Nursing Ethics Education in Finland from the Perspective of Codes of Ethics

The purpose of this study was to analyze nursing ethics education from the perspective of nurses’ codes of ethics in the basic nursing education programmes in polytechnics in Finland with the following research questions: What is known about nurses’ codes in practice and education, what contents of the codes are taught, what teaching and evaluation methods are used, which demographic variables are associated with the teaching, what is nurse educators’ adequacy of knowledge to teach the codes and nursing students’ knowledge of and ability to apply the codes, and what are participants’ opinions of the need and applicability of the codes, and their importance in nursing ethics education. The aim of the study was to identify strengths and possible problem areas in teaching of the codes and nursing ethics in general. The knowledge gained from this study can be used for developing nursing ethics curricula and teaching of ethics in theory and practice. The data collection was targeted to all polytechnics in Finland providing basic nursing education (i.e. Bachelor of Health Care). The target groups were all nurse educators teaching ethics and all graduating nursing students in the academic year of 2006. A total of 183 educators and 214 students from 24 polytechnics participated. The data was collected using a structured questionnaire with four open-ended questions, designed for this study. The data was analysed by SPSS (14.0) and the open-ended questions by inductive content analysis. Descriptive statistics were used to summarize the data. Inferential statistics were used to estimate the differences between the participant groups. The reliability of the questionnaire was estimated with Cronbach’s coefficient alpha. The literature review revealed that empirical research on the codes was scarce, and minimal in the area of education. Teaching of nurses’ codes themselves and the embedded ethical concepts was extensive, teaching of the functions of the codes and related laws and agreements was moderate, but teaching of the codes of other health care professions was modest. Issues related to the nurse-patient relationship were emphasised. Wider social dimensions of the codes were less emphasized. Educators’ and students’ descriptions of teaching emphasized mainly the same teaching contents, but there were statistically significant differences between the groups in that educators assessed their teaching to be more extensive than what students had perceived it had been. T he use of teaching and evaluation methods was rather narrow and conventional. However, educators’ and students’ descriptions of the used methods differed statistically significantly. Students’ knowledge of the codes and their ability to apply them in practice was assessed as mediocre by educators and by students themselves. Most educators assessed their own knowledge of the codes as adequate to teach the codes, as did most of the students. Educators who regarded their knowledge as adequate taught the codes more extensively than those who assessed their knowledge as less adequate. Also students who assessed their educators’ knowledge as adequate perceived the teaching of the codes to be more extensive. Otherwise educators’ and students’ demographic variables had little association with their descriptions of the teaching. According to the participants, nurses need their own codes, and they are also regarded as applicable in practice. The codes are an important element in nursing ethics education, but their teaching needs development. Further research should focus on the organization of ethics teaching in the curricula, the teaching process, and on the evaluation of the effectiveness of ethics education and on educators’ competence. Also the meaning and functions of the codes at all levels of nursing deserve attention. More versatile use of research methods would be beneficial in gaining new knowledge.Hoitotyön etiikan opetus Suomessa eettisten ohjeiden näkökulmasta tarkasteltuna Tämän tutkimuksen tarkoituksena oli analysoida hoitotyön etiikan opetusta sairaanhoitajien eettisten ohjeiden näkökulmasta sairaanhoitajien peruskoulutuksessa Suomen ammattikorkea¬kouluissa seuraavilla tutkimuskysymyksillä: Mitä tiedetään sairaanhoitajien eettisistä ohjeista käytännössä ja koulutuksessa, mitä eettisten ohjeiden sisältöjä opetetaan, mitä opetus- ja arviointimenetelmiä käytetään, millä taustamuuttujilla on yhteys opetukseen, mikä on hoitotyön opettajien tietoperusta eettisten ohjeiden opettamiseen, mitkä ovat sairaanhoitajaopiskelijoiden tiedot eettisistä ohjeista ja taidot soveltaa niitä, ja mitkä ovat vastaajien mielipiteet eettisten ohjeiden tarpeellisuudesta ja soveltuvuudesta sekä niiden opettamisen tärkeydestä osana hoitotyön etiikan opetusta. Tutkimuksen tavoitteena oli tunnistaa eettisten ohjeiden ja hoitotyön etiikan opetuksen vahvuuksia sekä mahdollisia ongelma-alueita. Tutkimuksesta saatua tietoa voidaan käyttää hoitotyön etiikan opetussuunnitelmien ja etiikan teoreettisen ja käytännön opetuksen kehittämiseen. Aineiston keräys kohdistettiin kaikkiin Suomen ammattikorkeakouluihin, joissa on tarjolla sairaanhoitajakoulutusohjelma (sairaanhoitaja AMK). Kohderyhminä olivat etiikkaa opettavat hoitotyön opettajat ja lukuvuonna 2006 valmistuneet sairaanhoitajaopiskelijat. Kaikkiaan 183 opettajaa ja 214 opiskelijaa 24. ammattikorkeakoulusta osallistui tutkimukseen. Aineisto kerättiin tätä tutkimusta varten kehitetyllä strukturoidulla kyselylomakkeella, jossa oli myös neljä avointa kysymystä. Aineisto analysoitiin SPSS (14.0) ohjelmalla ja avoimet kysymykset induktiivisella sisällönanalyysillä. Aineisto esitettiin kuvailevan tilastotieteen menetelmin ja vastaajaryhmien välisiä eroja mitattiin vertailevan tilastotieteen menetelmin. Kyselylomakkeen luotettavuus arvioitiin Cronbach’in α-kertoimella. Kirjallisuuskatsaus osoitti, että tutkimusta eettisistä ohjeista on vähän ja se on lähes olematonta ohjeiden opetuksen alueella. Sairaanhoitajan eettisiä ohjeita ja niihin sisältyviä eettisiä käsitteitä opetettiin paljon, ohjeiden tarkoituksia ja ohjeisiin liittyviä lakeja ja sopimuksia opetettiin jokseenkin paljon, mutta muiden terveydenhuoltoalan ammattien eettisten ohjeiden opettaminen oli vähäistä. Opetuksessa korostui hoitaja-potilassuhteeseen liittyvät asiat. Eettisten ohjeiden yhteiskunnalliset ulottuvuudet korostuivat vähemmän. Opettajien ja opiskelijoiden kuvaukset opetuksen määrästä keskittyivät samoihin opetussisältöihin, mutta ryhmien väliset erot olivat tilastollisesti merkitseviä opettajien arvioidessa oman opetuksensa määrällisesti suuremmaksi kuin mitä opiskelijat olivat sen havainneet olleen. Opetus- ja arviointimenetelmien käyttö oli melko kapea-alaista ja perinteistä. Opettajien ja opiskelijoiden kuvaukset käytetyistä menetelmistä erosivat toisistaan tilastollisesti merkitsevästi. Sekä opettajat että opiskelijat itse arvioivat opiskelijoiden tiedot eettistä ohjeista ja taidot soveltaa niitä käytännössä keskitasoisiksi. Useimmat opettajat arvioivat oman tietoperustansa riittäväksi eettisten ohjeiden opettamiseen kuten useimmat opiskelijatkin. Ne opettajat, jotka arvioivat omat tietonsa riittäviksi, opettivat eettisiä ohjeita enemmän kuin ne, jotka arvioivat omat tietonsa vähemmän riittäviksi. Myös opiskelijat, jotka arvioivat opettajiensa tiedot riittäviksi kokivat saaneensa enemmän opetusta eettisistä ohjeista. Muilla opettajien ja opiskelijoiden taustamuuttujilla oli vähän yhteyttä heidän kuvaukseensa opetuksesta. Opettajien ja opiskelijoiden näkemysten mukaan sairaanhoitajat tarvitsevat omat eettiset ohjeet, ja ne ovat pääasiallisesti sovellettavissa hoitotyön käytäntöön. Ohjeet ovat tärkeä osa hoitotyön etiikan opetusta, mutta niiden opettamista pitää kehittää. Jatkotutkimus tulisi kohdistaa etiikan opetuksen organisointiin opetussuunnitelmissa, opetusprosessiin, ja opetuksen vaikuttavuuden sekä opettajien pätevyyden arviointiin. Myös eettisten ohjeiden merkitys ja tarkoitukset kaikilla hoitotyön tasoilla ansaitsevat huomiota. Monipuolisempi tutkimusmenetelmien käyttö olisi hyödyksi uuden tiedon hankkimiselle.Siirretty Doriast

Ethical climate and nurse competence - newly graduated nurses' perceptions

Background: Nursing practice takes place in a social framework, in which environmental elements and interpersonal relations interact. Ethical climate of the work unit is an important element affecting nurses' professional and ethical practice. Nevertheless, whatever the environmental circumstances, nurses are expected to be professionally competent providing high-quality care ethically and clinically. Aim: This study examined newly graduated nurses' perception of the ethical climate of their work environment and its association with their self-assessed professional competence, turnover intentions and job satisfaction. Method: Descriptive, cross-sectional, correlational research design was applied. Participants consisted of 318 newly graduated nurses. Data were collected electronically and analysed statistically. Ethical considerations: Ethical approval and permissions to use instruments and conduct the study were obtained according to required procedures. Data were rendered anonymous to protect participant confidentiality. Completing the questionnaire was interpreted as consent to participate. Findings: Nurses' overall perception of the ethical climate was positive. More positive perceptions related to peers, patients and physicians, and less positive to hospitals and managers. Strong associations were found between perceived ethical climate and self-assessed competence, turnover intentions in terms of changing job, and job satisfaction in terms of quality of care. Nurses at a higher competence level with positive views of job satisfaction and low turnover intentions perceived the climate significantly more positively. Conclusion: Nursing management responsible for and having the power to implement changes should understand their contribution in ethical leadership, as well as the multidimensional nature of nurses' work environment and the interaction between work-related factors in planning developmental measures. Future research should focus on issues in nurse managers' ethical leadership in creating ethical work environments. There is also a need for knowledge of newly graduated nurses' views of factors which act as enhancers or barriers to positive ethical climates to develop. Interventions, continuing education courses, and discussions designed to promote positive ethical climates should be developed for managers, nurses, and multi-professional teams.Peer reviewe

Newly graduated nurses' empowerment regarding professional competence and other work-related factors

cited By 1Peer reviewe

Moral Courage in Nursing - An Integrative Literature Review

Moral courage and understanding of its meaning are essential when nurses face ethical conflicts in their practice. This integrative review aimed to explore moral courage in nursing and possible associated individual and organizational factors. A database search in January 2020 identified 1308 scientific articles of which 25 were selected for the review. Inductive analysis with clear steps for defining and synthesizing themes in research reviews revealed three categories concerning moral courage in nursing: definition and descriptions of moral courage, characteristics of the morally courageous nurse, and skills and acts of the morally courageous nurse. Individual and organizational factors, such as positive personal experiences, commitment to ethical principles, supportive work environment and teamwork, were associated with moral courage in nursing, contributing to a more comprehensive description of nurses' moral courage. Findings indicate that in nursing practice, there is a need for promoting multi-professional collaboration and discussion of ethical dilemmas to provide opportunities to enhance moral courage. Developing care environments in which hierarchy does not inhibit nurses' moral courage seems justified. Further research on moral courage with varying methodologies and multi-disciplinary and international approaches is needed.</p

Nurses' self-assessed moral courage and related socio-demographic factors

Background: Nurses need moral courage to ensure ethically good care. Moral courage is an individual characteristic and therefore it is relevant to examine its association with nurses' socio-demographic factors.Objective: To describe nurses' self-assessed level of moral courage and its association with their socio-demographic factors.Research design: Quantitative descriptive cross-sectional study. The data were collected with Nurses' Moral Courage Scale and analyzed statistically.Participants and research context: A total of 482 registered nurses from a major university hospital in Southern Finland completed the Finnish language version of Nurses' Moral Courage Scale in autumn 2017.Ethical considerations: Ethical approval was obtained from the university ethics committee and permission for the data collection from the participating hospital. Ethical principles and scientific guidelines were followed throughout the research process.Findings: Nurses' self-assessed level of moral courage was rather high. On Visual Analogy Scale (0-10), the mean value was 8.20 and the mean score of the four dimensional, 21-item Nurses' Moral Courage Scale was 4.09 on a 5-point Likert-type scale. Respondents' gender, present work role, ethical knowledge base, additional ethics education, self-study as a means to acquire ethical knowledge, and frequency of work situations needing moral courage were statistically significantly associated with nurses' moral courage.Discussion: Strongest association was found between nurses' higher moral courage level and formal and informal ethics education. Honesty and patient's humane and dignified encounter received the highest scores indicating respondents' internalization of the core values of nursing.Conclusion: Although nurses were fairly morally courageous, moral courage should be a part of nurses' basic and continuing education thus covering its theoretical and practical learning. Since moral courage is a virtue that can be taught, learnt, and practiced, education is a relevant way to maintain and further strengthen nurses' moral courage.</p

Post doc -tutkijoiden urakehitykseen liittyvät kompetenssialueet – Scoping-katsaus

Scoping-katsauksen tarkoituksena oli kuvata tutkimusten perusteella post doc -tutkijoiden urakehitykseen liittyviä kompetenssialueita. Systemaattinen tietokantahaku suoritettiin yhdeksään tietokantaan (Academic Search Premier, CINAHL, Embase, Eric, Pubmed/Medline, PsychInfo, Scopus, SocIndex, Web of Science) rajaten haut vuosiin 2000–2020. Haku tuotti yhteensä 2231 viitettä, joista analyysiin valittiin kahdeksan tutkimusartikkelia. Tutkimukset analysoitiin deduktiivisesti hyödyntäen kansainvälisiin koulutusstrategiadokumentteihin perustuvia 12 kompetenssialuetta analyysikehyksenä. Tulosten mukaan post doc -tutkijoiden urakehitykseen liittyviä kompetenssialueita on tutkittu vähän, ja tutkimukset oli julkaistu 2010-luvulla. Kaikista kompetenssialueista oli löydettävissä kuvauksia, mutta erityisesti tutkimusetiikkaa tarkasteltiin niukasti. Aiheen hoitotieteellinen tutkimus oli vähäistä ja lisätutkimusta tarvitaan post doc -tutkijoilta edellytettävien kompetenssialueiden määrittämiseksi ja uralla kehittymisen tukemiseksi. Tutkimusta tulisi laajentaa esimerkiksi yritysten, globaalin terveyden ja kestävän kehityksen näkökulmista.&nbsp;&nbsp

Validation of the Dutch-language version of Nurses' Moral Courage Scale

Background:Moral courage as a part of nurses' moral competence has gained increasing interest as a means to strengthen nurses acting on their moral decisions and offering alleviation to their moral distress. To measure and assess nurses' moral courage, the development of culturally and internationally validated instruments is needed.Objective:The objective of this study was to validate the Dutch-language version of the four-component Nurses' Moral Courage Scale originally developed and validated in Finnish data.Research design:This methodological study used non-experimental, cross-sectional exploratory design.Participants and research context:A total of 559 nurses from two hospitals in Flanders, Belgium, completed the Dutch-language version of the Nurses' Moral Courage Scale.Ethical considerations:Good scientific inquiry guidelines were followed throughout the study. Permission to translate the Nurses' Moral Courage Scale was obtained from the copyright holder, and the ethical approval and permissions to conduct the study were obtained from the participating university and hospitals, respectively.Findings:The four-component 21-item, Dutch-language version of the Nurses' Moral Courage Scale proved to be valid and reliable as the original Finnish Nurses' Moral Courage Scale. The scale's internal consistency reliability was high (0.91) corresponding with the original Nurses' Moral Courage Scale validation study (0.93). The principal component analysis confirmed the four-component structure of the original Nurses' Moral Courage Scale to be valid also in the Belgian data explaining 58.1% of the variance. Confirmatory factor analysis based on goodness-of-fit indices provided evidence of the scale's construct validity. The use of a comparable sample of Belgian nurses working in speciality care settings as in the Finnish study supported the stability of the structure.Discussion and conclusion:The Dutch-language version of the Nurses' Moral Courage Scale is a reliable and valid instrument to measure nurses' self-assessed moral courage in speciality care nursing environments. Further validation studies in other countries, languages and nurse samples representing different healthcare environments would provide additional evidence of the scale's validity and initiatives for its further development.</div

Analysis of graduating nursing students’ moral courage in six European countries

Background: Moral courage is defined as courage to act according to one's own ethical values and principles even at the risk of negative consequences for the individual. In a complex nursing practice, ethical considerations are integral. Moral courage is needed throughout nurses' career.Aim: To analyse graduating nursing students' moral courage and the factors associated with it in six European countries.Research design: A cross-sectional design, using a structured questionnaire, as part of a larger international ProCompNurse study. In the questionnaire, moral courage was assessed with a single question (visual analogue scale 0-100), the questionnaire also covered several background variables.Participants and research context: The sample comprised graduating nursing students (n = 1796) from all participating countries. To get a comprehensive view about graduating nursing students' moral courage, the views of nurse managers (n = 538) and patients (n = 1327) from the same units in which the graduating nursing students practised were also explored, with parallel questionnaires.Ethical considerations: Ethical approvals and research permissions were obtained according to national standards in every country and all participants gave their informed consent.Results: The mean of graduating nursing students' self-assessed moral courage was 77.8 (standard deviation 17.0; on a 0-100 scale), with statistically significant differences between countries. Higher moral courage was associated with many factors, especially the level of professional competence. The managers assessed the graduating nursing students' moral courage lower (66.5; standard deviation 18.4) and the patients slightly higher (80.6; standard deviation 19.4) than the graduating nursing students themselves.Discussion and conclusions: In all countries, the graduating nursing students' moral courage was assessed as rather high, with differences between countries and populations. These differences and associations between moral courage and ethics education require further research.</p

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

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