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)

Dilemma discussions have been proven to be one of the most effective methods to enhance students’ moral reasoning in ethics education. Dilemma discussions are increasingly arranged online, but research on the topic has remained sparse, especially in the context of continuing professional education. The aim of the present paper was to develop a method of dilemma discussions for professional ethics. The method was based on asynchronous discussions in small groups. Health and social care students raised work-related dilemmas from their experiences (...) and discussed them in terms of professional values, ethical guidelines and theories. Participants in this quasi-experimental study were 87 first-term graduate students at a Finnish university of applied sciences. Health and social care students in two consecutive ethics courses constituted two experiment groups, whereas health and social care students and business students in other programmes served as control groups. Students filled in a Defining Issues Test (DIT2) at the beginning of their studies and three months apart. Statically significant increase in moral reasoning was evidenced for experiment group 2, when discussion groups were purportedly composed to maximise differences in initial levels of moral reasoning. Findings suggest that online dilemma discussions can advance students’ moral reasoning development, especially when students’ exposure to higher-level arguments is ensured through complementary means, such as instructions, examples and plenary discussions. Online real-life dilemma discussions may also serve other important goals of ethics education, especially acquiring ethical concepts, and they can promote other components of ethical decision making: ethical sensitivity and motivation, and acquisition of implementation skills. (shrink)

Ethics is of vital importance to the Swedish educational system, as in many other educational systems around the world.Yet, it is unclear how ethics should be dealt with in school, and prior research and evaluations have found serious problems regarding ethics in education.The field of moral education lacks clear and widely accepted definitions of key concepts, and these ambiguities negatively impact both research and educational practice. This thesis draws a distinction between three approaches to ethics in school – the descriptive (...) ethics approach, the value transmission approach, and the inquiry ethics approach – and studies in what way (if at all) they are prescribed by the national curriculum for the Swedish compulsory school, how they relate to students’ moral reasoning about technology choices and online behaviour, and what pedagogical merits and disadvantages they have. Hopefully, this both contributes to reducing the ambiguities of the field, and to answering the question of how ethics should be dealt with in education. The descriptive ethics approach asserts that school should teach students empirical facts about ethics, such as what views and opinions people have. The value transmission approach holds that school should mediate some set of predefined values to the students and make sure the students come to accept these values.The inquiry ethics approach is the view that school should teach students to reason and think critically about ethics and to engage in ethical inquiry. The role of ethics in the curriculum has not been studied in light of the above distinction, in prior research,and such an investigation is undertaken here.The results suggest that ethics has a prominent, but complicated, role in the Swedish national curriculum. Although no explicit distinction is drawn or acknowledged in the curriculum, all three approaches are prescribed throughout the curriculum, albeit to different degrees. In the general section of the curriculum, the value transmission and inquiry ethics approaches are more extensively prescribed than the descriptive ethics approach. It was found that most of the syllabi contained explicit references to ethics, while some only contained implicit references to ethics, and two syllabi lacked references to ethics altogether. In the syllabi, the inquiry ethics approach is the most dominant, both in the sense of being present in the most syllabi, and in the sense of being more strongly prescribed in many of the syllabi where several approaches occur.The value transmission approach has the weakest role in the syllabi. In total, the inquiry ethics approach is the approach most strongly prescribed by the curriculum. But prior research has shown that inquiry ethics is very rarely implemented in the classroom. In this thesis, it is found that the inquiry ethics and the value transmission approaches are incompatible, given certain reasonable interpretations, which makes the finding that inquiry ethics is rarely implemented less surprising, since value transmission is practiced in schools. Some possible causes, and some consequences, of this is discussed. The students, in their moral reasoning about technology choices, reasoned in accordance with several classical normative theories – including consequentialism, deontological ethics and virtue ethics – and in doing so, they expressed reasoning that in the discussion is found to be in conflict with the values of the value foundation in the curriculum. These findings complement earlier findings, for example that students in their actions contradict the value foundation, by adding that such conflicts also exist in their reasoning. The existence of these conflicts is found to be problematic for a value transmission approach. Many of the students defended very restrictive views on disclosing personal information online, and prior research as well as the present data has shown that adults typically hold views that are very similar to these, concerning how they think that young people ought to act online. On the other hand, youths’ actual online behaviour, as reported in earlier studies, differs considerably from this. In line with this, the students also seemed to endorse a form of private morals view, according to which moral choices are simply up to one’s own taste, which would yield an escape exit from the restrictive views mentioned above, and permit any behaviour. In the discussion, it is argued that this is the result of an attempt at value transmission from the grown-up community, probably including teachers, which might seem to work, since the students claim to hold certain views, but which likely instead constitutes a false security, since these values are not actually accepted, but only paid lip service to, and the adults are therefore wrong in their belief that the students are protected by a certain set of values (that they think the students are upholding), since the students in fact do not uphold, and therefore do not act based upon, these values. This situation risks making the students more vulnerable than had no value transmission attempt been taken in the first place. Hence, the attempted value transmission runs the risk of counteracting its purpose of helping the students acquire a safe online behaviour. Throughout the moral reasoning mentioned above, extensive variations in the students’ reasoning were found, both interpersonally and intrapersonally, both in the decision method and in the rightness criterion dimensions, as well as in between the dimensions.The existence of such variations is a novel finding, and while possible applications in future research are discussed, it is also noted that this existence constitutes a reason to question the successfulness of both the value transmission and the inquiry ethics endeavours of the educational system. The results and discussions described above highlight the importance of investigating the merits of the different approaches. Several arguments that arise from the material of this thesis are presented, evaluated and discussed. The ability of each approach to fulfil some alleged key aims of ethics education is scrutinised; their abilities to educate for good citizenship, to educate for quality of life of the individual, and to facilitate better educational results in other subjects are all investigated, as well as the ability of each approach to help counteract the influence from online extremist propaganda aimed at young people and to promote safe online behaviour in general. It is concluded that the inquiry ethics approach has the strongest support from the material of this thesis. Some consequences for school practice are discussed, and it is concluded that changing the role of ethics in the curriculum would be beneficial, downplaying the role of value transmission and further increasing, and making more explicit and clear, the role of inquiry ethics. It is also shown that there are strong reasons for the inclusion of a new subject in the Swedish compulsory education with special focus on ethics. (shrink)

In this study, the age-old distinction between decision method and criterion of rightness, commonly employed in normative ethics, was used to attain a detailed understanding of inter- and intrapersonal variety in students' moral reasoning. A total of 24 Swedish students, 12–15 years of age, were interviewed. Inter- and intrapersonal varieties in and between the two dimensions of moral reasoning were found, constituting six novel forms of varieties. We describe several explanations proposed within the field of social-cognitive domain theory, and argue (...) that these do not suffice to explain all the found forms of varieties in students' moral reasoning. Some limitations of the present study are discussed, and some suggestions for future research are given. (shrink)

Background Ethical decision‑making and behavior of nurses are major factors that can affect the quality of nursing care. Moral development of nurses to making better ethical decision-making is an essential element for managing the care process. The main aim of this study was to examine and comparison the effect of training in ethical decision-making through lectures and group discussions on nurses’ moral reasoning, moral distress and moral sensitivity. Methods In this randomized clinical trial study with a pre- and post-test design, (...) 66 nurses with moral reasoning scores lower than the average of the community were randomly assigned into three equal groups (n = 22) including two experimental groups and one control group. Ethical decision-making training to experimental groups was provided through the lectures and group discussions. While, the control group did not receive any training. Data were collected using sociodemographic questionnaire, the nursing dilemma test (NDT), the moral distress scale (MDS) and the moral sensitivity questionnaire (MSQ). Unadjusted and adjusted binary logistic regression analysis was reported using the odds ratio (OR) and 95% confidence intervals. Results Adjusted regression analysis showed that the probability of increasing the nursing principle thinking (NPT) score through discussion training was significantly higher than lecture (OR: 13.078, 95% CI: 3.238–15.954, P = 0.008), as well as lecture (OR: 14.329, 95% CI: 16.171–2.005, P < 0.001) and discussion groups compared to the control group (OR: 18.01, 95% CI: 22.15–5.834, P < 0.001). The possibility of increasing moral sensitivity score through discussion training was significantly higher than lecture (OR: 10.874, 95%CI: 6.043–12.886, P = 0.005) and control group (OR: 13.077, 95%CI: 8.454–16.774, P = 0.002). Moreover, the moral distress score was significantly reduced only in the trained group compared to the control, and no significant difference was observed between the experimental groups; lecture group vs. control group (OR: 0.105, 95% CI: 0.015–0.717, P = 0.021) and discussion group vs. control group (OR: 0.089, 95% CI: 0.015–0.547, P = 0.009). Conclusions The results of this study indicate that ethical decision-making training is effective on empowerment of ethical reasoning. Whereas the group discussion was also effective on increasing the ethical sensitivity, it is recommended the training plan provided in this study to be held as workshop for all nurses in health and treatment centers and placed in curricular plan of nursing students. Registration This randomized clinical trial was registered in Iranian Registry of Clinical Trials under code (IRCT2015122116163N5) in 02/07/2016. (shrink)