Table 1 Final component rotated matrix of the EDMAS and its items’ loading

Dimension 1: Ethical sensitivity

 1. I will check with the doctor about the situation

0.639

 2. ^a The patient said the doctor believed it was OK to inject, so I do not have to/do not want to check

0.670

 3. I will try to understand the reason why the patient insists on injecting the drug

0.786

 4. I think there is a risk of conflict with the patient in this situation

0.685

 5. I believe there is a risk that this scenario will harm the patient’s health and cause adverse events

0.587

 19. I will ask Xiao Li why she does not want to report it

0.758

 20. I will observe the patient’s physical condition again

0.736

 21. I think this situation may damage my working relationship with Xiao Li

0.662

 22. In my opinion, there is a risk that this scenario will violate the relevant management system of the hospital

0.544

 35. I will review and evaluate the patient’s physical condition, treatment, and other information

0.728

 36. I will abandon conventional thinking, try to obtain as much information as possible about the patient’s condition, and actively participate in the decision-making process

0.704

 37. I think there is a risk of conflict with the patient or family in this scenario

0.721

 38. I think there is a risk that the patient’s condition will be affected by this scenario

0.682

 51.^a My colleague has told me the relevant information, so there is no need to know the specific situation

0.701

 52.^a There is so much work that needs to be done that I have little time or energy to find new information

0.687

 53. I will confirm with the doctor and head nurse whether they are aware of the patient’s relevant situation

0.690

 54. I consider that there is a risk to the life of the patient in this scenario

0.711

 55. I consider that there is a risk of a breach of professional norms in this scenario

0.684

Dimension 2: Ethical motivation

 6. Respect patient autonomy

0.725

 7. Avoid nurse-patient conflict

0.682

 8.^a Do not question your doctor’s treatment decisions

0.718

 9. Avoid damaging patients’ health and causing adverse events

0.718

 23. Prevent Xiao Li from blaming or punishing

0.751

 24. Avoid blaming or punishing Xiao Li for this

0.812

 25.^a Avoid being incriminated

0.731

 26. Protect patients from harm

0.731

 39.^a Avoid saying the wrong thing and getting myself into trouble

0.707

 40. Avoid compromising patients’ right to know

0.694

 41. Avoid causing harm to patients and harming their lives and health

0.696

 42.^a Avoid disobeying family requests

0.735

 56.^a Able to complete my work on time

0.669

 57. Not violate the relevant rules and regulations

0.719

 58. Not harm the life and health of patients to avoid adverse events

0.715

Dimension 3: Ethical judgment

 10.^a I take the advice and suggestions from my colleagues directly

0.674

 11. I will propose various solutions and envisage the possible consequences

0.841

 12.^a I have little time or energy to examine the consequences of my choices

0.662

 13. I will communicate and weigh with my colleagues and try to be as clear as possible about the consequences of various solutions

0.709

 27. I will try to find as many solutions as possible, taking into account the latest or seemingly unworkable ones

0.690

 28. I will try to listen to the suggestions and opinions of other colleagues as much as possible

0.671

 29. Before I make a decision, I will try to consider the consequences as much as possible

0.690

 43.^a The patient’s attitude left me no time to think of more ways to deal with the problem

0.682

 44.^a When a mentor (doctor, head nurse, or someone with more experience than me) recommends an option, I adopt it without considering other ways to solve the problem

0.691

 45. When faced with similar problems, although others have done the same, I will still make assumptions about the possible consequences

0.693

 59.^a Other colleagues have done this, and I do not think I can find another solution

0.654

 60. I usually start with "If I do this, I will…" The way to consider the consequences of all alternatives

0.681

Dimension 4: Ethical action

 14.^a I will explain to the patient the risks of injecting the drug, and if the patient insists on injecting the drug, I will ask him to write a statement and sign a certificate

0.691

 15.^a I will refuse the injection and refer the patient to the doctor

0.796

 16.^a I will inject the patient with this drug, but for fear of accidents, after the patient leaves the hospital, I will instruct the patient to observe for 30 min and subsequently leave

0.734

 17. I will refuse to inject the drug, and after explaining to the patient, we will communicate with the doctor and ask the doctor to issue a new medical order

0.701

 18.^a Since the doctor says yes, there should be no problem; I do not want to check and give the patient the drug directly

0.694

 30.^a It is recommended that Xiaoli continue to pay attention to the patient’s physical condition first and do not report if there is no abnormality, and then report if there is an abnormality

0.717

 31. Tell Xiao Li the severity of adverse reactions in case of patients, and then help her report together

0.704

 32.^a It is suggested that Xiao Li consult the head nurse before deciding whether to report

0.727

 33. Tell Xiao Li to bear the ethical responsibility for her medical errors and draw lessons to avoid more mistakes in the future, and suggest that Xiao Li take the initiative to report

0.700

 34.^a Do not give any opinions; just tell Xiao Li to respect any decision she makes

0.699

 46.^a My experience does not allow me to judge whether I have made the right decision. I will tell the patient that she is not sure about her condition and ask her to ask another nurse or doctor

0.739

 47.^a Because family repeatedly told me not to tell the patient about her condition, I chose not to tell the patient about her real condition

0.682

 48. I will make an assessment. If the patient is not suitable to know the true condition, I will hide it from her to prevent her condition from getting worse after she knows the truth and threatening her life safety

0.688

 49.^a Because the patient has a firm attitude, I choose to tell the patient about her condition

0.721

 50. I will evaluate the patient first, and if the evaluation results support it, I will respect the patient’s right to know and inform her of her true condition to help the patient spend her final time better

0.713

 61.^a In order to complete my work, I would choose to continue to use propofol on the patient

0.697

 62.^a Other colleagues have given the patient propofol, so can I

0.709

 63.^aI will inform the head nurse that there are not enough nursing staff to ensure the safety of the nursing work, act on the head nurse’s advice, and state that I will not be liable if the patient has an accident

0.684

 64. I will re-evaluate the needs of patients and coordinate with colleagues to solve the critical situation in the current situation

0.749

Percentage of variance explained

14.975%

13.733%

10.581%

16.764%

The total percentage of the factor model

56.05%