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Commentary on Nursing Ethics article: Facilitating ethics education in nursing students

Nursing Ethics 2014, Vol. 21(6) 742–745 ª The Author(s) 2014 Reprints and permission: sagepub.co.uk/journalsPermissions.nav 10.1177/0969733014538907 nej.sagepub.com

Annamaria Bagnasco, Gianluca Catania, Giuseppe Aleo and Loredana Sasso University of Genoa, Italy We found the article ‘Contribution of ethics education to the ethical competence of nursing students: Educators’ and students’ perceptions’ by Nancy Cannaerts et al.1 very interesting. We agree that nurses do not always have the competences to engage in ethical practice and that ethics education can increase ethical perception in nursing students and develop their reflective skills in a safe learning environment. In fact, we would suggest the simulation laboratory as a strategic safe learning environment for this purpose for various reasons. An ethical reflection on nursing actions implies the description of the ethical comportment on the basis of the models available in the healthcare and educational settings. Healthcare settings either have an organizational culture that can facilitate reflection in nursing students about ethical competence or are settings that do not support this type of reflection. Ethical education in nursing is facilitated through the identification of values, and organizational and personal models. For instance, an organizational model based on a list of tasks generates situations that are conditioned by a narrow vision focusing on the healthcare task, and not by a comprehensive view of the patient as a whole, by the rapidness of performing procedures and not by the humanization of care and viewing of patients as ‘persons’. Clinical training should offer students a learning opportunity that goes beyond the identification of the physiological needs, symptoms and the nursing interventions, and complete it with the identification of the values, choices and rights of the ‘persons’ they care for. Students often see ethics as a series of abstract principles and do not recognize the ‘ethical issues’ in nursing practice. Nursing curricula include contents regarding the ethical principles and the ethical nature of nursing behaviour. In order to interiorize ethical behaviour, this needs to be observed, practiced and experienced throughout the educational process. Such ethical competences can be built also by means of simulation labs and guided reflection and evaluated in appropriate settings that make ethical competence visible and measurable. During their education, students have difficulty recognizing the ethical implications of the actions linked to the care they provide to patients on a daily basis, in the relationships with their colleagues, and with the other healthcare team members. The exemplars that offer learning opportunities should be captured, discussed and shared by means of debriefing, starting from the clinical training experience. Clinical training is the context where all teachings, including ethics, are practically applied. Simulation centres can offer a protected and appropriate setting that facilitate this learning process and where students can integrate technical and relational behaviours with ethical decision-making through guided reflection exercises regarding the values at stake and the ethical implications embedded in the caring relationship. Realistic scenarios together with true life cases can facilitate reflection about daily practice and highlight the ethical complexity of the various scenarios. Therefore, also in the field of ethics education, teamwork between students and educators conducted in a simulated environment can be of great benefit in building the ethical competence of nursing students. Teamwork education conducted in a safe simulated environment also gives Corresponding author: Annamaria Bagnasco, Department of Health Sciences, University of Genoa, Via Pastore 1, I-16132 Genoa, Italy. Email: [email protected]

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students the possibility to exchange their ideas both with their peers and their educators, to discuss the best decisions (i.e. problem-based learning) and to analyse the ethical implications. This leads to what Vanlaere et al.2 describe as a ‘care-ethical lab’, a learning environment where ‘care ethics focuses on unearthing the valuebased vision underlying all of the care practices’. This enables students to analyse also the context of the situation but would also need to take into account the beliefs, feelings, sensations and experiences of those involved, which are linked to moral theory and influenced by cultural and social factors. The latter aspects could be addressed in the simulation lab with the support of a real person who plays the role of a patient. Another very important element that plays an important role in ethics education is the way educators are trained to teach ethics and their ethical knowledge base. Educators who teach ethics to nursing students are required to have both a solid experience in the field of clinical practice and a sound theoretical knowledge base in the field of ethics. In this way, educators should be able to adequately apply ethics theories to the clinical cases that can be used as practical examples for nursing students, both in classes and in the simulation ethics lab. In addition, educators would also have the skills and competences to select the best clinical cases from the students’ clinical apprenticeship experience, which would help students reflect deeper during their storytelling sessions. To conclude, we agree with Cannaerts et al. when they state that there is still a paucity of research studies focusing on the perceptions of educators about the contribution of ethics education, and to this, we would like to add that more attention needs to paid to the way educators who teach nursing ethics are prepared to do this work, both in classes and in simulation labs, to improve the effectiveness and quality of education in nursing ethics. References 1. Cannaerts N, Gastmans C and Dierckx de Casterle´ B. Contribution of ethics education to the ethical competence of nursing students: Educators’ and students’ perceptions. Nurs Ethics. Epub ahead of print 8 April 2014. DOI: 10. 1177/0969733014523166. 2. Vanlaere L, Coucke T and Gastmans C. Experiential learning of empathy in a care-ethics lab. Nurs Ethics 2010; 17(3): 325–336.

Response to Commentary (1): Effectiveness of Nursing Ethics education: Much more research needed Nancy Cannaerts, Chris Gastmans and Bernadette Dierckx de Casterle´ Catholic University of Leuven, Belgium In their comment, Dr Bagnasco and colleagues suggest the simulation lab as a strategic, safe learning environment to develop nursing students’ ethical competences. A simulation lab may offer the opportunity to students to recognize everyday ethical issues in nursing practice; to integrate technical, communicative and social Corresponding author: Nancy Cannaerts, Department of Health Care and Technology, University College of Nursing, Herestraat 49, 3000 Leuven, Belgium. Email: [email protected]

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Commentary on Nursing Ethics article: Facilitating ethics education in nursing students.

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