Professionelles Handeln bedarf moralischen Handlungsvermögens. Im Kontext pflegerischer Weiterbildungen beschreibt der Philosoph Andrew Jameton vor über drei Jahrzehnten psychologische Reaktionen auf kompromittiertes moralisches Handlungsvermögen, die er als moralischen Stress definiert. Diese Standarddefinition hat in der Pflegewissenschaft zu einer dichten Forschung geführt und zum Vorschlag einer weiten Definition. Belegt sind gravierende Folgen von moralischem Stress auf die Patientensicherheit und auf die psychische Gesundheit von Mitarbeitenden. Der Beitrag diskutiert die Rezeption des Konzepts innerhalb der Pflegewissenschaft und die jüngst vorgeschlagene weite Definition von (...) moralischem Stress als Reaktion auf Situationen wahrgenommener moralischer Unerwünschtheit. Er bezweifelt die Kongruenz der Definitionen. Gerade das Verständnis der Prävalenz von moralischem Stress in der Pflegepraxis wird durch die Ausweitung der Definition erschwert, welche den Messinstrumenten jeweils zugrunde liegt. Trotz dieser Unschärfe bleibt der Umgang mit moralischem Stress eine zentrale Herausforderung für alle Gesundheitsfachpersonen. Für die wirksame Bewältigung bedarf er aber einer Schärfung, die die Kernanliegen sowohl der „alten“ wie auch der „neuen“ Definition aufnimmt: Wahrgenommene moralische Unerwünschtheit wird als Gesamtheit an emotionalen Reaktionen auf ethisch belastende Situationen vorgeschlagen, der bei kompromittiertem moralischen Handlungsvermögen moralischer Stress folgen kann, bei erschwertem moralischen Handlungsvermögen hingegen moralisches Unbehagen. In normativer Hinsicht steht moralischer Stress für Reaktionen auf Situationen moralischer Komplizität, moralisches Unbehagen für solche auf moralischer Komplexität. Durch diese Schärfung wird moralischer Stress hinreichend klar bestimmbar und die Standarddefinition im Kern bestätigt. Aber auch das Anliegen der weiten Definition wird aufgenommen für das breite Spektrum ethischer Belastungen, die den Alltag von Gesundheitsfachpersonen prägen und spezifische Strategien zu deren Bewältigung erfordern. (shrink)

Background: Nursing practice takes place in a social framework, in which environmental elements and interpersonal relations interact. Ethical climate of the work unit is an important element affecting nurses’ professional and ethical practice. Nevertheless, whatever the environmental circumstances, nurses are expected to be professionally competent providing high-quality care ethically and clinically. Aim: This study examined newly graduated nurses’ perception of the ethical climate of their work environment and its association with their self-assessed professional competence, turnover intentions and job satisfaction. Method: (...) Descriptive, cross-sectional, correlational research design was applied. Participants consisted of 318 newly graduated nurses. Data were collected electronically and analysed statistically. Ethical considerations: Ethical approval and permissions to use instruments and conduct the study were obtained according to required procedures. Data were rendered anonymous to protect participant confidentiality. Completing the questionnaire was interpreted as consent to participate. Findings: Nurses’ overall perception of the ethical climate was positive. More positive perceptions related to peers, patients and physicians, and less positive to hospitals and managers. Strong associations were found between perceived ethical climate and self-assessed competence, turnover intentions in terms of changing job, and job satisfaction in terms of quality of care. Nurses at a higher competence level with positive views of job satisfaction and low turnover intentions perceived the climate significantly more positively. Conclusion: Nursing management responsible for and having the power to implement changes should understand their contribution in ethical leadership, as well as the multidimensional nature of nurses’ work environment and the interaction between work-related factors in planning developmental measures. Future research should focus on issues in nurse managers’ ethical leadership in creating ethical work environments. There is also a need for knowledge of newly graduated nurses’ views of factors which act as enhancers or barriers to positive ethical climates to develop. Interventions, continuing education courses, and discussions designed to promote positive ethical climates should be developed for managers, nurses, and multi-professional teams. (shrink)

Introduction Good quality of care is dependent on nurses’ strong clinical skills and moral competencies, as well. While most nurses work with high moral standards, the moral performance of some nurses in some organizations shows a deterioration in their moral sensitivity and actions. The study reported in this paper aimed to explore the experiences of nurses regarding negative changes in their moral practice. Materials and methods This was a qualitative study utilizing an inductive thematic analysis approach, which was conducted from (...) February 2017 to September 2019. Twenty-five nurses participated in semi-structured interviews. Results The main theme that emerged from our analysis was one of moral neutralization in the context of an unethical moral climate. We found five sub-themes, including: feeling discouraged; normalization; giving up; becoming a justifier; and moral indifference. Conclusions Unethical moral climates in health organizations can result in deterioration of morality in nurses which can harm both patients and health systems. Some unethical behaviors in nurses can be explained by this process. (shrink)

Ethics education in the professions has become close to compulsory with continuing education following suit. What is the de facto as opposed to the de jure function of an ethics education program? Have they increased compliance with laws and codes of conduct? Is that the goal? What would an ethics education program look like that was not primarily concerned with compliance with relevant laws or professional codes and not merely an exercise in good public relations? I argue that, ultimately, ethics (...) education is about happiness… not happiness as we generally think of it today, but in the Aristotelian sense of “fulfillment” and the collateral good that is generated for clients and the profession. As a result of this point of view I argue that ethics is not a subject in the normal sense of the term but a meta-subject which implies that teaching ethics as a class or stand alone module in a law, policy or practice management course is usually ineffective. Another implication is that the richest source for moral reflection within a profession are case studies generated by students in clinical assignments, despite the inherent risks associated with making these cases prominent. (shrink)

Advanced practice nursing is an expanding field within many healthcare environments around the world. The scope and particular focus of an advanced practice nurse’s role is highly variable and thus the ethical challenges they face are equally diverse. Yet, the dominant existing ethics pedagogies used in the nursing context have been described as not fit-for-purpose. Existing pedagogies do not adequately prepare APN candidates to meet the ethical challenges they will encounter in practice. Applying an arts-based pedagogy in ethics education for (...) advanced practice nurses has the capacity to provide effective ethics learning. This article reports on the value of a multidisciplinary pedagogy used in a graduate course in nursing leadership, law and ethics for advanced practice at an Australian university. Written in a multidisciplinary mode that allies with the pedagogy it presents, it addresses the key pedagogical challenges and opportunities of teaching ethics through an innovative arts-based pedagogy centred upon the changing depictions of the human person in works of art housed in a major state-funded art gallery. (shrink)

Die Anforderungen an das ethisch-professionelle Handeln Pflegender und somit auch die Forderungen an die professionelle Ethikkompetenz Pflegender im praktischen Berufsfeld wandeln sich sowohl qualitativ als auch quantitativ. Dies wird auch in den veränderten normativen Rahmungen der Pflegebildung deutlich. Der Lernort Praxis als ein zentraler Ort pflegebezogener Bildungsprozesse rückt somit nochmals stärker in den Fokus der Ethikkompetenzentwicklung professionell Pflegender. Der Beitrag konturiert zentrale Anforderungen und veränderte Bezüglichkeiten für die Ethikbildung im beruflichen Handlungsfeld professioneller Pflege und formuliert davon ausgehend zentrale Prämissen an (...) organisationsethische Rahmenbedingungen mit dem Ziel, eine ethisch fundierte professionelle pflegerische Handlungspraxis zu unterstützen. (shrink)

There is a need to explore educational strategies that translate ethics knowledge into ethical behavior. Commonly used pedagogical approaches steeped in traditional normative ethical theory are less powerful than sensemaking in preparing clinicians to respond to ethical problems in practice. This integrative review of 15 articles explores the use of sensemaking as an instructional method for clinical ethics. Whittemore and Knafl’s :546–553, 2005) integrative review method guided a systematic appraisal of data from both qualitative and quantitative research traditions, synthesizing disparate (...) studies in analyzing literature about the use of sensemaking as a pedagogical approach in teaching ethics. Findings supported the use of Weick’s sensemaking theory to develop instructional methods that encourage ethical decision making in students as well as promote ethical response by health care providers. The review reveals important theoretical and training implications for introducing sensemaking as a means to promote ethical action in clinical practice. (shrink)

Die Anforderungen an die ethische Kompetenzentwicklung im Rahmen der hochschulischen Pflegeausbildung sind anspruchsvoll und methodisch zu konkretisieren. Der Beitrag geht zunächst der Frage nach, wie Ethikkompetenz in Bezug auf die hochschulische Pflegeausbildung zu konturieren ist. Basierend auf dieser definitorischen Rahmung liegt das Augenmerk auf dem Prozess der Ethik-Leitlinienentwicklung als mögliche zu diskutierende Methode der Ethikkompetenzentwicklung. Hierbei ist die Frage leitend, ob der Prozess der Ethik-Leitlinienentwicklung im Rahmen des Studiums – analog zu den bis dato vielfach realisierten Fallanalysen – eine weitere (...) beziehungsweise ergänzende Methode der Ethikdidaktik sein könnte, um die für das professionelle Pflegehandeln relevanten Ethikkompetenzen im Rahmen der hochschulischen Pflegeausbildung anzubahnen und/oder zu verdichteten. (shrink)

Background: Undergraduate nursing students have been documented to experience ethical distress during their clinical training and felt poorly supported in discussing the ethical issues they encountered. Research aims: This study was aimed at exploring nursing students’ perceived opportunity to discuss ethical issues that emerged during their clinical learning experience and associated factors. Research design: An Italian national cross-sectional study design was performed in 2015–2016. Participants were invited to answer a questionnaire composed of four sections regarding: (1) socio-demographic data, (2) previous (...) clinical learning experiences, (3) current clinical learning experience quality and outcomes, and (4) the opportunity to discuss ethical issues with nurses in the last clinical learning experience (from 0 – ‘never’ to 3 – ‘very much’). Participants and research context: Participants were 9607 undergraduate nursing students who were attending 95 different three-year Italian baccalaureate nursing programmes, located at 27 universities in 15 Italian regions. Ethical considerations: This study was conducted in accordance with the Human Subject Research Ethics Committee guidelines after the research protocol was approved by an ethics committee. Findings: Overall, 4707 (49%) perceived to have discussed ethical issues ‘much’ or ‘very much’; among the remaining, 3683 (38.3%) and 1217 (12.7%) students reported the perception of having discussed, respectively, ‘enough’ or ‘never’ ethical issues emerged in the clinical practice. At the multivariate logistic regression analysis explaining 38.1% of the overall variance, the factors promoting ethical discussion were mainly set at the clinical learning environment levels (i.e. increased learning opportunities, self-directed learning, safety and nursing care quality, quality of the tutorial strategies, competences learned and supervision by a clinical nurse). In contrast, being male was associated with a perception of less opportunity to discuss ethical issues. Conclusion: Nursing faculties should assess the clinical environment prerequisites of the settings as a context of student experience before deciding on their accreditation. Moreover, the nursing faculty and nurse managers should also enhance competence with regard to discussing ethical issues with students among clinical nurses by identifying factors that hinder this learning opportunity in daily practice. (shrink)

Professionelles Handeln bedarf moralischen Handlungsvermögens. Im Kontext pflegerischer Weiterbildungen beschreibt der Philosoph Andrew Jameton vor über drei Jahrzehnten psychologische Reaktionen auf kompromittiertes moralisches Handlungsvermögen, die er als moralischen Stress definiert. Diese Standarddefinition hat in der Pflegewissenschaft zu einer dichten Forschung geführt und zum Vorschlag einer weiten Definition. Belegt sind gravierende Folgen von moralischem Stress auf die Patientensicherheit und auf die psychische Gesundheit von Mitarbeitenden. Der Beitrag diskutiert die Rezeption des Konzepts innerhalb der Pflegewissenschaft und die jüngst vorgeschlagene weite Definition von (...) moralischem Stress als Reaktion auf Situationen wahrgenommener moralischer Unerwünschtheit. Er bezweifelt die Kongruenz der Definitionen. Gerade das Verständnis der Prävalenz von moralischem Stress in der Pflegepraxis wird durch die Ausweitung der Definition erschwert, welche den Messinstrumenten jeweils zugrunde liegt. Trotz dieser Unschärfe bleibt der Umgang mit moralischem Stress eine zentrale Herausforderung für alle Gesundheitsfachpersonen. Für die wirksame Bewältigung bedarf er aber einer Schärfung, die die Kernanliegen sowohl der „alten“ wie auch der „neuen“ Definition aufnimmt: Wahrgenommene moralische Unerwünschtheit wird als Gesamtheit an emotionalen Reaktionen auf ethisch belastende Situationen vorgeschlagen, der bei kompromittiertem moralischen Handlungsvermögen moralischer Stress folgen kann, bei erschwertem moralischen Handlungsvermögen hingegen moralisches Unbehagen. In normativer Hinsicht steht moralischer Stress für Reaktionen auf Situationen moralischer Komplizität, moralisches Unbehagen für solche auf moralischer Komplexität. Durch diese Schärfung wird moralischer Stress hinreichend klar bestimmbar und die Standarddefinition im Kern bestätigt. Aber auch das Anliegen der weiten Definition wird aufgenommen für das breite Spektrum ethischer Belastungen, die den Alltag von Gesundheitsfachpersonen prägen und spezifische Strategien zu deren Bewältigung erfordern. (shrink)

Background: In order to prove their commitment to the nursing profession, nurses need to base their professional activities on certain acknowledged values. Although a large number of studies have addressed professional values in nursing, only a few studies are available on the identification and comparison of nurses’, nursing students’, and nursing instructors’ understanding of such values. Objective: The study aims to compare nurses’, nursing students’, and nursing instructors’ perception of nursing professional values. Research design: In this descriptive-comparative study, data were (...) collected using Weis and Schank’s Nurses’ Professional Values Scale–Revised. The data were analyzed using the SPSS statistical software (v 22). Participants and research context: A total of 299 nurses, 341 nursing students, and 100 nursing instructors from multisite, 20 different wards from 3 university hospitals and associated nursing schools located in the cities of Shiraz, Fasa, and Jahrom in Fars province, participated in 2016. Ethical considerations: The Institutional Review Board of the researchers’ primary university has verified that the study complies with research ethics. Findings: The total mean scores of the nurses’, nursing students’, and nursing instructors’ perception were found to be 4.23 (0.44), 3.92 (0.50), and 4.34 (0.35), respectively, in the domain of justice—this domain was the subjects’ top priority—and 3.40 (0.56), 3.29 (0.49), and 3.55 (0.36), respectively, in the domain of activism—this domain was attached the least importance by the subjects. There were significant differences across the three groups’ perception in all of the dimensions of professional values ( p < 0.001). Discussion: The three study groups’ overall mean scores fall within the range of relatively important or important. Several studies show the same results, but there are still controversies in this regard. Conclusion: There is need for plans to increase nurses’ awareness of certain professional duties and improve their professional performance in all areas alongside their care duties. (shrink)

This theoretical paper proposes a new perspective to understand the moral distress of nurses more fully, using virtue ethics. Moral distress is a widely studied subject, especially with respect to the determination of its causes and manifestations. Increasing the theoretical depth of previous work using ethical theory, however, can create new possibilities for moral distress to be explored and analyzed. Drawing on more recent work in this field, we explicate the conceptual framework of the process of moral distress in nurses, (...) proposed by Ramos et al., using MacIntyrean virtue ethics. Our analysis considers the experience of moral distress in the context of a practice, enabling the adaptation of this framework using virtue ethics. The adoption of virtue ethics as an ethical perspective broadens the understanding of the complexity of nurses’ experiences of moral distress, since it is impossible to create a ready model that can cover all possibilities. Specifically, we describe how identity, social context, beliefs, and tradition shape moral discomfort, uncertainty, and sensitivity and how virtues inform moral judgments. Individuals, such as nurses, who are involved in a practice have a narrative history and a purpose ( telos) that guide them in every step of the process, especially in moral judgment. It is worth emphasizing that the process described is supported by the formation of moral competence that, if blocked, can lead to moral distress and deprofessionalization. It is expected that nurses seek to achieve the internal good of their practice, which legitimizes their professional practice and supports them in moral decision-making, preventing moral distress. (shrink)

In a time marked by the development of innovative treatments in healthcare and the need for health professionals to deal with resulting ethical dilemmas in clinical practice, this study was developed to determine the influence of the bioethics teaching on the moral competence of medical and nursing students. The authors conduct a longitudinal study using the Moral Competence Test extended version before and after attending the ethics curricular unit, in three nursing schools and three medical schools of Portugal. In this (...) questionnaire the participant is confronted with three ethical dilemmas and asked to evaluate arguments for and against the attitude of the main character. For both nursing and medical students, C-score was lower after the attendance of the ethics curricular units, with a statistically significant decrease in the total score for nursing students and a decrease not statistically significant for medical students. A multivariate analysis did not find any association between this decrease and gender, course, or age. The phenomenon of moral segmentation was observed, with better performance in the worker and judge dilemma, than in the doctor dilemma. These results highlight the need to reflect on the curricular strategies that can be implemented for health professionals to better develop moral competence and decision-making, allowing for the provision of humanized health care. (shrink)

In clinical practice, evidence suggests that teaching ethics using normative ethical theory has little influence on the ethical actions of providers in practice. Thus, new training methods are needed that improve clinician response to ethical problems. A sensemaking approach to ethics training has demonstrated promise as an evidence-based pedagogical method to improve ethical reasoning and response. Project ECHO is theoretically linked to improved sensemaking. This study examines the effectiveness of ECHO and training in use of sensemaking approaches to ethical response (...) by clinicians. A quasi-experimental design study using univariate linear regression was used to examine the effect of the three types of ethics training on ethical response self-efficacy scores, while controlling for participant characteristics of years in practice, discipline and sex. We found evidence that training in sensemaking through participation in ECHO promotes improved ethical response self-efficacy of clinicians. However, results also suggest that a traditional ECHO format that does not explicitly introduce sensemaking strategies into the training does not result in the same learning outcomes as measured through an ethical response self-efficacy survey. This study found important preliminary results to support use of sensemaking approaches in clinical ethics training. (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)

Die Anforderungen an das ethisch-professionelle Handeln Pflegender und somit auch die Forderungen an die professionelle Ethikkompetenz Pflegender im praktischen Berufsfeld wandeln sich sowohl qualitativ als auch quantitativ. Dies wird auch in den veränderten normativen Rahmungen der Pflegebildung deutlich. Der Lernort Praxis als ein zentraler Ort pflegebezogener (Aus‑)Bildungsprozesse rückt somit nochmals stärker in den Fokus der Ethikkompetenzentwicklung professionell Pflegender. Der Beitrag konturiert zentrale Anforderungen und veränderte Bezüglichkeiten für die Ethikbildung im beruflichen Handlungsfeld professioneller Pflege und formuliert davon ausgehend zentrale Prämissen an (...) organisationsethische Rahmenbedingungen mit dem Ziel, eine ethisch fundierte professionelle pflegerische Handlungspraxis zu unterstützen. (shrink)

Background: Nurses’ ethical competence has been identified as a significant factor governing high quality of care. However, nurses lack support in dealing with ethical problems, and therefore managerial support for nurses’ ethical competence is needed. Research questions: This study aimed to analyse, from the perspective of nurse and nurse leaders, the level of nurses’ and nurse leaders’ ethical competence, perceptions of support for nurses’ ethical competence at the organisational and individual levels and background factors associated with this support. Research design: (...) A descriptive, cross-sectional study design was employed. The Ethical Competence and Ethical Competence Support questionnaires were used to measure the main components. Descriptive statistics and multifactor analysis of variance were used for data analysis. Participants: The participants were 298 nurses and 193 nurse leaders working in specialised (48%/52%), primary (43%/36%) or private healthcare (5%/7%) in Finland. Ethical considerations: Ethical approval was obtained from the university ethics committee. Results: Nurses estimated their own ethical competence to be at an average level, whereas nurse leaders estimated their own competence at a high level. Nurses’ and nurse leaders’ perceptions of provided support for nurses’ ethical competence was not at a high level. The positive agreement percentage related to organisational support was 44% among nurses and 51% among nurse leaders. The positive agreement percentage related to individual support was lower, that is, 38% among nurses and 61% among nurse leaders. University education had a positive association with some items of individual support. Conclusion: Despite the findings that ethical competence was estimated at a high level among nurse leaders, perceptions of support for nurses’ ethical competence were not at a satisfactory level. At the organisational level, nurse leaders need to inform of ethical procedures and practices in orientation; encourage multidisciplinary ethics discussions and collaboration; and support nurses at an individual level to participate in ethics education, multidisciplinary ethics discussions and in solving ethical problems. (shrink)