Development and validation of the conscientious objection in nursing care scale: a methodological study

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.