COVID-19 era healthcare ethics education: Cultivating educational and moral resilience

Development of the ethical decision-making competence scale

BACKGROUND

Developing confident capacity for ethical decision-making is vital in nursing education. However, no tool examines nursing students' competence in ethical decision-making.

AIM

This study aimed to develop an Ethical Decision-Making Competence Scale (EDM-CS) to assess ethical care decision-making competencies in nursing students.

PARTICIPANTS AND RESEARCH CONTEXT

Original items were obtained by employing a focus group and the Delphi method. A cross-sectional design was used to confirm the items remained on the scale. Additionally, the scale's reliability and validity were assessed. The EDM-CS was completed by 498 nursing students. An exploratory factor analysis (EFA) was used to examine the factor structure based on data from group 1 (n = 250). A second-order confirmatory factor analysis (CFA) was used to examine the model's fitness based on data from group 2 (n = 248). This study was conducted between August 2022 and July 2023.

ETHICAL CONSIDERATIONS

The Institutional Review Board of Chung Shan Medical University Hospital approved this study's design and procedure.

RESULTS

From the original 34 items, nine were deleted in the EFA. Thus, the EDM-CS had 25 items and a four-factor structure (ethical judgement, ethical sensitivity, ethical motivation, and ethical action), which explained 60.97% of the total variance. A second-order CFA identified a second-order factor termed 'ethical decision-making competence' with 18 items (root mean square residual = 0.052). The EDM-CS scores correlated significantly and positively with the scores on the Scale of Protective Factor-24 (r = 0.47, p < .001), which indicated good convergent validity. Cronbach's alpha coefficient of the final EDM-CS was 0.90 and ranged from 0.73 to 0.80 for the four subscales.

DISCUSSION AND CONCLUSION

The EDM-CS was validated to fit the data adequately. It can be used to evaluate clinical nursing students' ethical decision-making abilities and to develop education strategies to improve their ethical care competence.

Good death disrupted: Nurses' moral emotions navigating clinical and public health ethics during the first wave of COVID-19 pandemic

AIM

To explore the moral emotions that frontline nurses navigated in endeavouring to ensure a 'good death' for hospital patients and care home residents during the first wave of the COVID-19 pandemic.

BACKGROUND

Under normal circumstances, frontline staff are focused on clinical ethics, which foreground what is best for individuals and families. Public health crises such as a pandemic require staff to adapt rapidly to focus on what benefits communities, at times compromising individual well-being and autonomy. Visitor restrictions when people were dying provided vivid exemplars of this ethical shift and the moral emotions nurses encountered with the requirement to implement this change.

METHODS

Twenty-nine interviews were conducted with nurses in direct clinical care roles. Data were analysed thematically informed by the theoretical concepts of a good death and moral emotions.

RESULTS

The data set highlighted that moral emotions such as sympathy, empathy, distress and guilt were integral to the decisions participants described in striving for a good palliative experience. Four themes were identified in the data analysis: nurses as gatekeepers; ethical tensions and rule bending; nurses as proxy family members; separation and sacrifice.

CONCLUSIONS

Participants reflected on morally compromising situations and highlighted agency through emotionally satisfying workarounds and collegial deliberations that enabled them to believe that they were party to painful but morally justifiable decisions.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Nurses are required to implement national policy changes that may disrupt notions of best practice and therefore be experienced as a moral wrong. In navigating the moral emotions accompanying this shift, nurses benefit from compassionate leadership and ethics education to support team cohesion enabling nurses to prevail.

PUBLIC CONTRIBUTION

Twenty-nine frontline registered nurses participated in the qualitative interviews that inform this study.

REPORTING METHOD

The study adhered to the Consolidated Criteria for Reporting Qualitative Research checklist.

Impressions of the Nursing Profession Among Nursing Students and New Graduates During the First Wave of COVID-19: A Qualitative Content Analysis

BACKGROUND

The COVID-19 pandemic has been a defining event for the next generation of the nursing workforce. Complex pandemic practice environments have raised concerns for the preparation and support of novice nurses, even as a multitude of nurses leave the profession.

PURPOSE

Researchers sought to examine nursing students' and new graduate nurses' impressions of the nursing profession in contrasting regions of New York State during the first wave of the COVID-19 pandemic.

METHODS

Inductive content analysis was performed on narrative text responses (n = 295) drawn from a larger multisite mixed-methods survey.

RESULTS

Five subconcepts were abstracted, leading to the main concept of shocked moral distress .

CONCLUSION

Nursing students and new graduate nurses have experienced high levels of moral distress but remain committed to the profession. Building moral resilience, fostering ethical decision making, and implementing protective policies can reduce the incidence of moral distress.

Evaluation of interactive teaching strategies and learning outcomes on the topic of kidney pharmacotherapy

BACKGROUND AND PURPOSE

Students' knowledge retention decreases overtime when experiencing large-group teaching. Engaging class activities improve student learning. We report the rapid changes in teaching methods and measurable learning outcomes on the topic of kidney pharmacotherapy (KP) in a doctor of pharmacy program.

EDUCATIONAL ACTIVITIES AND SETTING

The KP modules were delivered using two different methods, traditional lecture (TL) (in-person class) and interactive strategies of online learning (ISOL), to fourth-year pharmacy students during the academic years 2019 and 2020, respectively. This study aimed to compare the learning outcomes from TL and ISOL examinations. Students' perceptions regarding their new learning experiences were also explored.

FINDINGS

A total of 226 students were included in the study (TL, n = 118; ISOL, n = 108). The median percentage of the overall score from the ISOL examinations was higher than that achieved by the TL class (73% vs. 67%, P = .003). Further analyses revealed similar improvements in most learning outcomes and cognitive domains. A higher proportion of students taught through ISOL achieved scores >80% than those in the TL group (39% vs. 16%, P < .001). The student respondents provided positive feedback regarding activities in the ISOL cohort.

SUMMARY

The delivery of online KP when integrated with interactive strategies can maintain the outcome-based learning in Faculty of Pharmacy, Mahidol University. Approaches that aid student engagement during teaching and learning become opportunities for the improvement of education adaptability.

The blacksmith approach: a strategy for teaching and learning in the medical anatomy course (a qualitative study)

BACKGROUND

Anatomy is a symbolic, essential core topic and one of the fundamental pillars of medical and paramedical knowledge. Nevertheless, few exploratory data analyses have focused on how students approach learning anatomy. This study examined how students perceive their learning experience during anatomy lessons and how to make a model which promotes their meaningful learning and professional identity.

METHODS

Using purposive sampling with maximum variation, we conducted a qualitative content analysis at the Shiraz University of Medical Sciences in Iran (2020 to 2021). Twenty-four medical students and twelve faculty members of Iran's medical science universities were enrolled in the study. The data were collected through semi-structured interviews and analyzed according to the theme.

RESULTS

A conceptual model emerged from the data analysis with the main theme called the blacksmith approach, which included Three sub-themes: (1) making a new forge (adequate preparation and mindful beginning), (2) heating the students' hearts (considering supporting systems that learners need) and (3) using Sledgehammer's approach (teaching anatomy by using more active methods and engaging all neuroanatomical regions) and (Using fun for enjoyable learning). All the concepts were related to each other.

CONCLUSION

Medical students experience a challenging fundamental evolution into professional doctors. Educational systems focus primarily on teaching and learning, while students' transition can be facilitated by a three-step model called the Blacksmith Approach. It best serves as an educational framework for any pivotal, preclinical course capable of helping students acquire new roles and tackle challenges. Further research should be conducted to confirm how hard work leads to satisfying results with the opportunity to create enjoyable learning.

An Exploration of Resiliency Among Nurse Educators During the COVID-19 Pandemic

AIM

The purpose of this study was to explore resilience among nursing faculty during the COVID-19 pandemic and to examine associations or differences that may exist among variables and between groups.

BACKGROUND

Nurse educators' resilience has been identified as an important characteristic because of the challenges involved in nursing education. It is important to explore resilience among nurse educators to determine which factors promote or inhibit this important characteristic.

METHOD

This correlational research study used an online survey to explore factors related to resilience among nurse faculty during the COVID-19 pandemic. Correlational analyses were used to determine the relationship between various resilience constructs and select demographic variables.

RESULTS

Findings indicated that higher levels of resilience were associated with age (ρ = .21, p < .001), experience teaching online ( r = .22, p < .001), and professional development related to online teaching ( M = 80.7, SD = 11.0), t (276) = 2.41, p = .017.

CONCLUSION

Resilience and related characteristics have the potential to assist nurse educators in adapting successfully to stressful circumstances. It is crucial that schools of nursing develop programs to enhance or develop resilience among nurse educators. Support and training in the area of online education are also of paramount importance.

Ethical problems among nurses during pandemics: A study from Turkey

Background

Fighting Covid 19 at the forefront, increased the risk of infection and scarcity of resources have caused the ethical problems among nurses. It was planned to examine the ethical problems faced by nurses caring for Covid-19 patients and how they overcame the outcomes of these problems.

Methodology

This qualitative study was conducted with 20 nurses who caring Covid 19 patients in Turkey. Data were collected between January 24 and February 21, 2021. Purposive sampling was used in the study and a qualitative content analysis was performed.

Results

The research findings were discussed under two main themes as ethical problems and outcomes of ethical problems faced by nurses working in Covid-19 units. Then, 4 sub-categories for the theme of ethical problems (institutional problems, lack of knowledge and experience in nurses’ new place of duty, enforcing nurses to do doctors’ duties, problems encountered while caring for patients) and 2 sub-categories (emotions felt by nurses, coping strategies) for the theme of outcomes of ethical problems faced by nurses were defined.

Conclusion

The findings emphasize that nurses face ethical problems while giving care to Covid 19 problems. The nature of health services requires an ethical perspective to protect and improve human health, especially in uncertain, difficult and risky situations. Nurses should be supported to provide the ethical perspective in the best way.

The experience of diagnostic radiography students during the early stages of the COVID-19 pandemic - a cross-sectional study

INTRODUCTION

The rationale for this study was to ascertain the impact of the COVID-19 pandemic on Undergraduate B.Sc (Hons) Diagnostic Radiography students at the University of Hertfordshire in the UK. This would provide an ideal opportunity for students to reflect on their experience and indicate if they required additional support from the University.

METHODS

An online anonymous cross-sectional survey was deployed to all year groups (n = 283) during the first nationwide lockdown in May 2020, eliciting qualitative responses on questions about the effect of the pandemic; emotions experienced; support required and consideration of their choice of a career in the health sector.

RESULTS

Two hundred and one students responded to the survey, with many having experienced the illness or loss of a loved one. Trying to balance family commitments and study was a concern to some students, as well as struggling with the financial burden of job losses or furlough. Many students commented that educational support was a requirement with the move to online teaching and assessment. The main focus of student responses was the emotions that they had experienced, many of which were negative. Anxiety and fear were commonly expressed feelings, along with sadness and feelings of isolation. A small number of students reported feeling grateful, happy and relieved. An overwhelming majority of respondents commented that they were proud to be healthcare students and they were resolute in wanting to continue the course and join the frontline of the NHS workforce.

CONCLUSION

Some students have been deeply affected by their experiences of the pandemic, and University support mechanisms should be refined to better assist with their ongoing challenges.

Professional identity of Chinese nursing students during the COVID-19 pandemic outbreak: A nation-wide cross-sectional study

Practicing in unprecedented working environment and fighting against the COVID-19 crisis influenced the image of nursing in the general population, as well as among nurses themselves. This study aimed to describe the sense of professional identity among Chinese nursing students during the COVID-19 outbreak and to explore the relationship between psychological resilience and the sense of professional identity in this cohort. A nationwide online cross-sectional survey was conducted. Nursing students were recruited from 18 Chinese universities. The 10-item Connor-Davidson resilience scale (CD-RISC-10) evaluated psychological resilience and professional identity was assessed by the Professional Identity Questionnaire for Nursing Students (PIQNS). A total of 6348 respondents had a moderate level of professional identity to nursing (average PIQNS score at 62.02 ± 12.02). About 86% of respondents attributed the response to the COVID-19 pandemic in elevating the nursing image. Psychological resilience was the strongest contributor to professional identity (β = 0.371, P < 0.001). There was a high level of professional identity among Chinese nursing students during the COVID-19 crisis. Policy support and courses to enhance psychological resilience are critical to sustain professional identity among nursing students.