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Conclusions: The research presented contributes to a larger study and the understanding of the experience of ethical conflict and supports needed. Describing successes and challenges of recruitment strategies may contribute to a dialogue about best practice for qualitative recruitment.

Become A Student. Explore Our Campuses. Memorial University Research Repository. Browse By:. Department theses only. Key Words: ethics, education, nursing, nursing practice, pedagogy, curriculum development. Knowledge generation from breakthroughs Nurses often share in intimate struggles and complexities of life and death decisions with patients and families within any given clinical unit, practice setting, or designated role. Knowledge generation from breakthroughs in genetics, genomics, precision medicine, and other scientific areas test nurses' ability to keep pace with the ethical issues often associated with these technological developments in both clinical care and research.

Ethical issues also arise in everyday nursing practice.

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These issues may be concerns affecting the nurse-patient relationship, including but not limited to, misunderstandings associated with informed consent; conflict about treatment goals; power differentials between and among healthcare clinicians, patients, families, and others; lack of supportive resources and policies to guide practice decisions; truth-telling; and disparities in access to care.

As one of the vital health professions, nursing today has a special significance as well as new responsibilities and outstanding opportunities. Spectacular advances in all fields of science are being translated into everyday living. Since the practice of nursing is the operation of principles of the social, biologic, and physical sciences, our profession will play an important part in helping to apply new knowledge, to create new patterns of life, and to guarantee that the means of attaining optimum health are available to everyone p.

Although much has changed since , nursing remains committed to health advocacy on behalf of the public good and the beneficent care of the sick. Today, nurses represent the largest professional group of healthcare clinicians in the United States, and their responsibilities are indeed great. The nursing workforce has experienced rapid growth in the past decade, with a doubling of annual output of United States nursing programs from to , contributing to a registered nurse workforce estimated between 3.

Demand for nurses may continue to grow with expanded care under the Affordable Care Act, projected physician shortages, and population growth with an aging society Auerbach et al. As more individuals become interested in a nursing career, preparing them for the realities of clinical practice assumes increasing importance in light of the changing societal sociodemographic and everyday ethical challenges in patient care delivery. Nursing as a scholarly discipline has grown too. Advances in educational pedagogy have shaped nursing roles as expert bedside clinicians, advanced practitioners, and innovative researchers.

Yet, despite growth of nursing scholarship and pressing societal, research, and clinical ethical concerns, there is little consensus about the importance of ethics education in nursing, the role of ethics education in the nursing curricula, and outcomes that can be achieved from ethics education. The purpose of this article is to discuss the importance of ethics education in nursing, highlight the research and clinical opportunities that support it, and address ways to incorporate ethics inquiry in nursing curricula for educating future generations of nurses.

We review innovative models for ethics pedagogy, discuss how our interdisciplinary colleagues developed a framework in medicine for ethics education, and provide specific recommendations for further action. Nursing practice is inextricably entwined with moral complexity. From the moment a newly graduated nurse enters the clinical environment, he or she must be ready to deliver quality patient care while navigating complex relationships with patients, families, physicians, nurses, and other members of the healthcare team.

In navigating these relationships, ethical conflict commonly occurs. These conflicts, especially when not addressed, can lead to a frustrated workforce and a loss of qualified nurses who are physically and emotionally worn out. Pavlish, Brown-Saltzman, Jakel, and Fine noted that ethical conflicts in clinical practice are on the rise with an aging society, changes in the financial healthcare landscape, technological advances, finite resources, populations who are culturally and religiously diverse, and changing public expectations of the healthcare system.

Nurses need a solid knowledge base that supports the recognition of emerging ethical problems, as well as the skills to deliberate judiciously and take moral action when required in any clinical or research situation. Nurses across the continuum of educational level, from entry-level to doctorally-prepared, must be equipped to confidently manage the ethical components of clinical and research practice, especially those that come with caring for patients and families.

The nursing profession has an obligation to prepare nurses for the ethical morass of clinical practice; and high-quality ethics pedagogy should be an essential component of nursing education. Didactic immersion is a first step in cultivating professional identity, steeping student nurses in the values of the profession e. In , the Presidential Commission for the Study of Bioethical Issues under President Obama recommended bioethics education for all professional groups as a means to engage in morally relevant issues at both the micro and macro levels. Despite the importance of ethics education for student nurses and for those already in clinical practice, many gaps remain.

Grady et al. Moreover, nurses with ethics education were more likely to take moral action and have higher levels of confidence than those without education. Multiple articles have described limited progress toward consensus in ethics education Burkemper and colleagues found notable variation across MSN programs in terms of ethics instruction, content, and faculty education. The authors noted a lack of core objectives and significant gaps in clinical ethics topics.

Ethical Issues in Healthcare | UT Tyler Online

In addition, they highlighted the absence of consensus on ethics education and a need for ethics education standards. Multiple articles have described limited progress toward consensus in ethics education, recognizing ongoing variations in knowledge dissemination across the educational continuum Grady et al. Krautscheid and Brown conducted a qualitative study of undergraduate senior-level Bachelor of Science BSN students to understand student experiences making microethical clinical decisions in practice settings.

When faced with a microethical issue, specifically decision-making around safe medication administration, in a simulated environment, participants struggled to recall and deliberately apply ethics principles. Though Krautscheid and Brown reported thematic saturation for their qualitative data, the small sample size of seven participants should be noted and interpreted with caution.

Laabs surveyed advanced practice registered nurses APRNs to assess their preparation to manage ethical challenges, post-graduate education in advanced clinical practice. APRN respondents were asked about the degree of confidence in their ability to: 1 recognize a genuine ethical problem; 2 reach a sound decision when facing a clinical ethics problem; 3 determine if consent is truly informed; 4 understand and manage ethical aspects of cost containment; and five other key issues.

The discrepancy between reports of ethics education course completion and knowledge scores indicates a need to reassess relevant ethics content and teaching strategies, as well as to examine the validity of outcome measures as they pertain to APRNs Laabs, The discrepancy between reports of ethics education course completion and knowledge scores indicates a need to reassess relevant ethics content and teaching strategies Understanding the educational gaps between academia and practice requires a more detailed analysis and evaluation of ethics content delivery. In another study, Laabs used a conventional Delphi technique to survey self-identified ethics experts to develop consensus about essential ethics content, teaching strategies, and teacher preferred qualifications for APRNs prepared at the doctor of nursing practice DNP level.

Experts reached consensus about only a few items that represent foundational knowledge, such as the American Nurses Association ANA, Code of Ethics for Nurses with Interpretive Statements and certain ethics terminology. These experts also agreed that an ethics course should be required. Laabs argued that while codified rules and terminology may be appropriate for entry-level clinicians, APRNs require more sophisticated knowledge to manage the increasing complexities of care delivery.

Of note, a key limitation of her survey was the limited response rate. It is also not clear whether those who identified as bioethics experts with an interest in nursing ethics had received specific instruction in bioethics or had ever taught a course in nursing ethics. Nurses graduating from undergraduate, graduate, and doctoral programs do not necessarily share an ethics vocabulary Nurses graduating from undergraduate, graduate, and doctoral programs do not necessarily share an ethics vocabulary nor a sufficient ethics-related knowledge base, potentially contributing to difficulty addressing ethical challenges in practice.

With no uniform expectations for ethics education, it is difficult to identify relevant outcomes or competencies to measure knowledge transmission and implementation. Much more research is needed to examine the critical role that ethics education plays with respect to quality of patient care, health equity issues, interdisciplinary collaboration, as well as the overall satisfaction and health of the workforce. We do not really know whether or what kind of ethics education e. No systemic evaluation has been done to determine the type of ethics education programs or methods that best prepare nurses for managing ethical dilemmas, conflicts, and morally distressing situations in clinical practice Grady et al.

On the Tragic Nature of Ethics Consultation

Controversy remains regarding inclusion of theory versus skill-based approaches, which specific topics to teach, and the importance of education in interdisciplinary ethics. Benner and colleagues claimed that bioethics is critically necessary for the nursing profession, particularly because bioethics offers an external stance and disciplined thinking regarding patient rights and provider obligations. These authors emphasized the importance of specifying principles and learning good practices internal to the discipline Benner et al.

This might include practices related to how nurses support patient decision-making, provide comfort to those who are suffering, fairly allocate time and resources among patients, and appropriately advocate for patients and their families Benner et al. Empirical research would be helpful to address this critique.


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Grace and Milliken echoed concerns regarding the potential loss of a nursing-specific disciplinary perspective when dilemma- and principle-based approaches are primary teaching modalities. The authors called for further support and development of nursing ethics. Grady argued that nursing ethics underscores commitment to the patient, but also acknowledges a broader social responsibility to act collaboratively with others to meet public health needs. Moreover, nursing, with its relational emphasis, infuses practice insight back into theory Grady, Today, legal issues remain relevant and are often intertwined with ethical issues.

Nursing scholars, however, have increasingly shifted their attention from law and traditional bioethics topics to the day-to-day ethical concerns of nursing practice, as described below. For example, in their study of the type, frequency, and level of stress experienced by nurses in everyday practice, Ulrich et al.

The most stressful and frequently encountered issues were protecting patient rights, autonomy and informed consent to treatment, staffing patterns, advanced care planning, and surrogate decision-making Ulrich et al. Microethics often involves nuanced, contextualized decision-making Microethics often involves nuanced, contextualized decision-making, and the resolution of these microethical issues requires moral sensitivity i. Milliken and Grace stated that while much attention has focused on the role of nurses in recognizing ethical dilemmas, less attention has been paid to whether nurses understand the ethical nature of everyday practice.

They asserted that that all nursing actions, from routine to complex, have ethical components.

Examples of Conflicts of Interest

Ideally, academic curricula redesign for nursing education would incorporate foundational instruction in theoretical underpinnings of bioethics, methods for deliberative decision-making, clinical cultivation of moral agency, and an actionable philosophical, empirical, and conceptual skill set to navigate stressors across clinical unit, organizational, and policy domains. The national shortage of nursing faculty has been a barrier to ethics education content development and delivery.

Data from the AACN indicate a national nurse faculty vacancy rate of 7. Ethics experts and educators lack agreement on the required credentials for ethics faculty within nursing programs Laabs, Medical schools face similar shortages of suitably trained faculty in ethics. Doukas et al. Furthermore, the Presidential Commission on the Study of Bioethical Issues explicitly recommended the development of teacher instruction in bioethics education.

Ethics faculty qualifications, meaningful faculty development, nursing program resources, and cross-discipline instructional opportunities should be further examined as content discussions continue. Undergraduate Level Methods Despite limited consensus regarding optimal ethics education content, several nursing scholars have piloted innovative methods for ethics education within academic and clinical milieus.

Hickman and Wocial referenced the expectations for ethical comportment outlined in the Carnegie Study and emphasized the need for strong moral competence in everyday nursing practice. They used an active learner approach with the integration of team-based learning concepts in an undergraduate applied ethics course.

Ethico-legal conflict in daily forensic medical practice: two examples from Indonesia

Students work through case-based exercises with diverse teams. Unannounced team and individual readiness assessment tests hold students accountable to course reading content. Students may clarify reading concepts before tests and receive immediate feedback. They also complete a midterm and final exam, case analysis paper, and peer reviews.

Krautscheid expanded on her prior work by implementing ethics education via microethical dilemmas embedded in high-fidelity simulation scenarios in an undergraduate senior level medical-surgical course.

Medical Ethics and Physician-Patient Encounters: Case Studies and Best Practices

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