Moral competence in nursing practice

This article presents the derivation of moral competence in nursing practice by identifying its attributes founded on Thai culture. In this process moral competence is formed and based on the Thai nursing value system, including personal, social and professional values. It is then defined and its three dimensions (moral perception, judgment and behavior) are also identified. Additionally, eight attributes as indicators of moral competence are identified and selected from three basic values. The eight attributes are loving kindness, compassion, sympathetic joy, equanimity, responsibility, discipline, honesty, and respect for human values, dignity and rights. All attributes are discussed by addressing the three moral dimensions in order to present how to deal with ethical issues in nursing practice. As a summary, a model of moral competence is presented to demonstrate moral competence in nursing practice in Thailand.     

A conceptual approach to the identification of essential ethics content for the undergraduate nursing curriculum

While the importance of ethics content in the nursing curriculum is recognized, few guidelines exist to aid faculty in decisions regarding 'essential' content. Comparison of documents from the Hastings Center Institute of Society, Ethics and the Life Sciences, and the American Association of Colleges of Nursing suggests that outcomes for the undergraduate nursing curriculum reflect the goals of both undergraduate and professional ethics education as identified by the Hastings Center study. Faculty are faced with the challenge of adequately addressing ethics in an already filled undergraduate curriculum. The conceptual integration of traditional clinical ethics with professional socialization and issues of professionalism provides a workable approach for identifying and integrating the necessary ethics content. Within this integrated approach the author identifies seven areas essential to the undergraduate curriculum: the moral ideals of the nursing profession, clarification of personal and professional values, moral issues/dilemmas common to nursing practice, recognizing ethical issues, basic ethical theory and principles, practice in analysis and debate, and the moral nature of a profession.     

Ethical issues in rural nursing practice in Botswana

The concern for ethical principles and values is not limited to health professionals alone. However, ethical principles in nursing act as safety valves for social control to prevent professional misconduct and abuse of the rights of clients. As a result of colonial experience, developing countries like Botswana usually follow the European lead, especially examples from the UK. This article examines the ethical problems and dilemmas associated with rural nursing practice in Botswana, a developing country in sub-Saharan Africa. The major ethical problems identified are related to the distribution of and access to health resources in rural communities. It is proposed that nurses must assume responsibility in the field of access and allocation by working collaboratively with governments and other professional bodies, and that nurses as a global community must work together as a team to support each other.     

Nursing dementing elderly people: ethical issues

It has been estimated that up to 40% of people with moderate to severe dementia live in residential homes or long-stay hospital wards This paper examines some of the ethical issues that arise in nursing people suffering from dementia within an institutional setting The paper focuses first on the nursing profession and the recently published Strategy for Nursing The fundamental patient/client values within the strategy recognize the uniqueness of the individual and the importance of providing nursing care which is tailored to meet individual needs The next part of the paper will examine the difficulties associated with individualizing care for people suffering from dementia and highlight some of the ethical issues involved in looking after them Finally, some of the general professional issues involved are examined and some tentative suggestions are put forward as to how some of the identified problems might be tackled     

Ethics content in baccalaureate degree curricula. Clarifying the issues

Competency in ethical decision making is an identified expectation of the baccalaureate degree graduate. Values, both personal and professional, do not provide a systematic foundation for ethical decision making. The nurse is a unique health care provider and as such is faced with ethical decision of practice that are derived from and are relevant to that role. An understanding of ethical principles and theories as well as application of them to the role of the professional nurse is essential to ethical decision making in nursing practice. Seventy four per cent of recent graduates stated that the ethical content in their nursing programs most influenced their ethical decision-making skills, yet, only 23% used an ethical model or framework in analyzing and resolving the ethical dilemma of practice. The usual format for presentation of this content is a course in ethics. The content of such courses should include ethical theories and principles and their application to the practice of nursing. Teaching methodologies include guided case analysis and written responses to cases and current issues. Placement of separate required ethics courses remains a problem because of the overwhelming amount of content in baccalaureate degree curricula. Research has tentatively validated the need for a separate required course in nursing ethics. Further studies are necessary. If ethics content is integrated throughout the curriculum, it should be presented early with continual reinforcement and with the use of a specific ethics textbook. Research indicates that students who have completed a nursing ethics course not only know the correct ethical action but are more likely to implement it.(ABSTRACT TRUNCATED AT 250 WORDS)     

Educating for ethical leadership

In this article we consider the nature of ethical leadership in nursing. An appreciation of the basis of such leadership requires an understanding of responsibility and of key intellectual and ethical qualities or virtues. We examine some of the educational and practice strategies to promote ethical leadership. We argue that there are different levels of ethical leadership. All members of the nursing workforce are ethical leaders in so far as they demonstrate a commitment to ethical practice in their everyday work and act as ethical role models for others. Nurse managers are responsible for influencing their team and for acting as arbiters between organisational and professional values. Nurse educators are role models and ethical leaders as they ensure that the explicit and hidden curriculum demonstrate a commitment to professional values. Nurses who assume political roles have an obligation to lead on ethical agenda compatible with the values of nursing.     

Social media and professional boundaries in undergraduate nursing students

Social media use and professional boundaries are growing challenges for nurse educators. The current undergraduate nursing student population is a technology savvy generation that enjoys the constant stimulation and social connections created by social media. Professional standards in nursing are dictated by the ANA's Code of Ethics, and educators are responsible for instilling professional values into impressionable nursing students. Professional boundaries have become blurred with increased use of social media as students struggle to differentiate between personal and professional identities. Increased exposure to professional expectations along with clearly defined policies and procedures regarding social media use can foster the development of an ethical conscience in students that can be carried into future practice. The establishment of clear professional boundaries upon entry into nursing programs can support safe use of social media and promote a positive image for the future of the nursing profession.     

Ethical dilemmas and moral distress in oncology nursing practice

Although ethical values and principles guide oncology nursing practice, nurses often are challenged to fulfill every professional core duty and responsibility in their everyday practice. Nurses commonly encounter clinical situations that have ethical conflicts, and they often have difficulty recognizing and articulating them. Unresolved conflicts can cause feelings of frustration and powerlessness, which can lead to compromises in patient care, job dissatisfaction, disagreements among those in the healthcare team, and burnout. This article reviews the ethical principles and values individual nurses bring to their practice as well as those basic to the profession of nursing. This article also discusses ethical conflicts in oncology practice and describes how nurses, especially students and novice nurses, may react to such situations with moral uncertainty or distress. In addition, a process for analyzing and resolving ethical problems in clinical situations is outlined. Increasing awareness and dialogue about ethical issues is an important first step in the process. Additional resources in the clinical setting may encourage nurses to actively participate in ethical decision making and take deliberate action as moral agents.     

Do ethical guidelines give guidance? A critical examination of eight ethics regulations

The number of legal and nonlegal ethical regulations in the biomedical field has increased tremendously, leaving present-day practitioners and researchers in a virtual crossfire of legislations and guidelines. Judging by the production and by the way these regulations are motivated and presented, they are held to be of great importance to ethical practice. This view is shared by many commentators. For instance, Commons and Baldwin write that, within the nursing profession, patient care can be performed unethically or ethically depending on the professional standards the nurses have set for themselves. They also hold that such standards are set when nurses become aware of the ethical codes available. As nurses are often not familiar with the codes, they do not all conform to them. Commons and Baldwin argue that nurses' ability to deal with ethical dilemmas is effectively secured with education on guidelines, creating a "barrier" between personal and professional values (p. 5).     

Core ethical issues of clinical nursing supervision

Clinical nursing supervision enables supervisees to reflect on ethically difficult caring situations, thereby strengthening their professional identity, integrating nursing theory and practice, and leading to the development of ethical competence. The aim of this study was to develop an understanding of the core ethical issues of clinical nursing supervision, using previous research as well as philosophical analysis of the theories of three moral philosophers: Harald Ofstad, Richard Hare and Carol Gilligan. The ultimate aim of this study was to develop a general model for ethical decision-making and to establish its relevance for clinical nursing supervision. The findings highlight four important values for the development of a basis for ethical decision-making. These values are caring, dignity, responsibility and virtue.     

Development of the ethical dimension in nursing theory

Nurses encounter ethical dilemmas in their practice and need guidance in making relevant patient-care decisions. Nursing theory is believed to be the best source of such guidance. The aim of this paper is to describe the ethical dimension in nursing theory. A literature review shows the intricate relationship between ethics and nursing, yet there is lack of elaboration of ethical features in nursing theories. The identified elements of the ethical dimension include ethical theories and principles, values, ethical practice issues, moral reasoning and contextual factors. Criteria for the development and evaluation of the ethical dimension are presented, with an example using a middle range theory. The ethical components pertinent to a nursing theory need to be made explicit if theory is to guide practice. Nursing scholars are invited to elucidate the ethical dimension in their theories in order to enhance moral reasoning and provide a framework for ethical practice.     

Moral professional personhood: ethical reflections during initial clinical encounters in nursing education

Moral agency is an important constituent of the nursing role. We explored issues of ethical development in Greek nursing students during clinical practice at the beginning of their studies. Specifically, we aimed to explore students' lived experience of ethics, and their perceptions and understanding of encountered ethical conflicts through phenomenological analysis of written narratives. The process of developing an awareness of personal values through empathizing with patients was identified as the core theme of the students' experience. Six more common themes were identified. Development of the students' moral awareness was conceptualized as a set of stages, commencing with empathizing with patients and nurses, moving on to taking a moral stand and, finally, concluding by becoming aware of their personal values and showing evidence of an emerging professional moral personhood. The notions of empathy, caring and emotion were in evidence throughout the students' experience. Implications for practice and nurse education are discussed.     

Rural Nurse Practitioners: Perceptions of Ethical Dilemmas

The purposes of this study were to identify ethical dilemmas encountered by rural nurse practitioners in primary practice and to identify constraints or enhancers that influenced ethical decision making. Nine nurse practitioners from Wyoming and Colorado responded to in-depth interviews. Six categories of ethical dilemmas and a list of constraints and enhancers were identified. One central concept, conflict between personal values and professional responsibility, emerged. Beneficence, nonmaleficence, justice, and patient autonomy, as core ethical principles, were related to this central conflict.     

A sociological analysis of the extent and influence of professional socialization on the development of a nursing identity among nursing students at two universities in Brisbane, Australia

Professions make extraordinary demands on its practitioners Professionals are required to master substantive theory and technical skills They also develop their own unique subcultures, demanding specific normative standards from their members, which are symbolized by professional ethical codes In the health professions, ethical codes include strong altruistic elements Professiona normative standards are learnt on a formal level (for example, at a university) and informal level (during the process of professional socialization and contact with the peer group, as well as informal sanctions) The transformation process of a novice to a professional is essentially an acculturation process during which the values, norms and symbols of the profession are internalized Acculturation can be so strong that it may cause personality transformation, which the French refer to as 'deformation professionelle', usually displayed by stereotypes, which are almost always exemplified by members of professions as ideal professionals, those who have internalized the profession's culture completely The question is, what is the extent of normative standards and professional characteristics that nursing students are exposed to during professional socialization, and to what extent are these standards and characteristics internalized so that a nursing 'deformation professionelle' develops9 A reliable Likert-type measurement scale was developed to measure this phenomenon One of the most important findings of this study was that students at both universities are highly professionally socialized     

Preparing students to be moral agents in clinical nursing practice. Report of a national study

Various types of teaching and learning strategies can be effectively employed to assist students' professional development in ethical decision-making skills. To be prepared to act as a moral agent in clinical practice, a terminal goal upon completion of the baccalaureate program is the student's ability to develop and consistently use a systematic approach/framework when confronted by an ethical dilemma. Eleven skill steps not necessarily exclusive or in sequence were outlined as selected activities that can be considered for the ethical decision process. Specific ethical issues that are germane and applicable to many patient care situations were investigated and identified as frequently occurring in clinical practice. Course work about these issues prior to completion of their nursing programs may be beneficial in preparing students with basic knowledge and skill about them as they enter or return to clinical practice.     

Ethical considerations related to evidence-based practice.

In this article, we have identified some of the ethical considerations related to evidence-based practice and surrounding issues as they bear on occupational therapy and rehabilitation. We acknowledge that practitioners are professionally and morally obligated to ensure that their decisions are informed and reflect best practices. Further, we recognize the value of encouraging practitioners to assume responsibility for searching and appraising available evidence so that informed options can be shared with patients. Table 1 summarizes the ethical considerations in evidence-based practice. Ethical dilemmas are a natural part of the health care enterprise. They existed before evidence-based practice became an everyday term, and they present themselves whether or not evidence-based practice is introduced into a clinical decision. From a moral and professional standpoint, the dangers of not attending to evidence are just as significant as the ethical issues attending to its application. Evidence-based practice has clear limitations in occupational therapy and rehabilitation. Currently, these limitations loom as major obstacles to practice behaviors that are better informed and influenced by research. In the United States, the implementation of a prospective payment system in rehabilitation will provide increased impetus for research and for attention to the results of that research. As we consider and apply this research to practice, we must do so judiciously, mindful that evidence-based practice is a gift that comes to health care in ethical wrappings.     

Curriculum changes and moral issues in nursing education

Through history nursing education has strongly advocated the importance of educating students towards moral and ethical responsibility. In today's society however, it has become increasingly difficult to honour this concern. One peephole to capture the ongoing struggle is to look into the curriculum where different stakeholders voice different opinions. Following a social constructive perspective the curriculum texts represent specific interest among stakeholders related to nursing education in a certain historical periods. By analysing the two last versions of the curriculum we get an insight into moral and ethical issues at stake and different ways of addressing these questions. While moral and ethical issues in the curriculum of 1987 follow a disciplinary discourse emphasising the importance of learning ethical concepts and modes of arguments, the curriculum of 2000 places ethical and moral issues within an employability discourse. In this curriculum moral issues are seen as an obligation linked to students practical and technical skills. The 2000 curriculum represents a shift from emphasising the independent and reflective professional to underline the skillful and morally obliged practitioner.     

Primary care nurse practitioners and the interface with secondary care: a qualitative study of referral practice

In the United Kingdom nurse practitioners are assuming responsibilities traditionally considered to be within the domain of general practitioners. Important amongst these is the referral of patients to medical consultants in secondary care, a responsibility commonly associated with the general practitioner's role as 'gatekeeper' to health care. This paper describes a study designed to identify issues raised by the challenge that a developing nursing role presents to interprofessional working at the interface between primary and secondary care. When invited to comment, study participants (nurse practitioners, nurse educators, medical consultants and general practice registrars) related nursing referrals to issues associated with professional boundary changes, namely: teamwork, regulation of practice, communication, professional conflict and professional relationships. This paper discusses the views of primary and secondary care practitioners about who should take responsibility for the referral of patients in the light of concerns raised about professional competence and accountability. Individual nurse practitioners and their colleagues have found pragmatic ways to manage their work however, although UK government policy supports development of advanced clinical nursing, there remains much work to be done to provide the professional and legal infrastructure to support the role.     

The relationship between professional values,ethical sensitivities and caring behaviors among nursing students: A structural equation modeling approach

AimTo examine the relationship between professional values, ethical sensitivity and caring behaviors among nursing students and determine whether professional values play a moderator role in the relationship between ethical sensitivity and caring behaviors among nursing students.BackgroundDeveloping professional nursing values, ethical sensitivity and caring behaviors is critical in nursing programs from the first year to graduation to prepare students for increasingly complex and diverse work environments.DesignA cross‐sectional study using structural equation modeling. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used.MethodsThis study was conducted with 189 undergraduate nursing students. The study was conducted in a four-year nursing faculty in the Mediterranean region of Turkey from February to June 2022. Data were collected using a personal information form, the Nurses’ Professional Values Scale, the Moral Sensitivity Questionnaire and the Caring Behaviors Assessment Tool Nursing Version-Short Form.ResultsWe found that nursing students' perceptions of professional values and caring behaviors were high and their ethical sensitivity was moderate. Nursing students who are successful in high school have higher professional values. In addition, it was determined that nursing students who chose the nursing profession because of altruism had higher perceptions of caring behaviors. A positive relationship exists between professional values, ethical sensitivity (r = −0.258, p < 0.001) and caring behaviors (r = 0.431, p < 0.001) (p < 0.05). Professional values have a positive effect on ethical sensitivity and caring behaviors.ConclusionProfessional values, ethical sensitivity and caring behaviors are relationships and professional values positively predict nursing students' ethical sensitivities and caring behaviors. As the professional value perceptions of nursing students increase, their ethical sensitivity and caring behaviors increase. Improving the curricula in a way that will improve professional values may enable nursing students to increase their ethical sensitivity and caring behaviors. The research contributes to a broader understanding of nursing education curriculum content.