Open Access Research article

Development process and initial validation of the Ethical Conflict in Nursing Questionnaire-Critical Care Version

Anna Falcó-Pegueroles1*, Teresa Lluch-Canut2 and Joan Guàrdia-Olmos3

Author Affiliations

1 Department of Fundamental Care and Medical-Surgical Nursing, Campus of Health Science of Bellvitge, Nursing School, University of Barcelona, Central Pavilion, 3r floor, L’08907, Hospitalet de Llobregat, Barcelona, Spain

2 Department of Public Health, Mental Health and Midwife Nursing, Health Science Campus of Bellvitge, Nursing School, University of Barcelona, Barcelona, Spain

3 Methodology of Behavioural Sciences, Faculty of Psychology, Research Institute on Brain, Cognition and Behaviour (IR3C), University of Barcelona, Barcelona, Spain

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BMC Medical Ethics 2013, 14:22  doi:10.1186/1472-6939-14-22

Published: 1 June 2013



Ethical conflicts are arising as a result of the growing complexity of clinical care, coupled with technological advances. Most studies that have developed instruments for measuring ethical conflict base their measures on the variables ‘frequency’ and ‘degree of conflict’. In our view, however, these variables are insufficient for explaining the root of ethical conflicts. Consequently, the present study formulates a conceptual model that also includes the variable ‘exposure to conflict’, as well as considering six ‘types of ethical conflict’. An instrument was then designed to measure the ethical conflicts experienced by nurses who work with critical care patients. The paper describes the development process and validation of this instrument, the Ethical Conflict in Nursing Questionnaire Critical Care Version (ECNQ-CCV).


The sample comprised 205 nursing professionals from the critical care units of two hospitals in Barcelona (Spain). The ECNQ-CCV presents 19 nursing scenarios with the potential to produce ethical conflict in the critical care setting. Exposure to ethical conflict was assessed by means of the Index of Exposure to Ethical Conflict (IEEC), a specific index developed to provide a reference value for each respondent by combining the intensity and frequency of occurrence of each scenario featured in the ECNQ-CCV. Following content validity, construct validity was assessed by means of Exploratory Factor Analysis (EFA), while Cronbach’s alpha was used to evaluate the instrument’s reliability. All analyses were performed using the statistical software PASW v19.


Cronbach’s alpha for the ECNQ-CCV as a whole was 0.882, which is higher than the values reported for certain other related instruments. The EFA suggested a unidimensional structure, with one component accounting for 33.41% of the explained variance.


The ECNQ-CCV is shown to a valid and reliable instrument for use in critical care units. Its structure is such that the four variables on which our model of ethical conflict is based may be studied separately or in combination. The critical care nurses in this sample present moderate levels of exposure to ethical conflict. This study represents the first evaluation of the ECNQ-CCV.