Ethical Considerations In Nursing Education Understanding Ethics in Nursing Education
Ethics, derived from early philosophical traditions, deals with the principles of right and wrong that guide human behavior. The roots of ethical thought can be traced back to Greek and Roman philosophers who explored concepts such as the “good life.” Aristotle, for example, identified this good life as one of virtue, forming the foundation for natural law—a set of rules that governs our actions and decisions (Kraut, 2014; Baltzly, 2014). Ethics is broadly defined as “rules of behavior based on ideas about what is morally good and bad” (Merriam-Webster, 2014). In nursing education, ethics involves guiding the behavior of both educators and students to ensure moral conduct in professional practice.
Ethical theories evolved significantly in the 18th and 19th centuries, further refining our understanding of morality. Kantian ethics, or deontology, focuses on the duty to act according to moral principles, irrespective of the consequences (Johnson, 2014). Conversely, utilitarianism or consequentialist theories emphasize the importance of outcomes, considering the consequences as paramount in determining the ethical nature of a situation. These theories provide a conceptual framework for understanding ethics in nursing education.
Ethical and Educational Aspects in Nursing
The development of ethical principles in healthcare, particularly bioethics, has been influenced by earlier philosophical teachings combined with technological advances in the 20th century. Four major ethical principles—autonomy, beneficence, non-maleficence, and justice—form the cornerstone of bioethics (Beauchamp & Childress, 2009). These principles align with the ethical standards set forth in documents such as the Nuremberg Code and the Declaration of Helsinki, and they intersect with professional nursing codes of conduct (International Council of Nursing [ICN], 2012). These codes establish a social contract that guides ethical practice in nursing.
Ethics in nursing education is introduced to students at various levels. For undergraduate students, the curriculum focuses on defining key terms, exploring values clarification, and providing examples of ethical dilemmas they may encounter in clinical practice. Graduate nursing education often involves case-based learning, with topics extending to leadership and organizational ethics. Ethical issues in nursing frequently emerge as moral dilemmas, requiring difficult decisions between equally undesirable options.
For instance, consider a scenario in which a hospital patient is found unresponsive and without a pulse. The nursing staff knows that the patient had expressed a desire for no further treatment and had discussed Do-Not-Resuscitate (DNR) orders with her husband. However, no DNR order is recorded in the medical file. If the nurses proceed with cardiopulmonary resuscitation (CPR), they risk contravening the patient’s wishes and those of the family. On the other hand, withholding CPR without a formal order places them in a legally precarious situation. This example illustrates the ethical quandaries that nurses face and the importance of ethical training in their education.
Purposes of Ethical Education in Nursing
Ethical education in nursing focuses on two primary areas: fostering an environment of professional and academic integrity and providing students with a fundamental understanding of ethical principles and their application in practice. The first nursing code of ethics was established in 1950 (American Nurses Association [ANA], 2005). It emphasized the commitment to service, prioritizing patient welfare over personal interests. In 1953, the International Council of Nurses (ICN) developed its code of ethics, which is based on four key responsibilities: promoting health, preventing illness, restoring health, and alleviating suffering. These responsibilities apply to four principal areas: nurses and people, practice, profession, and coworkers (ICN, 2012).
While both codes address ethical education broadly, an additional code of ethics was developed to specifically address the responsibilities of nurse educators, focusing on their relationships with students and colleagues (Rosenkoetter, 1983; Rosenkoetter & Milstead, 2010). The National League for Nursing (NLN, 2012) further expanded these principles for nurse educators, emphasizing caring, integrity, diversity, and excellence. Across these codes, the guiding themes for educators involve creating a climate that supports professional values, academic integrity, and a collegial, respectful environment conducive to learning and ethical practice.
The second major focus of ethics in nursing education involves teaching ethical principles and their application in clinical practice. Ethical considerations are woven throughout the framework of nursing education, as outlined in “The Essentials of Baccalaureate Education for Professional Nursing Practice” (American Association of Colleges of Nursing [AACN], 2008). However, while the inclusion of ethics is mandated, there is little guidance on the depth, breadth, or specific content of ethics instruction. Some state nursing boards specify that ethics content must be part of the curriculum, but few studies have explored how this is implemented (Park, 2009).
The strategies and methods used to teach ethics in nursing programs vary widely and often lack consistency, highlighting the need for further development in this area (Numminen, Leino-Kilpi, van der Arent, & Katajisto, 2009, 2010; Numminen, van der Arent, & Leino-Kilpi, 2009; Ramos et al., 2013). Through theoretical instruction, discussion, and examination of case-based ethical dilemmas, students acquire the knowledge necessary to form the basis for ethical practice in the future.
Addressing Gaps and Future Directions in Ethical Education
The inconsistencies in teaching methods, curricula, and the educational preparation of faculty suggest the need for further research to standardize these components of ethics education. For instance, the question of academic honesty and its potential impact on future ethical practice in nursing also requires additional study. Initial research in this area has revealed concerns about academic dishonesty, but further investigation is needed to understand its long-term implications (Laduke, 2013).
Future research could provide more concrete guidance on the essential components of ethics education in nursing. This could involve developing standardized curricula that ensure consistency in how ethical principles are taught across nursing programs. Additionally, examining the effects of various teaching strategies on students’ understanding and application of ethical principles could help identify the most effective methods for preparing future nurses for ethical dilemmas in their professional practice.
Conclusion
Ethics in nursing education is fundamental to fostering a professional culture of integrity and accountability. The incorporation of ethical principles into nursing curricula ensures that future nurses are well-equipped to navigate complex moral dilemmas in their practice. Despite the varied approaches to teaching ethics in nursing programs, the underlying goal remains consistent: to instill a robust ethical foundation that guides nurses throughout their careers.
By addressing current gaps and inconsistencies in ethics education and promoting further research, the field can advance towards a more standardized and effective approach to teaching ethics. This will help prepare nursing students to uphold the highest ethical standards in their practice, ensuring quality care and patient safety in a rapidly changing healthcare environment.