Ethics education to support ethical competence learning in healthcare: an integrative systematic review

Simulation as a foundation for experiential learning among ambulance nursing students: A qualitative observation study

Simulation-based education is commonly used in undergraduate training but has gained increased utilization in postgraduate education. Ambulance nursing programs struggle to provide suitable simulations, as ambulance care can involve any possible situation. Simulation-based education in ambulance nursing programs commonly includes basic assessment and treatment of various conditions. However, there seems to be a lack of knowledge regarding students' experience of simulating pediatric emergency care in an ambulance care setting. Thus, the aim of this study was to explore specialist nursing students' experiences of simulating pediatric emergency care in an ambulance care setting. A qualitative design was deployed, utilizing field notes, individual and group interviews to capture the students' experiences. The results show that students immerse themselves in the simulations when the environment and facilitators support this. The simulation can elicit both emotional and physical responses among the students. Students gain insights into their knowledge deficit regarding certain topics, such as pediatric emergency care, as well as the rules and regulations governing what they are allowed to do for a child's safety and well-being. During simulation, students understand the importance of using adequate communication and recognize that there might be several aspects influencing this. Finally, the students gain insight into their emotional and behavioral responses when encountering patients and relatives in situations that conflict with their own views. In conclusion, simulation-based education can be a useful pedagogical tool if barriers to immersion are reduced. It can provide students with insights into their emotional and behavioral responses when encountering unexpected events. If properly discussed in debriefing sessions, these matters lead to increased learning that students can carry with them into their future careers. However, more research is needed on the feasibility of this kind of simulation in the ambulance nurse education setting.

Ethical competence in nursing: A theoretical definition

BackgroundEthical competence in nursing is essential. However, a theoretical definition of ethical competence in nursing and the critical components of ethical competence appear to be absent, resulting in a lack of convergence on the core content to be taught on ethical competence in nursing education.Aim and research questionsThis study aimed to answer the following questions: What are the essential components of ethical competence in nursing? What is their definition in terms of nursing? What is the theoretical definition of ethical competence in nursing?MethodWalker and Avant's concept synthesis.ResultsEthical competence in nursing consists of 12 essential components, defined and grouped into three main themes: (1) Ethical knowledge and understanding; having knowledge and understanding of the main theories of theoretical and practical ethics and the principal codes of ethics in nursing; (2) Personal ethical qualities; having ethical awareness and ethical self-awareness, ethical sensitivity, ethical perception, and ethical judgement. (3) Ethical ability and courage to perform; capable of moral reasoning, ethical reflection, and ethical decision-making, having moral courage and demonstrating ethical action and behaviour. The theoretical definition is thus: Nurses considered ethically competent have knowledge and understanding of the main ethical principles in nursing and possess personal ethical qualities, that is, ethical self-awareness, ethical awareness, ethical sensitivity, ethical perception, and ethical judgment as well as having the ethical ability and the courage to perform ethically, that is, capable of moral reasoning, ethical reflection, ethical decision-making, having moral courage, they demonstrate ethical action, and ethically responsible conduct.ConclusionsThis study is essential to nursing as a discipline and profession. The findings provide a theoretical definition of ethical competence in nursing and the qualities characterising ethically competent nurses, which can be of great value in clinical practice, nursing education, leadership, and nursing research and theory development.

Assessing educational needs of nurses' ethical competence based on the four components model of moral behaviour: a cross-sectional study using the Borich needs assessment and locus for focus models

BACKGROUND

Ethical competence is an essential attribute for professional nurses. Before designing ethics education programmes for nurses, it is crucial to conduct a systematic and accurate analysis of the needs of nurses to optimise the effectiveness of such programmes. This study performed an educational-needs analysis aimed at assessing and prioritising ethical competence requirements among nurses.

METHODS

We developed a 35-item questionnaire based on the Four Components Model of moral behaviour and adjusted it according to findings from a review of the pertinent nursing literature and input from expert panel discussions. The questionnaire, which comprised questions across four ethical competencies (ethical sensitivity, ethical judgment, ethical motivation, and ethical implementation) was distributed to 400 nurses working in three general hospitals in Seoul and Gyeonggi Province, Republic of Korea. Of the 400 questionnaires returned, 307 met our inclusion criteria. The responses were analysed with the aim of determining in which areas nurses needed more training to achieve the required competence. The three-step educational-needs analysis first employed paired t-tests to determine where reliable differences lie between the nurses' present competence level and required competence level, and then we employed Borich Needs Assessment and the Locus for Focus models to rank and prioritise the identified educational needs.

RESULTS

Our analysis revealed significant differences between the nurses' present competence levels and the required competence levels in all 35 items (p < .001) of the questionnaire. Borich Needs Assessment and the Locus for Focus models identified four items in the questionnaire that had the highest priorities for educational needs in ethical competence: three ethical judgment items and one ethical implementation item. These items deal with ethical judgment grounded in ethical theories such as virtue ethics and the principle of justice within principlism; and ethical implementation that specifically addresses issues related to the concealment of clear medical errors.

CONCLUSIONS

This study suggests that specific ethical competencies, identified as high-priority needs through the educational-needs analysis, should be included in student and post-graduate nursing education and in institutional policies in order to foster good nursing practices in daily care.

Enhancing comprehensive geriatric nursing competence: Insights into training status, demands, and willingness among clinical nurses-A multi-center study in China

This study aims to evaluate geriatric nursing competence (GNC), training status, demands and willingness of clinical nurses, and to identify the key factors that influence GNC. A cross-sectional multi-centre study was conducted, including 1024 clinical nurses. Results indicated an overall lower-to-moderate level of GNC, coupled with a low training rate (43.53 %) and a high demand for further training (87.44 %), 67.5 % of nurses expressed willingness to participate in geriatric nursing training, and 35.6 % were willing to engage in geriatric nursing practice. Multiple linear regression analysis identified several independent factors influencing GNC, including training status, willingness to participate in geriatric nursing training and engage in geriatric nursing practice, years of experience in geriatric nursing practice, nursing job satisfaction, and department (i.e., Geriatrics, Internal Medicine, and Surgery). The study underscores the complex interplay of factors shaping GNC among clinical nurses, highlighting significant areas for targeted improvements in geriatric care training.

Lived experience of ethical challenges among undergraduate nursing students during their clinical learning

BackgroundUndergraduate nursing students may experience several ethical challenges during their clinical learning placement that can lead to moral distress and intention to leave the profession. Ethical challenges are complex phenomena and ethical frameworks may help improve their understanding and provide actionable recommendations to enhance students' readiness for practice.AimTo explore undergraduate nursing students' ethical challenges experienced during their clinical learning and their suggestions for better ethics education; to illuminate students' experience against a foundational ethical framework.Research designQualitative study based on interpretative phenomenology. Semi-structured, in-person or at distance, one-to-one interviews were performed, audio-recorded, and transcribed verbatim. The 'Dignity-enhancing care framework' was employed to frame the study findings.Participants and research contextNineteen nursing graduands attending seven sites of one Northwestern Italian University were interviewed.Ethical considerationThe study protocol was approved by the Ethics Committee of the University of Torino (number 0187646/2023). All participants provided written informed consent.FindingsStudents experienced several ethical challenges concerning daily practice such as pain control or the decision to restrain patients, and reported deficient professional ethics with healthcare professionals who demonstrated poor caring attitudes and teamwork. Moreover, they perceived professionals poorly committed to their role of educators and complained of poor support in the learning process. When a supportive, dialogical, and relational context lacked, students experienced negative feelings about the profession and the healthcare system and reported the intention to leave the profession. Dialogue with peers, family members or significant others, nursing educators, and clinical nurse supervisors, as well as self-learning activities and discussion-based teaching methods grounded on real scenarios helped to overcome challenging situations.ConclusionWhile complying with normative standards, nursing education policies should encourage the adoption of dynamic teaching methods and sustain a regular, dialogical approach within and between the clinical and academic contexts to improve readiness for practice.

Ethical climate in higher education: The interplay of leadership, moral efficacy, and team cohesion in diverse cultural contexts

Ethical climate, ethical leadership, team cohesion, and collective moral efficacy influence organizational integrity and performance within higher education institutions. How do these factors interact within various cultural and institutional contexts, and what mechanisms reveal their relationships? This research investigates the relationship between ethical climate, ethical leadership, collective moral efficacy, and team cohesion within Pakistan, China, and Saudi Arabia higher education institutions. The research is based on Social Cognitive Theory and utilizes a quantitative survey method, obtaining data from 15 universities chosen for their varied cultural, economic, and institutional contexts. The results indicate that ethical climate substantially improves ethical leadership, with collective moral efficacy as a mediator and team cohesion as a moderator. The strength of these relationships differs among countries: China's collectivist culture and strong institutional frameworks enhance these associations, whereas Pakistan's resource limitations and systemic challenges diminish them. Saudi Arabia's Vision 2030 reforms indicate advancement; however, they encounter challenges in implementation. This study addresses significant gaps in the literature by introducing collective moral efficacy and team cohesion as mediating and moderating variables, extending Social Cognitive Theory, and offering a cross-cultural perspective on ethical leadership. The findings highlight the significance of promoting ethical climates, enhancing team cohesion, and tackling systemic challenges to improve leadership effectiveness and organizational outcomes. This investigation provides strategies for higher education institutions to enhance ethical practices and resilience across varied cultural and economic contexts. Ultimately, this study raises a pivotal question: How can higher education institutions worldwide leverage ethical climate and leadership to foster sustainable organizational practices and achieve institutional excellence in an increasingly complex global landscape?

Collaborative competence, values, and ethics in interprofessional education and collaborative practice: findings from a scoping review

Despite the abundance of studies on Interprofessional Education and Collaborative Practice (IPECP) and the integration of competencies into health curricula, there appears to be a lack of understanding of the development of ethical competencies for interprofessional teamwork.The objective of this scoping review was to examine how collaborative competence in values/ethics is characterized and developed within IPECP, along with an understanding of researchers' recommendations. A comprehensive search of nine databases was conducted for the period between 2011 and 2025, encompassing a total of 52 studies. The review identified several key findings, including: focus on IPEC Core Competences; an emphasis on certain values/ethics sub-competencies; the identification of conflicts related to professional hierarchy; and a range of approaches to developing ethical competence through educational strategies. The review highlights challenges in fostering ethical competence in IPECP, noting progress and limitations.

Effectiveness of a competency-based coordinator of advance care planning competency enhancement program: a mixed method

BACKGROUND

Clinical Ethics Support Services (CESS) improve health-care quality by systematically identifying and resolving ethical issues. CESS providers should be trained to understand patients' difficulties with existential issues and advocate on their behalf. This study evaluates the effectiveness of educational programs to enhance the competencies to solve ethical issues in clinical practice for CESS providers related to life-sustaining-treatment, based on Jonsen et al.'s "the four topics approach."

METHODS

This is an explanatory sequential mixed-method study conducted in quantitative and qualitative phases. Participants included 52 life-sustaining medical workers at general hospitals. The participants were categorized into 24 experimental and 28 control groups, including nurses, social workers, and legal administrations. The program encompassed bioethics, end-of-life care, critical thinking, decision-making training through clinical ethics cases, role-playing, communication skills, and discussions. In the quantitative phase, a quasi-experimental study design with pre-test, intervention, and post-test was used. The program for experimental group was provided through 8 sessions spread across 4 weeks. The participants' experiences were explored through semi-structured interviews in the qualitative phase.

RESULTS

After the education, the experimental and control groups differed significantly in critical thinking disposition, and hospice and palliative care knowledge. Participants acknowledged that critical thinking education improved their ability to analyze and evaluate clinical ethical dilemmas.

DISCUSSION

The case-based, role-playing intervention effectively enhanced participants' communication and critical thinking skills concerning life-sustaining treatments. Participants highlighted the importance of ongoing education and professional development to maintain core knowledge and skills, aiming to enhance the quality of care for patients, families, and colleagues.

TRIAL REGISTRATION

This study was retrospectively registered as a code (No: KCT0009687) in the Korean Clinical Trial Service on August 9, 2024.URL: https://cris.nih.go.kr/cris/search/detailSearch.do?seq=27805&status=5&seq_group=27805&search_page=M .

Epistemic humility meets virtual reality: teaching an old ideal with novel tools

The pace of scientific advancements in medicine, driven by artificial intelligence as much as by novel biotechnologies, demands an ever-faster update of professional knowledge from physicians and collaboration in interdisciplinary teams. At the same time, the increased heterogeneity of patients' lifeworlds in socially and culturally diverse societies requires healthcare professionals to consider diverging personal and cultural perspectives in their treatment recommendations. Both developments require conveying to students a professional virtue that can be summarised as epistemic humility-a teaching process which, we argue, can and should be supported by novel technologies. By embedding students in realistic scenarios, virtual reality can play a crucial role in teaching medical students a stance of epistemic humility. Such stance implies acknowledging the limitations of one's knowledge as well as taking individual patients' perspectives and experiences seriously. In this sense, epistemic humility can also provide a crucial step towards tackling epistemic injustice and biases in medicine. We discuss how teaching epistemic humility with virtual reality tools can succeed and suggest the development of novel teaching tools that make use of this technology to immersively enable moral growth. Our paper thereby contributes to the emerging field of digital bioethics, calls for more work in the area of experimental bioethics and informs ongoing debates on how medical ethics teaching can prepare future physicians for the challenges of tomorrow's practice of medicine.

A leadership ethics curriculum: Bringing mixed-methods interdisciplinary insights to the ethical complexities of healthcare leadership

In response to the increasingly complex ethical issues facing health leaders, the Bioethics Department at The Hospital for Sick Children (a Canadian quaternary care paediatric research institution) was asked by senior leadership to develop a leadership ethics curriculum that would further develop the ability of its institution's leaders to deliberate and make morally defensible decisions in their roles. Insights from an interdisciplinary literature review suggest that the general objectives and structure of leadership ethics teaching remain constant, with specifics changing depending on the organization and intended participants. Implementing findings from an institutional needs assessment, our modular leadership ethics curriculum, which engages participants in asynchronous and synchronous learning, was designed to support (1) understanding of personal and organizational values, (2) recognizing the significance of attending to the ethical dimensions of decisions, (3) familiarity with leadership and organizational expectations, and (4) practicing application of ethical analysis, enhancing abilities and confidence to engage with ethical issues.

Investigating the influence of self‑leadership on moral sensitivity in medical students: A comparative study

Most previous studies have focused mainly on the influence of external interventions (such as moral climate, moral education, and training) on students' moral sensitivity. However, few studies have explored the impact of self‑leadership on promoting moral sensitivity. Based on social cognitive theory, this study aimed to explore the relationship between self‑leadership and moral sensitivity among medical college students and compare the differences between medical students and nursing students. This study is a cross-sectional study. A total of 479 medical college students from China were investigated via self‑leadership scale and moral sensitivity scale. Pearson's correlation analysis, Structural Equation Modeling (SEM), and a group comparison test in Mplus 7.4 were conducted. The results showed that self‑leadership has a significant effect on moral sensitivity and major is a significant moderator in this relationship. Specifically, although medical students' moral sensitivity is greater than that of nursing students, the effect of self‑leadership on the moral sensitivity of nursing students is greater than on that of medical students. These results put forwards feasible opportunities for improving the moral sensitivity of medical students, which has important impacts on medical ethics education.

Art of Caring Model for Emergency Care Patients and Professionals

The Art of Caring model is developed from a general structure of the flow in the encounter between the injured patients and the different professionals within emergency care, in turn founded on four phenomenological essences, which encompass the experiences of patients, next of kin, and various professionals during the encounter at the scene of an accident and at the emergency department. The Art of Caring model represents a philosophical and theoretical rethinking of an ethical approach. It draws upon the works of the Danish philosopher Løgstrup, the French philosopher Levinas as well as selected aspects of Merleau Ponty. The Art of Caring model is illustrated by coppersmith and artist Michaela Ivarsdotter, further developed and reflected upon with Anna Bratt, a psychologist working according to the compassion-focused tradition. The model is made to disclose and visualise the Art of Caring and facilitate reflections on achieving a win-win situation for both patients and different professionals within emergency care. Healthcare involves a variety of professions, and for the benefit of the patient, we must recognise the significance of professionals taking on the advocacy role from a caring science perspective, which includes the unique and shared experiences of the lifeworld. This is a challenge within the context of demanding efficiency and time pressure in emergency care. To address this, a concrete action plan for ethical reflections is needed to find a balance between giving and receiving, essential for healthcare professionals to avoid compassion fatigue. In the context of ethical competence and the challenges faced by different healthcare professionals within emergency care, the Art of Caring model could be used for ethical reflections, as an approach to achieve a balance between patient advocacy, ethical considerations, and effective emergency care delivery. Achieving this goal will lead to better patient outcomes and a more supportive work environment for the entire emergency care team.

Ethics in optometry: an educational intervention

CLINICAL RELEVANCE

As registered health professionals, optometrists have a responsibility to apply ethical reasoning skills to ensure the best outcomes for their patients.

BACKGROUND

The ability to apply ethical knowledge in practical situations has emerged as a crucial skillset for health professionals. This research aimed to highlight the potential benefits and challenges associated with employing case-based scenario workshops as a method for teaching the application of ethical knowledge.

METHODS

An intervention study was conducted at an Australian university to establish whether a case-based ethics workshop could improve the confidence of optometry students in navigating ethical dilemmas. Prior to completing the workshop, optometry students were invited to complete a survey, and the survey was repeated at the end of each workshop.

RESULTS

Fifty nine students completed the pre-workshop survey, and 49 students completed the post-workshop survey. A Mann-Whitney U test showed no significant difference in the baseline confidence levels of students who had prior or no prior experience in tertiary education, healthcare work or eyecare work. There was a statistically significant improvement in confidence navigating ethical dilemmas (Z = -2.541, p = 0.011) from 53% very or moderately confident pre-workshop to 82% post-workshop.

CONCLUSION

These results suggest that case-based ethics workshops are an effective educational tool that should be considered for incorporation into optometry and other health profession courses.

A Qualitative Study on Ethics Education at Pharmacy Colleges in Japan Based on a Survey of Ethics Educators

Background: In pharmacy education in Japan, efforts continue to develop a model for ethics education that fosters high ethical standards and the problem-solving skills essential for medical professionals. This study qualitatively analyzed the attitudes of ethics educators-those who teach ethics classes-to establish a model of ethics education for pharmacy colleges in Japan. Methods: This study analyzed open-ended responses from 32 universities to the question, "What do you think about ethics education provided by faculties of pharmaceutical sciences?" Result: The qualitative analysis revealed that ethics educators at pharmacy colleges in Japan believe in the potential of ethics education to nurture problem-solving skills and logical thinking. However, the educator's question whether or not the students would be able to apply ethics content in clinical settings as medical professionals. Another issue is that faculties of pharmaceutical sciences lack the staff and expertise to teach ethics. In other words, the educators lack the wherewithal to break the logjam in ethics education through their efforts; hence, they are desperate for an ethics education model. Conclusions: Based on our findings, further research is needed to design strategies that can enhance the quality of pharmacy education in Japan.

Organ Donation and Transplantation Coordinators' Experience and needs for ethics education

BACKGROUND

Transplant coordinators face ethical conflicts in various situations, such as deciding who should receive organ donations and how to consider patient costs and such conflicts are expected to be more frequent in Korea, as organ transplant coordinators in the country perform both organ acquisition and transplantation.

RESEARCH AIM

This study aims to develop an ethics education program to enhance organ transplant coordinators' ethical competence and address the ethical conflicts faced by them during clinical practice.

RESEARCH DESIGN

A descriptive study.

PARTICIPANTS AND RESEARCH CONTEXT

An online survey was conducted from March 22 to May 28, 2021. The study was conducted among 160 registered members of the Korea Organ Transplant Coordinators Association. Ultimately, 87 participants agreed to participate in the study.

ETHICAL CONSIDERATIONS

Permission to conduct the study was obtained from the Institutional Review Board.

RESULTS

The study revealed variations in the degree of ethical conflict based on the participants' general characteristics. Furthermore, organ transplant coordinators exhibited high levels of ethical competence and expressed a need for ethics education. The findings also indicated a positive correlation between higher ethical competence and greater demand for ethics education.

CONCLUSIONS

Based on the findings, developing standardized ethics education programs tailored to organ transplant coordinators is recommended. These programs should focus on improving ethical decision-making skills and establishing professional ethics. The education provided should be practical, applicable in the clinical setting, and responsive to the participants' awareness and concerns regarding ethics education.

Enhancing medical imaging education: integrating computing technologies, digital image processing and artificial intelligence

The rapid advancement of technology has brought significant changes to various fields, including medical imaging (MI). This discussion paper explores the integration of computing technologies (e.g. Python and MATLAB), digital image processing (e.g. image enhancement, segmentation and three-dimensional reconstruction) and artificial intelligence (AI) into the undergraduate MI curriculum. By examining current educational practices, gaps and limitations that hinder the development of future-ready MI professionals are identified. A comprehensive curriculum framework is proposed, incorporating essential computational skills, advanced image processing techniques and state-of-the-art AI tools, such as large language models like ChatGPT. The proposed curriculum framework aims to improve the quality of MI education significantly and better equip students for future professional practice and challenges while enhancing diagnostic accuracy, improving workflow efficiency and preparing students for the evolving demands of the MI field.

Development and Evaluation of an AI-Assisted Answer Assessment (4A) for Cognitive Assessments in Nursing Education

Artificial intelligence (AI) can potentially enhance cognitive assessment practices in maternal and child health nursing education. Objectives: To evaluate the reliability, accuracy and precision, and external validity of an AI-assisted answer assessment (4A) program for cognitive assessments in nursing education. Methods: This study is a validation study. Initially, 170 nursing students from northern Thailand participated, with 52 randomly selected for detailed testing. Agreement testing between the 4A program and human experts was conducted using the intraclass correlation coefficient (ICC). Accuracy and precision testing compared 4A scores with human expert assessments via the McNemar test. External validation involved 138 participants to compare the 4A program's assessments against national examination outcomes using logistic regression. Results: Results indicated a high level of consistency between the 4A program and human experts (ICC = 0.886). With an accuracy of 0.808 and a precision of 0.913, compared to the human expert's accuracy of 0.923 and precision of 1.000. The McNemar test (χ2 = 0.4, p = 0.527) showed no significant difference in evaluation performance between AI and human experts. Higher scores on the 4A program significantly predicted success in the national nursing examination (OR: 1.124, p = 0.031). Conclusions: The 4A program demonstrates potential in reliably assessing nursing students' cognitive abilities and predicting exam success. This study advocates for the continued integration of AI in educational assessments and the importance of refining AI systems to better align with traditional assessment methods.

Re-evaluation of the psychometric properties of ATE following changes in euthanasia regulations in Spain

Understanding healthcare professionals' attitudes toward euthanasia, especially within teams assisting patients who request it, is essential for providing appropriate support throughout the process. The objectives of this study were to re-adapt and validate the Attitude Towards Euthanasia Scale for the Spanish context, to examine its dimensional structure, and to estimate its reliability, particularly in light of the 2021 regulation of euthanasia in Spain. A cross-sectional study was conducted with a non-probabilistic sample of 778 healthcare professionals from the Balearic Health Service. Data collection involved a self-reported sociodemographic questionnaire and the Attitude Towards Euthanasia Scale. The scale's psychometric properties were assessed through reliability and validity tests, including confirmatory factor analysis. The Attitude Towards Euthanasia Scale demonstrated strong reliability, with a Cronbach's alpha of α = 0.889 and item homogeneity ranging from 0.66 to 0.78. Factor loadings were reported for four models, including a unidimensional model and models with two, three, and four factors. The two-factor model explained 64.51% of the variance, with a Kaiser-Meyer-Olkin (KMO) value of 0.873. Fit indices indicated good model fit: root mean square residual = 0.040, goodness-of-fit index = 0.960, adjusted goodness-of-fit index = 0.927, and root mean square error of approximation = 0.069. After performing a Parallel Analysis, two loading factor were found. The adapted version of the Attitude Towards Euthanasia Scale, aligned with the current societal and legislative context, is a valid and reliable tool for assessing healthcare professionals' attitudes toward euthanasia, with psychometric properties consistent with the original version.

Enhancing student nurses' ethical skills via simulation-based learning: barriers and opportunities

BACKGROUND

Nurses lack skills to analyse ethical problems, and some feel powerless and frustrated when encountering and having to deal with ethical dilemmas in clinical practice. The lack of ethical competence among nurses might somewhat be related to the neglect and side-lining of ethics in the education system. For those nurse educators who are facilitating ethics within their curriculum, their strategies and practices are inefficient due to lack of resources. Lack of efficient strategies to facilitate ethical competence create threats to ethical values in healthcare with a potential to jeopardise patients' health outcomes.

METHODS

This was a qualitative, descriptive, exploratory, and contextual research that was done in one higher education institution among 9 nurse educators and clinical nurse preceptors. Online semi-structured interviews were conducted, data were transcribed and analysed following Giorgi's thematic analysis method.

RESULTS

Two themes with 5 related subthemes emerged from the data. The theme of barriers that hinder the facilitation of ethical skills for nursing students indicated how Covid-19 pandemic lead to constraints that lead to facilitators focusing on clinical skills and procedures and side lining ethics education. While the theme transformative approaches to fostering ethical competency through simulation- based learning indicated some strategies that facilitators could adopt to ensure efficient ethics education for nursing students.

CONCLUSION

Barriers related to insufficient human resources and infrastructure made it almost impossible to facilitate ethics education among nursing students, especially during Covid-19 pandemic. This research offers some transformative solutions that could be adopted by higher education institutions to ensure that ethical competence is effectively facilitated.

Infectious diseases ethics: a worldwide survey

OBJECTIVES

COVID-19 unravelled new ethical issues in the neglected field of infectious diseases ethics (IDE). We investigated IDE involvement among infectious diseases professionals.

METHODS

A global survey was disseminated during 2021-2022. Responses were stratified by demographics, WHO region, income, and ethics training. A confirmatory factor analysis was used to identify two themes representing IDE relevant areas (theme 1, including stigma, inequity, vulnerability, public health, and global impact) and emerging topics (theme 2, including inequity and research integrity in COVID-19, increased ethics interest, and gaps in IDE). Quantile and logistic regression analyses investigated determinants of ethics themes and responders' ethics attitude.

RESULTS

We included 477 participants from 71 countries. Most were females (282/460, 61%) and clinicians (327/457, 72%). Participants advocated further personal (289/443, 65%) or societies' (374/450, 83%) involvement in bioethics. Only 5% (22/477) of respondents claimed to have received enough bioethics training and 28% (114/412) were dissatisfied with it. Dedicated courses or expert case discussion were the preferred ways for receiving education in bioethics. Theme 1 and 2 median values were above 7 (on a 1-10 scale), showing high interest in IDE. Confirmatory factor analysis showed optimal and acceptable fit, respectively. Being from the region of Americas was associated with theme 1, whereas having received bioethics training was associated with both themes. Females and respondents from the Americas and Europe regions reported lower involvement in bioethics activities, whereas those aged between 44 and 54 years and trained in bioethics were more involved. Age above 55 years and nonclinical role were negatively associated with aspiration for further bioethics involvement.

DISCUSSION

We identified IDE themes that can inform on gaps in bioethics. Ethics training was associated with interest in IDE and bioethics activities and should be offered to integrate this discipline into daily clinical practice across age, gender, and different areas worldwide.

Awareness of Financial Conflicts of Interest in Selecting Clinical Practice Guidelines Among Nepalese Oncologists: A Cross-Sectional Study

BACKGROUND

Financial conflicts of interest (FCOIs) between pharmaceutical companies and clinical practice guideline (CPG) authors can influence guideline recommendations, posing challenges to patient care. Despite global concerns, limited research exists on FCOI awareness among healthcare professionals in lower-middle-income countries like Nepal.

METHODS

This cross-sectional study, conducted between June 2020 and January 2021, aimed to assess FCOI awareness among Nepalese oncologists and identify associated factors. Data were collected through an online survey of 102 oncologists selected from three medical societies. Descriptive statistics and Fisher's exact tests were used for analysis.

RESULTS

Of the participants, 64 (63%) considered FCOIs between pharmaceutical companies and CPG authors when implementing guidelines. Significant associations were found between FCOI consideration and three factors: type of CPGs used, with higher consideration among users of national (80%) and international guidelines (69%) compared with local guidelines (44%) (p = 0.04); place of medical education, with higher consideration among Nepal-trained physicians (77%) compared with those trained abroad (61%) or both (44%) (p = 0.012); and experience in cancer field, with higher consideration among those with less than 10 years of experience (75%) compared with those having 10-20 years (49%) or more than 20 years (63%) of experience (p = 0.033).

CONCLUSION

While nearly two-thirds of Nepalese oncologists consider FCOIs when implementing CPGs, enhancing awareness among the remaining one-third is crucial. The findings suggest the need for targeted educational programs and stronger FCOI disclosure mechanisms, particularly as Nepal develops its own CPGs.

Assessing the performance of ChatGPT in medical ethical decision-making: a comparative study with USMLE-based scenarios

INTRODUCTION

The integration of artificial intelligence (AI) into healthcare introduces innovative possibilities but raises ethical, legal and professional concerns. Assessing the performance of AI in core components of the United States Medical Licensing Examination (USMLE), such as communication skills, ethics, empathy and professionalism, is crucial. This study evaluates how well ChatGPT versions 3.5 and 4.0 handle complex medical scenarios using USMLE-Rx, AMBOSS and UWorld question banks, aiming to understand its ability to navigate patient interactions according to medical ethics and standards.

METHODS

We compiled 273 questions from AMBOSS, USMLE-Rx and UWorld, focusing on communication, social sciences, healthcare policy and ethics. GPT-3.5 and GPT-4 were tasked with answering and justifying their choices in new chat sessions to minimise model interference. Responses were compared against question bank rationales and average student performance to evaluate AI effectiveness in medical ethical decision-making.

RESULTS

GPT-3.5 answered 38.9% correctly in AMBOSS, 54.1% in USMLE-Rx and 57.4% in UWorld, with rationale accuracy rates of 83.3%, 90.0% and 87.0%, respectively. GPT-4 answered 75.9% correctly in AMBOSS, 64.9% in USMLE-Rx and 79.6% in UWorld, with rationale accuracy rates of 85.4%, 88.9%, and 98.8%, respectively. Both versions generally scored below average student performance, except GPT-4 in UWorld.

CONCLUSION

ChatGPT, particularly version 4.0, shows potential in navigating ethical and interpersonal medical scenarios. However, human reasoning currently surpasses AI in average performance. Continued development and training of AI systems can enhance proficiency in these critical healthcare aspects.

Assessing the Current Limitations of Large Language Models in Advancing Health Care Education

Unlabelled

The integration of large language models (LLMs), as seen with the generative pretrained transformers series, into health care education and clinical management represents a transformative potential. The practical use of current LLMs in health care sparks great anticipation for new avenues, yet its embracement also elicits considerable concerns that necessitate careful deliberation. This study aims to evaluate the application of state-of-the-art LLMs in health care education, highlighting the following shortcomings as areas requiring significant and urgent improvements: (1) threats to academic integrity, (2) dissemination of misinformation and risks of automation bias, (3) challenges with information completeness and consistency, (4) inequity of access, (5) risks of algorithmic bias, (6) exhibition of moral instability, (7) technological limitations in plugin tools, and (8) lack of regulatory oversight in addressing legal and ethical challenges. Future research should focus on strategically addressing the persistent challenges of LLMs highlighted in this paper, opening the door for effective measures that can improve their application in health care education.

Blueprint of ethics content in undergraduate education: A workshop-research study

BACKGROUND

Ethics is a fundamental component of nursing education to increase students' moral competence and moral reasoning abilities. However, the core ethics content that should be included in undergraduate education has not been established to date at the international level.

AIM

To identify the core contents required in formal undergraduate education to ensure morally competent nurses.

RESEARCH DESIGN

An international workshop-research study design in 2023 reported here according to the COnsolidated criteria for REporting Qualitative research.

PARTICIPANTS AND RESEARCH CONTEXT

Five countries in the context of Promoting a Morally Competent Nurse project participated. In each country, two workshops took place, one with nurse professionals and one with patients' representatives for a total of 58 individuals (32 and 26, respectively). After being translated into English language, data were categorized deductively. The Dublin Learning Outcomes Descriptors and the blueprint methodology were applied.

ETHICAL CONSIDERATIONS

The research protocol was ethically approved in every country where the study was performed.

RESULTS

A total of 59 core content elements emerged, with 'ethics of individualized/tailored/patient-centred care' (n = 8) and 'empathy' (n = 6) as the most suggested. Nearly half (n = 26) of the core content items suggested were reported only once (e.g. 'priority setting') while overall several referred to 'communication skills' (n = 17). A diverse richness across countries emerged, with some suggesting a few items, and others providing several. Similarly, professionals and patients in most countries agreed that some contents of individualized care, empathy and responsibility should be taught in nursing education, but several core contents were mentioned by only one group of participants and in one country.

CONCLUSION

The lack of convergence on core content to be taught suggests that different views are still present. Merging these perspectives may stimulate a reciprocal understanding between professionals and patients, as well as across countries, and support the identification of commonalities and differences to further harmonize undergraduate education in the field.

Does education increase ethical sensitivity a semi-experimental study

Ethics education plays a crucial role in enhancing the ethical sensitivity of nursing students. This study aimed to assess the impact of an ethics course on the ethical sensitivity levels of nursing students. In this study, one-group pretest-posttest semi-experimental design method is used. The mean total score of the Ethics Sensitivity Scale for Nursing Students before education was determined as 4.93 (neutral), while the mean score increased to 5.62 (significant) after education. There was a statistically significant difference between the pre-education and post-education mean scores of students who reported encountering ethical problems during clinical practice. The findings underscore the importance of ethics education in fostering the ethical sensitivity and awareness of nursing students. They also highlight the need for high-quality ethics education that integrates theoretical knowledge with engaging content, real-life case studies, and practical applications to enhance students' learning experiences.

A podcast to teach medical humanities at medical school: a text-mining study of students' lived experience

The teaching of medical humanities is increasingly being integrated into medical school curricula. We developed a podcast called Le Serment d'Augusta (Augusta's Oath), consisting of six episodes tackling hot topics in the modern world of healthcare related to the patient-doctor relationship, professionalism, and ethics. This podcast aimed to provide scientific content in an entertaining way, while promoting debate among medical students. The Le Serment d'Augusta podcast was proposed as one of the various optional modules included in the second- to fifth-year curriculum at the School of Medicine of Sorbonne University (Paris). We asked students to report their lived experience of listening to the podcast. We then used a text-mining approach focusing on two main aspects: i) students' perspective of the use of this educational podcast to learn about medical humanities; ii) self-reported change in their perception of and knowledge about core elements of healthcare after listening to the podcast. 478 students were included. Students were grateful for the opportunity to participate in this teaching module. They greatly enjoyed this kind of learning tool and reported that it gave them autonomy in learning. They appreciated the content as well as the format, highlighting that the topics were related to the very essence of medical practice and that the numerous testimonies were of great added value. Listening to the podcast resulted in knowledge acquisition and significant change of perspective. These findings further support the use of podcasts in medical education, especially to teach medical humanities, and their implementation in the curriculum.

Factors contributing to the promotion of moral competence in nursing

Ethics is a foundational competency in healthcare inherent in everyday nursing practice. Therefore, the promotion of qualified nurses' and nursing students' moral competence is essential to ensure ethically high-quality and sustainable healthcare. The aim of this integrative literature review is to identify the factors contributing to the promotion of qualified nurses' and nursing students' moral competence. The review has been registered in PROSPERO (CRD42023386947) and reported according to the PRISMA guideline. Focusing on qualified nurses' and nursing students' moral competence, a literature search was undertaken in January 2023 in six scientific databases: CINAHL, Cochrane Library, PsycINFO, PubMed Medline, Scopus and Web of Science. Empirical studies written in English without time limitation were eligible for inclusion. A total of 29 full texts were retrieved and included out of 5233 citations. Quality appraisal was employed using Joanna Briggs Institute checklists and the Mixed Method Appraisal Tool. Data were analysed using inductive content analysis. Research about the factors contributing to the promotion of qualified nurses' and nursing students' moral competence is limited and mainly explored using descriptive research designs. The contributing factors were identified as comprising two main categories: (1) human factors, consisting of four categories: individual, social, managerial and professional factors, and ten sub-categories; and (2) structural factors, consisting of four categories: educational, environmental, organisational and societal factors, and eight sub-categories. This review provides knowledge about the factors contributing to the promotion of qualified nurses' and nursing students' moral competence for the use of researchers, nurse educators, managers, organisations and policymakers. More research about the contributing factors is needed using complex intervention, implementation and multiple methods designs to ensure ethically sustainable healthcare.

Ethical issues in palliative care: nursing and quality of life

BACKGROUND

Nurses occupy a pivotal role in the provision of palliative care, acting as frontline providers who address the physical, emotional, social, and spiritual needs of patients. The complexities inherent in palliative care frequently give rise to ethical dilemmas that significantly impact nurses' decision-making and patient interactions. It is therefore essential to gain an understanding of nurses' perceptions of ethical issues, quality of life, and adherence to patient rights in order to enhance the care delivered in these settings.

AIM

This study aims to assess the ethical issues encountered by nurses in palliative care, evaluate their quality of life, and measure their understanding and adherence to patient rights.

METHODS

A quantitative cross-sectional survey was conducted among a sample of 85 nurses working in palliative care settings, specifically within the Oncology Department and Pain Clinic at a Specialized Hospital in Egypt. A stratified random sampling technique was employed. The data were collected using standardised questionnaires, including the Ethical Issues Scale (EIS), the Nursing Quality of Life Scale (NQOLS), and the Patient Rights Questionnaire (PRQ). The validity and reliability of these instruments were established prior to the commencement of the study. The collected data were subjected to mean and standard deviation (SD) calculations. Statistical analyses, including the calculation of Pearson correlation coefficients, were conducted.

RESULTS

The study sample comprised a diverse cohort of nurses, with a mean age of 40 years. The ethical issues were evaluated, yielding a mean score of 4.03 (SD = 0.74) on the EIS, with the highest score for "Patient Care" (M = 4.2, SD = 0.7). The overall quality of life mean score was 6.75, with the working dimension exhibiting the highest mean score at 7.1. The PRQ results indicated a high level of awareness regarding patient rights, with a total mean score of 49.5 (SD = 6.8). The results of the correlation analysis indicated a moderate positive correlation between ethical issues and patient rights (r = 0.52, p < 0.01), and ethical issues and quality of life (r = 0.45, p < 0.01). Conversely, a weaker correlation was found between quality of life and patient rights (r = 0.40, p < 0.05).

CONCLUSIONS

The findings elucidate the ethical challenges confronted by nurses in palliative care and their ramifications for the quality of life and adherence to patient rights. It is imperative that nurses engaged in palliative care undergo continuous education and training in order to enhance their ethical decision-making abilities and thereby improve the quality of care they provide.

RECOMMENDATIONS

It is imperative that strategies be developed to support nurses in addressing ethical dilemmas, to promote awareness of patient rights, and to enhance their overall quality of life through targeted interventions and resources.

CLINICAL TRIAL

No clinical Trial.

Ethical self-efficacy among healthcare professionals caring for people with dementia: a brief pre- and post-report on the CARE intervention

BACKGROUND

Interventions targeting healthcare professionals' confidence in managing ethical issues in dementia care are limited despite documented positive effects of educational programs on staff knowledge and self-efficacy. However, inconsistencies in the literature regarding the impact of educational programs underscore the need for targeted interventions. The CARE intervention, specifically designed to enhance confidence in ethical decision-making, aims to address this gap. This study evaluates the effectiveness of the CARE intervention in enhancing the ethical self-efficacy of healthcare professionals caring for people with dementia, particularly those with initially low levels of self-efficacy.

METHODS

Using a non-experimental pre-post evaluation design, the CARE intervention was administered to healthcare professionals (n = 86), measuring ethical self-efficacy pre-and post-intervention. We hypothesized significant differences in ethical self-efficacy mean scores pre- and post-intervention for all participants, particularly those with low pre-measurement scores, whom we expected to benefit most from the intervention. Statistical analysis included paired t-tests and Wilcoxon tests for the low pre-measurement subgroup analysis.

RESULTS

While no significant change was observed in the entire sample, participants with low initial self-efficacy showed a statistically significant improvement post-intervention.

CONCLUSIONS

The CARE intervention holds promise in improving ethical self-efficacy among healthcare professionals with initial low confidence levels. Targeted interventions are essential in addressing confidence gaps in managing ethical challenges in dementia care, with implications for professional well-being and quality of care. Further research should explore long-term effects and expand sample size to enhance generalizability and sustainability of findings.

Possible Health Benefits and Risks of DeepFake Videos: A Qualitative Study in Nursing Students

BACKGROUND

"DeepFakes" are synthetic performances created by AI, using neural networks to exchange faces in images and modify voices.

OBJECTIVE

Due to the novelty and limited literature on its risks/benefits, this paper aims to determine how young nursing students perceive DeepFake technology, its ethical implications, and its potential benefits in nursing.

METHODS

This qualitative study used thematic content analysis (the Braun and Clarke method) with videos recorded by 50 third-year nursing students, who answered three questions about DeepFake technology. The data were analyzed using ATLAS.ti (version 22), and the project was approved by the Ethics Committee (code UCV/2021-2022/116).

RESULTS

Data analysis identified 21 descriptive codes, classified into four main themes: advantages, disadvantages, health applications, and ethical dilemmas. Benefits noted by students include use in diagnosis, patient accompaniment, training, and learning. Perceived risks include cyberbullying, loss of identity, and negative psychological impacts from unreal memories.

CONCLUSIONS

Nursing students see both pros and cons in DeepFake technology and are aware of the ethical dilemmas it poses. They also identified promising healthcare applications that could enhance nurses' leadership in digital health, stressing the importance of regulation and education to fully leverage its potential.

The relationship and influencing factors of critical thinking and medical ethical decision-making among pediatric medical students

Pediatric diseases possess unique characteristics, requiring pediatricians to have strong critical thinking skills and sound ethical decision-making abilities. This study aims to investigate and analyze the critical thinking dispositions of pediatric medical students and their impact on ethical decision-making levels, and to propose suggestions for improving teaching methods. A cross-sectional study design was adopted, using the Chinese version of the California Critical Thinking Disposition Inventory (CCTDI-CV) and an ethical decision-making questionnaire. An online survey was conducted among 240 pediatric medical students at Chongqing Medical University, collecting participants' basic demographic information. The study described the CCTDI-CV scores and ethical decision-making questionnaire scores (mean ± standard deviation), with distribution and trend analyses performed using t tests and H-tests. Pearson correlation analysis was used to examine the relationship between the 2, and regression analysis was conducted to explore factors influencing ethical decision-making abilities. A total of 229 students (95.4%) completed the survey. The overall average score of critical thinking disposition among pediatric medical students was 287.96 ± 39.09, with 139 students (60.70%) demonstrating positive or highly positive critical thinking dispositions. Ethical decision-making abilities were excellent in 85 students (37.12%). There was a significant positive correlation between critical thinking abilities and ethical decision-making abilities (R = 0.774, P < .001), particularly with analysis abilities, systematic abilities, and cognitive maturity showing higher correlations with total ethical decision-making scores. CCTDI-CV scores had a significant positive impact on ethical decision-making levels (P < .001), with factors such as family background and high school performance also significantly influencing ethical decision-making abilities (P < .001). Chinese pediatric medical students generally exhibit strong critical thinking and ethical decision-making abilities. Critical thinking plays a crucial role in medical ethical decision-making, with family background and high school performance being important influencing factors. Educators should focus more on developing multidimensional critical thinking skills to enhance students' ethical decision-making abilities, thereby improving overall healthcare service quality. The study results also provide new perspectives for international pediatric medical educators.

Informed Strategies Based on Education Research to Enhance the Learning Ecosystem

Educational institutions must change to create a learning ecosystem that prioritizes skills crucial for the 21st-century learners in the current global context that is quickly evolving. With an emphasis on evidence-based education, global citizenship, the integration of Sustainable Development Goals (SDGs), translatory practice, active learning strategies, improved clinical placement experiences, and peer learning, this paper explores the strategies for enhancing the efficacy of learning ecosystems. These elements are essential for encouraging continuous education in students and preparing them to meet their personal and professional needs. Through the integration of these components into instructional strategies, teachers can cultivate an atmosphere that readies students for the intricacies of contemporary work environments and global citizenship.

Tumor board simulation improves interdisciplinary decision-making in medical students

INTRODUCTION

Training of interdisciplinary clinical reasoning and decision-making skills, essential in daily clinical practice in oncological specialties, are still underrepresented in medical education. Therefore, at LMU University Hospital Munich, we implemented a didactically modified tumor board simulation with experts from five different disciplines (medical oncology, pathology, radiation oncology, radiology, and surgery) presenting patient cases into a one-week course on the basic principles of oncology. In this survey, we examined the self-assessed impact of our course on the interdisciplinary decision-making skills of medical students.

METHODS

Between November-December 2023 and January-February 2024, we surveyed two cohorts of medical students in the third year of medical school in our one-week course before and after participating in the tumor board simulation. The objective was to evaluate the self-assessed knowledge in interdisciplinary clinical decision-making, in integrating ethical considerations into clinical reasoning, and in comprehension of various professional viewpoints in interdisciplinary decision-making. Knowledge was assessed using a five-step Likert scale from 1 (no knowledge) to 5 (complete knowledge).

RESULTS

The survey was answered by 76 students before and 55 after the simulation, equaling 60-70% of all 100 course participants. Mean knowledge level regarding principles of interdisciplinary clinical decision-making improved significantly in all of the following exemplary aspects: purpose and procedure of tumor boards in clinical practice (from 2.4 ± 1.1 to 4.0 ± 1.0, Spearman's ρ = 0.6, p < 0.001), principles of dealing with ethical challenges in oncology (from 2.4 ± 1.1 to 3.4 ± 1.0, ρ = 0.4, p < 0.001), and principles of shared decision-making in oncology (2.7 ± 1.1 to 3.7 ± 1.0, ρ = 0.4, p < 0.001). Students reported that their skills in clinical decision-making and ability to discuss oncological patient cases from different professional viewpoints improved due to the teaching course.

CONCLUSION

By employing our interdisciplinary one-week course and a didactically modified tumor board simulation featuring experts from various oncological disciplines, medical students' comprehension of interdisciplinary clinical decision-making in oncology improved significantly.

Nurturing ethical insight: exploring nursing students' journey to ethical competence

BACKGROUND

Ethical competence is a key competence in nursing and the development of the competence is a central part in nursing education. During clinical studies, nursing students face ethical problems that require them to apply and develop their ethical knowledge and skills. Little is known about how ethical competence evolves during students' initial clinical placements. This study explored the development of ethical competence in first-year nursing students during their first clinical placements in nursing homes.

METHODS

This exploratory-descriptive qualitative study used focus group interviews to collect data and a phenomenological hermeneutical method for analysis. Twenty-eight first-year nursing students participated in six focus groups. The data were collected between March and April 2024 at Oslo Metropolitan University in Norway.

RESULTS

The naïve reading of the data involved an awareness of the students applying their prior knowledge, modifying their prior knowledge and developing skills that allowed them to manoeuvre ethical practices that, in some cases, appeared excellent and, in other cases, grim. The structural analysis identified three themes: (i) ethical competence forges in practice, (ii) ethical competence evolves at the intersection of knowledge and skills and (iii) ethical competence unfolds through meaningful discussions. A comprehensive understanding of the data was formulated as 'Being on a journey towards ethical competence'. This presents a metaphor illustrating that nursing students embark on a journey towards ethical competence; from their point of departure, their clinical experiences forge the essential waypoints along their path, knowledge and skills fuelling their navigation in rugged terrain towards their destination.

CONCLUSIONS

Nursing students' ethical competence evolved in intricate ways during their initial clinical period. Being informed bystanders or participants in the care of nursing home residents in situations of ethical tension may be a unique position enabling students to evaluate care options differently from those immersed in the ward culture. The findings indicate that organised professional development in nursing homes needs to focus on more reflexively driven ways of supervising students in their first clinical study period. Educational institutions need to continue and further develop reflection-based learning activities and meeting points with students and their peers during their clinical placement periods.

Ethical values held by nursing students. Comparative study in two country

INTRODUCTION

Ethical values are a guideline for behavior in certain situations. They take on particular importance in patient care. Ethical values depend on many factors including culture. The aim of this study is to compare the ethical values of nursing students.

METHODS

A cross-sectional study design was used. A total of 463 students participated in the survey, including 191 from Poland and 272 from Turkiye. The study was conducted from April to June 2022. For the purposes of this study was used Ethical Values Scale (IEVS). The criteria for excluding participants from the study were nursing student status and consent to participate in the study.

RESULTS

The IEVE total score for all respondents was 68.20 and the median was 68. In the individual subscales: Love-Respect 34.76 (median 35), Justice-Honesty 21.29 (median 21) and Cooperation 12.14 (median 12). Polish students' total IEVS score average was 70.48 ± 6.81 and Turkish students' IEVS total score average was 66.61 ± 9.65. There is a statistically significant difference between the total score average on the IEVS of students from the two countries (p < 0.001).

CONCLUSION

Students in both countries generally demonstrate high ethical standards. There are noticeable differences between the responses of students from Poland and Turkiye.

Moral caring competency and moral distress among Ghanaian nurses in adult care settings: A descriptive-correlational study

Background

Nurses in adult care settings frequently encounter moral distress due to the daily ethical obligations they must fulfill. In contrast to other healthcare professionals, nurses often grapple with a heightened frequency of moral dilemmas, resulting in increased moral distress.

Objective

This study aimed to explore the levels and relationship between moral caring competency and moral distress among Ghanaian nurses in adult care settings.

Methods

This quantitative study utilized a descriptive-correlational design. A multistage sampling was used to select three public hospitals. Simple random sampling was used to recruit 231 nurses from the three public hospitals. Data were collected from June to July 2023 using validated questionnaires. The study utilized frequency and percentages, mean and standard deviation, and Spearman's Correlation.

Results

The nurses had a low level of moral caring competency (M = 2.18, SD = 0.340). The composite moral distress score was 227.31, indicating a high level of moral distress among the nurses. Furthermore, there was a moderate, negative significant relationship between moral caring competency and moral distress (rs = -.474, N = 231, p <0.001).

Conclusions

Nurses in public hospitals had limited personal cognitive, affective, and psychomotor abilities to address patient moral issues. The nurses also experience significant moral distress when delivering patient care. Furthermore, to decrease the level of moral distress, moral caring competency should be strengthened among nurses. Therefore, it is recommended that nurse administrators provide adequate organizational support and implement continuous moral training to improve nurses' moral caring competency and mitigate their moral distress. Healthcare policymakers are encouraged to develop or refine policies to navigate moral dilemmas and reduce moral distress among nurses. Future studies employing qualitative designs can explore the influence of culture on moral caring competency within the Ghanaian setting.

Implementation of the Dementia Isolation Toolkit in long-term care improves awareness but does not reduce moral distress amongst healthcare providers

BACKGROUND

Healthcare providers may experience moral distress when they are unable to take the ethically or morally appropriate action due to real or perceived constraints in delivering care, and this psychological stressor can negatively impact their mental health, leading to burnout and compassion fatigue. This study describes healthcare providers experiences of moral distress working in long-term care settings during the COVID-19 pandemic and measures self-reported levels of moral distress pre- and post-implementation of the Dementia Isolation Toolkit (DIT), a person-centred care intervention designed for use by healthcare providers to alleviate moral distress.

METHODS

Subjective levels of moral distress amongst providers (e.g., managerial, administrative, and front-line employees) working in three long-term care homes was measured pre- and post-implementation of the DIT using the Moral Distress in Dementia Care Survey and semi-structured interviews. Interviews explored participants' experiences of moral distress in the workplace and the perceived impact of the intervention on moral distress.

RESULTS

A total of 23 providers between the three long-term care homes participated. Following implementation of the DIT, subjective levels of moral distress measured by the survey did not change. When interviewed, participants reported frequent experiences of moral distress from implementing public health directives, staff shortages, and professional burnout that remained unchanged following implementation. However, in the post-implementation interviews, participants who used the DIT reported improved self-awareness of moral distress and reductions in the experience of moral distress. Participants related this to feeling that the quality of resident care was improved by integrating principals of person-centered care and information gathered from the DIT.

CONCLUSIONS

This study highlights the prevalence and exacerbation of moral distress amongst providers during the pandemic and the myriad of systemic factors that contribute to experiences of moral distress in long-term care settings. We report divergent findings with no quantitative improvement in moral distress post-intervention, but evidence from interviews that the DIT may ease some sources of moral distress and improve the perceived quality of care delivered. This study demonstrates that an intervention to support person-centred isolation care in this setting had limited impact on overall moral distress during the COVID-19 pandemic.

Defining dignity in higher education as an alternative to requiring 'Trigger Warnings'

This article examines trigger warnings, particularly the call for trigger warnings on university campuses, and from a Levinasian and Kantian ethical perspective, and addresses the question: When, if ever, are trigger warnings helpful to student's learning? The nursing curriculum is developed with key stakeholders and regulatory bodies to ensure graduate nurses are competent to deliver a high standard of care to patients and clients. Practical teaching practice and published research has uncovered an increasing use of 'Trigger Warnings' before a topic is discussed, or used as warnings on core module texts. It is appreciated that some students have personal experience of psychological or physical trauma. However, apart from identifying these students through Mitigating Circumstances committees, or when the student feels confident to share this information with a personal tutor, this information remains strictly confidential. There is the potential for covert skills such as critical analysis and skilful discussion not being attained by the student. With the assistance of Kants moral theory, an argument will develop that the insidious use of Trigger warnings and the embargo of recommended reading, requires critical discussion with the public. This would involve the rationale and pedagogical justification for the use of texts, and the necessity within nursing education to address challenging clinical topics. To support students with PTSD this may involve the research discussed on personal educational needs analysis.

"Being prevented from providing good care: a conceptual analysis of moral stress among health care workers during the COVID-19 pandemic"

BACKGROUND

Health care workers (HCWs) are susceptible to moral stress and distress when they are faced with morally challenging situations where it is difficult to act in line with their moral standards. In times of crisis, such as disasters and pandemics, morally challenging situations are more frequent, due to the increased imbalance between patient needs and resources. However, the concepts of moral stress and distress vary and there is unclarity regarding the definitions used in the literature. This study aims to map and analyze the descriptions used by HCWs regarding morally challenging situations (moral stress) and refine a definition through conceptual analysis.

METHODS

Qualitative data were collected in a survey of 16,044 Swedish HCWs who attended a COVID-19 online course in autumn 2020. In total, 643 free-text answers with descriptions of moral stress were analyzed through content analysis.

RESULTS

Three themes emerged from the content analysis (1) "Seeing, but being prevented to act; feeling insufficient/inadequate and constrained in the profession," (2) "Someone or something hindered me; organizational structures as an obstacle," and (3) "The pandemic hindered us; pandemic-related obstacles." The three themes correspond to the main theme, "Being prevented from providing good care."

DISCUSSION

The main theme describes moral stress as various obstacles to providing good care to patients in need and acting upon empathic ability within the professional role. The themes are discussed in relation to established definitions of moral stress and are assessed through conceptual analysis. A definition of moral stress was refined, based on one of the established definitions.

CONCLUSIONS

On the basis of the study results and conceptual analysis, it is argued that the presented definition fulfils certain conditions of adequacy. It is essential to frame the concept of moral stress, which has been defined in different ways in different disciplines, in order to know what we are talking about and move forward in developing prevention measures for the negative outcomes of this phenomenon.

Training nurses to facilitate and implement CURA in palliative care institutions: development and evaluation of a blended learning program

BACKGROUND

Healthcare professionals in palliative care are found to be confronted with moral challenges on a frequent basis. CURA is a low-threshold instrument for dialogical ethical reflection that was developed to deal with these challenges. A previous study identified the need of healthcare professionals to be trained to introduce CURA in their organization, initiate and facilitate reflections with CURA, and contribute to the implementation of CURA. The aim of this study was to develop and evaluate a training for professionals to become 'CURA-ambassadors'.

METHODS

The training was developed in a participatory way in two cycles. We trained 72 healthcare professionals. The training was evaluated by means of a questionnaire and six semi-structured interviews.

RESULTS

The study resulted in a blended learning training combining training sessions with an e-module and with practicing with organizing and facilitating CURA in daily healthcare practice. The main objectives of the training are to enable CURA-ambassadors to introduce CURA within their organization, initiate and facilitate ethical reflections using CURA, and contribute to the implementation of CURA. Participants were generally positive about the training program and the trainers. Technical difficulties related to the e-module were mentioned as main point of improvement.

DISCUSSION

The training program can generate ownership, responsibility, and competency among CURA-ambassadors, which are essential foundations for implementing complex interventions in healthcare practice. The training program received positive evaluations shortly after completing the program. This study adds to our understanding of what is needed for healthcare professionals to use CURA, in order to support them in dealing with moral challenges and to foster their moral resilience. Further research is needed to assess whether participants experience the training as sufficient and effective when using and implementing CURA structurally in their organizations over a longer period of time.

Aligning values with standards: a comparison of professional values in Continuing Education standards

Continuing education (CE) aims to help health professionals fulfill their ethical responsibility of maintaining professional competence. This research compares the CE guidelines and standards of 11 health professional organizations in relation to five domains of evolving professional values: ethics, cultural diversity, social justice, interprofessionalism, and self-care. Results showed that ethics received the greatest attention across the CE standards, followed by interprofessionalism and cultural diversity. This study offers a starting point for CE accreditors to examine the extent to which their CE standards align with their profession's stipulated values, and to situate themselves within the broader context of health profession accreditors.

Physiotherapists' Ethical Climate and Work Satisfaction: A STROBE-Compliant Cross-Sectional Study

(1) Background: This study aimed to examine the relationship between Spanish physical therapists' perceptions of the ethical climate, their moral sensitivity (awareness of ethical issues), and job satisfaction. (2) Methods: the study analyzed descriptive correlational data on 104 physical therapists from three Spanish metropolitan hospitals. Respondents completed a demographic data form, an ethical climate questionnaire, a job satisfaction survey, and a moral sensitivity scale. This study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. (3) Results: With a mean score of 4.2, physical therapists are typically content with their jobs. The mean scores for the moral sensitivity and ethical climate questionnaires are high, at 40.1 (SD 6.3) and 96.8 (SD 17.1), respectively. There is a significant positive correlation between job satisfaction and ethical climate (r between 0.59 and 0.79) but only a weak correlation between job satisfaction and moral sensibility (r between 0 and 0.32 for the three aspects measured). (4) Conclusions: Generally speaking, physical therapists reported that they had high job satisfaction, a positive workplace environment, and excellent management support. Despite a weak relationship with moral sensibility, there is a strong association between ethical behavior, hospital organization, and higher levels of job satisfaction. It is important to encourage the development of moral sensibilities to boost psychological well-being and therapeutic decision-making.

Ethical considerations in the prehospital treatment of out-of-hospital cardiac arrest: A multi-centre, qualitative study

BACKGROUND

Prehospital emergency physicians have to navigate complex decision-making in out-of-hospital cardiac arrest (OHCA) treatment that includes ethical considerations. This study explores Danish prehospital physicians' experiences of ethical issues influencing their decision-making during OHCA.

METHODS

We conducted a multisite ethnographic study. Through convenience sampling, we included 17 individual interviews with prehospital physicians and performed 22 structured observations on the actions of the prehospital personnel during OHCAs. We collected data during more than 800 observation hours in the Danish prehospital setting between December 2019 and April 2022. Data were analysed with thematic analysis.

RESULTS

All physicians experienced ethical considerations that influenced their decision-making in a complex interrelated process. We identified three overarching themes in the ethical considerations: Expectations towards patient prognosis and expectations from relatives, bystanders, and colleagues involved in the cardiac arrest; the values and beliefs of the physician and values and beliefs of others involved in the cardiac arrest treatment; and dilemmas encountered in decision-making such as conflicting values.

CONCLUSION

This extensive qualitative study provides an in-depth look at aspects of ethical considerations in decision-making in prehospital resuscitation and found aspects of ethical decision-making that could be harmful to both physicians and patients, such as difficulties in handling advance directives and potential unequal outcomes of the decision-making. The results call for multifaceted interventions on a wider societal level with a focus on advance care planning, education of patients and relatives, and interventions towards prehospital clinicians for a better understanding and awareness of ethical aspects of decision-making.

Analyzing the Evolution of Medical Ethics Education: A Bibliometric Analysis of the Top 100 Cited Articles

Ethics education plays a pivotal role in healthcare by providing professionals and students with the essential competencies to navigate intricate ethical challenges. This study conducts a comprehensive bibliometric analysis of the most-cited articles on ethics education, investigating parameters such as citation count, document types, geographical origin, journal analysis, publication year, author analysis, and keyword usage. The findings reveal a substantial impact characterized by high citation counts and the influence of a prominent publication focusing on the hidden curriculum and structure of medical education. Moreover, the analysis demonstrates a discernible increase in research output since 2000, signaling a growing recognition of the significance of ethics education in the healthcare domain. Notably, specific journals, particularly those dedicated to medical education and ethics, emerge as major contributors in this field, publishing many articles. Renowned authors have made noteworthy contributions, and emerging themes encompass the ethical implications of virtual reality and artificial intelligence in healthcare education. Additionally, undergraduate medical education garners significant attention, emphasizing the importance of establishing ethical values and professionalism early. Overall, this study highlights the imperative of interdisciplinary collaboration and the necessity for effective ethics education programs to equip healthcare professionals with the requisite skills to navigate complex ethical challenges. The findings inform educators, curriculum developers, and policymakers about enhancing ethics education and ensuring the ethical competence of future healthcare practitioners.

The Right to Refuse: Understanding Healthcare Providers' Perspectives on Patient Autonomy in Emergency Care

Healthcare providers in prehospital care and emergency departments are often at the frontline of medical crises, facing a range of ethical dilemmas, particularly when it comes to patients refusing treatment. This study aimed to delve into the attitudes of these providers toward treatment refusal, unearthing the strategies they employ in navigating such challenging situations while actively working in prehospital emergency health services. Our findings showed that, as the participants' age and experience increased, so did their inclination to respect patient autonomy and avoid persuading them to change their decision about treatment. It was noted that doctors, paramedics, and emergency medical technicians demonstrated a deeper understanding of patients' rights than other medical specialists. However, even with this understanding, the prioritization of patients' rights tended to diminish in life-threatening situations, giving rise to ethical dilemmas. This underlines the complexity of balancing the healthcare professionals' responsibilities and the patients' autonomy, which can generate ethically challenging scenarios for those working in emergency healthcare. By investigating these attitudes and experiences, this study seeks to foster a more profound understanding of the ethical quandaries faced by emergency healthcare providers. Our ultimate aim is to contribute to the development of effective strategies that support both patients and professionals in managing these tough circumstances.