Ethics in Turkish Nursing Education Programs

Problem-based learning versus reflective practice on nursing students' moral sensitivity

BACKGROUND

Moral sensitivity is one of the prerequisites for nurses' professional competency and patient care. It is critical to teach professional ethics in a student-centered manner in order to increase students' moral sensibility. This study evaluated the effects of professional ethics education via problem-based learning and reflective practice on nursing students' moral sensitivity.

METHODS

This experimental study was performed on 74 nursing students who were randomly divided into three groups of problem-based learning, reflective practice and control. Principles of professional ethics were presented for the two intervention groups in four 2-hour sessions using ethical dilemmas scenarios. Participants completed the Moral Sensitivity Questionnaire before, immediately, and three months after the intervention. Data were analyzed using SPSS₁₆.

RESULTS

Demographic characteristics of the three groups were similar (p > 0.05). The total moral sensitivity score significantly differed between the groups immediately and three months after the intervention (p < 0.001). The total mean score for moral sensitivity was significantly different between the two groups of problem-based learning and reflective practice, with the mean scores in the problem-based learning group being higher (p = 0.02). The mean score of moral sensitivity decreased statistically significantly in both experimental groups three months after the intervention as compared to immediately after the intervention (p < 0.001).

CONCLUSION

Nursing students' moral sensitivity can be increased through reflective practice and problem-based learning. While the results indicated that problem-based learning was more successful than reflective practice, additional research is recommended to confirm the influence of these two strategies on moral sensitivity.

Determinants of nursing students' inclination to ethical values: Compassionate love and perceived social support from the family

BACKGROUND

Since professional values and the associated behaviors constitute the basis of practice in nursing, which is a profession based on professional ethics and ethical values, it is important to determine the inclination of nurses and nursing students to ethical values and the associated factors.

AIM

In this study, it was aimed to determine nursing students' levels of inclination to ethical values, compassionate love and perceived social support from the family, to examine the relationship between sociodemographic characteristics, compassionate love and perceived social support from family and inclination to ethical values, and the determining factors affecting the inclination to ethical values.

DESIGN

This is a descriptive relational study.

METHODS

The study was conducted with 558 students studying at the faculty of nursing between April-June 2022. The data were collected face-to-face using the Personal Information Form, Inclination to Ethical Values Scale, Compassionate Love Scale, and Scale of Perceived Social Support from Family.

RESULTS

It was found that there was a positive and significant relationship between compassionate love and perceived social support from the family and the level of inclination to ethical values, and that the mean scores of compassionate love (β = 0.882) and perceived social support from the family (β = 0.623) explained 89.3% of the change in the level of inclination to ethical values.

CONCLUSIONS

It was observed that males, freshman students, those with illiterate parents and students who did not take courses on ethics were in the risky group in terms of inclination to ethical values, and that sociodemographic characteristics, compassionate love and perceived social support from the family were the determinants of inclination to ethical values.

Views of nursing students on using standardized patient and in-class case analysis in ethics education

BACKGROUND

It is important to use student-centred, active teaching strategies in ethics education to develop students' skills in dealing with ethical problems.

OBJECTIVES

This study sought the opinions, suggestions, and thoughts of students receiving ethics education with in-class case analysis (ICCA) and standardized patient (SP) practice.

RESEARCH DESIGN AND PARTICIPANTS

A phenomenological and interpretive design based on qualitative interviews was used. The sample was 86 nursing students in 8 focus groups.

RESULTS

The mean age of participants was 21.40 ± 0.844, and most of the participants were female (n = 76). Themes obtained from the student interviews were 1) impact on knowledge, skills and emotions, 2) learning process, 3) decision making process, 4) recommendations for the future practice.

CONCLUSIONS

The students stated that both teaching methods were beneficial in ethics education; they understood the subject better, gained multi-directional thinking skills, and their awareness of ethical problems increased. Thus, ICCA and SP practice are teaching methods that should be used in nursing ethics education.

A scoping review of alternative methods of delivering ethics education in nursing

AIM

We conducted a scoping review of nursing ethics education to examine educational formats that go beyond traditional lectures.

DESIGN

This study was a scoping review.

METHODS

We used seven databases and relevant search terms, including nursing ethics, morals, values, nursing students and nursing ethics education.

RESULTS

Of 5,190 papers, 14 quasi-experimental studies met the inclusion criteria. All papers examined practices and self-study added to traditional lecture styles (i.e. the control group). Five practices emerged as follows: combined web (i.e. Internet) and lecture, web-based self-study, simulation, group learning and analysing ethical issues. The purpose, method and evaluation method differed based on the country in which the study was conducted. These educational interventions yielded significant differences in knowledge and in nursing students' critical thinking and ethical sensitivity postintervention. Multi-faceted ethics education will lay the foundation for effective practical training and practice.

Attributes of a good nurse

Background:

The opinions of students regarding the attributes of a good nurse can make a major contribution to the planning and the conducting of professional education. There are few studies which aim at identifying the qualifications of a good nurse from the perspectives of nursing students.

Objectives:

To determine the opinions of first- and fourth-year nursing students concerning the ‘attributes of a good nurse’, and whether and how their views change depending on their year of study.

Research design:

Descriptive research.

Participants and research context:

This study was conducted in the nursing department of a vocational school of health in the 2010/2011 academic year. The study participants consisted of first-year and intern students. A survey form was used to identify characteristics of participants, and students were asked the following open-ended question about their opinions related to the attributes of a good nurse.

Ethical considerations:

The permission was taken from the school administration. Informed consent was obtained, and anonymity was ensured for participating students.

Findings:

A total of 120 students participated in this study. Most frequently expressed attributes were ‘professional competence’ in first-year and ‘responsibility’ in fourth-year students. While first-year students placed a greater emphasis on the attributes of ‘geniality’, ‘patience’, ‘calmness’, ‘love of nursing’, ‘loyalty to nursing’ and ‘not attaching importance to material values’, fourth-year students emphasized the attributes of ‘empathy’, ‘honesty’, ‘responsibility’ and ‘scientific curiosity’ significantly more.

Discussion and conclusion:

Fourth-year students placed a greater emphasis on the attributes which the students are expected to acquire through a nursing program and clinical experience. However, they mentioned the attributes related to a good nurse–patient relationship and communication significantly less. Appropriate ethical training methods and good role models can help students acquire attributes that are important for the nursing profession and combine them with the attributes they already have.

Pediatric Nurses' Information and Applications Related To Ethical Codes

Background:

Ethics is defined as the entirety of moral principles that form the basis of individuals’ behavior; it can also be defined as “moral theory” or “theoretical ethics”.

Objectives:

To determinate information and applications related to ethical codes of pediatric nurses.

Patients and Methods:

Participants were nurses attending the Neonatal Intensive Care Unit Nursing Course and the Pediatric Nursing Course conducted in Istanbul between September 2011 and December 2012. A total of nurses attending the courses at the specified dates and who agreed to participate in the study were included in the analysis. Data were collected through a questionnaire that we developed in accordance with current literature on nursing ethics.

Results

140 nurses participated in this study. Information and applications were related to ethical codes of nurses including four categories; autonomy, beneficence, nonmaleficence, justice. The principle of confidentiality/keeping secrets. Exactly 64.3% of nurses reported having heard of nursing ethical codes. The best-known ethical code was the principle of justice. Furthermore, while the rates were generally low, some nurses engaged in unethical practices such as patient discrimination and prioritizing acquaintances.

Conclusions:

We conclude that most nurses working in pediatric clinics act in compliance with ethical codes. We also found that the majority of nurses wanted to learn about ethical codes. For this reason, we recommended that nurses working in clinics and future nurses in training be informed of the appropriate ethical behavior and codes.

The Nursing Students' Views About the Patient's Rights at the West Black Sea Universities in Turkey

BACKGROUND

The members of healthcare team have an important role in implementation and protection of patient's rights. Contemporary nursing entails an ethical responsibility to advocate and protect the patients' rights.

OBJECTIVES

This study was designed to evaluate how ready nursing students, at the end of their education, were to play the role of patient's rights advocates and to discuss ethics education in nursing.

MATERIALS AND METHODS

This descriptive study was performed on nursing students at Black Sea Universities in the academic year 2010-2011. Data were collected using a structured questionnaire about students' attitudes regarding patients' rights including patient's rights regulations. The association between gender and students' attitudes was analyzed using Chi-square test.

RESULTS

The mean age of the 238 participants was 22.11 ± 1.21 years and 82.8% of them were female. The majority of the nursing students held desirable attitudes toward patient information, truth telling, and protection of patients' privacy and medical records. However, the students' views about the rights of patients to refuse treatment, children's active participation in treatment, prioritization of the quality of life in treatment, and respect for the rights of dying patients were less satisfactory.

CONCLUSIONS

The results of this study was concerning with regard to nursing students' readiness for duties such as patient's rights advocacy. Therefore, it proposes ethics education that covers both patient's rights and the obligations of nurses to defend these rights.

The effect of ethics training on students recognizing ethical violations and developing moral sensitivity

BACKGROUND

Moral sensitivity is a life-long cognitive ability. It is expected that nurses who work in a professional purpose at "curing human beings" should have a highly developed moral sensitivity. The general opinion is that ethics education plays a significant role in this sense to enhance the moral sensitivity in terms of nurses' professional behaviors and distinguish ethical violations.

AIM

This study was conducted as intervention research for the purpose of determining the effect of the ethics training on fourth-year students of the nursing department recognizing ethical violations experienced in the hospital and developing ethical sensitivity.

METHODS

The study was conducted with 50 students, with 25 students each in the experiment and control groups. Students in the experiment group were provided ethics training and consultancy services. The data were collected through the data collection form, which consists of questions on the socio-demographic characteristics and ethical sensitivity of the students, Moral Sensitivity Questionnaire, and the observation form on ethical principle violations/protection in the clinic environment. The data were digitized on the computer with the SPSS for Windows 13.0 program. The data were evaluated utilizing number, percentile calculation, paired samples t-test, Wilcoxon test, and the McNemar test.

RESULTS

The total Moral Sensitivity Questionnaire pre-test score averages of students in the experiment group were determined to be 93.88 ± 13.57, and their total post-test score averages were determined to be 89.24 ± 15.90. The total pre-test score averages of students in the control group were determined to be 91.48 ± 17.59, and their total post-test score averages were determined to be 97.72 ± 19.91. In the study, it was determined that the post-training ethical sensitivity of students in the experiment group increased; however, this was statistically not significant. Furthermore, it was determined that the number of ethical principle protection/violation observations and correct examples provided by students in the experiment group were higher than the control group and the difference was statistically significant.

ETHICAL CONSIDERATIONS

Written permission and ethical approval were obtained from the university where the study was conducted. Written consent was received from students accepting to participate in the study.

CONCLUSION

As a result, ethics education given to students enables them to distinguish ethical violations in a hospital and make a proper observation in this issue.

Nurse educators and professional ethics--ethical principles and their implementation from nurse educators' perspectives

This study describes nurse educators' knowledge of the ethical principles of professional codes of ethics and educators' assessment of the implementation of principles of fairness and human respect. Data for this study was collected from nurse educators in Finland. The data was analyzed by SPSS (15.0) for Windows. A total of 342 nurse educators participated. The response rate was 46%. Nurse educators knew well the ethical principles of professional codes governing their work. Older and more experienced educators knew the principles better than younger and less experienced. According to the educators the principle of fairness was implemented the best whereas fair treatment of nurse educators and respect for educators' opinions in the society were implemented the weakest. Educators who knew the principles well assessed themselves to act in a fairer way and to respect other persons' opinions in a better way than educators who knew these principles less well. They also felt themselves to be better treated than educators having less knowledge of the principles. These findings can be utilized to develop nurse educators' ethics education. Further research should focus on students', colleagues' and superiors' assessments of nurse educators' ethical knowledge base to gain comparative data on the phenomenon.

The relationship of ethics education to moral sensitivity and moral reasoning skills of nursing students

This study described the relationships between academic class and student moral sensitivity and reasoning and between curriculum design components for ethics education and student moral sensitivity and reasoning. The data were collected from freshman ( n = 506) and senior students ( n = 440) in eight baccalaureate nursing programs in South Korea by survey; the survey consisted of the Korean Moral Sensitivity Questionnaire and the Korean Defining Issues Test. The results showed that moral sensitivity scores in patient-oriented care and conflict were higher in senior students than in freshman students. Furthermore, more hours of ethics content were associated with higher principled thinking scores of senior students. Nursing education in South Korea may have an impact on developing student moral sensitivity. Planned ethics content in nursing curricula is necessary to improve moral sensitivity and moral reasoning of students.

Blended learning in ethics education: a survey of nursing students

Nurses are experiencing new ethical issues as a result of global developments and changes in health care. With health care becoming increasingly sophisticated, and countries facing challenges of graying population, ethical issues involved in health care are bound to expand in quantity and in depth. Blended learning rather as a combination of multiple delivery media designed to promote meaningful learning. Specifically, this study was focused on two questions: (1) the students' satisfaction and attitudes as members of a scenario-based learning process in a blended learning environment; (2) the relationship between students' satisfaction ratings of nursing ethics course and their attitudes in the blended learning environment. In total, 99 senior undergraduate nursing students currently studying at a public nursing college in Taiwan were invited to participate in this study. A cross-sectional survey design was adopted in this study. The participants were asked to fill out two Likert-scale questionnaire surveys: CAAS (Case Analysis Attitude Scale), and BLSS (Blended Learning Satisfaction Scale). The results showed what students felt about their blended learning experiences - mostly items ranged from 3.27-3.76 (the highest score is 5). Another self-assessment of scenario analysis instrument revealed the mean scores ranged from 2.87-4.19. Nearly 57.8% of the participants rated the course 'extremely helpful' or 'very helpful.' This study showed statistically significant correlations (r=0.43) between students' satisfaction with blended learning and case analysis attitudes. In addition, results testified to a potential of the blended learning model proposed in this study to bridge the gap between students and instructors and the one between students and their peers, which are typical of blended learning, and to create meaningful learning by employing blended pedagogical consideration in the course design. The use of scenario instruction enables students to develop critical analysis and problem solving skills through active learning and social exchange of ideas.

Comparison of nurse educators’ and nursing students’ descriptions of teaching codes of ethics

This study analysed teaching of nurses’ codes of ethics in basic nursing education in Finland. A total of 183 educators and 214 students responded to a structured questionnaire. The data was analysed by SPSS. Teaching of nurses’ codes was rather extensive. The nurse-patient relationship was highlighted. Educators assessed their teaching statistically significantly more extensive than what students’ perceptions were. The use of teaching and evaluation methods was conventional, but differences between the groups concerning the use of these methods were statistically significant. Students’ knowledge of and their ability to apply the codes was mediocre. Most educators and students assessed educators’ knowledge of the codes as adequate for teaching. These educators also taught the codes more extensively and these students perceived the teaching as more extensive. Otherwise educators’ and students’ socio-demographic variables had little association with the teaching. Research should focus on the organization and effectiveness of ethics education, and on educators’ competence.

Evaluation of nursing students' training in medical law

There is no co-ordinated focus on liabilities arising from nurses' medical interventions in terms of occupational, administrative, civil legal and criminal activities. However, the Turkish Criminal Code, the Turkish Medical Ethics Code of Practice, and guidelines for patients' rights offer some framework for the relevant ethical principles and responsibilities of nurses. The aim of this study was to investigate the evaluation of nursing students' training in their legal liabilities. The sample consisted of 309 students who were taking a course entitled 'Nurses' legal liabilities under Turkish criminal and civil law arising from medical interventions'. Data were obtained by means of self-administered questionnaires and McNemar's test was used to evaluate the answers. In conclusion, after their training, a great majority of the students demonstrated an improvement in terms of their percentage of correct answers relating to malpractice. This does not, however, mean that they will not face malpractice charges after graduating, but their increased awareness of the issue may encourage them to make more effort to reduce the risk of mistakes. It is recommended that nursing faculty carry out studies into medical malpractice, that they focus more on this subject in nursing education, and that all nursing schools review their curricula from the point of view of malpractice.

A comparison of problem-based learning and conventional teaching in nursing ethics education

The aim of this study was to compare the learning effectiveness of peer tutored problem-based learning and conventional teaching of nursing ethics in Taiwan. The study adopted an experimental design. The peer tutored problem-based learning method was applied to an experimental group and the conventional teaching method to a control group. The study sample consisted of 142 senior nursing students who were randomly assigned to the two groups. All the students were tested for their nursing ethical discrimination ability both before and after the educational intervention. A learning satisfaction survey was also administered to both groups at the end of each course. After the intervention, both groups showed a significant increase in ethical discrimination ability. There was a statistically significant difference between the ethical discrimination scores of the two groups (P < 0.05), with the experimental group on average scoring higher than the control group. There were significant differences in satisfaction with self-motivated learning and critical thinking between the groups. Peer tutored problem-based learning and lecture-type conventional teaching were both effective for nursing ethics education, but problem-based learning was shown to be more effective. Peer tutored problem-based learning has the potential to enhance the efficacy of teaching nursing ethics in situations in which there are personnel and resource constraints.

Turkish nurses' decision making in the distribution of intensive care beds

The aim of this study was to assess the opinions and role of intensive care unit (ICU) nurses regarding the distribution of ICU beds. We conducted this research among 30% of the attendees at two ICU congresses in Turkey. A self-administered questionnaire was used, which included 13 cases and allocation criteria. Of the total (136 nurses), 53.7% participated in admission/discharge decisions. The most important criterion was quality of life as viewed by the physician; the least important was the patient's social status. According to the findings, the nurses thought that medical benefit and avoiding discrimination were important. On the other hand their ignorance of patients' autonomous preferences arouses suspicions about these nurses' role in advocating for patients' rights. For this reason, nurses' role in allocation decisions should be clearly described and should also be the basis on which intensive care nurses' duties in allocation decisions should be determined.

Nurse educators' teaching of codes of ethics

Although codes of ethics are thought to be an important element of nursing ethics curriculum research focusing on nurses' codes is scarce and negligible in the area of education. This study explores Finnish nurse educators' teaching of codes of ethics. A total of 183 nurse educators from polytechnics providing basic nursing education in Finland answered a structured questionnaire with one open-ended question. The data was analysed statistically by SPSS and by content analysis. The responding educators' teaching of the codes was rather extensive. The focus of teaching was on the nurse-patient relationship. Nursing in a wider social context was less emphasized. Integrated teaching was the prevalent teaching format. Educators' use of teaching and evaluation methods was fairly narrow aiming at a student-centred approach. Educators' knowledge of the codes was mainly based on informal learning. The majority assessed their knowledge as adequate for teaching the codes. Educators who were motivated to build their knowledge voluntarily also taught the codes more. Educators assessed nursing students' knowledge and ability to apply the codes as mediocre. Organization of integrated teaching, objective assessment of nurse educators' competence to teach the codes, and evaluation of student outcomes need further exploring.

Ethical problems observed by student nurses

This descriptive study was conducted to determine nursing students' observation of ethical problems encountered in their clinical practice. Data were collected through a questionnaire from 153 volunteer nursing students at a university-based nursing school in Ankara, Turkey. The students reported that some patients are either physically or psychologically mistreated by doctors and nurses; they were not given appropriate information; they were subjected to discrimination according to their socio-economic situation; and their privacy was ignored. The findings reveal that nurses' own unethical behaviors contribute to a rise in ethical problems. It is argued that nurses should internalize their professional and ethical roles in order to provide safe and ethical care and be good role models for students.

Attitudes to end-of-life decisions in paediatric intensive care

The aim of this study was to assess attitudes of intensive care nurses to selected ethical issues related to end-of-life decisions in paediatric intensive care units. A self-administered questionnaire was distributed in 2005 to intensive care nurses at two different scientific occasions in Turkey. Of the 155 intensive care nurse participants, 98% were women. Fifty-three percent of these had intensive care experience of more than four years. Most of the nurses failed to agree about withholding (65%) or withdrawing (60%) futile treatment. In addition, 68% agreed that intravenous nutrition must continue at all costs. In futile treatment cases, the nurses tended to leave the decision to parents or act maternalistically. The results showed that intensive care nurses could ignore essential ethical duties in end-of-life care. We suggest that it is necessary to educate Turkish intensive care nurses about ethical issues at the end of life.