Enhancing Awareness of Moral Residue Through Literature: What Are the Underlying Mechanisms?
References
- Alber, J. (2015). The social minds in factual and fictional we-narratives of the twentieth century. Narrative, 23(2), 213–225. 10.1353/nar.2015.0010
- Altmann, U., Bohrn, I. C., Lubrich, O., Menninghaus, W., & Jacobs, A. M. (2014). Fact vs fiction – how paratextual information shapes our reading processes. Social Cognitive and Affective Neuroscience, 9(1), 22–29. 10.1093/scan/nss098
- Andrews, G., Singh, M., & Bond, M. (1993). The defense style questionnaire. The Journal of Nervous and Mental Disease, 181(4), 246–256. 10.1097/00005053-199304000-00006
- Appel, M., & Maleckar, B. (2012). The influence of paratext on narrative persuasion. Fact, fiction, or fake? Human Communication Research, 38(4), 459–484. 10.1111/j.1468-2958.2012.01432.x
- Aristotle. (1970). Poetics (G. E. Else, Ed. & Trans.). University of Michigan Press.
- AsPredicted. (2024). Study preregistration [#182095].
https://aspredicted.org/3p6f-74mw.pdf - Batavia, C., Nelson, M. P., & Wallach, A. D. (2020). The moral residue of conservation. Conservation Biology 34(5), 1114–1121. 10.1111/cobi.13463
- Beauvoir, S. de. (2018). The ethics of ambiguity (B. Frechtman, Trans.). Open Road Integrated Media. (Original work published 1947)
- Becker, M. H. (1974). The health belief model and personal health behavior. Health Education Monographs, 2(4), 324–508. 10.1177/109019817400200405
- Bernaards, C. A., & Jennrich, R. I. (2005). Gradient projection algorithms and software for arbitrary rotation criteria in factor analysis. Educational and Psychological Measurement, 65(5), 676–696. 10.1177/0013164404272507
- Bloom, H. (1994). The western canon: The books and school of the ages. Harcourt Brace.
- Brown, C., Solbakk, J. H., et al. (in prep). Moral distress: An overview and philosophical critique of a proliferating concept in the healthcare literature. [Manuscript in preparation].
- Brown, C., & Tessman, L. (in prep.). Holding oneself responsible. [Manuscript in preparation].
- Busselle, R., & Bilandzic, H. (2009). Measuring narrative engagement. Media Psychology, 12(4), 321–347. 10.1080/15213260903287259
- Burnkrant, R. E., & Unnava, H. R. (1989). Self-referencing: A strategy for increasing processing of message content. Personality and Social Psychology Bulletin, 15(4), 628–638. 10.1177/0146167289154015
- Burnkrant, R. E., & Unnava, H. R. (1995). Effects of self-referencing on persuasion. Journal of Consumer Research, 22(1), 17–26. 10.1086/209432
- Carleton, R. N., Norton, M. A. P. J., & Asmundson, G. J. G. (2007). Fearing the unknown: A short version of the Intolerance of Uncertainty Scale. Journal of Anxiety Disorders, 21(1), 105–117. 10.1016/j.janxdis.2006.03.014
- Chen, M., Bell, R. A., & Taylor, L. D. (2016). Narrator point of view and persuasion in health narratives: The role of protagonist–reader similarity, identification, and self-referencing. Journal of Health Communication, 21(8), 908–918. 10.1080/10810730.2016.1177147
- Chen, M., Bell, R. A., & Taylor, L. D. (2017). Persuasive effects of point of view, protagonist competence, and similarity in a health narrative about type 2 diabetes. Journal of Health Communication, 22(10), 1–11. 10.1080/10810730.2017.1341568
- Chlebuch, N., Goldstein, T. R., & Weisberg, D. S. (2020). Fact or fiction? Scientific Study of Literature, 10(2), 167–192. 10.1075/ssol.20007.chl
- Cohen, J. (2001). Defining identification: A theoretical look at the identification of audiences with media characters. Mass Communication and Society, 4(3), 245–264. 10.1207/S15327825MCS0403_01
- Cohen, J., Appel, M., & Slater, M. D. (2019).
Media, identity, and the self . In M. B. Oliver, A. A. Raney, & J. Bryant (Eds.), Media effects: Advances in Theory and Research (4th ed., pp. 179–194). Routledge. 10.4324/9780429491146-12 - Coplan, A. (2004). Empathic engagement with narrative fictions. The Journal of Aesthetics and Art Criticism, 62(2), 141–152. 10.1111/j.1540-594X.2004.00147.x
- De Graaf, A. (2014). The effectiveness of adaptation of the protagonist in narrative impact: Similarity influences health beliefs through self-referencing. Human Communication Research, 40(1), 73–90. 10.1111/hcre.12015
- De Graaf, A. (2023). The role of identification and self-referencing in narrative persuasion. Communications, 48(2), 163–179. 10.1515/commun-2021-0029
- De Snoo-Trimp, J., Molewijk, A. C., et al. (in prep.) Healthcare professionals’ experience of moral residue: Unravelling dynamic stories of unavoidable moral failure, co-occurring feelings and impact. [Manuscript in preparation].
- De Vries, E. N., Ramrattan, M. A., Smorenburg, S. M., Gouma, D. J., & Boermeester, M. A. (2008). The incidence and nature of in-hospital adverse events: a systematic review. Quality & Safety in Health Care, 17(3), 216–223. 10.1136/qshc.2007.023622
- Dunlop, S. M., Wakefield, M., & Kashima, Y. (2010). Pathways to persuasion: Cognitive and experiential responses to health-promoting mass media messages. Communication Research, 37(1), 133–164. 10.1177/0093650209351912
- Efron, B., & Tibshirani, R. J. (1993). An introduction to the bootstrap. Chapman & Hall/CRC. 10.1007/978-1-4899-4541-9
- Elliott, W. R., Rudd, R., & Good, L. (1983, August).
Measuring the perceived reality of television: Perceived plausibility, perceived superficiality and the degree of personal utility . Paper presented at the annual meeting of the Association for Education in Journalism and Mass Communication. Corvallis, OR. - Epstein, E. G., & Hamric, A. B. (2009). Moral distress, moral residue, and the crescendo effect. The Journal of Clinical Ethics, 20(4), 330–342. 10.1086/JCE200920406
- Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191. 10.3758/bf03193146
- Felski, R. (2008). Uses of literature. Blackwell Publishing. 10.1002/9781444302790
- Fialho, O. (2025, June). Moral residue reading experiences among healthcare professionals: A computational cognitive poetics analysis. [Paper presentation]. IGEL Conference, Austin, TX.
- Fidell, L. S., & Tabachnick, B. G. (2003).
Preparatory data analysis . In J. A. Schinka & W. F. Velicer (Eds.), Handbook of Psychology: Research Methods in Psychology, Vol. 2, pp. 115–141. John Wiley & Sons, Inc. 10.1002/0471264385.wei0205 - Fitzgerald, K., & Green, M. C. (2017).
Narrative persuasion: Effects of transporting stories on attitudes, beliefs, and behaviors . In F. Hakemulder, M. Kuijpers, E. Tan, K. Bálint, & M. Doicaru (Eds.), Narrative Absorption (pp. 49– 67). John Benjamins. 10.1075/lal.27.04fit - Gabriel, S., & Young, A. F. (2011). Becoming a vampire without being bitten: The narrative collective-assimilation hypothesis. Psychological Science, 22(8), 990–994. 10.1177/0956797611415541
- Gebbers, T., Wit, J.B., & Appel, M. (2017). Transportation into narrative worlds and the motivation to change health-related behavior. International Journal of Communication, 11(21), 4886–4906. Retrieved from
https://ijoc.org - Gerrig, R. J. (1993). Experiencing narrative worlds. Yale University Press. 10.12987/9780300159240
- Green, M., & Brock, T. (2000). The role of transportation in the persuasiveness of public narrative. Journal of Personality and Social Psychology, 79(5), 701–721. 10.1037/0022-3514.79.5.701
- Green, M., Brock, T. C., & Kaufman, G. F. (2004). Understanding media enjoyment: The role of transportation into narrative worlds. Communication Theory, 14(4), 311–327. 10.1111/j.1468-2885.2004.tb00317.x
- Green, M. C. (2004). Transportation into narrative worlds: The role of prior knowledge and perceived realism. Discourse Processes, 38(2), 247–266. 10.1207/s15326950dp3802_5
- Green, M. C. (2006). Narratives and cancer communication. Journal of Communication, 56(S1), S163–S183. 10.1111/j.1460-2466.2006.00288.x
- Green, M. C., Chatham, C., & Sestir, M. A. (2012). Emotion and transportation into fact and fiction. Scientific Study of Literature, 2(1), 37–59. 10.1075/ssol.2.1.03gre
- Green, M. C., Strange, J. J., & Brock, T. C. (Eds.) (2002). Narrative impact: Social and cognitive foundations. Lawrence Erlbaum Associates Publishers. 10.4324/9781410606648
- Greene, K., & Brinn, L. S. (2003). Messages influencing college women’s tanning bed use: Statistical versus narrative evidence format and a self-assessment to increase perceived susceptibility. Journal of Health Communication: International Perspectives, 8(5), 443–461. 10.1080/713852118
- Gregory, W. L., Cialdini, R. B., & Carpenter, K. M. (1982). Self-relevant scenarios as mediators of likelihood estimates and compliance: Does imagining make it so? Journal of Personality and Social Psychology, 43(1), 89–99. 10.1037/0022-3514.43.1.89
- Hakemulder, J. (2000). The moral laboratory: Experiments examining the effects of reading literature on social perception and moral self-knowledge. John Benjamins. 10.1075/upal.34
- Hanauer, D. (2018). Intermediate states of literariness: Poetic lining, sociological positioning, and the activation of literariness. Scientific Study of Literature, 8(1), 114–134. 10.1075/ssol.18001.han
- Hayes, A. F. (2009). Beyond Baron and Kenny: Statistical mediation analysis in the new millennium. Communication Monographs, 76(3), 408–420. 10.1080/03637750903310360
- Hinyard, L. J., & Kreuter, M. W. (2007). Using narrative communication as a tool for health behavior change: A conceptual, theoretical, and empirical overview. Health Education & Behavior, 34(5), 777–792. 10.1177/1090198106291963
- Jameton, A. (1984). Nursing practice: The ethical issues. Prentice-Hall.
- Kamtekar, R., & Nichols, S. (2019). Agent-Regret and accidental agency. Midwest Studies in Philosophy, 43, 181–202. 10.1111/misp.12112
- Kaufman, G. F., & Libby, L. K. (2012). Changing beliefs and behavior through experience-taking. Journal of Personality and Social Psychology, 103(1), 1–19. 10.1037/a0027525
- Kay, A. (2017). This is going to hurt: Secret diaries of a junior doctor. Picador.
- Keen, S. (2007). Empathy and the Novel. Oxford University Press. 10.1093/acprof:oso/9780195175769.001.0001
- Keltner, D., & Stamkou, E. (2024). Possible worlds theory: How the imagination transcends and recreates reality. Annual Review of Psychology, 76, 329–358. 10.1146/annurev-psych-080123-102254
- Kline, R. B. (2005). Principles and practice of structural equation modeling (2nd ed.). Guilford Press.
- Kreuter, M. W., Bull, F. C., Clark, E. M., & Oswald, D. L. (1999). Understanding how people process health information: A comparison of tailored and nontailored weight-loss materials. Health Psychology, 18(5), 487–494. 10.1037//0278-6133.18.5.487
- Kreuter, M. W., & Wray, R. J. (2003). Tailored and targeted health communication: Strategies for enhancing information relevance. American Journal of Health Behavior, 27, s227–s232. 10.5993/ajhb.27.1.s3.6
- Kuijpers, M., Hakemulder, F., Tan, E., & Doicaru, M. (2014). Exploring absorbing reading experiences: Developing and validating a self-report scale to measure story world absorption. Scientific Study of Literature, 4(1), 89–122. 10.1075/ssol.4.1.05kui
- Loi, C., Hakemulder, F., Kuijpers, M., & Lauer, G. (2023). On how fiction impacts the self-concept: Transformative reading experiences and storyworld possible selves. Scientific Study of Literature, 12(1), 44–67. 10.61645/ssol.181
- MacKenzie, J. (2017). Agent-Regret and the social practice of moral luck. Res Philosophica, 94(1), 95–117. 10.11612/resphil.1496
- Marcus, R. B. (1980). Moral dilemmas and consistency. The Journal of Philosophy, 77(3), 121–136. 10.2307/2025665
- Markus, H., & Nurius, P. (1986). Possible selves. American Psychologist, 41(9), 954–969. 10.1037/0003-066X.41.9.954
- Martínez, M. A., & Herman, L. (2020). Real readers reading Wasco’s ‘City’: A storyworld possible selves approach. Language and Literature: International Journal of Stylistics, 29(2), 147–170. 10.1177/0963947020936013
- McCroskey, L. L., McCroskey, J. C., & Richmond, V. P. (2006). Analysis and improvement of the measurement of interpersonal attraction and homophily. Communication Quarterly, 54(1), 1–31. 10.1080/01463370500270322
- McDonald, D. G., Sarge, M. A., Lin, S. F., Collier, J. G., & Potocki, B. (2015). A role for the self: Media content as triggers for involuntary autobiographical memories. Communication Research, 42(1), 3–29. 10.1177/0093650212464771
- McEwan, I. (2014a). The children act. Jonathan Cape.
- McEwan, I. (2014b, September 5). The law versus religious belief. The Guardian.
https://www.theguardian.com/books/2014/sep/05/ian-mcewan-law-versus-religious-belief - McLain, D. L. (2009). Evidence of the properties of an ambiguity tolerance measure: The Multiple Stimulus Types Ambiguity Tolerance Scale–II (MSTAT–II). Psychological Reports, 105(3), 975–988. 10.2466/PR0.105.3.975-988
- Miksanek, T. (2024). Medical humanities and the contemporary novel. Journal for Medical Humanities, 45,
465 . 10.1007/s10912-024-09904-7 - Neff, K. D. (2003). The development and validation of a scale to measure self-compassion. Self and Identity, 2(3), 223–250. 10.1080/15298860309027
- Nussbaum, M. C. (1995). Poetic justice: The literary imagination and public life. Beacon.
- Nussbaum, M. C. (2001). Upheavals of thought: The intelligence of emotions. Cambridge University Press. 10.1017/CBO9780511840715
- Nussbaum, M. C. (2010). Not for profit: Why democracy needs the humanities. Princeton University Press.
- Oatley, K. (1999). Why fiction may be twice as true as fact: Fiction as cognitive and emotional simulation. Review of General Psychology 3(2), 101–117. 10.1037/1089-2680.3.2.101
- Oatley, K. (2002).
Emotions and the story world of fiction . In M. C. Green, J. J. Strange, & T. C. Brock (Eds.), Narrative Impact: Social and Cognitive Foundations (pp. 39–69). Psychology Press. - Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879–891. 10.3758/BRM.40.3.879
- Raes, F., Pommier, E., Neff, K. D., & Van Gucht, D. (2011). Construction and factorial validation of a short form of the self-compassion scale. Clinical Psychology & Psychotherapy, 18(3), 250–255. 10.1002/cpp.702
- Rafter, N., Hickey, A., Condell, S., Conroy, R., O’Connor, P., Vaughan, D., & Williams, D. (2015). Adverse events in healthcare: Learning from mistakes. QJM: Monthly Journal of the Association of Physicians, 108(4), 273–277. 10.1093/qjmed/hcu145
- Revelle, W. (2024). Psych: procedures for psychological, psychometric, and personality research. Northwestern University, Evanston, Illinois. R package version 2.4.6,
https://CRAN.R-project.org/package=psych - Richter, T., Appel, M., & Calio, F. (2014). Stories can influence the self-concept. Social Influence, 9(3), 172–188. 10.1080/15534510.2013.799099
- Rosseel, Y. (2012). lavaan: An R package for structural equation modeling. Journal of Statistical Software, 48(2), 1–36. 10.18637/jss.v048.i02
- Schoemann, A., Boulton, A., & Short, S. (2017). Determining power and sample size for simple and complex mediation models. Social Psychological and Personality Science, 8(4), 379–386. 10.1177/1948550617715068
- Seilman, U., & Larsen, S. F. (1989). Personal resonance to literature: A study of remindings while reading. Poetics, 18(1/2), 165–177. 10.1016/0304-422X%2889%2990027-2
- Sestir, M., & Green, M. C. (2010). You are who you watch: Identification and transportation effects on temporary self-concept. Social Influence, 5(4), 272–288. 10.1080/15534510.2010.490672
- Solbakk, J. H. (2006). Catharsis and moral therapy II: An Aristotelian account. Medicine, Health Care, and Philosophy, 9, 141–153. 10.1007/s11019-005-8319-1
- Solbakk, J. H. (2021).
Bio(po)ethics – Didactic inspirations . In M. Mant & C. Mounsey (Eds.), The History and Bioethics of Medical Education: “You’ve Got to Be Carefully Taught” (pp. 147–185). Routledge Advances in the History of Bioethics. Routledge. 10.4324/9781003107156-13 - Strange, J. J., & Leung, C. C. (1999). How anecdotal accounts in news and in fiction can influence judgments of a social problem’s urgency, causes, and cures. Personality and Social Psychology Bulletin, 25(4), 436–449. 10.1177/0146167299025004004
- Sussman, D. (2018). Is agent-regret rational? Ethics, 128(4), 788–808. 10.1086/697492
- Tal-Or, N., & Cohen, J. (2010). Understanding audience involvement: Conceptualizing and manipulating identification and transportation. Poetics, 38(4), 402–418. 10.1016/j.poetic.2010.05.004
- Tal-Or, N., & Cohen, J. (2015). Unpacking engagement: Convergence and divergence in transportation and identification. Annals of the International Communication Association, 40(1), 33–66. 10.1080/23808985.2015.11735255
- Tchernev, J. M., Collier, J., & Wang, Z. (2021). There and Back Again? Exploring the Real-Time Cognitive Journey of Narrative Transportation. Communication Research, 50(3), 312–337. (Original work published 2023). 10.1177/00936502211018577
- Tessman, L. (2024). Holding ourselves responsible: When what rightly matters doesn’t really matter. Proceedings and Addresses of the APA, 98, 60–98.
- Todorov, T. (2014). The imperfect garden: The legacy of humanism (C. Casman, Trans.). Princeton University Press. (Original work published 1998)
- Tooby, J., & Cosmides, L. (2001). Does beauty build adapted minds? Toward an evolutionary theory of aesthetics, fiction and the arts. SubStance, 30(1/2), 6–27. 10.2307/3685502
- University of Oslo. (2022).
Moral residue in evidence-based health care (MORE) . University of Oslo.https://www.med.uio.no/helsam/english/research/projects/more/index.html - Van Leeuwen, L., Van Den Putte, B., Renes, R. J., & Leeuwis, C. (2017). Do narrative engagement and recipients’ thoughts explain the impact of an entertainment-education narrative on discouraging binge drinking? Media Psychology, 20(2), 194–220. 10.1080/15213269.2016.1142379
- Webster, G., & Baylis, F. (2000).
Moral Residue . In S. B. Rubin & L. Zoloth (Eds.), Margin of Error: The Ethics of Mistakes in the Practice of Medicine (pp. 217–230). University Publishing Group. - Williams, B. (1973). Problems of the Self. Cambridge University Press. 10.1017/CBO9780511621253
- Williams, B. (1981). Moral Luck. Cambridge University Press. 10.1017/CBO9781139165860
DOI: https://doi.org/10.61645/ssol.201 | Journal eISSN: 2210-4380
Language: English
Page range: 60 - 81
Submitted on: Mar 31, 2025
Accepted on: Jan 5, 2026
Published on: Mar 27, 2026
Published by: International Society for the Empirical Study of Literature
In partnership with: Paradigm Publishing Services
Keywords:
© 2026 Nikoletta Alexandri, Cullin Brown, Frank Hakemulder, Jan Helge Solbakk, published by International Society for the Empirical Study of Literature
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