Ethical decision-making has become an issue of importance in nursing education and nursing practice. The purpose of this study was to determine the effect of moral dilemma discussions utilized in an ethical decision-making course on moral reasoning levels of senior generic baccalaureate nursing students and registered nurses who were completing the baccalaureate degree. The conceptual framework was derived from the cognitive-developmental approach to moral development and moral education.

Sixty-seven senior baccalaureate nursing students were nonrandomly assigned to treatment and control groups. Each of the two treatment groups, generic and registered nurse, were enrolled in a 5-week ethical decision-making course which emphasized moral dilemma discussions. Moral reasoning was assessed by administering the Defining Issues Test (Rest, 1986) as a pretest and posttest.

Statistical analysis with an independent t-test on pretest data revealed no significant difference in moral reasoning levels between generic and registered nurse students. Dependent t-tests indicated a significant increase in principled level moral reasoning (p score) between pretest and posttest in both the generic treatment (p $<$.05) and registered nurse treatment (p $<$.05) groups. Statistical analysis with ANOVA revealed a significant difference in posttest P scores among the four groups when pretest P scores were used as a covariate (p $<$.05). Post-hoc analysis indicated a significant difference between posttest P scores of the registered nurse treatment group and the registered nurse control group.

It was concluded that previous nursing experience did not enhance moral reasoning levels of registered nurses. Participation in moral dilemma discussions increased the percentage of principled level moral reasoning of generic and registered nurse students. When compared with generic students, registered nurse students who participated in moral dilemma discussions demonstrated a greater increase in the percentage of principled level moral reasoning.

Baccalaureate nursing programs should consider incorporating teaching of ethical decision-making skills into curricula. Recommendations for further study include replication in health care institutions and different geographic areas. Replication of the study with consideration of interaction of demographic variables is also recommended. Research should be conducted that investigates the impact of moral reasoning levels on behaviors.