Nursing Education and Ethical Decision Making

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Ethical Decision Making In Nursing Education

Nursing Education ad Ethical Decision Making

What Is Ethical Decision Making,Implementation of Ethical Decision Making In Nursing Education,Outcomes of Ethical Decision Making,Role of Faculty Members in Decision Making.

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.

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