The population of most non-dominant ethnic groups in the USA is growing dramatically. Faculty members are challenged to develop curricula that adequately prepare our future nurses. An increased focus on clinical ethics has resulted from the use of sophisticated technology, changes in health care financing, an increasing elderly population and the shift of care from inpatient to outpatient settings. Nurses frequently face situations demanding resolution of ethical dilemmas involving cultural differences. Nursing curricula must include content on both ethics and cultural (...) sensitivity. Active student participation is an important element providing a foundation for ethical practice. A proposed educational format was introduced with graduating baccalaureate students. In a pilot study, curricular content on cultural sensitivity and ethical practice was taught in separate modules. Students were then asked to identify and problem solve an ethical dilemma involving patients and professional caregivers from vastly different cultures. Course faculty members provided discussion questions to guide the students' thinking. (shrink)

This article explores the social and ethical elements of cultural safety and combines them in a model of culturally safe practice that should be of interest and relevance for nurses, nurse educators and nurse ethicists in other cultures. To achieve this, the article briefly reviews and critiques the main underpinnings of the concept from its origins and development in New Zealand, describes its sociocultural and sociopolitical elements, and provides an in-depth exploration of the key socioethical elements. Finally, a model is (...) presented to illustrate the strong connection between the social and ethical components of cultural safety that combine to produce culturally safe practice through the activities of a ‘socioethical’ nurse. (shrink)

The target article by Grady and colleagues (2008) is a valuable and exciting contribution to the debate about the importance of ethics education for nurses. The findings indicated that ethics educa...

Providing good care requires nurses to reflect critically on their nursing practices. Ethics education must provide nurses with tools to accomplish such critical reflection. It must also create a pedagogical context in which a caring attitude can be taught and cultivated. To achieve this twofold goal, we argue that the principles of a right-action approach, within which nurses conform to a number of minimum principles, must be integrated into a virtue ethics approach that cultivates a caring attitude. Ethics education that (...) incorporates both the `critical companionship' method and the use of codes of ethics contributes positively to cultivating critical reflection by nurses. (shrink)

The post-Soviet scene in Lithuania is one of rapid change in medical and nursing ethics. A short introduction to the current background sets the scene for a wider discussion of ethics in health care professionals' education. Lithuania had to adapt rapidly from a politicized nursing and ethics curriculum to European regulations, and from a paternalistic style of care to one of engagement with choices and dilemmas. The relationships between professionals, and between professionals and patients, are affected by this in particular. (...) This short article highlights these issues and how they impact on all involved. (shrink)

The implementation of care robotics in care settings is identified by some authors as a disruptive innovation, in the sense that it will upend the praxis of care. It is an open ethical question whether this alleged disruption will also have a transformative impact on established ethical concepts and principles. One prevalent worry is that the implementation of care robots will turn deception into a routine component of elderly care, at least to the extent that these robots will function as (...) simulacra for something that they are not (i.e. human caregivers). At face value, this may indeed seem to indicate a concern for how this technology may upend existing practices and relationships within a care setting. Yet, on closer inspection, this reaction may rather point to a rediscovery and a revaluation of a particularly well-entrenched value or virtue, i.e. veracity. The virtue of veracity is one of the values that is mobilized to argue against a substitution of human caregivers (while a combination of care robots and human caregivers is much more accepted). The subject of this paper is to explore how the moral panic surrounding care robots should not so much be interpreted as an anticipated and probable disruptor in a care setting, but rather as a sensitizing – in a way conservationist – argument that identifies veracity as an established value that is supposed to be protected and advanced in present day and future care settings. (shrink)

Background:Nurses and nursing students appear vulnerable to moral distress when faced with ethical dilemmas or decision-making in clinical practice. As a result, they may experience professional dissatisfaction and their relationships with patients, families, and colleagues may be compromised. The impact of moral distress may manifest as anger, feelings of guilt and frustration, a desire to give up the profession, loss of self-esteem, depression, and anxiety.Objectives:The purpose of this review was to describe how dilemmas and environmental, relational, and organizational factors contribute (...) to moral distress in undergraduate student nurses during their clinical experience and professional education.Research design:The research design was a systematic literature review.Method:The search produced a total of 157 articles published between 2004 and 2014. These were screened with the assessment sheet designed by Hawker and colleagues. Four articles matched the search criteria (one quantitative study and three qualitative), and these were separately read and analyzed by the researchers. The process of review and analysis of the data was supervised by a colleague experienced in moral distress who provided an independent quality check.Ethical consideration:Since this was a systematic review, no ethical approval was required.Findings:From the analysis, it emerged that inequalities and healthcare disparities, the relationship with the mentor, and students’ individual characteristics can all impact negatively on the decisions taken and the nursing care provided, generating moral distress. All these factors condition both the clinical experience and learning process, in addition to the professional development and the possible care choices of future nurses.Conclusion:Few studies dealt with moral distress in the setting of nurse education, and there is a knowledge gap related to this phenomenon. The results of this review underline the need for further research regarding interventions that can minimize moral distress in undergraduate nursing students. (shrink)

Today, nurses are required to have knowledge and awareness concerning professional values as standards to provide safe and high-quality ethical care. Nurses’ perspective on professional values affects decision-making and patient care. Therefore, the present study aimed to investigate the importance of professional values from clinical nurses’ perspective. The present cross-sectional study was conducted in 2016 in four educational hospitals of Kerman University of Medical Sciences, Iran. Data were collected via the Persian version of Nursing Professional Values Scale-Revised by Weis and (...) Schank. Sampling was conducted through the use of stratified random sampling method and 250 clinical nurses participated in the study. Results indicated that the total score of the nurses’ professional values was high.. From nurses’ perspective items such as “Maintaining confidentiality of patients” and “Safeguarding patients’ right to privacy” had more importance; however, “Recognizing role of professional nursing associations in shaping healthcare policy” and “Participating in nursing research and/or implementing research findings appropriate to practice had less importance. A statistically significant relationship was observed between NPVS-R mean scores and nurses’ age, work experience as well as participation in professional ethical training. Although the total score related to the clinical nurses’ perspective on professional values was high, the importance of certain values was at a lower level. Owing to the emerging ethical challenges, it is indispensable to design educational programs in order to improve nurses’ awareness and understanding of the comprehensive importance of professional values. Furthermore, it is recommended that mixed methods studies should be conducted in order to design an instrument to evaluate the use of values in nursing practice. (shrink)

Background:This article combines foundational and empirical aspects of healthcare education and develops a framework for teaching ethical theories inspired by pragmatist learning theory and recent work on the concept of moral resilience. It describes an exemplary implementation and presents data from student evaluation.Objectives:After a pilot implementation in a regular ethics module, the feasibility and acceptance of the novel framework by students were evaluated.Research design:In addition to the regular online module evaluation, specific questions referring to the teaching of ethical theories were (...) added using simple (yes/no) and Likert rating answer formats.Participants and research context:At the Bern University of Applied Sciences, a total of 93 students from 2 parallel sub-cohorts of the bachelor’s program in nursing science were sent the online survey link after having been exposed to the same modular contents. A total of 62% of all students participated in the survey.Ethical considerations:The survey was voluntary and anonymous. Students were free to write their name and additional comments.Findings:Students consider ethical theories—as taught within the proposed framework—as practically applicable, useful, and transferable into practice.Discussion:Teaching ethical theories within the proposed framework overcomes the shortcomings described by current research. Students do not consider the mutually exclusive character of ethical theories as an insurmountable problem.Conclusion:The proposed framework is likely to promote the effectiveness of healthcare ethics education. Inspired by pragmatist learning theory, it enables students to consider ethical theories as educative playgrounds that help them to “frame” and “name” the ethical issues they encounter in daily practice, which is seen as an expression of moral resilience. Since it does not advocate a single ethical theory, but is open to the diversity of traditions that shape ethical thinking, it promotes a culturally sensitive, ethically reflected healthcare practice. (shrink)

Ethical awareness enables nurses to recognize the ethical implications of all practice actions, and is an important component of safe and high quality nursing care (Milliken 2016; Milliken and Grac...

Growing evidence suggests that nurses and other clinicians often feel insufficiently equipped to manage ethical issues that arise in their practice (Truog et al. 2015; Woods 2005; Darmon et al. 201...

The interconnection between moral distress, moral sensitivity, and moral resilience was explored by constructing two hypothetical scenarios based on a recent Swedish newspaper report. In the first scenario, a 77-year-old man, rational and awake, was coded as “do not resuscitate” (DNR) against his daughter’s wishes. The patient died in the presence of nurses who were not permitted to resuscitate him. The second scenario concerned a 41-year-old man, who had been in a coma for three weeks. He was also coded as (...) “do not resuscitate” and, when he stopped breathing, was resuscitated by his father. The nurses persuaded the physician on call to resume life support treatment and the patient recovered. These scenarios were analyzed using Viktor Frankl’s existential philosophy, resulting in a conceivable theoretical connection between moral distress, moral sensitivity, and moral resilience. To substantiate our conclusion, we encourage further empirical research. (shrink)

This article reports a study exploring the meaning of the complex phenomenon of moral responsibility in nursing practice. Each of three focus groups with a total of 14 student nurses were conducted twice to gather their views on moral responsibility in nursing practice. The data were analysed by qualitative thematic content analysis. Moral responsibility was interpreted as a relational way of being, which involved guidance by one’s inner compass composed of ideals, values and knowledge that translate into a striving to (...) do good. It was concluded that, if student nurses are to continue striving to do good in a way that respects themselves and other people, it is important that they do not feel forced to compromise their values. Instead they should be given space and encouragement in their endeavours to do good in a relational way that advances nursing as a moral practice. (shrink)

Grady and colleagues (2008) have provided a major contribution to the field of bioethics, and their research should lend a significant hand to the oft-neglected ethics needs of professional nurses....

This longitudinal study examined how nursing students' moral judgment changes after they become qualified nurses working in a hospital environment. The sample used was a group of 80 nursing students attending a university in Suwon, Korea, between 2001 and 2003. By using a Korean version of the Judgment About Nursing Decisions questionnaire, an instrument used in nursing care research, moral judgment scores based on Ketefian's six nursing dilemmas were determined. The results were as follows: (1) the qualified nurses had significantly (...) higher idealistic moral judgment scores than the nursing students; (2) the qualified nurses showed significantly higher realistic moral judgment scores than the nursing students; and (3) when comparing idealistic and realistic moral judgment scores, both the qualified nurses and the nursing students had higher scores for idealistic moral judgment. Further study is recommended to examine changes in moral judgment. (shrink)

Background: Moral reasoning is a vital skill in the nursing profession. Teaching moral reasoning to students is necessary toward promoting nursing ethics. Objectives: The aim of this study was to compare the effectiveness of problem-based learning and lecture-based methods in ethics education in improving moral decision-making, moral reasoning, moral development, and practical reasoning among nursing students. Research design: This is a repeated measurement quasi-experimental study. Participants and research context: The participants were nursing students in a University of Medical Sciences in (...) west of Iran who were randomly assigned to the lecture-based or the problem-based learning groups. The subjects were provided nursing ethics education in four 2-h sessions. The educational content was similar, but the training methods were different. The subjects completed the Nursing Dilemma Test before, immediately after, and 1 month after the training. The data were analyzed and compared using the SPSS-16 software. Ethical considerations: The program was explained to the students, all of whom signed an informed consent form at the baseline. Findings: The two groups were similar in personal characteristics. A significant improvement was observed in the mean scores on moral development in the problem-based learning compared with the lecture-based group. Although the mean scores on moral reasoning improved in both the problem-based learning and the lecture-based groups immediately after the training and 1 month later, the change was significant only in the problem-based learning group. The mean scores on moral decision-making, practical considerations, and familiarity with dilemmas were relatively similar for the two groups. Conclusion: The use of the problem-based learning method in ethics education enhances moral development among nursing students. However, further studies are needed to determine whether such method improves moral decision-making, moral reasoning, practical considerations, and familiarity with the ethical issues among nursing students. (shrink)

Nurses are obliged to provide quality nursing care that meets the ethical standards of their profession. However, clear descriptions of ethical practice are largely missing in the literature. Qualitative research using a phenomenological approach was conducted to explicate ethical nursing practice in Japanese end-of-life care settings and to discover how ethical practices unfold in clinical situations. Two paradigm cases and contrasting narratives of memorable end-of-life care from 32 Japanese nurses were used to reveal four levels of ethical practice: ethical, distressed, (...) uncertain, and unethical. Having the ability to actualize, justify, and recognize what is the good and/or right differentiated between these levels of ethical practice, empirical descriptions of which are given, followed by discussion of how nurses gain the skilled knowledge necessary for ethical practice. (shrink)

Cases of poor care have been documented across the world. Contrary to professional requirements, evidence indicates that these sometimes go unaddressed. For patients, the outcomes of this inaction are invariably negative. Previous work has either focused on why poor care occurs and what might be done to prevent it, or on the reasons why those who are witness to it find it difficult to raise their concerns. Here, we build on this work but specifically foreground the responsibilities of registrants and (...) students who witness poor care. Acknowledging the challenges associated with raising concerns, we make the case that failure to address poor care is a breach of moral expectation, professional requirement and, sometimes, legal frameworks. We argue that reporting will be more likely to take place if those who wish to enter the profession have a realistic view of the challenges they may encounter. When nurses are provided with robust and applied education on ethics, when “real‐world” cases and exemplars are used in practice and when steps are taken to develop and encourage individual moral courage, we may begin to see positive change. Ultimately however, significant change is only likely to take place where practice cultures invite and welcome feedback, promote critical reflection, and where strong, clear leadership support is shown by those in positions of influence across organisations. (shrink)

This descriptive study investigated the current status of ethics instruction in Turkish nursing education programs. The sample for this study comprised 39 nursing schools, which represented 51% of all nursing schools in Turkey. Data were collected through a postal questionnaire. The results revealed that 18 of these nursing schools incorporated an ethics course into undergraduate and three into graduate level programs. Most of the educators focused on the basic concepts of ethics, deontological theory, ethical principles, ethical problems in health care, (...) patient rights and codes of ethics for nurses. More than half of the educators believed that students' theoretical knowledge of ethics is applied to their clinical experiences. The teaching methods used included discussion in class, lectures, case studies, small group discussion, dramatization and demonstration. Assessment was carried out by means of written essays and written examinations. (shrink)

There are studies on the normative ethical frameworks used by long-term care staff and studies proposing how staff should reason, but few studies explore how staff actually reason. This study reports on the ethical reasoning process and experiences of moral distress of long-term care staff in the provision of social care. Seven interdisciplinary focus groups were conducted with twenty front-line staff. Staff typically did not have difficulty determining the ethical decision and/or action; however, they frequently experience moral distress. To manage (...) these experiences of moral distress in making ethical decisions, staff 1) comply with being told what to do out of fear of consequences, 2) defer decisions to family, 3) “have a meeting,” 4) socialization into and acceptance of workplace culture. Findings suggest that to better understand how and why staff make ethical decisions and improve quality and ethical care, we must explore the interaction between front-line practice and organizational and public policy. (shrink)

Background To practice nursing ethics, students must first understand the ethical concepts and principles of their profession, but despite this knowledge, students face challenges in implementing ethical principles in clinical settings. The educational performance of nurse educators is critical in resolving these challenges. This study focused on the lived experiences of nurse educators. Objective To address the main concern of educators when teaching ethics to undergraduate nursing students and how they deal with it. Research Design We conducted this qualitative content (...) analysis in Iran in 2020. We used individual semi-structured interviews to collect, record, and transcribe data, as well as Graneheim and Lundman method to analyze them. Participants and research context: We used purposive sampling to select 11 nurse educators who either were currently in the position of ethics educators or had taught ethics from Iranian universities of medical sciences. Ethical considerations The present study received the code of ethics No. IR.MODARES.REC.1399.036. Participants were aware of the study’s purpose and signed a consent form to participate in the study. We considered data confidentiality and the voluntary principle in data collection. Findings Nurse educators’ main concern was how to sensitize students to ethical principles in clinical settings, so they tried to involve students in the teaching process, to repeat and practice ethical principles and concepts, simplify and simulate ethical principles and concepts, and provide opportunities for students to gain clinical experiences. Discussion To sensitize students to ethical nursing care, nurse educators try to institutionalize ethical principles using different teaching methods, including students' involvement in teaching, experiential learning through simulated situations, practice, repetition, and provision of opportunities for practice and experience. Conclusion Improving students’ cognitive ability and objectifying moral concepts and principles for students will institutionalize moral values in them that are fundamental for their moral sensitization. (shrink)

Background: Food is an important part of nursing care and recognized as a basic need and a human right. Nutritional care for older adults in institutions represents a particularly important area to address in nursing education and practice, as the right to food can be at risk and health personnel experience ethical challenges related to food and nutrition. Objective: The present study investigates the development of coursework on nutritional care with a human rights perspective in a nursing programme for first-year (...) nursing students and draws upon reflections and lessons learned. Research design: The study utilized educational design research. The coursework, developed through two rounds, combined on-campus learning and clinical placement in nursing homes. Nursing studentsʼ perspectives and experiences gathered through focus groups and a written assignment informed the development and evaluation of the coursework. Participants and research context: In the first round, multistage focus group interviews were conducted with 18 nursing students before, during and after placement. In the second round, four focus group interviews with 26 nursing students were conducted shortly after placement. Ethical consideration: The study was approved by the Norwegian Centre for Research Data. Findings: Three main ʽlessons learnedʼ emerged regarding introducing a human rights perspective in nursing education: 1) the contribution of the human rights perspective in changing the narrative of ʽvulnerable and malnourished patientsʼ, 2) the importance of relationships and experiences for learning about human rights and 3) the benefit of combining development of ethical competence with a human rights perspective. Conclusion: A human rights perspective enabled the students to give meaning to nutritional care beyond understanding of food as a basic physical need. Incorporating human rights in nursing education can support nursing students and nurses in recognizing and addressing ethical and structural challenges and being able to fulfil the right to food for patients. (shrink)

Graduate nursing students should have a strong ethical theoretical foundation to identify and explore scientific and technological ethical issues impacting nursing care, to assume leadership positions in practice and education, and to conduct research contributing to nursing’s knowledge base. This paper reports the implementation and evaluation of a new ethics course at Turkish doctoral nursing programs. The first section describes course design and implementation. The second section evaluates the course and discusses results. Students’ evaluations indicated that the concept of caring (...) in key ethical theories, particularly care ethics, was vital to course content. The most preferred teaching method was case analysis. Students suggested increase in course length and credits, content inclusion of feminist ethics, and real-world knowledge application by other teaching strategies such as clinical practice visits and hospital ethics committee member participation. (shrink)

BackgroundProfessional ethics refers to the use of logical and consistent communication, knowledge, clinical skills, emotions and values in nursing practice. This study aimed to explore and describe factors that affect professional ethics in nursing practice in Iran.MethodsThis qualitative study was conducted using conventional content analysis approach. Thirty nurses with at least 5 years of experience participated in the study; they were selected using purposive sampling. Data were collected through semi-structured interviews and analyzed using thematic analysis.ResultsAfter encoding and classifying the data, (...) five major categories were identified: individual character and responsibility, communication challenges, organizational preconditions, support systems, educational and cultural development.ConclusionsAwareness of professional ethics and its contributing factors could help nurses and healthcare professionals provide better services for patients. At the same time, such understanding would be valuable for educational administrators for effective planning and management. (shrink)

A recent Carnegie Report on Nursing Education – Educating Nurses: A Call for Radical Transformation challenges the nursing profession to embrace an education model that integrates knowledge, skilled know how and ethical comportment. Placing ethics in such a prominent position in nursing education is a radical transformation. Teaching ethics must be intentional and it is integral to the development of individual nurses and the profession as a whole. The development of moral imagination has a prominent place in this new education (...) model. The moral imagination is the ability to ponder and wonder about the inherent rightness or wrongness of decisions, choices and behaviors. This paper will review some key issues relevant to teaching ethics and then explore what nurturing the moral imagination could do for nurses as they learn to apply abstract ethics concepts to their clinical practice. (shrink)