Main Ethical Considerations In Nursing Education
Whats are Ethics In Nursing Education
Early
Greek and Roman philosophers examined the idea of a good life and what may be
required to live this kind of life. Aristotle identified this good life as one
of virtue (Kraut, 2014) and the basis for a form of natural law ( Baltzly ,
2014) that guides our thoughts and actions. These philosophical theories are
the basis for the definition of ethics, the “rules of behavior based on
ideas about what is morally good and bad” (Merriam-Webster, 2014), that
address right and wrong behaviors.
Subsequent ethical schools of thought
developed by 18th and 19th
century philosophers further define morality in
reference to rules and consequences. According to Kantian ethics or deontology,
the focus is on the duty to act and not on the consequences Johnson, 2014),
Conversely, through theories of utilitarianism or consequence,
consequences must be considered and are in fact an ultimate concern when
defining the ethics of a situation.
Ethical and Educational Aspects
The
result of earlier philosophical teachings combined with the technological
advances of the 20th century created the field of bio ethics addressing ethics
in health care. Four major ethical principles autonomy, benefit, non-maleficence
, and justice-provide the framework for the study of bioethics (Beauchamp &
Childress, 2009). These principles are closely aligned with research codes of
ethics such as the Nuremberg Code and the Declaration of Helsinki. These
principles also dovetail with nursing professional codes of conduct
(International Council of Nursing [ICN], 2012) established a social contract
and guideline for ethical practice.
Ethics is taught in a variety of formats to
undergraduate and graduate nursing students. In the undergraduate study, the
focus is often defining the terms, discussing values clarification as a novice
nurse, and providing examples of clinical application for future reference. In
graduate nursing courses, much of the work may be case based and additional
topics include leadership and organizational ethics Clinically, the issue of
ethics in nursing often arises with the identification of an ethical or moral
dilemma, a choice between two equally unfavorable options.
For example, a
hospital inpatient is found unresponsive and without a pulse. The nurses know
that the patient’s condition was critical, that the patient and her husband
discussed her desire for no further treatment, and that do-not-resuscitate
(DNR) orders were discussed and agreed on with the family and patient. however,
no DNR order exists in the medical record. If the nurses initiate cardio
pulmonary resuscitation (CPR), they will be going against the wishes of the
patient and the family. If they do not initiate CPR, they are doing so without
an order. This places the nurse in an ethical quandary as to how to proceed.
Purposes of Ethical Education In Nursing
Ethics
in nursing education encompasses two broad areas: fostering a climate of
professional and academic integrity and providing students with a basic
understanding of ethical principles and their application in practice. The
first nursing code of ethics dates back to 1950 (ANA, 2005). Throughout its
nine provisions, the focus has been on service to others. In 1953, the ICN
(2012) developed its code of ethics focusing on four basic responsibilities:
the promotion of health, prevention of illness, restoration of health, and
alleviation of suffering. These responsibilities apply to four principal
elements describing the ethical conduct of care nurses and people, practice,
profession, and coworkers.
Although both codes address education (ANA, 2005;
ICN, 2012), an additional code of ethics was created to specifically address
the issues of nurse educators with a focus on students and colleagues
(Rosenkoetter, 1983; Rosenkoetter & Milstead , 2010 ) . More recently. The
National League for Nursing (NLN, 2012) developed ethical principles for nurse
educators focused on caring, integrity, diversity, and excellence. Throughout
these various codes and principles, the guiding themes for educators are the
creation and maintenance of a climate that supports professional values and
beliefs; academic integrity, a collegial creative spirit; and an autonomous,
honest, open, and respectful exchange (ICN, 2012, NLN, 2012).
The
second focus for ethics in nursing education is the teaching of ethical
principles and their application to clinical practice. Ethics is intricately
woven throughout the curricular elements The Essentials of Baccalaureate
Education for Professional Nursing Practice, the framework for baccalaureate
nursing education (American Association of Colleges of Nursing (AACN], 2008).
Despite the requirement that ethics be an integral part of nursing education ,
little guidance is provided as to the depth, breadth, or specific content of
instruction.
Some state boards of nursing identify ethics content as part of the
required nursing curriculum, yet only a few have been examined in the
literature (Park, 2009). The manner and strategies with which ethics is taught
in nursing programs are inconsistent and require further development ( Numminen
, Leino-Kilpi , van der Arent , & Katajisto , 2009, 2010; Numminen , van
der Arent , & Leino-Kilpi , 2009; Ramos et al 2013. Through instruction,
discussion of theory, and examination of case-based ethical dilemmas, students
require this necessary knowledge to provide a basis for ethical future
practice.
Based
on the inconsistencies in teaching methods, curriculum, and educational
preparation of faculty, future research may provide further guidance in
standardizing some of these key components in ethics education. The question of
academic honesty and its potential impact on future ethical practice in nursing
also requires additional study, initial research in this area revealed a
pattern of concern, however, more research is needed ( Laduke , 2013 ) .