Nursing Students’ Responses to Ethical Dilemmas in Nursing Practice

Abstract

In literature as well as in nursing practice a growing concern about nurses' ethical competence can be observed. Based on the cognitive theory of moral development by Kohlberg, this research examined nursing students' ethical behaviour in five nursing dilemmas. Ethical behaviour refers not only to the ethical reasoning of nursing students but also to the relationship between reasoning and behaviour. Kohlberg's definition of morality was refined by adding a care perspective. The results show that the majority of students can be located in the fourth moral stage according to Kohlberg's theory, that is, the conventional level of moral development. This finding implies that students are still guided by professional rules, norms and duties, and have not (yet) succeeded in making personal ethical decisions on the basis of their own principles and acting according to such decisions.

In search of salience: phenomenological analysis of moral distress

“…On the one hand, if it is true that, as argued by Benner and Wrubel (1989, p. xi), nursing is 'a practice of care whose science is driven by moral art and ethics of care and responsibility', on the other hand, it is not always easy to understand on what to exercise this primacy of ethics and responsibility. The discovery of what is salient, paramount, and vital in a situation is not immediate or obvious: it requires a lot of experience and perspicuous reflective capacities in order to avoid to be subjugated by the emotions and conflicts that can arise in situations of care (Dierckc de Casterlé et al, 1997Benner et al, 2010).…”

“…As ethical reasoning is drenched into the personal relationship between a patient and a nurse, the personal qualities of both influence the ethical decision making. Nurses are strongly guided by values (Vogel Smith, 1996;Dierckc de Casterlé et al, 1997;Rodney et al, 2002;Varcoe et al, 2004;Monterosso et al, 2005) such as beliefs, religion, education and training (Vogel Smith, 1996), their insights, feelings, ethical considerations (Aström et al, 1995), and previous personal and professional experiences (Vogel Smith, 1996;Dierckc de Casterlé et al, 1997Varcoe et al, 2004;Monterosso et al, 2005).…”

“…Many scholars are keen to stress the distance between the 'ideal' ethical choice and the 'real' ethical behaviour (Raines, 2000;Kim et al, 2007). Some studies illustrate how nurses have difficulties to implement their decisions in practice underlining the importance of contextual factors in limiting the ability of nurses to put into practice their decisions or to act according to their values (Dierckc de Casterlé et al, 1997Raines, 2000;Rodney et al, 2002;Varcoe et al, 2004;Kim et al, 2007).…”

Ethical problems in the clinical setting from the perspective of nursing students

“…Tam da bu noktada etik eğitiminin, etik değerlerin hayata geçirilmesinde önemi büyüktür (13). Eğitimin etik davranış ve profesyonel değerler üzerinde önemli bir etkisi olduğuna inanılmaktadır (17)(18)(19). Eğitim süreci ve etik davranış arasında varsayılan bu ilişki, hemşirelerin etik olarak yetkin olmasını sağlayan hemşirelik eğitiminin kritik bir görevi olduğu kanaatine dayanmaktadır (17).…”

“…Eğitimin etik davranış ve profesyonel değerler üzerinde önemli bir etkisi olduğuna inanılmaktadır (17)(18)(19). Eğitim süreci ve etik davranış arasında varsayılan bu ilişki, hemşirelerin etik olarak yetkin olmasını sağlayan hemşirelik eğitiminin kritik bir görevi olduğu kanaatine dayanmaktadır (17). Sınıfta öğrencilere verilen etik dersi her ne kadar giriş niteliğinde olup kısa ömürlü olsa da (20), hemşirelik öğrencilerinin mesleki kimlik ve yetkin etik davranış gelişiminde etik eğitiminin rolü büyüktür (21).…”