Clinical simulation is used in nursing education and in other health professional programs to prepare students for future clinical practice. Simulation can be used to teach students communication skills and how to deliver bad news to patients and families. However, skilled communication in clinical practice requires students to move beyond simply learning superficial communication techniques and behaviors. This article presents an unexplored concept in the simulation literature: the exercise of moral imagination by the health professional student. Drawing from the works (...) of Hume, Aristotle and Gadamer, a conceptualization of moral imagination is first provided. Next, this article argues that students must exercise moral imagination on two levels: towards the direct communication exchange before them; and to the representative nature of simulation encounters. Last, the limits of moral imagination in simulation-based education are discussed. (shrink)

The role of individual life accounts has been promoted--largely through what has come to be described as narrative ethics-as important to the practice of medical ethics for a number of years. Beyond this the apparent incompatibility of personal stories with scientific procedure has limited their use. In this article I will argue that this represents a serious under-utilisation of a valuable method for researching ethical dilemmas and the settings in which these dilemmas are played out. Life stories need not simply (...) provide a stimulus to scientific research but can in themselves yield intellectually robust evidence on the general as well as the particular. By drawing on the rigorous methods developed elsewhere, personal accounts not only allow us to "enter the world of the sick person" but allow us to do so in such a way as to contribute to empirical and theoretical knowledge. (shrink)

Moral imagination is a central component of moral agency and person‐centred care. Becoming moral agents who can sustain attention on patients and their families through their illness and suffering involves imagining the other, what moral possibilities are available, what choices to make, and how one wants to be. This relationship between moral agency, moral imagination, and personhood can be effaced by a focus on task‐driven technical rationality within the multifaceted challenges of contemporary healthcare. Similarly, facilitating students' moral agency can also (...) be obscured by the task‐driven technical rationality of teaching. The development of moral agency requires deliberate attention across the trajectory of nursing education. To prepare nursing students for one practice challenge, workplace violence, we developed a multimodal education intervention which included a simulated learning experience (SLE). To enhance the realism and consistency of the educational experience, 11 nursing students were trained as simulated participants (SP). As part of a larger study to examine knowledge acquisition and practice confidence of learners who completed the SLE, we explored the experience of being the SP through interviews and a focus group with the SP students. The SP described how their multiple performances contributed to imagining the situation ‘on both sides’ prompting empathy, a reconsideration of their moral agency, and the potential to prevent violence in the workplace beyond technical rational techniques, such as verbal de‐escalation scripts. The empirical findings from the SP prompted a philosophical exploration into moral imagination. We summarise the multimodal educational intervention and relevant findings, and then, using Johnson's conception of moral imagination and relevant nursing literature, we discuss the significance of the SP embodied experiences and their professional formation. We suggest that SLEs offer a unique avenue to create pedagogical spaces which promote moral imagination, thereby teaching for moral agency and person‐centred care. (shrink)

In this chapter, we identify and present predominant debates at the intersection of ethics and imagination. We begin by examining issues on whether our imagination can be constrained by ethical considerations, such as the moral evaluation of imagination, the potential for morality’s constraining our imaginative abilities, and the possibility of moral norms’ governing our imaginings. Then, we present accounts that posit imagination’s integral role in cultivating ethical lives, both through engagements with narrative artworks and in reality. Our final topic of (...) consideration focuses on the possibility of imagination constituting or constructing new ethical or political frameworks. (shrink)

Senior lecturers/lecturers in mental health nursing (11 in round one, nine in round two, and eight in the final round) participated in a three-round Delphi study into the teaching of health care ethics (HCE) to students of nursing. The participants were drawn from six (round one) and four (round three) UK universities. Information was gathered on the organization, methods used and content of HCE modules. Questionnaire responses were transcribed and the content analysed for patterns of interest and areas of convergence (...) or divergence. Findings include: the majority (72.8%) of the sample believed that insufficient time was allocated to the teaching of HCE; case studies were considered a popular, although problematic, teaching method; the ‘four principles’ approach was less than dominant in the teaching of HCE; and virtue ethics was taught by only 36.4% of the participants. The Delphi technique proved adequate and worth while for the purposes of this study. Further empirical research could aim to replicate or contradict these findings, using a larger sample and recruiting more university departments. Reflection is required on several issues, including the depth and breadth to which ethics theory and, more controversially, meta-ethics, are taught to nursing students. (shrink)

This article explores stories related by perioperative nurses when asked to describe ethical judgements and subsequent actions that affected patient outcomes. A total of 214 patient care situations were analysed for moral actions taken and moral outcomes achieved in the perioperative arena. Content analysis of the patient care situations revealed a wide variety of ethical issues. Concerns about informed consent and quality of care were the most frequently identified issues. Respondents reported that 7% of patients underwent unwanted procedures and that (...) positive moral outcomes were achieved in 65% of situations. It is of concern that, despite the fact that more than two-thirds (69%) of the respondents reported undergoing ethics education, only 27% could relate a story of an ethical situation. (shrink)

This paper analyses a situation where a patient's suffering provoked feelings of compassion in a student nurse, and distress at her patient's circumstances. The reported behaviour of qualified nurses within the situation suggests that they lacked compassion, had inadequate knowledge, and that they failed to understand their patient's plight. An account of the situation is followed by an exploration of the nature of moral agency, and understanding in nursing. Nurses' capacity for moral imagination is shown to be of crucial importance (...) to the care that patients receive. The extent of nurses' responsibility for their behaviour is considered, and in particular, the extent of nurses' responsibility during times when they experience strain. Argument leads to the conclusion that we are justified in holding nurses responsible for their behaviour in situations of patient care, although we must not judge a nurse's behaviour too hastily. Attention is drawn to the need for a moral climate to sustain those nurses who struggle to give good patient care, despite the strain that is ever present within today's world of health care. (shrink)

Moral sensitivity and moral reasoning are essential competencies biomedical researchers have to develop to make ethical decisions in their daily practices. Previous research has shown that these competencies can be developed through ethics education. However, it is unclear which underlying mechanisms best support the development of these competencies. In this article we argue that the development of moral sensitivity and moral reasoning can be fostered through teaching strategies that tap into students’ moral imagination. We describe how moral imagination can stimulate (...) the development of these competencies through three different merits of moral imagination. Moral imagination can help students to 1) transfer and apply abstract moral concepts to concrete situations and contexts, 2) explore the perspective of others, 3) explore and foresee the moral consequences of different decisions and actions. We explain these three merits of moral imagination in the context of biomedical research and present a theoretical model for how these merits can be used to stimulate the development of moral sensitivity and moral reasoning. Furthermore, we describe multiple teaching strategies for biomedical curricula that tap into the three merits of moral imagination. These teaching strategies can inspire teachers to design ethics education that activates students’ moral imagination for the development of moral sensitivity and moral reasoning. (shrink)

Abstract:Moral imagination is a reasoning process thought to counter the organizational factors that corrupt ethical judgment. We describe the psychology of moral imagination as composed of the four decision processes identified by Rest (1986), i.e., moral sensitivity, moral judgment, moral intention, and moral behavior. We examine each process in depth, distilling extant psychological research and indicating organizational implications. The conclusion offers suggestions for future research.The majority of men are subjective toward themselves and objective toward all others—terribly objective sometimes—but the real (...) task is in fact to be objective toward one’s self and subjective toward all others. (shrink)

The role of literature and imagination in medicine and medical ethics is currently under discussion. This paper argues that the role of literature is not to furnish generalisable examples for guidance. Rather, engagement with literature parallels moral engagement with other people. The work of the imagination, in this context, is not to hypothesise, but to grant life to the characters and world of literature. In doing this, one may develop one's moral life.