Exploring the heart of ethical nursing practice: implications for ethics education

The limitations of rational models of ethical decision making and the importance of nurses' human involvement as moral agents is increasingly being emphasized in the nursing literature. However, little is known about how nurses involve themselves in ethical decision making and action or about educational processes that support such practice. A recent study that examined the meaning and enactment of ethical nursing practice for three groups of nurses (nurses in direct care positions, student nurses, and nurses in advanced practice positions) highlighted that humanly involved ethical nursing practice is also simultaneously a personal process and a socially mediated one. Of particular significance was the way in which differing role expectations and contexts shaped the nurses' ethical practice. The study findings pointed to types of educative experiences that may help nurses to develop the knowledge and ability to live in and navigate their way through the complex, ambiguous and shifting terrain of ethical nursing practice.     

Virtue ethics: an approach to moral dilemmas in nursing

Nurses are increasingly confronted with situations of moral difficulty, such as not to feed terminally ill patients, whistle blowing, or participation in termination of pregnancy. Most of these moral dilemmas are often analyzed using the principle-based approach which applies the four moral principles of justice, autonomy, beneficence, and non-malificence. In some instances, consequentialism is considered, but these frameworks have their limitations. Their limitations has to do with a consideration for the interpersonal nature of clinical nursing practice on the one hand, and is not always clear on how to judge which consequences are best on the other hand. When principles are in conflict it is not always easy to decide which principle should dominate. Furthermore, these frameworks do not take into account the importance of the interpersonal and emotional element of human experience. On the contrary, decision-making about moral issues in healthcare demands that nurses exercise rational control over emotions. This clearly focuses the attention on the nurse as moral agent and in particular their character. In this article I argue that virtue ethics as an approach, which focus of the character of a person, might provide a more holistic analysis of moral dilemmas in nursing and might facilitate more flexible and creative solutions when combined with other theories of moral decision-making. Advancing this argument, firstly, I provide the central features of virtue ethics. Secondly I describe a story in which a moral dilemma is evident. Lastly I apply virtue ethics as an approach to this moral dilemma and in particular focusing on the virtues inherent in the nurse as moral agent in the story.     

A humanistic-educative approach to evaluation in nursing education

A continuing challenge for nurse educators is to create a learning environment in which students receive fair and timely evaluations. Traditional or behavioural evaluation methods have been criticized as being too limited. A humanistic-educative evaluation method is offered with its emancipation of faculty and students and emphasis on collaboration, caring, creativity, critical thinking and self-assessment. A teacher-student shared home visit for a Family Nursing clinical assignment is provided to illustrate this approach. The potential benefit of the method for developing self-directed and competent professional nurses is proposed.     

A didactic and experiential approach to nursing education

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POSTANESTHESIA CARE UNIT (PACU) nursing practice requires in-depth understanding of sedation, analgesia, and anesthetic agents and techniques; physiological and psychological responses to anesthesia; and the vulnerability of patients subjected to anesthesia.

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THIS ARTICLE reviews a pilot program designed to broaden the knowledge base of PACU RNs. Twenty-three RNs completed a self-paced module on anesthetic agents before participating in an anesthesia and surgical observation phase. The nurses then completed evaluations.

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RESULTS OF THE EVALUATIONS indicated that this approach to learning was rewarding for the participants. AORN Journal 78 (August 2003) 274-288.

     

A study of an ethics education topic for undergraduate nursing students

The study aims to explore nursing students' perceptions of the relative value of various aspects of the ethical component of the undergraduate topic, 'Ethics and Law applied to Nursing' (topic NURS2104). To enable time for reflection on ethics in nursing, sampling occurred 1 year after successful completion of the above-mentioned topic and after successful completion of all but the final clinical experience components of the Bachelor of Nursing (BN) degree. A significant proportion of respondents perceived ethics education as relevant to professional practices. It is also noteworthy that the ethical decision-making strategies that had been incorporated into the topic (NURS2104) became transformed by the clinical experience of each particular student. While results of this study are not conclusive, they nevertheless provide important information for future nursing students on the evolutionary development of ethics education.     

A review of mentoring in education: some lessons for nursing

The mentoring relationship has been described as an invaluable learning activity for beginners as well as experienced practitioners such as teachers, administrators, nurses, managers, and other professionals. In an attempt to identify key outcomes of mentoring for the parties concerned, this paper examined some of the salient research literature on mentoring taken from the discipline of education. We drew upon the findings of a structured review, in which 159 pieces of empirical literature on mentoring in educational settings was examined. This paper reviews the positive and negative outcomes of mentoring for the mentor and protégé/mentee. Discussion of the findings as well as some important implications for those charged with planning mentoring programs in nursing are outlined.     

A human resource management approach to nursing education: 2.

In part 1 of this article, the elements that set human resource management apart from traditional approaches to personnel management were examined. Part 2 will consider the implications of these elements for the management and practice of labour relations within an NHS college of nursing in the 1990s.     

A human resource management approach to nursing education: 1.

Human resource management (HRM) is an entirely new approach to the management of employees. In this the first of two articles, the elements that set it apart from traditional approaches to personnel management will be identified.     

Developing case situations for ethics education in nursing

Developing cases for the clinical teaching of ethics can be extremely time-consuming. Often, the cases that are developed either represent unrealistic situations or mere technical puzzles rather than genuine ethical problems. This article describes how faculty at the University of Minnesota modified a simple, quick and inexpensive think tank technique, the Crawford Slip Method, for use with nursing educators to generate an extensive list of ethical issues within each clinical specialty. Selecting from these lists, faculty in each specialty developed one realistic nursing case situation to illustrate selected ethical issues. Faculty were asked to use the Alverno College criteria for designing a moral dilemma when writing their cases. Suggestions for adapting the cases for multiple uses are presented.     

Explorations of a trust approach for nursing ethics

Trust has long been acknowledged as central to nurse-patient relationships. It, however, has not been fully explored normatively. That is, trust must be examined from a perspective that encompasses not only reliability and competence, but also good will within nursing relationships. In this paper, we explore how a trust approach, based on Annette Baier's work on trust in feminist ethics, could help inform future developments in nursing ethics. We discuss the limitations of other approaches such as those based on contracts, paternalism, and care. By drawing out central features of Baier's theory, we demonstrate how it can help overcome the problems of these previous models. In doing so, we emphasise the importance of combining the ethics of care and justice, acknowledging vulnerability and the potential for evil in nursing relationships, and politically situating the ethical concerns of nursing.