Developing a moral compass: Themes from the Clinical Ethics Residency for Nurses’ final essays

Abstract

Background: The Clinical Ethics Residency for Nurses was offered selectively to nurses affiliated with two academic medical centers to increase confidence in ethical decision-making. Research Question/Aim: To discover how effective the participants perceived the program and if their goals of participation had been met. Research design: A total of 65 end-of-course essays (from three cohorts) were analyzed using modified directed content analysis. In-depth and recursive readings of the essays by faculty were guided by six questions that had been posed to graduates. Ethical considerations: Institutional review board approval was granted for the duration of the program and its reporting period. Confidentiality was maintained via the use of codes for all evaluations including the essays and potentially identifying content redacted. Findings: An umbrella theme emerged: participants had developed ethical knowledge and skills that provided a “moral compass to navigate the many gray areas of decision-making that confront them in daily practice.” Six major themes corresponding to questions posed to the participants included the ability to advocate for good patient care; to support and empower colleagues, patients, and families; they experienced personal and professional transformation; they valued the multimodal nature of the program; and were using their new knowledge and skills in practice. However, they also recognized that their development as moral agents was an ongoing process. Discussion: Findings support that enhancing nurse confidence in their moral agency with a multimodal educational approach that includes mentored practice in ethical decision-making, enhancing communication skills and role-play can mitigate moral distress. A majority found the program personally and professionally transformative. However, they recognized that ongoing ethics discussion involvement and supportive environments would be important in their continued development of ethical agency. Conclusion: Multimodal ethics education programs have potential to be transformative and enhance nurse confidence in their ethical decision-making.

Ethics Education for Nurses: Foundations for an Integrated Curriculum

“…Moral distress disempowers nurses and leads to attrition from the profession, or worse, distancing from patients (Grace, 2018b;Grace & Milliken, 2016;Jurchak et al, 2017;Oh & Gastmans, 2015;Ulrich et al, 2010). Methods for preparing nurses and other providers to recognize and engage in ethical discussions and decision making are in the early stages of development and documentation (Lee et al, 2020). Evidence remains scarce regarding ethics teaching modalities and their influence on promoting moral agency and positive patient outcomes.…”

“…It is becoming increasingly clear that no one pedagogic strategy can provide expertise in ethical decision making and action. Developing and maintaining ethical expertise requires ongoing reinforcement (Lee et al, 2020). A recent Health Resources and Services Administration funded collaborative ethics education program for practicing nurses highlighted the importance of a multimodal approach (Grace et al, 2014).…”

“…The literature supports that multimodal approaches are necessary to ensure ethics knowledge and skills translate to ethical action or nurse moral agency. Rest's model suggests it is likely that all of these modalities have a role to play in reinforcing nurses' ethical confidence (Grady et al, 2008;Lee et al, 2020).…”

“…Rather, we are highlighting that based as it is in a wide survey of findings in the cognitive sciences, Rest's model provides a useful way to structure curricula because it accounts for different facets or processes that need to be developed in nursing students and nursing graduates in order for them to practice ethically. The model also can be effective in facilitating the ethical competence and moral agency of health care professionals and members of other disciplines (Lee et al, 2020;Rest, 1994).…”

“…Thus, although the RN caring for the patient has the necessary component of ethical sensitivity, without the relevant resources and support, ethical sensitivity may be insufficient for moral agency, which requires interaction between all four components of the Rest framework. Data support that strategies are needed to promote and sustain practicing nurses' ethical sensitivity (Lee et al, 2020). One strategy is the development of a moral community in which professional values are shared and all feel safe to be heard (Hamric & Wocial, 2016;Walker, 1993).…”