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...

Background In the globalizing world, nurses often meet humans from different cultures and values. This fact has led them to make ethical decisions, which do not comply with their own moral jurisdictions at care setting. Objectives The objective of the study was to investigate the relationships between moral development levels of the nurses and their scores of nursing principled thinking and practical consideration during decision making for ethical dilemmas. Methods This was a descriptive correlational study. Nursing Dilemma Test, Moral Development (...) Scale for Professionals and socio-demographic form were used. Study was conducted with 227 nurses. Ethical considerations: An institutional authorization, an ethics approval from non-interventional ethics committee of the respective university, permission from the authors of the scales used and informed consents from the nurses were obtained in order to conduct the study. Results In this study, nurses were found to be at post-conventional level according to Kohlberg’s moral development theory. Sociodemographic and working characteristics of the nurses have not affected their scores of moral development level and their scores of nursing principled thinking, practical consideration and familiarity (p > 0.05). Nurses take attention for moral principles during decision making although not at a desirable level, and they are relatively affected by environmental factors Conclusion Although nurses are familiar with ethical problems at scenarios including ethical dilemmas, they cannot make decisions in accordance with their moral development levels during decision making for ethical dilemmas. Nurses should be instructed and supported for ethical decision making by recognizing factors that may be effective on their decision making. (shrink)

There are several challenges associated with traditional business ethics education. While case studies have been used extensively in ethics education, such use can be complemented by using Problem Based Learning (PBL). PBL represents a pedagogy employing more collaborative tools that involve students more extensively in the learning process. A well-designed teaching approach based on PBL can have significant positive impact on students’ learning. This paper supplies a representative teaching interaction based on PBL, and discusses the implications of its structure. Introducing (...) PBL is challenging and comes with significant costs as faculty members have to be trained, roles have to be exchanged, powers have to be relinquished, and learning materials have tobe written. We conclude that PBL is suitable for an ethics course as most ethical situations require introspection, reflection, discovery, and concern for other viewpoints, all of which can be facilitated in a PBL environment. (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)

A definitive theory for ethical decision making in nursing is still only conjecture. The literature confirms that there have been numerous examinations of ethical decision making in nursing, with most proposing either the justice or the care orientation, or a combination of both. In the absence of a definitive theory, this exploratory work sets out, via grounded theory, to shed some light on the methods used every day by nurses to make ethical decisions in the clinical area. The data show (...) that some factors, such as doctors, colleagues and the organization, profoundly influence ethical decision making. The informants used both care and justice to formulate decisions, which is known as the combined approach. As a result of these findings, this article concludes with tentative suggestions and recommendations for practice. (shrink)

Academic staff owe a duty of fidelity to uphold institutional standards of integrity. They also have their own values and conceptions of integrity as well as personal responsibilities and commitments. The question of how academic practitioners address or reconcile conflicting values and responsibilities has been underexplored in the literature. Before we can examine effectiveness of academic integrity strategies and develop best practices, we need to examine the breadth of integrity decisions. To this end we posited the academic integrity problem as (...) a set of seven dilemmas and presented them to post-secondary education staff (N = 80) located in Europe, North America, Oceania, and Asia. We asked the participants to recommend a solution to each dilemma. This yielded a modest sample of 498 themes across 30 categories. We expected the responses to fall on a binary scale where decisions either support the integrity or ignore it. However, the data suggests that academic integrity decisions are better suited to continuum where participants aim to reconcile personal and institutional obligations. We further argue that academic integrity decisions are predicated on personal experience and therefore pose a challenge for policy standardization and enforcement. We conclude with a discussion of the implications of the findings for practice. (shrink)

Background: Nurses are often faced with complex situations that made them to make ethical decisions; and to make such decisions, they need to possess the power of moral reasoning. Studies in Iran show that the majority of nursing students lack proper ethical development. Socratic teaching is a student-centered method which is strongly opposed to the lecturing method. Objectives: This study was conducted to evaluate the impacts of Socratic questioning on the moral reasoning of the nursing students. Research design: In a (...) quasi-experimental study, Crisham’s Nursing Dilemma Test was used to evaluate the results of three groups before, immediately after, and 2 months after intervention. The data were analyzed using the SPSS statistical software (v 15). Participants and research context: Through random allocation, 103 nursing students were divided into three groups. In experiment group 1 (37 students), intervention consisted of Socratic questioning-based sessions on ethics and how to deal with moral dilemmas; experiment group 2 (33 students) attended a 4-h workshop; and the control group (33 students) was not subject to any interventions. Signed informed consent forms: This research was approved by the Ethics Committee of the University. All the participants signed written informed consents. Findings: There were significant differences between experiment group 1 and experiment group 2’s pre-test and post-test scores on moral reasoning (p ≤ 0.001, p ≤ 0.001), nursing principled thinking (p ≤ 0.001, p ≤ 0.001), and practical considerations (p ≤ 0.001, p ≤ 0.031). Discussion: Both the teaching approaches improved the subjects’ moral reasoning; however, Socratic questioning proved more effective than lecturing. Compared to other similar studies in Iran and other countries, the students had inadequate moral reasoning competence. Conclusion: This study confirms the need for the development of an efficient course on ethics in the nursing curriculum. Also, it appears that Socratic questioning is an effective method to teach nursing ethics and develop nursing students’ competence of moral reasoning. (shrink)

Background: The advances in science and technology increasingly lead to the appearance of ethical issues and to the complexity of care. Therefore, it is important to define the ethics position of students studying in health departments so that high quality patient care can be achieved. Objectives: The aim of this study was to examine the ethics position of the students at Shool of Health of an University in western Turkey. Methods: The study design was descriptive and cross-sectional. The study population (...) included 540 first, second, third, and fourth year students from the Departments of Nursing, Midwifery, and Rescue and Disaster Management in the 2013–2014 academic year. Data were collected with a Personal Identification Form and The Ethics Position Questionnaire. Obtained data were analyzed with Chi-square test, Confirmatory Factor Analysis, and Nested Analysis of Variance. Ethical considerations: Before conducting the research, approval was obtained from Ege University Clinical Research Ethics Committee in İzmir and written informed consent was taken from all the participants. Findings: There was no significant difference in the mean scores for the Ethics Position Questionnaire between the students in terms of years and fields of study. Although the mean scores for the subscale idealism did not differ between fields of study, the mean scores significantly differed between years of study. However, the mean scores for the subscale relativism did not differ in terms of years and fields of study. Discussion: Whether students are idealistic or relativistic in terms of ethical judgment will be effective in ethical decision-making skills during patient care. Therefore, we need to define the factors that influence students’ ethics position in the future. Conclusion: It is suggested that the courses and practices that teach students to be aware of their ethics position to create an ethical outlook can be placed in the curriculum in health schools. (shrink)

This study described the relationships between academic class and student moral sensitivity and reasoning and between curriculum design components for ethics education and student moral sensitivity and reasoning. The data were collected from freshman (n = 506) and senior students (n = 440) in eight baccalaureate nursing programs in South Korea by survey; the survey consisted of the Korean Moral Sensitivity Questionnaire and the Korean Defining Issues Test. The results showed that moral sensitivity scores in patient-oriented care and conflict were (...) higher in senior students than in freshman students. Furthermore, more hours of ethics content were associated with higher principled thinking scores of senior students. Nursing education in South Korea may have an impact on developing student moral sensitivity. Planned ethics content in nursing curricula is necessary to improve moral sensitivity and moral reasoning of students. (shrink)

Background: The effectiveness of ethics education continues to be disputed. No studies exist on how nursing students perceive the effectiveness of nursing ethics education in Flanders, Belgium. Objectives: To develop a valid and reliable instrument, named the ‘Students’ Perceived Effectiveness of Ethics Education Scale’ (SPEEES), to measure students’ perceptions of the effectiveness of ethics education, and to conduct a pilot study in Flemish nursing students to investigate the perceived efficacy of nursing ethics education in Flanders. Research design: Content validity, comprehensibility (...) and usability of the SPEEES were assessed. Reliability was assessed by means of a quantitative descriptive non-experimental pilot study. Participants and research context: 86 third-year baccalaureate nursing students of two purposefully selected university colleges answered the SPEEES. Ethical considerations: Formal approval was given by the ethics committee. Informed consent was obtained and anonymity was ensured for both colleges and their participating students. Findings: The scale content validity index/Ave scores for the subscales were 1.00, 1.00 and 0.86. The comprehensibility and user-friendliness were favourable. Cronbach’s alpha was 0.94 for general effectiveness, 0.89 for teaching methods and 0.85 for ethical content. Students perceived ‘case study’, ‘lecture’ and ‘instructional dialogue’ to be effective teaching methods and ‘general ethical concepts’ to contain effective content. ‘Reflecting critically on their own values’ was mentioned as the only ethical competence that, was promoted by the ethics courses. The study revealed rather large differences between both schools in students’ perceptions of the contribution of ethics education to other ethical competences. Discussion and conclusion: The study revealed that according to the students, ethics courses failed to meet some basic objectives of ethics education. Although the SPEEES proved to be a valid and reliable measure, the pilot study suggests that there is still space for improvement and a need for larger scale research. Additional insights will enable educators to improve current nursing ethics education. (shrink)

The purpose of this study was to compare nursing students' perceptions of self-determination in elderly patients before and after clinical training in long term care institutions as a part of their course in gerontological nursing. A pre- post-test design was employed. The data were collected by questionnaires completed by students at one nurse education organization college in Finland (pre-test n ± 120, response rate 95%; post-test n ± 115, response rate 91%). The students' perceptions of elderly patients' self-determination were more (...) positive after their clinical training period concerning to what extent elderly patients are able to control their treatment and what kind of support they received from nurses to exercise their self-determination. The students' perceptions remained stable concerning how important self-determination is to elderly patients, and how willing and knowledgeable they are about using their self-determination. Ethics teaching, together with high quality clinical training placements, should be assured early during nursing studies. (shrink)

Research on nursing ideology and the ethics of child and adolescent psychiatric nursing care is limited. The aim of this study was to describe and explore the ideological approaches guiding psychiatric nursing in child and adolescent psychiatric inpatient wards in Finland, and discuss the ethical, theoretical and practical concerns related to nursing ideologies. Data were collected by means of a national questionnaire survey, which included one open-ended question seeking managers' opinions on the nursing ideology used in their area of practice. (...) Questionnaires were sent to all child and adolescent psychiatric inpatient wards (n = 69) in Finland; 61 ward mangers responded. Data were analysed by qualitative and quantitative content analysis. Six categories - family centred care, individual care, milieu centred care, integrated care, educational care and psychodynamic care - were formed to specify ideological approaches used in inpatient nursing. The majority of the wards were guided by two or more approaches. Nursing models, theories and codes of ethics were almost totally ignored in the ward managers' ideological descriptions. (shrink)

Their nursing experience and/or training may lead students preparing for the nursing profession to have less moral distress and more favorable attitudes towards a hastened death compared with those preparing for other fields of study. To ascertain if this was true, 66 undergraduates (54 women, 9 men, 3 not stated) in southeastern USA completed measures of moral distress and attitudes towards hastening death. Unexpectedly, the results from nursing and non-nursing majors were not significantly different. All the present students reported moderate (...) moral distress and strong resistance to any efforts to hasten death but these factors were not significantly correlated. However, in the small sample of nurses in training, the results suggest that hastened death situations may not be a prime reason for moral distress. (shrink)

This longitudinal study examined the development of moral judgement in 37 nursing students attending a university in Suwon, Korea. The participants completed the Korean version of the Defining Issues Test to allow analysis of their level of moral judgement. The development of moral judgement was quantified using ‘the moral development score’ at each stage (i.e. the six stages detailed by Kohlberg) and the ‘P(%) score’ (a measure of the overall moral judgement level). The results were as follows: (1) the moral (...) development score for stage 5A was consistently the highest across the four years of the students’ course, showing significant differences in some sociodemographic factors including home, birth order and monthly income; and (2) the P(%) score was higher in fourth-year (47.47 ± 11.21) than in first-year (46.13±9.73) students. There was no significant difference in the P(%) score according to sociodemographic factors. Further studies will examine in detail the correlation between curriculum and moral judgement development. We suggest that courses in ethics education should be made more relevant. (shrink)

A cross-sectional study explored the moral judgement competence and moral attitudes of 310 Czech and Slovak and 70 foreign national students at the Medical Faculty of Charles University in Hradec Králové, Czech Republic. Lind's Moral Judgement Test was used to evaluate moral judgement competence and moral attitudes depending on factors such as age, number of semesters of study, sex, nationality and religion. Moral judgement competence decreased significantly in the Czech and Slovak medical students as they grew older; in medical students (...) from other countries it did not significantly increase. The influence of other factors (sex, nationality and religion) on moral judgement competence was not proven in either the Czech and Slovak or the foreign national medical students. Moral attitudes do not change; the Czech and Slovak as well as the foreign students preferred the post-conventional levels of moral judgement (Kohlberg's 5th and 6th stages). The fact that the Czech and Slovak students' moral judgement competence decreased with age and number of semesters of study completed is not an optimistic sign: medical students who had undergone a lower number of semesters of study were morally more competent. (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....

Background: Ethics education is essential to the education of all healthcare professionals. The purpose of this study was to evaluate an interprofessional approach to ethics education to all students across an academic health science center. Research objectives: The objectives were to (1) compare student perception of ethics education before and after the implementation of the campus-wide ethics program and (2) determine changes in student ethical decision-making skills following implementation of a campus-wide ethics program. Research design: This study was a quasi-experimental (...) design with seniors graduating prior to the intervention serving as the control group. Participants and research context: The setting was a comprehensive health science center in the southwestern United States. All students enrolled in the university participated in the intervention; however, 976 graduating students were used for evaluation of the intervention. Ethical considerations: Study materials for each survey were submitted to the university’s IRB, and the project was approved as exempt by the Committee for the Protection of Human Subjects. Student participation in the surveys was voluntary. No names or other identifying information were collected, and responses to the survey questions were kept confidential. Findings: Students’ perception of the adequacy of time spent on the ethics content in course instruction and practical training decreased from the baseline to the fifth-year survey. Students’ overall comfort level with their abilities to deal with ethical issues increased from the baseline to the fifth year. Student ethical decision-making skills were higher at the third-year evaluation for all indicators. For the fifth-year survey, responses were also higher scoring on all four indicators. Discussion: After participation in an interprofessional campus-wide effort on health professions ethics, students demonstrated higher ethical decision-making scores according to the Health Professional Ethics Rubric. However, their scores still did not reach the proficiency level identified in the rubric. Conclusion: Examination of the effectiveness of each part of the intervention is needed. (shrink)