrated evidence of construct validity in two tests: a qualitative-quantitative triangulation procedure, and confirmatory factor analysis. Both male and female subjects scored significantly higher on the justice perspective than the care perspective; there were no significant differences between genders. Analysis of specific CJI scenarios, while revealing differences between the four scenarios, also revealed that justice elements received considerably higher rankings overall than care elements. CJI care and justice scores were positively correlated with each other (r =.626, p < .001). However, only the CJI justice score was correlated with nurse activism (r =.201, p =.005). The main predictor of the CJI care score was the CJI justice score. With justice controlled, RNs with lower ethical concern and lower clinical knowledge had higher care scores. Higher justice scores were significantly related to higher care scores, higher ethical concern and higher nurse influence. Moral behavior as measured by nurse activism scores was significantly related to nurse influence, clinical knowledge, ethical concern and continuing education in ethics. Together, these variables accounted for 34.8% of the variance in nurse activism. The CJI justice score for one scenario was a significant predictor of nurse activism, and the overall justice score was a significant predictor for nurses with formal education beyond their basic nursing preparation. The findings of this study challenge the notion that the care perspective is dominant in the moral reasoning of nurses, or that moral reasoning directs the moral behavior of nurses. Implications for practice, theory and further research are presented.