Ethical Decision Making In Nursing Education
What Is Ethical
Decision Making
Ethics
is a systematic approach to understanding, analyzing, and distinguishing right
and wrong matters (Beauchamp & Childress, 2013). Ethical decision making is
a complex dynamic process where a moral problem is revisited from evolving
perspectives as one reason through the dilemma to reach a resolution (Beauchamp
& Childress, 2013; Burkhardt & Nathaniel, 2014).
Implementation of Ethical Decision Making In Nursing Education
Moral
issues are present in almost every patient interaction. Moral reasoning plays a
key role in ethical decision making, as does the person’s cultural background,
the organizational environment, practical experience, and knowledge of ethics.
Because clinical ethical issues can differ from daily life experiences, norms
learned during childhood are insufficient. Through practice, nurses learn over
time how to be sensitive enough to identify and address ethical dilemmas.
Inability to pursue the right action due to organizational constraints when one
knows it is the morally correct action to take, leads to moral distress, a
negative feeling state (Corley, 2002), which can result in burnout. To honor
ethical decision-making skills, nurses are encouraged to use reflection to
analyze their feelings and difficult situations they encounter. Ethical
sensitivity develops as one gains the personal capacity to assess responses and
feelings of others and the ability to deal with the ethical conflict (Park,
Kjervik , Crandell . & Germann , 2012).
Numerous
models facilitate making ethical decisions, most of which promote a
step-by-step analysis of the moral problem. Burkhardt and Nathaniel’s (2014)
model provides a framework similar to the nursing process that enables nurses
to make decisions while requiring ongoing evaluation and assimilation of
information. Steps include problem identification, information gathering to
clarify issues, exploration of strategies, strategy implementation, and outcome
evaluation.
Use of such models promotes a systematic method to critically
analyze and reflect on the ethical dilemma, but they do not take into account
the ethical climate or the nature of organizational relationships in which
situations occur ( Hardingham , 2004; Pavlish , Brown Saltzman , Jakel ,
& Rounkle , 2012) Complementary teaching methodologies like
inte-rprofessional ethics rounds, classroom group reports, or use of case
studies in problem solving teams can foster consideration of others’ values and
conclusions ( Garity , 2009; Robichaux , 2012) .
Outcomes of Ethical Decision Making
Ethical
decision making is complex and described using multiple interchangeable terms
that make understanding the process even more complicated. For nursing
practice, the American Nurses Association Code of Ethics states that ethics is
an integral part of the foundation of nursing and one that is not negotiable in
any setting (ANA, 2001) For bac Cal aureate nursing, the American Association
of Colleges of Nurses (AACN, 2008) Essentials include two objectives on ethics.
These are encouraging use of an ethical framework and the ethical principles of
autonomy and justice in relation to ethical conduct and prevention of unethical
practices (AACN, 2008).
The AACN Essentials of Masters Education for Advanced
Practice Nurses, Essential III, objective 1, presses for ethical decision
making and analysis of common ethical dilemmas (AACN, 1996). Therefore, nurses
receive instruction on bioethical principles in curricula, but research has
continuously found nurses to be ill prepared to address ethical dilemmas (
Dierckx de Casterle , Izumi, Godfrey, & Denhaerynck , 2008). Laabs (2012)
found that advanced practice nurses have a high level of confidence in their
ability to manage clinical ethical problems, but their overall knowledge is
low.
Comrie (2012) found that junior and senior students did not recognize
conflict as part of patient care because they believed that they did not
confront individual moral issues in daily practice during clinical rotations.
Concurrently, new graduates base their clinical actions on individual ethical
codes, eventually changing with environmental pressure ( Dierckx de Casterle et
al., 2008: Ham, 2004) Most entry level nursing programs operate in an
institutionalized environment.
A lone ethics course is provided because the
primary focus of baccalaureate education is to instill knowledge and technical
competency for students to become generalists and pass the NCLEX. Faculty
freely choose how to implement ethical principles in classes. often not having time
to develop the student’s moral reasoning skills, no guidelines proffer faculty
qualifications to teach ethics in comparison to other program requirements
Role of Faculty Members in Decision Making
The
ability to make an ethical decision develops over time. A college course on
ethics may not be sufficient to prepare nurses to meet the growing ethical
challenges they experience at the bedside and in the workplace. Continuous
education of health care personnel, to include faculty, on bioethical
principles and ethical decision-making skills in relation to the nurse-patient
relationship must occur throughout nursing curricula and as one’s career
progresses. Special attention to the transition period from graduation to
clinical practice, as in a nurse residency, may address moral reasoning lapses.
Faculty must also be accomplished in the study of ethics as well as experienced
in ethical decision making before being selected to teach an ethics class.
The
need for scholarly inquiry on moral reasoning and ethical decision making in
multiple areas is vast Inter-professional team dynamics and identification of
forces influencing critical review of patient dilemmas within these teams
require study. High fidelity simulation exercises could be used to discover
types of moral issues that may arise during patient care experiences and how
ethical decisions are reached among health care personnel.