Nurses find themselves in a unique position - between patient and physicians, and in close proximity to the patient. Moral sensitivity can help nurses to cope with the daily turmoil of demands and opinions while delivering care in concordance with the value system of the patient. This article aims to reconsider the concept of moral sensitivity by discussing the function of emotions in morality. We turn to the ideas of historic and contemporary authors on the function of emotions in morality (...) to expand our understanding of moral sensitivity. Ancient philosophers and contemporary psychologists uphold different strategies on the orientation of morality being (a) personal growth or (b) community living, and the primordial function of (c) reason and (d) emotions in the creation of judgements about good and bad. The theoretical discussion on the function of emotions in morality shows that by focusing on reason alone, one leaves out an essential part of morality. The concept of moral sensitivity should (1) include an initial judgment of good and bad based on emotions, (2) hold the ability to reflect on the initial judgement and the associated emotions, (3) include the ability to understand other stakeholders' perspectives based on the ideal-types and (4) include a personal decision on the right course of action. (shrink)

Background Ethics education can be developed in undergraduate nursing curriculum using a variety of teaching and learning strategies, and the content of narrative-based stories has rarely been evaluated in ethics courses. Objective This study aimed to compare the effect of teaching ethical principles through narrative ethics and lectures on the moral sensitivity of undergraduate nursing students. Methods This was a pretest and posttest quasi-experimental study with a control group. A total of 105 undergraduate nursing students from the nursing department of (...) Kerman University of medical science were included in the study. The narrative-based story and lecture lasted for four two-hour sessions. The outcomes were measured by a moral sensitivity questionnaire. Results The study results showed that teaching ethical principles had a significant effect on the mean score of moral sensitivity in the intervention groups after the intervention, but it was not significant in the control group. Based on the mean score of moral sensitivity, the students in the narrative story group got a higher score in all subscales of moral sensitivity questionnaire. Conclusion Based on this study’s findings, it can be concluded that narrative-based education is an effective way for undergraduate nursing students to promote their moral sensitivity and the ability to make ethical decisions. (shrink)

This study was carried out to determine the ethical sensitivity levels of students enrolled in the nursing faculty. The sample of the descriptive study consisted of 594 students who were taught at the Faculty of Nursing in February - May 2018 and agreed to participate in the study. The data were collected by Personal Information Form prepared by researchers to evaluate the demographic characteristics of students and The Modified Moral Sensitivity Questionnaire for Student Nurses. The data obtained from the application (...) were analyzed using SPSS for Windows 23.0 program. The majority of the students (75.9%) participating in the study were women and 74.9% stated that they internalized the profession. The total score average of The Modified Moral Sensitivity Questionnaire for Student Nurses is 4.93 ± 0.49. While the lowest average score in all classes is “Experiencing Ethical Dilemma” sub-dimension, the highest average score is in the “Interpersonal Orientation” sub-dimension. It is the 3 rd year student with the highest average score received from the scale. It was determined that the ethical sensitivity of the nursing students was medium and there was a significant difference between the ethical sensitivity levels of the students between the classes. It is thought that ensuring the continuity of the ethical education of the nursing students will be effective in increasing the awareness of the students on the subject. For this reason, it is recommended to integrate ethical issues in all courses in the structuring of nursing education curriculum programs. (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)

BackgroundMoral Case Deliberation is a specific form of bioethics education fostering professionals’ moral competence in order to deal with their moral questions. So far, few studies focus in detail on Moral Case Deliberation methodologies and their didactic principles. The dilemma method is a structured and frequently used method in Moral Case Deliberation that stimulates methodological reflection and reasoning through a systematic dialogue on an ethical issue experienced in practice.MethodsIn this paper we present a case-study of a Moral Case Deliberation with (...) the dilemma method in a health care institution for people with an intellectual disability, describing the theoretical background and the practical application of the dilemma method. The dilemma method focuses on moral experiences of participants concerning a concrete dilemma in practice. By an in-depth description of each of the steps of the deliberation process, we elucidate the educational value and didactics of this specific method.ResultsThe didactics and methodical steps of the dilemma method both supported and structured the dialogical reflection process of the participants. The process shows that the participants learned to recognize the moral dimension of the issue at stake and were able to distinguish various perspectives and reasons in a systematic manner. The facilitator played an important role in the learning process of the participants, by assisting them in focusing on and exploring moral aspects of the case.DiscussionThe reflection and learning process, experienced by the participants, shows competency-based characteristics. The role of the facilitator is that of a Socratic teacher with specific knowledge and skills, fostering reflection, inquiry and dialogue.ConclusionThe specific didactics of the dilemma method is well suited for teaching bioethics in clinical settings. The dilemma method follows an inductive learning approach through a dialogical moral inquiry in which participants develop not only knowledge but also skills, attitude and character. The role of a trained facilitator and a specific view on teaching and practicing ethics are essential when using the dilemma method in teaching health care professionals how to reflect on their own moral issues in practice. (shrink)

One antidote to moral distress is stronger moral agency—that is, an enhanced ability to act to bring about change. The Clinical Ethics Residency for Nurses, an educational program developed and run in two large northeastern academic medical centers with funding from the Health Resources and Services Administration, intended to strengthen nurses’ moral agency. Drawing on Improving Competencies in Clinical Ethics Consultation: An Education Guide, by the American Society for Bioethics and Humanities, and on the goals of the nursing profession, CERN (...) sought to change attitudes, increase knowledge, and develop skills to act on one's knowledge. One of the key insights the faculty members brought to the design of this program is that knowledge of clinical ethics is not enough to develop moral agency. In addition to lecture‐style classes, CERN employed a variety of methods based in adult learning theory, such as active application of ethics knowledge to patient scenarios in classroom discussion, simulation, and the clinical practicum. Overwhelmingly, the feedback from the participants (sixty‐seven over three years of the program) indicated that CERN achieved transformative learning. (shrink)

To effectively train ethical decision-making of nursing students, a case-based computer program was developed using Flash animation. Seven ethical cases collected from practicing registered nurses’ actual clinical experiences and a six-step Integrated Ethical Decision-Making Model developed by the author were employed in the program. In total, 251 undergraduate students from three nursing schools used the program in their nursing ethics course. The usability of the program and its usefulness in improving 11 abilities needed in ethical decision-making were measured; it scored (...) higher than 4 on a 5-point scale. Of the students, 82% recommended the program as a valuable complementary tool in the teaching of a nursing ethics course. A variety of encouraging and positive experiences were reported by the students. The computer program is likely to be usefully practical in the training of abstract skills to nursing students, though certain challenges remain, such as the precise understanding of cognitive or affective responses to ethical issues. (shrink)

Background Nurses frequently experience ethical issues in their area of practice. In the challenging reality of today’s healthcare environment, nursing students need to be prepared to deal with ethical issues in their future roles. Nevertheless, Chinese nursing students’ ethical sensitivity status and the factors influencing it have not been described. Objective This study aims to explore the level of ethical sensitivity and its influencing factors among Chinese nursing students. Research design This was a cross-sectional study. We firstly cross-culturally adapted the (...) Japanese version of the Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS) into a Chinese version. Then, we administered the Chinese version of ESQ-NS, the Caring Ability Inventory (CAI), and general information questionnaire to nursing undergraduates. Participants and research context The invitations were sent to 600 nursing undergraduates from four universities in Hunan, China. Ethical considerations The study was supported by the Institutional Review Board (IRB) of the lead university. The Approval No. was E202092. Results A total of 489 undergraduate nursing students participated in the study. The mean score for ethical sensitivity of the samples was 36.34 ± 4.90, and 187.99 ± 22.64 for their humanistic care ability. Pearson’s correlation coefficient test indicated a meaningful and positive relationship between the ethical sensitivity and humanistic care ability (r = 0.576 and p <.01). And regression analysis showed that age, school year, experience in studying nursing ethics, how much you like nursing major, and humanistic care ability were of relevance to nursing students' ethical sensitivity. Discussion Our findings suggest that the mean ethical sensitivity score of Chinese nursing students is 36.34 (13–52). The humanistic caring ability of Chinese nursing students is still at a low level. Conclusion Future interventions for improving the ethical sensitivity of the nursing students should consider general information of participants and their humanistic care ability. (shrink)

Background Nursing students must graduate prepared to bravely enact the art and science of nursing in environments infiltrated with ethical challenges. Given the necessity and moral obligation of nurses to engage in discourse within nursing ethics, nursing students must be provided a moral supportive learning space for these opportunities. Situating conversations and pedagogy within a brave space may offer a framework to engage in civil discourse while fostering moral courage for learners. Research Objective The aim of this research is to (...) explore the influence of a structured self-assessment tool called the ESA “Engagement Self-Assessment” on the alignment and creation of a brave space in a nursing ethics course. Research Design This study used an exploratory, cross-sectional survey design. Participants and Study Setting Data from 39 undergraduate nursing students enrolled in a nursing healthcare ethics & law course using the ESA were recruited. Ethical Considerations Participation was voluntary and informed without coercion. Written consent was obtained prior to participation. Research ethics approval was obtained by the Institutional Research Ethics Board of the recruited participants (Ethics # 2022-23-03). Findings The ESA provided structured self-reflection on the impact of shared vulnerability within a brave space. However, commitment to a brave space was not strongly influenced by the ESA, but rather by a mutual “commitment to others.” Conclusion A teaching tool such as an ESA can be used to facilitate instructor expectations of civil discourse and discussion of difficult topics. Rules of engagement such as those found in brave spaces can help transform fear of vulnerability into authentic growth for learners. A morally supportive learning space can support critical opportunities for ethical development. This study provides insight into how self-assessment and the use of a brave space in nursing ethics education can facilitate a morally supportive learning space. (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 Ethics communication has been described as a pedagogical form, promoting development of ethical competence among nursing students. The ‘one to five method’ was developed by this research group as a tool for facilitating ethical communication in groups among healthcare professionals but has not yet been evaluated. Aim To explore post-graduate nursing students’ experiences of practicing ethical communication in groups Research design The study design is qualitative. Participants and research context The study comprised 12 nursing students on a post-graduate course (...) for Registered Nurses focusing on palliative care. After education the students engaged as participants and facilitators in ethics communication in groups, with support from the ‘one to five method’. Data were derived from the students written reflections and subjected to thematic analysis. Ethical considerations The study was performed in accordance with the ethical standards in the 2013 Helsinki Declaration and approved by the Ethics Committee of the Medical Faculty at Umeå University Results An overall theme was identified, ‘being supported to achieve a democratic dialogue concerning ethical problems’ and five themes, related to each step of the ‘one to five method’. The themes concerned: putting the experience of an ethical dilemma into words; being confirmed by shared emotions; defining the value conflict using ethical principles; expressing virtues of empathy and raised awareness; jointly finding various action approaches. Discussion Regular ethics communication in groups encourages nursing students to actively seek understanding and clarification of ethically difficult situations. Conclusions The results indicate that ethics communication in groups could be a way of developing virtues during education. Interventions using the ‘one to five method’ need to be further studied among student groups from other healthcare contexts. (shrink)

Background:Ethical competence in nursing practice helps clinical nurses to think critically, analyse issues, make ethical decisions, solve ethical problems and behave ethically in their daily work. Thus, ethical competence contributes to the promotion of high-quality care. However, studies on ethical competence in Malawi are scanty.Objectives:The aim of this study was to explore ethical competence among clinical nurses in selected hospitals in Malawi.Methodology:A cross-sectional survey was conducted in four selected hospitals in Malawi with a sample of 271 clinical nurses. Data were (...) collected using self-administered questionnaires, which included a Moral Competence Scale for Home Care Nurses. Descriptive statistics and logistic regression were computed for the dataset using STATA version 12.0.Ethical consideration:The study protocol complied with all ethical requirements and was approved by the College of Medicine Research Ethics Committee under the University of Malawi.Results:The clinical nurses in Malawi are ethically competent. However, there is a significantly high number (p 0.05). Three determinants of high ethical competence level (strong will, judgement skills and recognition of discrepancy of intention) were identified through a reduced model after stepwise logistic regression analysis. Furthermore, results show that indicators of ethical competence include caring, confidentiality and observance of nurses dressing code. The study has also confirmed that the Moral Competence Scale for Home Care Nurses is a reliable tool to assess ethical competence in low-resource settings.Conclusion:The majority of nurses who completed the survey had low ethical competence. However, clinical nurses with high ethical competence level are required to competently manage complex ethical challenges in health facilities. Strategies for enhancing ethical competence such as continuing ethics education, establishment of ethics committees and provision of supportive supervision are recommended to enable nurses in Malawi attain a high level of ethical competence. (shrink)

INTRODUCTION: This study was conducted to identify the professional self-concept and the related factors among student nurses studying at a nursing faculty and to investigate the relationship between moral sensitivity and the professional self-concept. METHODS: This was a descriptive and correlational study carried out on 381 nursing students. The Student Information Form, Professional Self-Concept Scale for the Student Nurses, and the Moral Sensitivity Questionnaire were employed as the study tools. Descriptive and inferential statistics were used to analyze the data. RESULTS: (...) A weak and reverse relationship was found between the professional self-concept and moral sensitivity of nursing students. A decrease in moral sensitivity score was correlated with a high professional self-concept. DISCUSSION AND CONCLUSION: There was a correlation between a decrease in moral sensitivity score and a high professional self-concept. (shrink)

Background:Nurses and nursing students increasingly confront ethical problems in clinical practice. Moral sensitivity, moral reasoning, and ethical decision-making are therefore important skills throughout the nursing profession. Innovative teaching methods as part of the ethics training of nursing students help them acquire these fundamental skills.Aim:This study investigated the effects and potential benefits of using standardized patients in ethics education on nursing baccalaureate students’ moral sensitivity, moral reasoning, and ethical decision-making by comparing this method with in-class case analyses.Research design:This is a quasi-experimental (...) study.Participants and research context:The sample comprised 89 students in Hacettepe University’s Faculty of Nursing. Following lectures describing the theoretical components of ethics, students were randomly assigned to two working groups, one using standardized patients and the other using in-class case analyses. Data were collected using the Moral Sensitivity Questionnaire, Rest’s Defining Issues Test, and the Nursing Dilemma Test. All data were analysed using IBM SPSS Statistics Version 23.Ethical considerations:Ethical approval and official permission were obtained. All participating students completed informed consent forms.Findings:According to the results, the moral sensitivity of students in the standardized patient group significantly improved over time compared to those in the case analysis group, while the mean scores of students in both groups for moral reasoning and ethical decision-making were not statistically significant.Conclusion:Based on our results, we recommend the use of both standardized patients and case analysis as appropriate teaching methods in ethics education. (shrink)

This study aimed at determining B.S. Biology students’ comprehension of the Bioethics principles and conviction schemas towards bioethical issues; as well as at identifying predictors for comprehension of bioethical principles and convictions and creating model constructs of predictors which are fit for the data. One-hundred sixteen Filipino Biology majors were pre and post-tested for comprehension of bioethics principles and convictions towards bioethical issues. Predictors for comprehension and convictions among personal and family background factors, global and primary personality factors, and mental (...) ability were identified through step-wise multiple regression. Constructed path models were tested for goodness of fit using Structural Equation Modeling. Results showed that case study discussion and the bioethics course had positive effects on comprehension of the bioethics principles and on convictions towards bioethical issues. Predictors for comprehension of Bioethics principles before intervention were verbal ability, warmth, and exposure to media. Sex and openness to change were predictors for pre-convictions. Post-conviction predictors were anxiety, self-control, extraversion, liveliness, and perfectionism. Four out of five model constructs were accepted based on model fit criteria. In conclusion, personal factors, i.e., sex and personality factors are contributors in bioethical convictions; not cognitive factors like mental ability or comprehension of Bioethics principles; implying that bioethical convictions are already pre-conceived and that empathy-based experiences may strengthen convictions towards bioethical issues. (shrink)

Ethics education is an emerging concept at the intersection of ethics and education, and this article aims to define the goals of ethics education in order to specify the general structure of teaching ethics in healthcare. Additionally, providing the opportunity to map the next stages of ethics education, such as what to teach and how to teach, is another purpose of the suggested normative framework. Kohlberg’s cognitive-developmental approach, Handelsman et al.’s ethical acculturation model, and the Delors Report’s learning throughout life (...) concept are utilized to determine the notion of teaching ethics and its objectives. Through the integration of these three approaches and the adaptation of the Delors Report’s pillars, the goals of ethics education are described as: increasing ethical knowledge; improving ethical skills to strengthen ethical sensitivity, awareness, and judgement; developing ethical behavior; and promoting cultural competence. These goals indicate that ethics education is an ongoing process transcending to teach or learn certain ethical codes, norms, and principles. Exploring and recognizing individuals’ abilities, personal values, and cultural backgrounds are also essential requirements of teaching ethics. Furthermore, this perspective demands administrating existing ethical challenges, differences, and conflicts in healthcare through augmenting cultural competence rather than imposing and/or assimilating policies. (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)

BackgroundAlthough nurses are crucial to ensure patients’ peaceful death in hospitals, many nurses experience various ethical conflicts during end-of-life care. Therefore, research on nurses’ entire ethical decision-making process is required to improve nurses’ ethical decision-making in end-of-life care. This study aimed to identify Korean nurses’ ethical decision-making process based on their moral sensitivity to end-of-life patients.MethodsIn total, 171 nurses caring for terminal patients responded to the survey questionnaire. To measure the participants’ moral sensitivity and ethical decision-making process, we used the (...) Korean version of the Moral Sensitivity Questionnaire and Nurses’ Ethical Decision-Making around End of Life Care Scale. Finally, multiple linear regression analysis was used to investigate the effect of moral sensitivity on nurses’ ethical decision-making.ResultsThe mean of moral sensitivity was 4.8 ± 0.5 (out of 7), and that of ethical decision-making was 4.6 ± 0.5 (out of 6). Among the sub-dimensions of ethical decision-making, the highest score was in perceived professional accountability (5.2 ± 0.5), and the lowest in moral reasoning and moral agency (3.9 ± 0.6); the score of moral practice was 4.4 ± 0.7. In the multiple linear regression model, moral sensitivity (β = 0.852, p <.001), clinical department (β = − 7.018, p =.035), ethics education (β = 20.450, p <.001), job satisfaction (β = 5.273, p <.001), and ethical conflict (β = − 2.260, p = 0.031) were influential ethical decision-making factors.ConclusionsThis study revealed a gap between nurses’ thoughts and practices through the ethical decision-making process. They failed to lead their thought to moral practice. It also implies that moral sensitivity could positively affect nurses’ ethical decision-making. To make nurses morally sensitive, exposing them to various clinical cases would be helpful. Additionally, ethics education and clinical ethics supporting services are valuable for improving nurses’ ethical decision-making. If nurses improved their ethical decision-making regarding end-of-life care, their patients could experience a better quality of death. (shrink)

Background and aim: Surgical intensive care nurses should have ethical sensitivity allowing them to identify ethical issues in order that they can recognize them and make the right decisions. This descriptive study was conducted with the aim of evaluating the ethical sensitivity of surgical intensive care nurses. Materials and methods: The research was carried out with the participation of 160 nurses in six Turkish hospitals, four state, one university, and one private. The data were collected using the “Nurse Description Form” (...) developed by the researcher and the “Ethical Sensitivity Questionnaire.” The percent, mean, standard deviation, median, minimum and maximum values, significance test for the difference between two means, variance analysis, Mann–Whitney U test, and Kruskal–Wallis Variance Analysis test were used to evaluate the data. Ethical considerations: Ethical commission permission and the corporate permission of the hospitals were received before conducting the research. Results: It was determined that the ethical sensitivities of surgical intensive care nurses were moderate based on the Ethical Sensitivity Questionnaire total score and subdimension score averages. A statistical difference was determined between the Ethical Sensitivity Questionnaire total score of surgical intensive care nurses and the institution where they worked, the period of working in the occupation, and the period of working in the intensive care unit. Conclusion: Based on the results of the research, the organization of training and studies devoted to the elimination of ethical sensitivity differences between institutions and workers is suggested. (shrink)

Ethics is a prominent subject in almost all academic fields. However, the teaching of ethics is a controversial matter in terms of its aim, scope, method, and so on. Besides these points, the issue of quality in ethics education is another essential consideration which needs to define the concept of quality and determine its indicators as well as its measurement. Therefore, establishing certain standards and principles in ethics education may benefit all ethics programs across the world and create a global (...) standardization at some points. Nevertheless, prior to proposing any method, model, standard, or indicator, looking at the existing situation of the current ethics programs would give opportunity to detect good practices, shortages, and shortcomings. In this sense, the aim of this paper was to review the literature on ethics education to exhibit the features of the present ethics programs and benefit from their experiences to determine what quality in ethics education is. The findings demonstrated that both students and educators believe that ethics education generates positive impact on ethical awareness, knowledge, and reasoning. However, the reviewed studies did not indicate explicit and adequate clues to draw a conclusion about what quality in ethics education is and which teaching method is the most effective. (shrink)

Background:Moral distress can be broadly described as the psychological distress that can develop in response to a morally challenging event. In the context of healthcare, its effects are well documented in the nursing profession, but there is a paucity of research exploring its relevance to healthcare assistants.Objective:This article aims to examine the existing research on moral distress in healthcare assistants, identity the important factors that are likely to contribute to moral distress, and propose preventative measures.Research Design:This is a survey of (...) the existing literature on moral distress in healthcare assistants. It uses insights from moral distress in nursing to argue that healthcare assistants are also likely to experience moral distress in certain contexts.Participants and Research Context:No research participants were part of this analysis.Ethical Considerations:This article offers a conceptual analysis and recommendations only.Findings:The analysis identifies certain factors that may be particularly applicable to healthcare assistants such as powerlessness and a lack of ethical knowledge. We demonstrate that these factors contribute to moral distress.Discussion:Recommendations include various preventative measures such as regular reflective debriefing sessions involving healthcare assistants, nurses and other clinicians, joint workplace ethical training, and modifications to the Care Certificate. Implementation of these measures should be monitored carefully and the results published to augment our existing knowledge of moral distress in healthcare assistants.Conclusion:This analysis establishes the need for more research and discussion on this topic. Future research should focus on evaluating the effectiveness of the proposed recommendations. (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)

Background The impact of healthcare ethics educational interventions on participants’ ethical development is rarely reported on and assessed; even less attention is paid to educational interventions that focus on end-of-life ethical issues. Aim To evaluate the impact of the Ethical Framework for End-of-Life Care Study Sessions Programme ( EOLCSS) on the moral development of healthcare staff who are delivering end-of-life care. Methods The EOLCSS was delivered to 20 multi-disciplinary health care staff in Ireland in May 2013. Effect on moral reasoning (...) was measured pre and post education using the Defining Issues Test 2 (DIT2). Inferential statistics were used to examine the relationships between change in DIT2 scores and demographic variables. Results Participants experienced moral reasoning development following receipt of EOLCSS. Age and previous ethics education contributed to the observed changes in moral reasoning. Conclusions Receipt of the EOLCSS may contribute to moral reasoning development in practicing healthcare professionals. (shrink)

This paper describes the first phase of an ongoing education and research project guided by three main intentions: (1) to create opportunities for phronesis in the classroom; (2) to develop new understandings about phronesis as it relates to nursing care generally and to caring for specific groups, like formerly incarcerated adults; and (3) to provide an opportunity for formerly incarcerated adults and graduate nursing students to participate in a dialectical conversation about ethical knowing. Gadamer's writings on practical philosophy, phronesis, and (...) the Socratic dialectic provide the philosophical foundation and framework for the project. The first phase in the project was a 4‐h class within a graduate‐level health promotion course during which 30 nursing students and three formerly incarcerated panelists engaged in a dialectic conversation about what it means to care for formerly incarcerated adults in a meaningful way. After the class, two focus groups were conducted, one with the students and one with the formerly incarcerated panelists. Findings articulated participants' prejudices and assumptions prior to the class, expanded sense of phronesis, and ability to consider nursing practice within a larger ethical framework. Panelists and students left the class with a deeper understanding of one another and expressed an openness towards continued dialectic conversations together. Use of the Socratic dialectic within nursing curricula reflects a current and critical trend in nursing education to bring non‐epistemologic forms of knowledge into the classroom. (shrink)

Euthanasia is one of the most controversial issues in medical ethics and one of the ten major ethical challenges in medicine and health sciences. The present study was conducted to evaluate the relationship between moral sensitivity and attitudes toward euthanasia among nursing students at Birjand University of Medical Sciences in 2020. Birjand University of Medical Sciences has four nursing schools. Cluster sampling method was used for selection of samples. After sampling Ferdows nursing school was selected. Nursing students of Ferdows School (...) were 156 person which 144 participated in the study based on inclusion and exclusion criteria. Students completed demographic information questionnaire, moral sensitivity questionnaire and euthanasia attitude questionnaire. Data were entered into SPSS software version 19 using descriptive and inferential statistical methods. Findings of this study showed that among nursing students, the mean score of moral sensitivity was 59.59 ± 11.21 and was moderate. The mean score of attitudes towards euthanasia was 0.981 ± 0.336. In addition, according to the results, correlation test showed that there is a significant direct but weak relationship between moral sensitivity and attitude to euthanasia in students. According to the findings of the present study, moral sensitivity as a scientific concept is one of the determining factors in attitudes toward euthanasia, but other factors can also affect nurses' attitudes toward euthanasia, which should be investigated and determined in future research. (shrink)

Background/purpose:Research from other disciplines demonstrates that ethical position, idealism, or relativism predicts ethical decision-making. Individuals from diverse cultures ascribe to various religious beliefs and studies have found that religiosity and culture affect ethical decision-making. Moreover, little literature exists regarding undergraduate nursing students’ ethical position; no studies have been conducted in the United States on students’ ethical position, their self-identified culture, and intrinsic religiosity despite an increase in the diversity of nursing students across the United States.Participants and Research Context Objectives:The study’s (...) two aims were to determine the relationship of self-identified culture, religiosity, and ethics position of undergraduate nursing student and whether students’ level of education and past ethics courses taken related to idealism. Two hundred and twelve volunteer undergraduate students participated.Research design:A descriptive cross-sectional study was designed for participants who completed the Ethical Position Questionnaire, The intrinsic subscale of the Religious Orientation Scale, and a Demographic, Cultural, Ethnicity Form. To test the five hypotheses, analyses included t-tests, correlations, and ANOVA.Ethical Considerations:The study was approved by the Institutional Review Board at Adelphi University.Results:Idealism and intrinsic religiosity were significantly related. Differences were observed for intrinsic religiosity and idealism for cultural identity and cultural dimensions such as parents’ place of birth, and if participants were US born. Students’ level of education or participation in past courses on ethics did not influence idealism.Conclusions:The study’s findings were similar to most of the research from other disciplines on culture, ethics position, and religiosity. Generic courses on ethics taken prior to clinical work may not assist nursing students in integrating principles into complex ethical dilemmas. Self-identified culture, religion, and intrinsic religiosity related to ethics position; completing ethics courses and level of education, juniors compared with seniors, did not influence idealism. Faculty should consider integrating students’ culture, religious orientation, and ethics position into teaching ethics for all levels of nursing education. (shrink)

Nursing students face various ethical issues, which may cause stress, that require coping strategies. This study investigated the thoughts and feelings underlying the coping behaviors adopted by nursing students when addressing ethical issues. Semi-structured interviews were conducted from September to October 2011 with 11 students enrolled at University A who had completed basic nursing and specialty practicums and consented to participate in the study. Data were analyzed using qualitative methods. The participant narratives about ethical issues encountered during clinical practicums were (...) organized into four themes and 20 scenarios. The ethical issues concerned the attitudes and conduct of nurses, doctors, physical therapists, and other medical professionals. Seven coping behaviors were identified. The results revealed that nursing students waver between valuing their relationships with nurses and their relationships with patients when they encounter an ethical issue. When their relationships with nurses were emphasized, their ethical values were restructured. These findings suggest the need to address the affective domain early on in lectures and in-class practice, and to create an environment in which students taking practicums can easily express their feelings and internal value system changes. (shrink)

This study examined the validity and reliability of a Turkish version of the Modified Moral Sensitivity Questionnaire for Student Nurses. After obtaining permission to adapt the MMSQSN into Turkish, the translation/back-translation method was used with expert opinions to determine content validity. Factor analysis was conducted to examine the construct validity and test–retest was performed on the questionnaire to determine reliability. Cronbach’s alpha coefficients were calculated to assess for internal consistency. Participants included 272 baccalaureate degree student nurses who took ethics lessons (...) prior to their clinical internship. The factor analysis revealed that even though the factor structure in the original scale was the same, relevant items were categorized with similar components, and factor loads were sufficient. The correlation coefficient in the analyses of test–retest scores was.66 for the total scale and the Cronbach’s alpha was.73 for the total scale. The translated MMSQSN is a valid and reliable measure of ethical sensitivity in student nurses in Turkey. (shrink)

Background:Nursing practice is complex, as nurses are challenged by increasingly intricate moral and ethical judgments. Inadequately studied in underrepresented groups in nursing, moral distress is a serious problem internationally for healthcare professionals with deleterious effects to patients, nurses, and organizations. Moral distress among nurses has been shown to contribute to decreased job satisfaction and increased turnover, withdrawal from patients, physical and psychological symptoms, and intent to leave current position or to leave the profession altogether.Research question:Do significant gender differences exist in (...) the moral distress scores of critical care nurses?Research design:This study utilized a quantitative, descriptive methodology to explore moral distress levels in a sample of critical care nurses to determine whether gender differences exist in their mean moral distress scores.Participants and research context:Participants ( n = 31) were critical care nurses from an American Internet nursing community who completed the Moral Distress Scale–Revised online over a 5-day period in July 2013.Ethical considerations:Institutional review board review approved the study, and accessing and completing the survey implied informed consent.Findings:The results revealed a statistically significant gender difference in the mean moral distress scores of participants. Females reported statistically significantly higher moral distress scores than did males. Overall, the moral distress scores for both groups were relatively low.Discussion:The findings of a gender difference have not previously been reported in the literature. However, other findings are consistent with previous studies on moral distress.Conclusion:Although the results of this study are not generalizable, they do suggest the need for continuing research on moral distress in underrepresented groups in nursing, including cultural and ethnic groups. (shrink)

Background:The Taiwan Nursing Accreditation Council has proposed eight core professional nursing qualities including ethical literacy. Consequently, nursing ethics education is a required course for student nurses. These courses are intended to improve the ethical literacy. Moral sensitivity is the cornerstone of ethical literacy, and learning moral sensitivity is the initial step towards developing ethical literacy.Objectives:To explore the effect of nursing ethics educational interventions based on multiple teaching strategies on student nurses moral sensitivity. Based on the visual, auditory and kinaesthetic model, (...) three strategies were developed for determining the programme components and corresponding learning styles.Research design:This was a quasi-experimental study.Participants:A total of 234 junior-college student nurses participated in this study. All participants were aged 18–19 years.Ethical considerations:The study protocol was approved by the institutional review boards of Kaohsiung Veterans General Hospital. Only the participants who signed an informed consent form took part in the study. The participants were permitted to withdraw from the study at any point if they wished to do so without affecting their academic score.Results:The scores of Modified Moral Sensitivity Questionnaire for Student Nurses were significantly improved after the intervention of integrating multiple teaching strategies. Significant relationships were observed between the satisfaction scores of two teaching strategies and moral sensitivity. The results indicated that using multiple teaching strategies is effective for promoting nursing ethics learning.Conclusion:This strategy was consistent with the student nurses’ preferred learning style and was used to correct their erroneous ethical conceptions, assisting in developing their ethical knowledge. (shrink)