{"title":"Development and validation of the conscientious objection in nursing care scale: a methodological study.","authors":"Simay Sirma, Esra Akin","doi":"10.1177/17449871261426942","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Conscientious objection in nursing care represents a critical ethical dilemma that undermines nurses' moral integrity and causes moral distress. The resulting internal conflict between professional responsibilities and personal values places a substantial emotional and ethical burden on nurses, potentially intensifying feelings of guilt and inadequacy and leading to conscience-related stress.</p><p><strong>Aim: </strong>This study aimed to develop and validate a scale for assessing conscientious objection in nursing care.</p><p><strong>Methods: </strong>Psychometric analyses were conducted with 165 nurses working in clinical and intensive care units of a university hospital in Türkiye. Exploratory factor analysis, reliability testing, and thematic analysis of open-ended questions using MAXQDA were performed.</p><p><strong>Results: </strong>The final scale comprised 20 items across four factors: conscientious practice, conscientious stress, conscientious sensitivity, and conscientious perception - explaining 59.4% of the total variance. Cronbach's alpha coefficients ranged from 0.710 to 0.863 for subscales and 0.887 for the total scale. Thematic analysis also revealed three main themes regarding conscientious objection: refusal of situations that conflict with their value systems, conscientious conflict, and deviation from conscientious values.</p><p><strong>Conclusion: </strong>The Conscientious Objection in Nursing Care Scale' (COSINC) is a valid and reliable instrument for evaluating nurses' attitudes and tendencies towards conscientious objection. By contributing to the consideration of ethical decision-making processes in clinical practice, the scale can support the development of institutional policies and practices regarding conscience-based ethical issues.</p>","PeriodicalId":47172,"journal":{"name":"Journal of Research in Nursing","volume":" ","pages":"17449871261426942"},"PeriodicalIF":2.0000,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065640/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Research in Nursing","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/17449871261426942","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"NURSING","Score":null,"Total":0}
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Abstract
Background: Conscientious objection in nursing care represents a critical ethical dilemma that undermines nurses' moral integrity and causes moral distress. The resulting internal conflict between professional responsibilities and personal values places a substantial emotional and ethical burden on nurses, potentially intensifying feelings of guilt and inadequacy and leading to conscience-related stress.
Aim: This study aimed to develop and validate a scale for assessing conscientious objection in nursing care.
Methods: Psychometric analyses were conducted with 165 nurses working in clinical and intensive care units of a university hospital in Türkiye. Exploratory factor analysis, reliability testing, and thematic analysis of open-ended questions using MAXQDA were performed.
Results: The final scale comprised 20 items across four factors: conscientious practice, conscientious stress, conscientious sensitivity, and conscientious perception - explaining 59.4% of the total variance. Cronbach's alpha coefficients ranged from 0.710 to 0.863 for subscales and 0.887 for the total scale. Thematic analysis also revealed three main themes regarding conscientious objection: refusal of situations that conflict with their value systems, conscientious conflict, and deviation from conscientious values.
Conclusion: The Conscientious Objection in Nursing Care Scale' (COSINC) is a valid and reliable instrument for evaluating nurses' attitudes and tendencies towards conscientious objection. By contributing to the consideration of ethical decision-making processes in clinical practice, the scale can support the development of institutional policies and practices regarding conscience-based ethical issues.
期刊介绍：
The Journal of Research in Nursing is a leading peer reviewed journal that blends good research with contemporary debates about policy and practice. The Journal of Research in Nursing contributes knowledge to nursing practice, research and local, national and international health and social care policy. Each issue contains a variety of papers and review commentaries within a specific theme. The editors are advised and supported by a board of key academics, practitioners and policy makers of international standing. The Journal of Research in Nursing will: • Ensure an evidence base to your practice and policy development • Inform your research work at an advanced level • Challenge you to critically reflect on the interface between practice, policy and research
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