Nurses work in a complex environment and encounter multifaceted life and death situations that require them to make critical decisions to achieve positive outcomes. The professionals share close complexities and struggle with their patients and families within health care settings. Therefore, they should learn how to relate appropriately with patients and their families to reassure them about their commitment to their health and wellbeing. One of the most important concepts in the care process is ethics, which is a system of moral principles that guide relationships and decision-making (Park, Jeon, Hong, & Cho, 2014). Understanding ethics form the basis for nurses to provide quality and safe care in an honest environment. Therefore, they should understand that the “The Code of Nursing Ethics” is designed to guide their practice, which includes the nine principles that all nurses should learn and apply in their practice.
Introducing ethics in nursing is imperative because it provides the background for understanding how to make the right decisions in the care process. Ethics education plays a vital role in the ability of nurses to address ethical questions that emanate in patient-provider relationships. Ethical questions are diverse and integrate core concerns that surround informed consent, truth-telling, protecting patient rights and their welfare in making medical decisions (Cannaerts, Gastmans, & Casterlé, 2014). Therefore, nurses should be ethically prepared at all levels of their education to provide satisfactory answers to patients and their families and use the information to make decisions, regarding their relationships with the recipients of care (Adams, 2016). Furthermore, learning about ethics enables them to work collaboratively with members of their teams and give informed opinions whenever ethical issues arise in the care process.
The importance of integrating nursing ethics in the curriculum is informed by considering that the subject is wide and affects all areas of nursing practice. For example, teaching about the nine principles within the nursing code of ethics might take a considerable amount of time. Therefore, it might help for the principles and other areas of ethics to be integrated into various areas of the curriculum. When learning about informed consent, some ethics topics arise such as autonomy. Notably, when discussing the aspect of end of life decisions, ethical questions such as patient rights to decision-making emanate (Adams, 2016). In addition, nursing and health care, in general, is a dynamic field. Knowledge keeps emerging in genomics, genetics, precision medicine, and other scientific fields that affect the ability of nurses to make ethical decisions and answer ethical questions. Those developmental challenges affect their capability to keep pace with ethical concerns in the care process (Cannaerts, Gastmans, & Casterlé, 2014). Thus, it is important for nurses to train and learn about ethics in emerging areas and relate those aspects to various changes in the healthcare setting.
Ethical issues arise in all areas of nursing practice. Thus, nursing students should learn and understand the role of ethics in their training and practice and consider it as a major topic in various areas of training (Grace & Milliken, 2016). Notably, they should comprehend how ethical principles affect their relationships with patients and their families (Park, Jeon, Hong, & Cho, 2014). Nurses need to be trained on how to identify ethical issues and address them effectively to maintain quality care. Therefore, ethics should be integrated or threaded in every aspect of the nursing curriculum to create the necessary knowledge about the application of ethical principles in practice.
Strategies for Threading Content
Designers of the nursing curriculum should understand the most effective strategies and approaches that would integrate ethics into the nursing curriculum to achieve success in teaching nursing students. Various strategies, including the moral concept model, group discussion, the clinical practice model, and ethics inquiry model are effective in this process.
The Moral Concepts Model
The moral concept model will be an introductory strategy for nurses to learn about ethics and their application in clinical decision-making. However, the strategy is more theoretical than practical. The beginning step towards developing nurses as moral agents is to explain the meaning of ethics and ethical principles in nursing. Therefore, the model plays an important role in developing moral agency in nursing education (DeSimone, 2016). The strategy is effective in preparing nurses to deal with everyday practice issues during their training and when they transition to practical settings. The approach develops expertise in the nursing practice by preparing nurses as ethical actors.
The instructor can use the moral concept model in the course to explain various aspects of ethics as used in nursing. For example, the model is useful in teaching the core ethical principles inherent in the Code of Nursing Ethics (such as non-maleficence, beneficence, autonomy, justice, fidelity, and integrity). Given that different concepts relating to ethics will emerge throughout the course, it is critical for the instructor to teach them using the model as they emerge. For example, the model can be used as part of the introduction to all courses within the curriculum to familiarize and define important concepts.
The group discussion is at the core of collaborative learning in nursing education. When teaching ethics, the instructor should give students a chance to discuss various aspects of ethical practice as they continue their training. Although the educator can pass information through the lecture method, he or she should give a chance for group discussion, which helps to assess the level of understanding and available gaps in knowledge that should be filled through further training (Baldwin, Mills, Birks, & Budden, 2014). The discussion also promotes critical thinking and problem solving when learners work together to discuss nursing ethics and their application in practice.
The instructor can use the teaching strategy by giving learners a series of questions relating to ethics that they should discuss and answer. They can present their findings in the classroom and allow their peers to give feedback. The process also tests their ability to use the lessons acquired in the classroom. They can use role play as a strategy to apply the ethical concepts that they learn in theoretical lessons. Discussion groups encourage students working in groups to support each other in areas that they experience weaknesses. Group discussions have been an important method for students to reflect on what they have learned.
The Clinical Practice Model
Although the process of learning ethical theories is a vital initiative because it supports nursing education, it is significant to have an opportunity to apply the lessons in practice. Practical training is also essential as part of the continued development of nurses as moral agents (DeSimone, 2016). Nursing education should make ethics a part of the everyday experience of nursing students. Instructors should provide real-life settings for students to use their knowledge and identify areas for further training and development. The situations will allow the instructor to assess the level of understanding of the various ethical concepts and also allow nursing students to learn through experience.
The instructor could model an ethical dilemma such as involving the refusal of a patient to receive a particular kind of treatment. The student could be allowed to work with such a patient and make the most ethical decision in the situation. Notably, the student will be applying various ethical principles and concepts in the situation, including informed consent, autonomy, non-malfeasance, and beneficence. The nursing student will have the opportunity to use the lessons in practice and assess the level of understanding of the various ethical principles in practical decision-making.
Ethics Inquiry Model
The ethics inquiry model is a training concept that develops nurses with the ability to apply ethical standards in their practice. The model facilitates the development of an environment where nursing students are trained beyond the theory of ethics (Crigger & Godfrey, 2014). Using the approach, instructors should model situations in which nurses are required to use ethical knowledge to make critical decisions (Brush & Saye, 2014). Although it is impossible to train students on how to develop and build moral character, the model creates an effective environment for nursing students to cultivate reflective inquiry into ethical issues that they are likely to encounter in their practice. Through the learning process and experience, students can examine their experience as moral actors.
While using the concept, the instructor could model situations that require ethical decisions and try to make moral decisions that will benefit their patients who are the most significant parties in the care process. The instructor will assess the ability of the students to employ moral character in clinical decision-making. Therefore, the model will build a high level of emotional competence and the ability of the nursing student to become aware of the self, others, and situations surrounding their roles as caregivers.
Topic to be Threaded: Nursing Ethics
- Support the delivery of nursing care using concepts of regulatory boundaries, health care policies and concepts of equity, access, affordabilityand social justice in healthcare.
- Develop quality improvement initiatives based on health care policy, quality assurance and cost effectiveness principles to promote optimal care and safety that are necessary to provide high quality patient-centered care.
- Develop interprofessional communications to effectively connect and collaborate in an interdisciplinary care team to deliver safe and quality patient care while developing improved patient outcomes.
- Integrate the concepts of caring and compassion and personal values that are based on behaviors to foster professional growth and development.
Program Outcome VIII: In this aspect, the concepts of personal values, compassion, and care should be integrated, especially anchored on behaviors to enhance both development and growth.
Although the other program outcomes are important in ethical training for nurses, developing compassion and personal values is the most important since it supports the development of the nurse as a moral agent. Therefore, the instructor should train nursing students with the aim of learning and integrating ethical concepts into their nursing practice. The outcome is associated with their role as caregivers to diverse patients.
By the end of this course, students should be able to
|Teaching strategies and activities||Teaching assignment and explanation|
|Students should be able to define various moral concepts such as the ethical principles in the code of nursing ethics.||The Moral Concepts Model: The educator will give a lecture to students involving the introduction and definitions of the concepts relating to ethics such as the ethical principles in the code of nursing ethics.
|Students should be asked to research and write about the scenarios in which they can apply the principles of nursing ethics. They should present their assignment in class.|
|Nursing Theory||Students should define and discuss the various theories relating to ethics in nursing||Discussion: The instructor should give a list of questions relating to ethical theories in nursing.
Nursing students should discuss the theories in groups and present their findings in class.
|Students will be asked to work in groups to answer a list of questions relating to nursing theories and present their findings in class.|
|Nursing Research||The student should perform empirical research relating to nursing ethics.||Ethics Inquiry Model: Each student should perform a study on the use of ethics in nursing practice. The research process will provide an opportunity for the students to reflect on whatever they have learned in the course relating to nursing ethics. For example, they can be requested to research on the application of the right of patients in the pediatric department.||Each student will conduct a research in a hospital setting about a particular topic relating to nursing ethics. The instructor will give feedback on the research assignment.|
|Maternal/Child Health||Students should be able to provide quality care to pregnant mothers throughout their pregnancy period and after birth.||The Clinical Practice Model: The teacher will use a real-life case of a pregnant mother whom the nurse should work with throughout the pregnancy until the delivery period.
The nurse should apply ethical principles relating to maternal and child health care, including informed consent.
|Each student will write a report relating to ethics in maternal and child health care in a hospital setting. For example, the report could cover the level of ethical practice in the department in a particular hospital.|
|Psychiatric/Mental Health Nursing
|Ethics Inquiry Model
|Ethics Inquiry Model: The instructor should provide students with an opportunity to reflect on their ability to apply ethics in real-life situations. The instructor will offer a case of a patient suffering from a mental health problem that might affect his ability to decide about the care process. The nurse should reflect on his or her role as an advocate for such patients.||Students will be asked to write a reflective essay regarding their ability to apply ethical principles in practical settings.|
|Students should be able to apply ethical decision-making in medical or surgical settings involving patients and families.||The Clinical Practice Model: The instructor will simulate a surgical situation involving an ethical dilemma and ask students to apply ethical decision-making to solve the dilemma and make a decision that benefits the patient and his or her family.
|The students will write a report on the simulated assignment in the medical/surgical nursing department.
In addition, the instructor will provide feedback to students after reviewing their reports, and hence, give suggestions.