Adaptation of the Ethical Sensitivity Scale in Nursing Students to Turkish

Adaptation of the Ethical Sensitivity Scale in Nursing Students to Turkish | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Adaptation of the Ethical Sensitivity Scale in Nursing Students to Turkish Yesim BAĞCI This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8754384/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Ethical sensitivity is a fundamental component of nursing practice, enabling nurses to recognize ethical issues and make appropriate ethical decisions. Measuring ethical sensitivity during nursing education is important for developing ethical awareness and professional values. Therefore, valid and reliable measurement tools are needed to assess nursing students’ ethical sensitivity. Design: This study was designed as a cross-sectional and methodological research. Methods The study was conducted with 84 nursing students between December 2020 and January 2021. Data were collected online using a Descriptive Characteristics Form and the Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS). TheǰThe scale was translated into Turkish using forward–backward translation. Content validity was evaluated using the Davis method. Construct validity was examined through exploratory and confirmatory factor analyses. Reliability was assessed using item–total correlations, split-half reliability, and Cronbach’s alpha coefficients. Results The content validity index of the scale was found to be 1. Exploratory factor analysis revealed a two-factor structure consisting of 11 items, explaining 70.96% of the total variance. Confirmatory factor analysis indicated acceptable to good model fit indices. The Cronbach’s alpha coefficient was 0.92 for the total scale, demonstrating high internal consistency. Item–total correlation values ranged between 0.403 and 0.868. Conclusion The Turkish version of the Ethical Sensitivity Questionnaire for Nursing Students is a valid and reliable measurement tool. It can be used to assess ethical sensitivity levels of nursing students in Turkey and may contribute to the evaluation and improvement of ethics education in nursing programs. Ethical sensitivity nursing education validity reliability scale adaptation Figures Figure 1 INTRODUCTION Ethics are behaviors that are obligatory for individuals in a professional discipline [ 1 ]. In other words, ethics are moral rulesregulate the behavior of a discipline and an individual as good or bad [ 2 ]. Nursing ethics, group of principles that help nurses to distinguish morally right and wrong behavior that they have to comply with during the health service they provide[ 3 ]. Ethics is a humanistic and scientific field that guides decisions and behaviors which help to solve problems with vital values, that directs behaviors towards good and right, and that develops new rules. Nursing services offered to individuals should be given in accordance with ethical principles and values [ 4 , 5 ]. There are ethical principles that individuals have to abide by and that help make an ethical decision about an issue. Ethical principles provide explanations to the individual about why a certain behavior should or should not be done [ 5 ]. Ethical principles that nurses have to abide by while fulfilling their duties and responsibilities, and that have been determined by the Turkish Nurses Association are “doing no harm-providing benefit, autonomy/respect for the individual, privacy and confidentiality, justice and equality” [ 3 , 5 , 6 ]. Ethical dilemma is the inability to decide between two values during a situation [ 7 ]. Studies have shown that nursing students face many ethical dilemmas in clinical practice, such as patient refusal of treatment, lack of attention to patient privacy, health professionals providing incomplete or incorrect information, and discrimination based on individual characteristics. These dilemmas affect students’ motivation and cause students to experience value conflicts [ 8 , 9 ]. In literature reviews, it is stated that ethics education in all disciplines is important for the formation and development of ethical sensitivity and awareness [ 10 – 14 ]. Ethical education of health professionals enables them to acquire competencies such as holistic evaluation of the patient during care and practices, as well as their professional duties and responsibilities [ 15 ]. In this context, nursing students need to become aware of and adopt basic professional principles and values ​​and develop ethical sensitivity during the education process consisting of clinical and theoretical practices [ 16 ]. Ethical sensitivity means that individuals can distinguish ethical issues. Nurses need to have developed ethical sensitivities in order to recognize the ethical problems they face and make ethical decisions appropriately. Ethical sensitivity developed with nursing ethics training is maintained by nurses acting in accordance with the ethical codes of their profession [ 17 ]. Developing ethical sensitivity in nurses helps them be self aware their values, how it affects their relationships with other individuals, and the provision of better quality care to individuals [ 18 ]. Ethical sensitivity, it is influenced by factors such as an individual's age, culture, religion, language, educational level, gender, experience and upbringing style [ 15 ]. This scale, which will be introduced to the Turkish literature, will be useful in determining the ethical sensitivity levels of students and the ethical behaviors they exhibit in their professional lives. Muramatsu et al. This study, which aims to adapt the "Ethical Sensitivity Questionnaire in Nursing Students (ESQ-NS)" developed by (2019) into Turkish, will be useful in determining the ethical sensitivity levels of students and the ethical behaviors they exhibit in their professional lives [ 19 ]. MATERIALS AND METHODS Design This study is a methodological type of research. Data Sources and Research Strategies The research was conducted by university students studying nursing in Turkey by filling out a survey created electronically via social media/online. Data collection tools In the data collection, the Descriptive Characteristics Form including socio-demographic characteristics and the Ethical Sensitivity Scale for Nursing Students were used. The Descriptive Characteristics Form It is a form consisting of 5 questions that include the individual characteristics of the participants. Ethical Sensitivity Scale in Nursing Students: This scale was developed by Muramatsu et al. (2019) is a Likert-type scale consisting of three subscales (1 = I don't think at all, 2 = I don't think much, 3 = I think little, 4 = I think a lot). The scale consists of 13 items, including respect for the individual (8 items), fair treatment (3 items), protecting the patient's privacy (2 items). The Cronbach alpha coefficient of the scale of the adapted study was found to be 0.82 and the Cronbach alpha coefficient of the scale was found to be 0.92 in the study [ 19 ]. The adjusted item total score correlations of the scale were calculated and 6. and 8. it was determined that the items were 0.142 and − 0.02, respectively, and these values were less than 0.30, and these two items were excluded from the scope [ 20 , 21 ]. This situation revealed that the scale is a quadruple Likert-type scale consisting of two sub-dimensions, Respect for a Person (8 items) and Fair Treatment (3 items), and a total of 11 items. Collection of Data Data was collected online from participants between December 2020 and January 2021. Analysis and Evaluation Data were analyzed with SPSS 22.0 and AMOS 24.0 software packages. Davis analysis was used for number, percentage, mean, content and content validity of the data. Kaiser-Meyer-Olkin-Bartlett test and exploratory factor analysis were used to evaluate sample adequacy. Additionally, Confirmatory Factor Analysis and item-total score correlation analysis, split-half reliability analysis and Cronbach's alpha coefficients were calculated. Ethical Considerations Ethical approval for the study was obtained from the Erzincan Binali Yıldırım University Health and Sports Sciences Ethics Committee with decision number 17.11 dated 18.12.2020. Furthermore, permission was obtained via email from the scale owner for the Turkish validity and reliability study of the scale. The study was conducted in accordance with the Helsinki Declaration. Students participating in the study were given detailed information about the purpose, methodology, and method of the study. Participants were assured that participation in the study was voluntary and that they could withdraw from the study at any time without giving any reason. Online consent forms were provided to participants during the informed consent process. Participants/students in the sample were informed and their informed consent was obtained before use. Limitations of the Research The research was conducted with 84 undergraduate nursing students who could be reached via the internet at the time the research was conducted and who were working in the institution throughout their education and training processes. This can be considered a limitation of the study as it cannot be generalized to nursing students in general.Çalışmada planlanan akıştan herhangi bir sapma varsa, sebepleri ile anlatılmalıdır ve bunların sonuçlara olan etkisinin nasıl en aza indirildiği veya önlendiği açıklanmalıdır. RESULTS The average age of the participants was 21 ± 1.71, and the majority (88.1%) were female and were in the 3rd grade (75%). In addition, 71.4% of the participants stated that they chose the profession willingly, and 54.8% stated that they did not encounter an ethical dilemma. Findings Related to the Validity of the Ethical Sensitivity Scale in Nursing Students Language Validity: The Turkish version of the scale was translated by three academicians whose native speakers are Turkish and who are proficient in both languages. The translations were compared with each other, the necessary corrections were made by the researcher, and the scale was translated into its original language, English, by three different experts (two linguists and a nursing faculty academician) who are native speakers of Turkish and fluent in both languages. After the translations, necessary checks were made for language equivalence. Scope Validity: Davis method was used for the scale items and the whole scale [ 22 ]. After linguistic validation of the scale, along with its Turkish form and the original form, the scale was emailed to 5 academics, mainly from the field of nursing principles, and they were asked to rate it. The experts evaluated the items on the basis of “ point if the item is not appropriate, 2 points if it is somewhat appropriate, 3 points if it is quite appropriate, 4 points if the item is very appropriate”. As a result of this evaluation made by five experts, the content validity index (CGI) of the draft scale and each of the items was calculated as 1. Construct Validity Explanatory Factor Analysis (EFA): Bartlett- Kaiser Meyer Olkin (KMO) tests were performed to assess sample adequacy. When the Artlett and Kaiser Meyer Olkin (KMO) test results were examined, Bartlett (χ2 = 680.078, p=.000) and KMO = 0.885 test results were determined to be significant [ 23 – 25 ]. According to the EFA test results, the scale was given its final form with 11 items. 6. and 8. since the load values of the items were below 0.30, they were removed from the scale and it was determined that the scale, the original of which was 3-dimensional, was 2-dimensional [ 20 , 21 ]. The varimax rotation method was used to distribute the scale's items into factor loadings. Additionally, a scree plot diagram was used to show the clarity of the number of factors and it was seen that the scale had a 2-factor structure (Fig. 1 ). According to Table 1 , it was determined that the first factor consisted of 8 items: 1,5,7,9,10,11,12,13 and the distribution of the factor load values ​​of the items varied between 0.636 and 0.882. It was determined that the second factor consisted of 3 items: 2, 3, and 4, and the factor loadings of the items varied between 0.716 and 0.853 (Table 1 ). Table 1 Distribution of Factor Load Values of Items According to the EFA Results of Ethical Sensitivity Scale Turkish Form in Nursing Students (Varimax Transformation) Item Factor 1 Factor 2 Item 1 .820 Item 2 .852 Item 3 .853 Item 4 .716 Item 5 .882 Item 7 .636 Item 9 .850 Item 10 .825 Item 11 .806 Item 12 .822 Item 13 .844 It was determined that the total variance of the two factors of the scale was 70.96%. Factor 1 has 57.053% of the total variance and an eigenvalue of 6.276, Factor 2 has 13.907% of the total variance and an eigenvalue of 1.530. Confirmatory Factor Analysis (CFA): CFA was performed to confirm the structure identified in EFA. During the CFA, a modification was made between item 5 and item 10, and item 12 and item 13. The factor load values of the items of the Ethical Sensitivity Scale in Nursing Students are given in Table 2 . The factor loading values of the items ranged from 0.562 to 0.902. Fit indices as a result of CFA were determined as: χ2/ df = 1.387, RMR = 0.62, GFI = 0.899, AGFI = 0.837, NFI = 0.921, RFI = 0.894, IFI = 0.977, TLI = 0.968, CFI = 0.976, RMSEA = 0.068 and SRMR = 0.054. As a result of confirmatory factor analysis, it was determined that eight items in the first factor had a standard solution between 0.55 and 1.00, and three items in the second factor had a standard solution between 1 and 1.30. Table 2 Factor Loading Values of the Items of the Turkish Form of the Ethical Sensitivity Scale in Nursing Students Item Factor Factor Load Values Item 1 Respect for Individual (Factor 1) 0.828 Item 5 0.867 Item 7 0.562 Item 9 0.850 Item 10 0.902 Item 11 0.801 Item 12 0.820 Item 13 0.863 Item 2 Acting Fairly (Factor 2) 0.873 Item 3 0.733 Item 4 0.617 Findings Related to the Reliability of the Ethical Sensitivity Scale in Nursing Students The reliability of the scale was evaluated with split-half reliability, item-total score correlation and Cronbach’s Alpha coefficients analyses. Two-Half Test (Split-Half) Reliability Analysis of the Scale: The Spearman-Brown correlation value (r= .89) and the Guttman Split Half Coefficient value (r= .89) of the scale were determined as a result of the two-half reliability analyzes of the final version of the scale, which consisted of 11 items. Internal Consistency Coefficients of Scale and Sub-Dimensions: The Cronbach’s alpha values calculated for the sub-dimensions and the whole scale as a result of the internal consistency analysis of the Turkish Form of the Ethical Sensitivity Scale in Nursing Students are given in Table 3 . As a result of the analyzes, the Cronbach’s Alpha internal consistency coefficient was calculated for the reliability analyzes of the 11 items of the scale, which was finalized as a result of the analyses, and it was calculated as 0.94 for the “Respect for Individual” sub-dimension, 0.775 for the “Acting Fairly” sub-dimension, and 0.92 for the whole scale. Table 3 Cronbach’s Alpha Values of the Turkish Form and Sub-Dimensions of the Ethical Sensitivity Scale in Nursing Students Scale and Sub-Dimensions Items Cronbach’s Alfa* Respect for Individual Items 1, 5, 7, 9, 10, 11, 12, and 13 0.94 Acting Fairly Items 2, 3, and 4 0.775 Ethical Sensitivity Scale Total Score in Nursing Students Items 1, 2, 3, 4, 5, 7, 9, 10, 11, 12, and 13 0.92 Item-Total Score Correlations: As a result of the reliability analyzes of the scale items, it was seen that the Corrected Item-Total Score Correlations of the 6th and 8th items of the original scale were 0.142 and − 0.02, respectively, and that these values were below 0.30, and these items were respectively removed from the scale. After the 6th and 8th items were removed from the scale, it was determined that the Adjusted Item-Total Score Correlations (r) ranged between 0.403 and 0.868. DISCUSSION Validity of the Scale In the research, language, content and structure validity were examined in order to test the validity of the scale. Language Validity: Language validity consists of the steps of translation back to the target language and the original language [26]. The translators to be selected according to the literature should have mastery of both the language and the culture and have knowledge about the characteristics of the scale used [20,26-29]. Language validity of the scale was done by back translation method. Firstly Turkish Turkish version of the scale was translated into Turkish by three independent academicians who are native speakers of Turkish and who are proficient in both languages. The scale items, which were corrected with the expert opinions and the necessary corrections, were translated back into English by three different experts (two language specialists and an academician from the faculty of nursing). Scope Validity: In order to adapt a scale, experts evaluate whether the factors and items of the scale are suitable for the culture to be adapted [26,30]. It is stated in the literature that the scope validity of the scale should be evaluated by at least three experts [31]. The Davis technique was used to calculate the scope validity ratios of the scale items and the scope validity index of the entire scale [22]. In the Davis technique, experts are asked to rate each item as “not appropriate”, “somewhat appropriate”, “quite appropriate” and “very appropriate”, and to report their suggestions regarding the scale and items. As a result, the Content Validity Index (CGI) is calculated, and a CQI value of 0.80 and above indicates that the item has a good scope validity [32]. The scope validity of the scale evaluated by five experts and the scope validity index (CGI) of each item were calculated as 1 and it was found that the scope validity of the scale was high according to the literature [22,32]. Explanatory Factor Analysis (EFA): It is stated in the literature that the KMO value should be greater than 0.50, and a value between 0.80 and 0.89 is very good [23-25]. KMO (0.885) and Bartlett test (χ2 = 680.078, s = .000) values mean that the sample size of the study is sufficient In the literature, it is accepted that factor loading values in EFA are 0.30 and above, it is stated that item eigenvalues should be 1, there should be no overlapping items between factors, and the explained variance should be between (40 -60%) [20,25,33]. The factor loadings (0.636-0.882) given in Table 1 of this scale adapted in accordance with the literature and the variance explained by the two factors in the scale (70.96%) were determined to be sufficient, and in this context, the scale factors and elements measure the structure at a good level. These results show that the scale may be sufficient to explain the ethical sensitivity of nursing students. Confirmatory Factor Analysis (CFA): CFA was applied to confirm the structure identified in EFA. During CFA modifications were made between item 5 and item 10, and item 12 and item 13 in terms of modification suggestions, and it was determined that the fit of the model was at a good level. The factor load values of the items of the Ethical Sensitivity Scale for Nursing Students ranged from 0.562 to 0.902 (Table 2). Fit indices as a result of CFA were determined as: χ2/ df=1.387, RMR=0.62, GFI=0.899, AGFI=0.837, NFI=0.921, RFI=0.894, IFI=0.977, TLI=0.968, CFI=0.976, RMSEA=0.068 and SRMR= 0.054. The fit indices obtained in CFA were examined in Table 4 in line with the literature, and as a result, the model was found to be compatible. The fit values were evaluated by considering the reference values of [20,25,34]. As a result of confirmatory factor analysis, it was seen that there was a low negative correlation between item 5 and item 10, and the items in the factors were significant for the factors they were included in, and the values obtained were found to be appropriate in terms of item-factor agreement. Table 4: Fit Indices related to CFA Compliance Criteria Good Fit Acceptable Fit Model Conclusion χ2/ df 0< χ2/sd ≤ 3 3< χ2/sd ≤ 5 1.387 Good Fit GFI 0.90< GFI≤ 1 0.90<GFI≤0.85 0.899 Acceptable Fit TLI 0.95<NFI<1 0.90<NFI<0.95 0.968 Good Fit CFI 0.95< CFI≤ 1 0.90 < CFI≤0.94 0.976 Good Fit RMSEA 0 ≤ RMSEA ≤ 0.05 0.05 ≤ RMSEA ≤ 0.08 0.068 Acceptable Fit SRMR 0≤SRMR≤0.05 0.05≤SRMR≤0.10 0.054 Acceptable Fit Reliability of the Scale The reliability of the scale was evaluated with split-half reliability, item-total score correlation, and Cronbach’s Alpha coefficients analyses. Two-Half Test (Split-Half) Reliability Analysis of the Scale: The Split-Half test is performed by dividing the scale into two equal parts and applying both parts to the participants at the same time. This test provides an estimate of reliability and correlation between the scores of the participants from the halves [20,35]. Secer stated that the reliability coefficients should be 0.70 and above [20]. Accordingly, as a result of the two-half reliability analyzes of the final form of the scale consisting of 11 items, it can be said that the Spearman-Brown correlation value (r= .89) and the Guttman Split Half Coefficient value (r= .89) of the scale were found to have appropriate values and that Cronbach’s Alpha reliability coefficients for the two halves are at appropriate values. Internal Consistency Coefficients of the Scale and Its Sub-Dimensions: The Cronbach's alpha values calculated for the sub-dimensions and the whole scale as a result of the internal consistency analysis of the Turkish Form of the Ethical Sensitivity Scale in Nursing Students are shown in Table 3. Secer states that it is acceptable if the Cronbach’s Alpha value is 0.70 and above, and Palant states that it is acceptable if the Cronbach’s Alpha value is 0.70 and above, and that 0.80 and above should be preferred [20,21]. According to Palant and Secer, these values obtained from the scale show that the scale has very good internal consistency (high reliability). Item-Total Score Correlations: The item-total score correlation of a scale shows the agreement between each item and the scale. According to Secer, items with total-item correlation values between 0.20 and 0.30 should be re-evaluated, and items with a value less than 0.20 should be removed from the scale [20]. Because, according to the literature, items with a correlation value of less than 0.30 indicate that they measure something different on the scale [20,21]. As a result of the analysis of the 11-item final version of the scale, it was determined that the Corrected Item-Total Score Correlations (r) ranged between 0.403 and 0.868. These results show that each item is appropriate for the scale and the Turkish version of the Ethical Sensitivity Scale in Nursing Students is a reliable form. The research was conducted with 84 undergraduate nursing students who could be reached via the internet at the time the research was conducted and who were practicing at the institution throughout their education and training processes. This can be considered a limitation of the study, as it cannot be generalized to nursing students in general. The disadvantage of the study was that there was a pandemic at the time the research was conducted, participants could not communicate face to face, and the data had to be collected online."Ethical Sensitivity Scale" adapted to Turkish is a valid and reliable scale for nursing students studying in Turkey. The scale will help nursing students to determine their ethical sensitivity and to exhibit ethical behaviors in their professional lives. It is proposed to apply the scale in a wider sample group. As nursing students gain ethical sensitivity, their ethical dilemmas during health service delivery will be minimized. The development of ethical sensitivity of health professionals enables the acquisition of competencies such as evaluating the patient holistically during care and practices, as well as the acquisition of professional duties and responsibilities. Ethical sensitivity helps nurses to be aware of their individual values, to be aware of the ethical problems they face during nursing practice and therefore to offer better quality care to individuals. Conclusıon and Recommendatıons As a result of the analysis of the final 11-item version of the scale, it was determined that the Corrected Item-Total Score Correlations (r) ranged between 0.403 and 0.868. These results show that each item is suitable for the scale and that the Turkish form of the Ethical Sensitivity Scale in Nursing Students is a reliable form. "Ethical Sensitivity Scale" is a valid and reliable scale adapted to Turkish. For nursing students studying in Turkey. The scale will help nursing students determine their ethical sensitivities and demonstrate ethical behavior in their professional lives. As nursing students gain ethical sensitivity, the ethical dilemmas they will encounter in healthcare delivery will be minimized. The development of ethical sensitivity of health professionals enables the acquisition of competencies such as evaluating the patient holistically during care and practices, and the acquisition of professional duties and responsibilities. Ethical sensitivity helps nurses to be aware of their individual values, to be aware of the ethical problems they encounter during nursing practice, and therefore to provide higher quality care to individuals. It is recommended that the scale be applied to a larger sample group. Declarations Ethical Approval and Consent to Participate This study was approved by the Erzincan Binali Yıldırım University Human Research Health and Sports Sciences Ethics Committee, decision no. 11/17, which included participants who gave both verbal and written consent, and the interviews were recorded for documentation. The study complies with the Declaration of Helsinki. Informed consent was obtained from all individual participants included in the study. Publication Consent Participants have consented to the publication of their data. Availability of Data and Materials Datasets are available from the corresponding author upon reasonable request. Funding This study has not received any funding. Conflict of Interest The authors declare that there is no financial or non-financial conflict of interest in connection with this study. Acknowledgements We thank the nursing students who participated in this study for their support. References Kucukoglu MT. 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XIV Natl Educational Sci Congress. 2005;1:771–4. Gaskin CJ, Happell B. On Exploratory Factor Analysis: a Review of Recent Evidence, an Assessment of Current Practice, and Recommendations for Future Use. Int J Nurs Stud. 2014;51:511–21. Karagöz Y, Ağbektaş A. Development of Life Satisfaction Scale with Structural Equation Modeling; Sivas province example. J Fac Econ Administrative Sci Bartın Univ. 2016;7(13):274–90. Ercan İ, Kan İ. Reliability and Validity in Scales. J Uludag Univ Fac Med. 2004;30(3):211–6. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8754384","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":586925751,"identity":"7dcd895f-a147-417a-be63-73791af3d622","order_by":0,"name":"Yesim BAĞCI","email":"data:image/png;base64,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","orcid":"","institution":"Erzincan Binali Yıldırım University","correspondingAuthor":true,"prefix":"","firstName":"Yesim","middleName":"","lastName":"BAĞCI","suffix":""}],"badges":[],"createdAt":"2026-02-01 07:23:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8754384/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8754384/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102188801,"identity":"1f9b6abb-a25d-4c8c-a0c5-364b651b5415","added_by":"auto","created_at":"2026-02-09 08:48:28","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":28462,"visible":true,"origin":"","legend":"\u003cp\u003eScree-plot Plot Factor Structure\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8754384/v1/f06914a2e296ffa79ca0a0e8.jpg"},{"id":102962291,"identity":"b13b7617-e9e1-4a8c-8ee0-34b963d2153c","added_by":"auto","created_at":"2026-02-19 04:07:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":976477,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8754384/v1/d507a4ae-91e1-4dbc-95c1-e7e65ed4b02f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eAdaptation of the Ethical Sensitivity Scale in Nursing Students to Turkish\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eEthics are behaviors that are obligatory for individuals in a professional discipline [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In other words, ethics are moral rulesregulate the behavior of a discipline and an individual as good or bad [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Nursing ethics, group of principles that help nurses to distinguish morally right and wrong behavior that they have to comply with during the health service they provide[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Ethics is a humanistic and scientific field that guides decisions and behaviors which help to solve problems with vital values, that directs behaviors towards good and right, and that develops new rules. Nursing services offered to individuals should be given in accordance with ethical principles and values [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e There are ethical principles that individuals have to abide by and that help make an ethical decision about an issue. Ethical principles provide explanations to the individual about why a certain behavior should or should not be done [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Ethical principles that nurses have to abide by while fulfilling their duties and responsibilities, and that have been determined by the Turkish Nurses Association are \u0026ldquo;doing no harm-providing benefit, autonomy/respect for the individual, privacy and confidentiality, justice and equality\u0026rdquo; [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Ethical dilemma is the inability to decide between two values during a situation [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStudies have shown that nursing students face many ethical dilemmas in clinical practice, such as patient refusal of treatment, lack of attention to patient privacy, health professionals providing incomplete or incorrect information, and discrimination based on individual characteristics. These dilemmas affect students\u0026rsquo; motivation and cause students to experience value conflicts [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn literature reviews, it is stated that ethics education in all disciplines is important for the formation and development of ethical sensitivity and awareness [\u003cspan additionalcitationids=\"CR11 CR12 CR13\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Ethical education of health professionals enables them to acquire competencies such as holistic evaluation of the patient during care and practices, as well as their professional duties and responsibilities [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In this context, nursing students need to become aware of and adopt basic professional principles and values ​​and develop ethical sensitivity during the education process consisting of clinical and theoretical practices [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEthical sensitivity means that individuals can distinguish ethical issues. Nurses need to have developed ethical sensitivities in order to recognize the ethical problems they face and make ethical decisions appropriately. Ethical sensitivity developed with nursing ethics training is maintained by nurses acting in accordance with the ethical codes of their profession [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Developing ethical sensitivity in nurses helps them be self aware their values, how it affects their relationships with other individuals, and the provision of better quality care to individuals [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Ethical sensitivity, it is influenced by factors such as an individual's age, culture, religion, language, educational level, gender, experience and upbringing style [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e This scale, which will be introduced to the Turkish literature, will be useful in determining the ethical sensitivity levels of students and the ethical behaviors they exhibit in their professional lives. Muramatsu et al. This study, which aims to adapt the \"Ethical Sensitivity Questionnaire in Nursing Students (ESQ-NS)\" developed by (2019) into Turkish, will be useful in determining the ethical sensitivity levels of students and the ethical behaviors they exhibit in their professional lives [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eThis study is a methodological type of research.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData Sources and Research Strategies\u003c/h3\u003e\n\u003cp\u003eThe research was conducted by university students studying nursing in Turkey by filling out a survey created electronically via social media/online.\u003c/p\u003e\n\u003ch3\u003eData collection tools\u003c/h3\u003e\n\u003cp\u003eIn the data collection, the Descriptive Characteristics Form including socio-demographic characteristics and the Ethical Sensitivity Scale for Nursing Students were used.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eThe Descriptive Characteristics Form\u003c/strong\u003e \u003cp\u003eIt is a form consisting of 5 questions that include the individual characteristics of the participants.\u003c/p\u003e \u003c/p\u003e\n\u003ch3\u003eEthical Sensitivity Scale in Nursing Students:\u003c/h3\u003e\n\u003cp\u003eThis scale was developed by Muramatsu et al. (2019) is a Likert-type scale consisting of three subscales (1\u0026thinsp;=\u0026thinsp;I don't think at all, 2\u0026thinsp;=\u0026thinsp;I don't think much, 3\u0026thinsp;=\u0026thinsp;I think little, 4\u0026thinsp;=\u0026thinsp;I think a lot). The scale consists of 13 items, including respect for the individual (8 items), fair treatment (3 items), protecting the patient's privacy (2 items). The Cronbach alpha coefficient of the scale of the adapted study was found to be 0.82 and the Cronbach alpha coefficient of the scale was found to be 0.92 in the study [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The adjusted item total score correlations of the scale were calculated and 6. and 8. it was determined that the items were 0.142 and \u0026minus;\u0026thinsp;0.02, respectively, and these values were less than 0.30, and these two items were excluded from the scope [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This situation revealed that the scale is a quadruple Likert-type scale consisting of two sub-dimensions, Respect for a Person (8 items) and Fair Treatment (3 items), and a total of 11 items.\u003c/p\u003e\n\u003ch3\u003eCollection of Data\u003c/h3\u003e\n\u003cp\u003eData was collected online from participants between December 2020 and January 2021.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis and Evaluation\u003c/h2\u003e \u003cp\u003eData were analyzed with SPSS 22.0 and AMOS 24.0 software packages. Davis analysis was used for number, percentage, mean, content and content validity of the data. Kaiser-Meyer-Olkin-Bartlett test and exploratory factor analysis were used to evaluate sample adequacy. Additionally, Confirmatory Factor Analysis and item-total score correlation analysis, split-half reliability analysis and Cronbach's alpha coefficients were calculated.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e for the study was obtained from the Erzincan Binali Yıldırım University Health and Sports Sciences Ethics Committee with decision number 17.11 dated 18.12.2020. Furthermore, permission was obtained via email from the scale owner for the Turkish validity and reliability study of the scale. The study was conducted in accordance with the Helsinki Declaration.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eStudents participating in the study were given detailed information about the purpose, methodology, and method of the study. Participants were assured that participation in the study was voluntary and that they could withdraw from the study at any time without giving any reason. Online consent forms were provided to participants during the informed consent process. Participants/students in the sample were informed and their informed consent was obtained before use.\u003c/p\u003e\n\u003ch3\u003eLimitations of the Research\u003c/h3\u003e\n\u003cp\u003eThe research was conducted with 84 undergraduate nursing students who could be reached via the internet at the time the research was conducted and who were working in the institution throughout their education and training processes. This can be considered a limitation of the study as it cannot be generalized to nursing students in general.\u0026Ccedil;alışmada planlanan akıştan herhangi bir sapma varsa, sebepleri ile anlatılmalıdır ve bunların sonu\u0026ccedil;lara olan etkisinin nasıl en aza indirildiği veya \u0026ouml;nlendiği a\u0026ccedil;ıklanmalıdır.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe average age of the participants was 21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.71, and the majority (88.1%) were female and were in the 3rd grade (75%). In addition, 71.4% of the participants stated that they chose the profession willingly, and 54.8% stated that they did not encounter an ethical dilemma.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eFindings Related to the Validity of the Ethical Sensitivity Scale in Nursing Students\u003c/h2\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003eLanguage Validity:\u003c/h2\u003e \u003cp\u003eThe Turkish version of the scale was translated by three academicians whose native speakers are Turkish and who are proficient in both languages. The translations were compared with each other, the necessary corrections were made by the researcher, and the scale was translated into its original language, English, by three different experts (two linguists and a nursing faculty academician) who are native speakers of Turkish and fluent in both languages. After the translations, necessary checks were made for language equivalence.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eScope Validity:\u003c/h2\u003e \u003cp\u003eDavis method was used for the scale items and the whole scale [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. After linguistic validation of the scale, along with its Turkish form and the original form, the scale was emailed to 5 academics, mainly from the field of nursing principles, and they were asked to rate it. The experts evaluated the items on the basis of \u0026ldquo; point if the item is not appropriate, 2 points if it is somewhat appropriate, 3 points if it is quite appropriate, 4 points if the item is very appropriate\u0026rdquo;. As a result of this evaluation made by five experts, the content validity index (CGI) of the draft scale and each of the items was calculated as 1.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eConstruct Validity Explanatory Factor Analysis (EFA):\u003c/h2\u003e \u003cp\u003eBartlett- Kaiser Meyer Olkin (KMO) tests were performed to assess sample adequacy. When the Artlett and Kaiser Meyer Olkin (KMO) test results were examined, Bartlett (χ2\u0026thinsp;=\u0026thinsp;680.078, p=.000) and KMO\u0026thinsp;=\u0026thinsp;0.885 test results were determined to be significant [\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. According to the EFA test results, the scale was given its final form with 11 items. 6. and 8. since the load values of the items were below 0.30, they were removed from the scale and it was determined that the scale, the original of which was 3-dimensional, was 2-dimensional [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe varimax rotation method was used to distribute the scale's items into factor loadings. Additionally, a scree plot diagram was used to show the clarity of the number of factors and it was seen that the scale had a 2-factor structure (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAccording to Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, it was determined that the first factor consisted of 8 items: 1,5,7,9,10,11,12,13 and the distribution of the factor load values ​​of the items varied between 0.636 and 0.882. It was determined that the second factor consisted of 3 items: 2, 3, and 4, and the factor loadings of the items varied between 0.716 and 0.853 (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of Factor Load Values of Items According to the EFA Results of Ethical Sensitivity Scale Turkish Form in Nursing Students (Varimax Transformation)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFactor 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFactor 2\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.820\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.852\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.853\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.716\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.882\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.636\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.850\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.825\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.806\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.822\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.844\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIt was determined that the total variance of the two factors of the scale was 70.96%. Factor 1 has 57.053% of the total variance and an eigenvalue of 6.276, Factor 2 has 13.907% of the total variance and an eigenvalue of 1.530.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eConfirmatory Factor Analysis (CFA):\u003c/h2\u003e \u003cp\u003eCFA was performed to confirm the structure identified in EFA. During the CFA, a modification was made between item 5 and item 10, and item 12 and item 13. The factor load values of the items of the Ethical Sensitivity Scale in Nursing Students are given in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The factor loading values of the items ranged from 0.562 to 0.902. Fit indices as a result of CFA were determined as: χ2/ df\u0026thinsp;=\u0026thinsp;1.387, RMR\u0026thinsp;=\u0026thinsp;0.62, GFI\u0026thinsp;=\u0026thinsp;0.899, AGFI\u0026thinsp;=\u0026thinsp;0.837, NFI\u0026thinsp;=\u0026thinsp;0.921, RFI\u0026thinsp;=\u0026thinsp;0.894, IFI\u0026thinsp;=\u0026thinsp;0.977, TLI\u0026thinsp;=\u0026thinsp;0.968, CFI\u0026thinsp;=\u0026thinsp;0.976, RMSEA\u0026thinsp;=\u0026thinsp;0.068 and SRMR\u0026thinsp;=\u0026thinsp;0.054. As a result of confirmatory factor analysis, it was determined that eight items in the first factor had a standard solution between 0.55 and 1.00, and three items in the second factor had a standard solution between 1 and 1.30.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactor Loading Values of the Items of the Turkish Form of the Ethical Sensitivity Scale in Nursing Students\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFactor Load Values\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eRespect for Individual\u003c/p\u003e \u003cp\u003e(Factor 1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.828\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.867\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.562\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.850\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.902\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.801\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.820\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.863\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eActing Fairly\u003c/p\u003e \u003cp\u003e(Factor 2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.873\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.733\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.617\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eFindings Related to the Reliability of the Ethical Sensitivity Scale in Nursing Students\u003c/h2\u003e \u003cp\u003eThe reliability of the scale was evaluated with split-half reliability, item-total score correlation and Cronbach\u0026rsquo;s Alpha coefficients analyses.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eTwo-Half Test (Split-Half) Reliability Analysis of the Scale:\u003c/h2\u003e \u003cp\u003eThe Spearman-Brown correlation value (r= .89) and the Guttman Split Half Coefficient value (r= .89) of the scale were determined as a result of the two-half reliability analyzes of the final version of the scale, which consisted of 11 items.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eInternal Consistency Coefficients of Scale and Sub-Dimensions:\u003c/h2\u003e \u003cp\u003eThe Cronbach\u0026rsquo;s alpha values calculated for the sub-dimensions and the whole scale as a result of the internal consistency analysis of the Turkish Form of the Ethical Sensitivity Scale in Nursing Students are given in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. As a result of the analyzes, the Cronbach\u0026rsquo;s Alpha internal consistency coefficient was calculated for the reliability analyzes of the 11 items of the scale, which was finalized as a result of the analyses, and it was calculated as 0.94 for the \u0026ldquo;Respect for Individual\u0026rdquo; sub-dimension, 0.775 for the \u0026ldquo;Acting Fairly\u0026rdquo; sub-dimension, and 0.92 for the whole scale.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCronbach\u0026rsquo;s Alpha Values of the Turkish Form and Sub-Dimensions of the Ethical Sensitivity Scale in Nursing Students\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScale and Sub-Dimensions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCronbach\u0026rsquo;s Alfa*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespect for Individual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItems 1, 5, 7, 9, 10, 11, 12, and 13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActing Fairly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItems 2, 3, and 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.775\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEthical Sensitivity Scale Total Score in Nursing Students\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItems 1, 2, 3, 4, 5, 7, 9, 10, 11, 12, and 13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eItem-Total Score Correlations:\u003c/h2\u003e \u003cp\u003eAs a result of the reliability analyzes of the scale items, it was seen that the Corrected Item-Total Score Correlations of the 6th and 8th items of the original scale were 0.142 and \u0026minus;\u0026thinsp;0.02, respectively, and that these values were below 0.30, and these items were respectively removed from the scale. After the 6th and 8th items were removed from the scale, it was determined that the Adjusted Item-Total Score Correlations (r) ranged between 0.403 and 0.868.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003e\u003cstrong\u003eValidity of the Scale\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the research, language, content and structure validity were examined in order to test the validity of the scale.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLanguage Validity:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLanguage validity consists of the steps of translation back to the target language and the original language [26]. The translators to be selected according to the literature should have mastery of both the language and the culture and have knowledge about the characteristics of the scale used [20,26-29].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLanguage validity of the scale was done by back translation method. Firstly Turkish Turkish version of the scale was translated into Turkish by three independent academicians who are native speakers of Turkish and who are proficient in both languages. The scale items, which were corrected with the expert opinions and the necessary corrections, were translated back into English by three different experts (two language specialists and an academician from the faculty of nursing).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eScope Validity:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn order to adapt a scale, experts evaluate whether the factors and items of the scale are suitable for the culture to be adapted [26,30]. It is stated in the literature that the scope validity of the scale should be evaluated by at least three experts [31]. The Davis technique was used to calculate the scope validity ratios of the scale items and the scope validity index of the entire scale [22]. In the Davis technique, experts are asked to rate each item as “not appropriate”, “somewhat appropriate”, “quite appropriate” and “very appropriate”, and to report their suggestions regarding the scale and items. As a result, the Content Validity Index (CGI) is calculated, and a CQI value of 0.80 and above indicates that the item has a good scope validity [32]. The scope validity of the scale evaluated by five experts and the scope validity index (CGI) of each item were calculated as 1 and it was found that the scope validity of the scale was high according to the literature [22,32].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExplanatory Factor Analysis (EFA):\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt is stated in the literature that the KMO value should be greater than 0.50, and a value between 0.80 and 0.89 is very good [23-25]. KMO (0.885) and Bartlett test (χ2 = 680.078, s = .000) values mean that the sample size of the study is sufficient\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the literature, it is accepted that factor loading values in EFA are 0.30 and above, it is stated that item eigenvalues should be 1, there should be no overlapping items between factors, and the explained variance should be between (40 -60%) [20,25,33].\u003csup\u003e\u0026nbsp;\u003c/sup\u003eThe factor loadings (0.636-0.882) given in Table 1 of this scale adapted in accordance with the literature and the variance explained by the two factors in the scale (70.96%) were determined to be sufficient, and in this context, the scale factors and elements measure the structure at a good level. These results show that the scale may be sufficient to explain the ethical sensitivity of nursing students.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConfirmatory Factor Analysis (CFA):\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCFA was applied to confirm the structure identified in EFA. During CFA modifications were made between item 5 and item 10, and item 12 and item 13 in terms of modification suggestions, and it was determined that the fit of the model was at a good level. The factor load values of the items of the Ethical Sensitivity Scale for Nursing Students ranged from 0.562 to 0.902 (Table 2). Fit indices as a result of CFA were determined as: χ2/ df=1.387, RMR=0.62, GFI=0.899, AGFI=0.837, NFI=0.921, RFI=0.894, IFI=0.977, TLI=0.968, CFI=0.976, RMSEA=0.068 and SRMR= 0.054. The fit indices obtained in CFA were examined in Table 4 in line with the literature, and as a result, the model was found to be compatible. The fit values were evaluated by considering the reference values of [20,25,34].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs a result of confirmatory factor analysis, it was seen that there was a low negative correlation between item 5 and item 10, and the items in the factors were significant for the factors they were included in, and the values obtained were found to be appropriate in terms of item-factor agreement.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4: Fit Indices related to CFA\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"606\"\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCompliance Criteria\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGood Fit\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcceptable Fit\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConclusion\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003eχ2/ df\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e0\u0026lt; χ2/sd ≤ 3\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e3\u0026lt; χ2/sd ≤ 5\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.387\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eGood Fit\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003eGFI\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e0.90\u0026lt; GFI≤ 1\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e0.90\u0026lt;GFI≤0.85\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.899\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eAcceptable Fit\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003eTLI\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e0.95\u0026lt;NFI\u0026lt;1\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e0.90\u0026lt;NFI\u0026lt;0.95\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.968\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eGood Fit\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003eCFI\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e0.95\u0026lt; CFI≤ 1\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e0.90 \u0026lt; CFI≤0.94\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.976\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eGood Fit\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003eRMSEA\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e0 ≤ RMSEA ≤ 0.05\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e0.05 ≤ RMSEA ≤ 0.08\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eAcceptable Fit\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003eSRMR\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e0≤SRMR≤0.05\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e0.05≤SRMR≤0.10\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eAcceptable Fit\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eReliability of the Scale\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe reliability of the scale was evaluated with split-half reliability, item-total score correlation, and Cronbach’s Alpha coefficients analyses.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTwo-Half Test (Split-Half) Reliability Analysis of the Scale:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Split-Half test is performed by dividing the scale into two equal parts and applying both parts to the participants at the same time. This test provides an estimate of reliability and correlation between the scores of the participants from the halves [20,35]. Secer stated that the reliability coefficients should be 0.70 and above [20]. Accordingly, as a result of the two-half reliability analyzes of the final form of the scale consisting of 11 items, it can be said that the Spearman-Brown correlation value (r= .89) and the Guttman Split Half Coefficient value (r= .89) of the scale were found to have appropriate values and that Cronbach’s Alpha reliability coefficients for the two halves are at appropriate values.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInternal Consistency Coefficients of the Scale and Its Sub-Dimensions:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Cronbach's alpha values calculated for the sub-dimensions and the whole scale as a result of the internal consistency analysis of the Turkish Form of the Ethical Sensitivity Scale in Nursing Students are shown in Table 3. Secer states that it is acceptable if the Cronbach’s Alpha value is 0.70 and above, and Palant states that it is acceptable if the Cronbach’s Alpha value is 0.70 and above, and that 0.80 and above should be preferred [20,21]. According to Palant and Secer, these values obtained from the scale show that the scale has very good internal consistency (high reliability).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eItem-Total Score Correlations:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe item-total score correlation of a scale shows the agreement between each item and the scale. According to Secer, items with total-item correlation values between 0.20 and 0.30 should be re-evaluated, and items with a value less than 0.20 should be removed from the scale [20].\u003csup\u003e\u0026nbsp;\u003c/sup\u003eBecause, according to the literature, items with a correlation value of less than 0.30 indicate that they measure something different on the scale [20,21]. As a result of the analysis of the 11-item final version of the scale, it was determined that the Corrected Item-Total Score Correlations (r) ranged between 0.403 and 0.868. These results show that each item is appropriate for the scale and the Turkish version of the Ethical Sensitivity Scale in Nursing Students is a reliable form.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe research was conducted with 84 undergraduate nursing students who could be reached via the internet at the time the research was conducted and who were practicing at the institution throughout their education and training processes. This can be considered a limitation of the study, as it cannot be generalized to nursing students in general.\u003c/p\u003e\n\u003cp\u003eThe disadvantage of the study was that there was a pandemic at the time the research was conducted, participants could not communicate face to face, and the data had to be collected online.\"Ethical Sensitivity Scale\" adapted to Turkish is a valid and reliable scale for nursing students studying in Turkey. The scale will help nursing students to determine their ethical sensitivity and to exhibit ethical behaviors in their professional lives. It is proposed to apply the scale in a wider sample group.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eAs nursing students gain ethical sensitivity, their ethical dilemmas during health service delivery will be minimized.\u003c/li\u003e\n \u003cli\u003eThe development of ethical sensitivity of health professionals enables the acquisition of competencies such as evaluating the patient holistically during care and practices, as well as the acquisition of professional duties and responsibilities.\u003c/li\u003e\n \u003cli\u003eEthical sensitivity helps nurses to be aware of their individual values, to be aware of the ethical problems they face during nursing practice and therefore to offer better quality care to individuals.\u003c/li\u003e\n\u003c/ul\u003e\n\n\n\n\n"},{"header":"Conclusıon and Recommendatıons","content":"\u003cp\u003eAs a result of the analysis of the final 11-item version of the scale, it was determined that the Corrected Item-Total Score Correlations (r) ranged between 0.403 and 0.868. These results show that each item is suitable for the scale and that the Turkish form of the Ethical Sensitivity Scale in Nursing Students is a reliable form.\u003c/p\u003e\u003cp\u003e\"Ethical Sensitivity Scale\" is a valid and reliable scale adapted to Turkish. For nursing students studying in Turkey. The scale will help nursing students determine their ethical sensitivities and demonstrate ethical behavior in their professional lives.\u003c/p\u003e\u003cul type=\"disc\"\u003e\n \u003cli\u003eAs nursing students gain ethical sensitivity, the ethical dilemmas they will encounter in healthcare delivery will be minimized.\u003c/li\u003e\n \u003cli\u003eThe development of ethical sensitivity of health professionals enables the acquisition of competencies such as evaluating the patient holistically during care and practices, and the acquisition of professional duties and responsibilities.\u003c/li\u003e\n \u003cli\u003eEthical sensitivity helps nurses to be aware of their individual values, to be aware of the ethical problems they encounter during nursing practice, and therefore to provide higher quality care to individuals.\u003c/li\u003e\n\u003c/ul\u003e\u003cp\u003eIt is recommended that the scale be applied to a larger sample group.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Erzincan Binali Yıldırım University Human Research Health and Sports Sciences Ethics Committee, decision no. 11/17, which included participants who gave both verbal and written consent, and the interviews were recorded for documentation. The study complies with the Declaration of Helsinki. Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePublication Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants have consented to the publication of their data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDatasets are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has not received any funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there is no financial or non-financial conflict of interest in connection with this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the nursing students who participated in this study for their support.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKucukoglu MT. 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A Guide for Transcultural Adaptation of the Scale II: Psychometric Characteristics and Cross-Cultural Comparison. \u003cem\u003eThe Turkish Journal of Research and Development in Nursing\u003c/em\u003e, 5, 3\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAtasoy N, Baykara ZG. Adaptation of Nurses' Attitudes towards Professional Autonomy Scale into Turkish: A Validity and Reliability Study. Turkiye Klinikleri J Med Ethics-Law-History. 2020;28(2):206\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYurdug\u0026uuml;l H. Using Content Validity Indices for Content Validity in Scale Development Studies. XIV Natl Educational Sci Congress. 2005;1:771\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGaskin CJ, Happell B. On Exploratory Factor Analysis: a Review of Recent Evidence, an Assessment of Current Practice, and Recommendations for Future Use. Int J Nurs Stud. 2014;51:511\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarag\u0026ouml;z Y, Ağbektaş A. Development of Life Satisfaction Scale with Structural Equation Modeling; Sivas province example. J Fac Econ Administrative Sci Bartın Univ. 2016;7(13):274\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErcan İ, Kan İ. Reliability and Validity in Scales. J Uludag Univ Fac Med. 2004;30(3):211\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Ethical sensitivity, nursing education, validity, reliability, scale adaptation","lastPublishedDoi":"10.21203/rs.3.rs-8754384/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8754384/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eEthical sensitivity is a fundamental component of nursing practice, enabling nurses to recognize ethical issues and make appropriate ethical decisions. Measuring ethical sensitivity during nursing education is important for developing ethical awareness and professional values. Therefore, valid and reliable measurement tools are needed to assess nursing students\u0026rsquo; ethical sensitivity.\u003c/p\u003e\u003ch2\u003eDesign:\u003c/h2\u003e \u003cp\u003eThis study was designed as a cross-sectional and methodological research.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe study was conducted with 84 nursing students between December 2020 and January 2021. Data were collected online using a Descriptive Characteristics Form and the Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS). TheǰThe scale was translated into Turkish using forward\u0026ndash;backward translation. Content validity was evaluated using the Davis method. Construct validity was examined through exploratory and confirmatory factor analyses. Reliability was assessed using item\u0026ndash;total correlations, split-half reliability, and Cronbach\u0026rsquo;s alpha coefficients.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe content validity index of the scale was found to be 1. Exploratory factor analysis revealed a two-factor structure consisting of 11 items, explaining 70.96% of the total variance. Confirmatory factor analysis indicated acceptable to good model fit indices. The Cronbach\u0026rsquo;s alpha coefficient was 0.92 for the total scale, demonstrating high internal consistency. Item\u0026ndash;total correlation values ranged between 0.403 and 0.868.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe Turkish version of the Ethical Sensitivity Questionnaire for Nursing Students is a valid and reliable measurement tool. It can be used to assess ethical sensitivity levels of nursing students in Turkey and may contribute to the evaluation and improvement of ethics education in nursing programs.\u003c/p\u003e","manuscriptTitle":"Adaptation of the Ethical Sensitivity Scale in Nursing Students to Turkish","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-09 08:48:24","doi":"10.21203/rs.3.rs-8754384/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"921cc363-bedc-492d-b6bf-6935bd979af9","owner":[],"postedDate":"February 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-09T08:48:26+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-09 08:48:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8754384","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8754384","identity":"rs-8754384","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}