The present study was conducted with the general purpose of “determining the effect of durability of knowledge transfer through reminiscence on the moral sensitivity of nurses”. Findings from comparison of demographic factors between intervention and control groups showed that, the two groups did not have significant difference in terms of age, gender, marital status, education, and work experience, and were homogeneous.
Based on the obtained results, the average moral sensitivity score between the two intervention and control groups at the beginning of the study was at an average level. Farasatkish et al. study (2014) showed that the average moral sensitivity score of nurses was in the medium range . In South Korea, psychiatric nurses had moderate moral sensitivity , which is consistent with the results of this study.
Karimi et al.(2016) have stated that the level of moral sensitivity in nursing students and nurses has reached an optimal level  also, Mousavi et al. have reported that the mean score of moral sensitivity of nursing students and nurses is higher than average . However, in the study of Imani et al. (2017), the mean score of moral sensitivity among nurses was reported to be low , which is not consistent with the results of the present study. The difference in the results can be caused by the level of culture and the study environment and the atmosphere of the work environment.
Comparison of mean scores of nurses’ moral sensitivity before intervention in the intervention and control groups showed that, the mean score of nurses’ moral sensitivity before intervention in the two groups was not statistically significant. The mean score of nurses’ emotional sensitivity after intervention was compared in the experimental and control groups. There was a significant increase in the mean score of moral sensitivity after intervention in the intervention group compared to the control group.
In the review of the literature, no study on the teaching of professional ethics by reminiscence has been found. But these findings are consistent with findings provided by some researchers. For example, in a study by Choe et al. (2014) entitled “The Effect of Structural Teaching Methods on Ethics Education for Nursing Students: A Semi-Experimental Study”, it was found that, knowledge, skills and moral competence of students after ethics education have been improved through active education and group discussion .
This finding is also consistent with the results obtained by Baykara’s (2015), which showed that ethics education increases student awareness of moral violations in hospitals and it helps them to have better interventions and care in this field. In this study, the researcher believes that moral education through discussion can have a positive impact on their emotional and cognitive outlook, given the cases experienced by the students in the hospital . Imanifar et al. (2015) have shown that the two methods of narrative ethics and lecture have significantly improved the moral sensitivity of nurses in each group compared to before the intervention, which is consistent with the results of the present study.
But this finding is in contradiction with the study of Hough (2008). He considers the small effect of experience and education on sensitivity in moral decision-making in his study and states its reason as, some moral problems make the nurse confused and prevent the nurse to make good decisions . This contradiction appears to be due to the following reasons. The first is the type of study, because the research has been qualitative in the above study, while this study was conducted as a controlled clinical trial. In the Hough’s study, the nurses working in the Intensive Care Unit were interviewed and the interview method has been a rethinking of past moral decisions, while in this study nurses from all wards were participated in the study and randomly divided into two groups of test and control. Also, inconsistent with the results of the previous research, Yeum et al. (2017) reported that there was no change in the overall scores for moral sensitivity and critical thinking . Different results it can be caused by a different educational method.
The mean of moral sensitivity scores before and after intervention in the test and control group was calculated and compared and, it was found that the mean scores of the moral sensitivity before and after the intervention in the test group was significant and in the control group it was not significant which shows the positive effect of training moral sensitivity with the reminiscence method in the intervention group. This finding is consistent with the study of Tamimi et al. (2013) showing that, the transfer of tacit knowledge through the narrative expression of individual experiences improves the clinical competence of nurses in the Intensive Care Unit of the Shahid Rajaee Cardiology and Research Center for Research and Therapy in order to communicate effectively with the patient and the treatment team .
Kim’s experimental study (2014) was conducted on 71 undergraduate nursing students and it was found that, the score of moral values in students after combination learning including case-based learning with problem-based learning, has significantly increased that, the result of this study is consistent with this result .
Also, the results of Ahns study (2014) in Korea showed that training ethics principles significantly improved the level of patient care, the range of moral sensitivity, the level of students’ knowledge and critical thinking. The question and answer about moral issues and expressing different perspectives and discussing these cases, actively promotes critical thinking, which is also consistent with the present study .
To compare the mean scores of moral sensitivity during the study period in the intervention and control groups, which in fact determines the durability of training, repeated measures analysis of variance test was used, and the results showed that the mean changes in moral sensitivity scores during the study group in the experimental group Comparison with the control group had a significant difference. The results of the present study show the effect of the intervention designed based on reminiscence; therefore, in addition to being effective, the educational method has also had a lasting effect. This finding was consistent with the results of Ghasemi (2012) and Tamimi (2013). In these two studies, the effect of the storytelling expression of clinical experiences in the course of workshops on the competence of nurses was assessed. Findings from post-test one month after intervention showed that, the educational method of expressing experiences through storytelling leads to the improvement of nurses’ clinical competency skills [36, 38]. Also, in Jamshidian et al. study (2017), the average score of moral sensitivity increased significantly immediately and two months after the intervention . The results of these studies are in line with the recent study.
However, in the study of Imanifar et al. (2014), the average score of moral sensitivity three months after the intervention showed a significant decrease compared to immediately after, in two groups , which is not consistent with the results of the present study. The decrease in the average score of moral sensitivity in Imanifar et al.‘s study may be due to a different teaching method that has less durability. Also, in the current study, the durability of education was measured one month after the intervention, while in Imanifar’s study, the duration was longer and it was measured three months after the intervention.
Also, this finding of the present study is different and inconsistent with Mayhew’s results (2009). The results of the aforementioned study have shown that, with the passage of time and through training courses, in some cases, no significant changes in moral sensitivity and subsequent development of moral behavior have been observed . This contradiction seems to be due to the following reasons. First, the study samples are in the above study include accounting students, but in the present study, the samples included nurses working in the hospital environment, the educational method in the study was not an active participation of students and samples have received the educational program, while in the present study, the samples have actively expressed and shared the memories of their work experience which can have a positive impact on the learning and promotion of their moral sensitivity. Also the area of moral sensitivity in the Mayhew’s study has been financial reporting and financial issues but in the present study, the area of moral sensitivity of the patient care and communication has been evaluated.