Development of an Instrument to Identify the Virtues of Expert Nursing Practice: Byrd's Nurses Ethical Sensitivity Test (Byrd's NEST)

Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Janie Butts

Advisor Department



The purpose of this research was to develop and analyze the psychometric properties of Byrd's Nurse's Ethical Sensitivity Test (Byrd's NEST). An instrument to evaluate nurses' ethical sensitivity in practice by examining choices of action in ethical dilemmas based on nursing virtues: compassion, fidelity to trust, moral courage, justice, self-confidence, resilience, practical reasoning, and integrity (Benner, Tanner, & Chelsa, 1996; Volbrecht, 2002). Benner's theory of skill acquisition---novice to expert---was the theoretical framework for this research which surveyed for correlations between a nurse's ethical sensitivity and educational level, years of experience, certification, and work setting. Until now, there have been no instruments available to measure nurses' ethical sensitivity. Instrument development was the focus of this research which employed multiple phases in creation and psychometric testing. The Byrd's NEST consists of 10 ethical dilemmas in nursing followed by three response choices to allow the participant to choose a course of action scored on a scale of low, medium, or high degree of ethical sensitivity. Concurrent validity was assessed utilizing the Moral Sensitivity Questionnaire (MSQ) (Lutzen, Everton, & Nordin, 1997) and the Multidimensional Ethics Scale (MES) (Reidenbach & Robin, 1990). Reliability and validity tests were conducted throughout the study in three stages: first two panels of experts evaluated the instrument and scored the items, next a small pilot study of 20 nurses were administered the instrument and test/retest stability was examined, and finally a larger pilot study of 500 nurses was conducted through a one-time mail-out. The scores in the large pilot study (N=115) indicated that all nurses who responded to this study demonstrated high ethical sensitivity regardless of educational degrees, years of experience, certification, or work setting. There was possibly a ceiling effect in which the different group's characteristics could not be seen. But these findings demonstrate that the nursing profession, as a whole, is an ethical practice. At this stage of development, the Byrd's NEST does not demonstrate internal consistency or concurrent validity with the MSQ or the MES items. The Byrd's NEST is in it's infancy and will require further revisions and additional testing to improve its reliability.