Abstract

The purpose of this investigation was to examine immediate and enduring effects of ethical decision-making models on moral judgment among novice and expert nurses. ;Group 1 was instructed in both decontextual and contextual models; group 2 was instructed in contextual models, only; and group 3 was instructed in decontextual models, only. Treatments lasted 5 weeks for a total of 30 contact hours of direct instruction. ;Rest's Defining Issues Test was used to measure principled reasoning prior to instruction, immediately after instruction, 2 months following instruction, and 1-year following instruction. Due to the longitudinal nature of the design and the repeated measure procedures, only subjects with complete sets of scores for the four testing times were included for final analyses or, 61 subjects. ;Pre-test findings indicated novice and expert nurses performed similarly on principled reasoning. One-way analysis of variance with repeated measure design showed that overall, the mean P scores varied significantly over time . Post hoc comparisons showed the average P scores differed significantly between the pre-test P score and post-test P score with p $<$.01. Post hoc comparisons between the pre-test and the 2-month testing times also yielded a significant F = 3.01, p $<$.05, while the 1-year testing time was not significantly different from the pre-test P scores. ;A 2 x 3 x repeated measures ANCOVA examining the effects of level of proficiency, treatment, and testing time on P scores yielded a significant level of proficiency by treatment interaction = 3.27, p $<$.05), and significant effect for time = 3.49, p $<$.05). The largest difference in mean P scores occurred in the contextual treatment group between novice and expert nurses , while no other significant differences emerged between levels of proficiency and treatments. ;Results suggest instruction in models of ethical decision-making improve moral judgment across all treatment groups. Findings also suggest less experienced nurses showed greater improvement in principled reasoning after instruction in contextual, care models of ethical decision-making than more experienced nurses. A nonsignificant pattern of improved P scores occurred among expert nurses with decontextualized treatments. All treatment effects dissipate over time.