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Background and Purpose: The purpose of reflection in the learning process is to create meaningful and deep learning. Considering the importance of emphasizing active and student-centered methods in learning and the necessity of learners' participation in the education process, the present study was conducted to investigate the effect of flipped classroom teaching method on the amount of reflection ability in nursing students and the course of professional ethics., Study Method: The current study is a quasi-experimental study using Solomon's four-group method. The statistical population included all nursing students who were taking the professional ethics course at Kermanshah University of Medical Sciences. The study tool was a 26-item questionnaire with acceptable validity and reliability. The sample size was 80 nursing students by simple random method and divided into four groups, which included: 1- experimental group 1 2- experimental group 2 3- control group 1, and control 2. The collected data were used by SPSS software and using descriptive statistics methods and two-way analysis of variance and analysis of covariance analysis., Findings: The findings showed that the four investigated groups do not have statistically significant differences in terms of gender composition (p = 0.599). There was no significant difference between the control and experimental groups in terms of all 5 reflection components in the pre-test. A significant difference was observed between the amount of reflection of the experimental and control groups., Conclusion: Considering that there are controversial issues in the course of professional ethics, this method can be effective in the field of deep learning of students., Competing Interests: Declarations. Ethics approval and consent to participate: We obtained ethics approval from the Ethics Committee of the Kermanshah University of Medical Sciences for this study. All methods were carried out in accordance with relevant guidelines and regulations. This article is the result of the research project of Kermanshah University of Medical Sciences with the code of ethics IR.KUMS.REC.1401.453. Informed consent to participate was obtained from all of the participants in the study. The present work is the outcome of a research proposal from Kermanshah University of Medical Sciences. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

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., Competing Interests: Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: This study has been reviewed and approved by a university’s Non-Interventional Ethics Committee (Protocol Code: 2021/44). The voluntary participants of the study were provided with detailed information about the purpose and procedures of the research. The personal information and privacy of the participants are of utmost importance, and the confidentiality of this information is rigorously maintained. Written and verbal consent was obtained from participants. Those who agreed to fill out the form first gave their consent and then answered the questions. The anonymity and confidentiality of the participants’ information were ensured. This reflects our commitment to adhering to ethical principles and protecting the rights of the participants., (© 2024. The Author(s).)

Background: The ethical component in midwifery education is governed by international professional values, codes, and ethical principles. The aim of midwifery education is to encourage students to develop a lifelong commitment to ethical practice within their midwifery role and scope. However, little evidence is available on the experiences of midwifery students and how they navigate ethical issues in maternity systems., Aim: To present a case study from a midwifery students' perspective that demonstrates observed ethical issues and to provide analysis of the ethical issues identified., Design: A Single explanatory case study design with a feminist lens applied. Explanatory case studies present the 'how and why' of a phenomenon and contributes to understanding phenomena in a holistic and real-life context., Setting: This project was set at a West Australian university from which pre-registration midwifery courses are delivered., Participants: A solitary case study is presented from a midwifery students' clinical placement., Methods: Ethics were approved 2023-04805. Edith Cowan University HREC. The source of data for this case study was direct observation by the primary author (Priya, 2021) and the Joanna Briggs Methods for Case study reporting guide followed. Thematic analysis with a feminist lens was applied to the data., Results: Three themes were generated 'Through the looking glass; observing ethical issues'; 'Whose body Is It? The Erosion of Maternal Consent' and 'Relational care versus defensive practice'. These themes explain the antecedents and consequences of the ethical issues identified by the midwifery student, the findings are supported by ethical theory and midwifery philosophy to highlight some of the underlying causes that contribute to ethical issues., Conclusion: Midwifery students experience ethical distress when they observe ethical issues and are powerless to support birth people in a way that aligns with midwifery philosophy of relational, woman-centred care. Further research is required to better understand how midwifery students may be better supported to foster ethical care., Competing Interests: Declaration of competing interest There is no Conflict of Interest to declare., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Although the literature includes studies on nursing students' ethical sensitivity and compassion competence, no study has examined and compared these skills among nursing students from different cultures., Aim: This research determined and compared the ethical sensitivity and compassion competency levels of nursing students in two different geographies, one in Turkey (Group I) and one in the Turkish Republic of Northern Cyprus (Group II), which hosts students with different cultural characteristics., Design: Quantitative and cross-sectional research., Method: The research was conducted with 201 nursing students in Group I and Group II, who were studying in the English Nursing program at the Nursing Faculties, received clinical practice training, took ethics in nursing courses, and agreed to participate. "Sociodemographic Form," "Moral Sensitivity Questionnaire," and "Compassion Competence Scale" were used to collect data. Frequency, percentage, mean, standard deviation, and Pearson correlation analysis were used to evaluate the data., Results: The mean "Moral Sensitivity Questionnaire" scores of nursing students in Group I and Group II are 149.52 (SD 21.13) and 155.63 (SD 25.21), respectively. The mean scores of the nursing students in Group I and Group II on the "Compassion Competence Scale" are 3.88 (SD 0.47) and 4.29 (SD 0.50), respectively. It was determined that the "Moral Sensitivity Questionnaire" and "Compassion Competency Scale" mean scores of the nursing students in Group II were higher than those of the nursing students in Group I, and this difference was statistically significant (p < 0.05)., Conclusion: The moral sensitivity and compassion competence of nursing students at the two universities were high. When the scores of the groups were compared, it was observed that the moral sensitivity and compassion competence levels of the nursing students in Group II were statistically significantly higher than those of the nursing students in Group I. The predictors of this were evaluated as to why students chose the nursing department, the country, and the department they liked., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: With the increasing ethical challenges and dilemmas faced by nurses due to various disasters such as COVID-19 worldwide, there is a need for a new public health ethics education curriculum to strengthen competencies for ethical responses in the nursing field., Objectives: This study was aimed to identify the impact of a teaching method utilizing news articles and panel discussion material in the public health ethics education program on nursing students' thinking regarding ethical issues., Design: This was an exploratory study to identify the thinking styles inherent in ethical reflection by analyzing the reflection contents written by nursing students using text mining techniques., Participants: 73 among the students taking a nursing ethics course at a university in Seoul, South Korea, voluntarily participated in this study after providing informed consent., Methods: The public health ethics program was conducted with sessions held once a week for a total of 7 weeks, and reflections written by nursing students were collected as text files during session 5 to 7. In this study, data preprocessing process, keyword analysis, and LDA topic modeling were sequentially conducted utilizing the R program according to the data analysis procedure of text mining techniques., Ethical Considerations: This study was conducted under ethics approval from the institution where participants were recruited., Findings and Discussion: The results of this study show that the teaching method utilizing news articles enhanced rational ethical deliberation from the cognitive aspect, whereas the teaching method utilizing panel discussion material strengthened the response to emotions on a more internal level., Conclusions: The teaching method utilizing news articles and panel discussion materials in public health ethics education is expected to be mutually complementary and effective, so further studies are recommended., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Moral sensitivity and academic integrity discernment hold paramount importance for healthcare professionals. Owing to distinct undergraduate educational backgrounds, nurses and physicians may exhibit divergent moral perspectives, academic integrity cognisance, and moral sensitivity within clinical environments. A limited number of studies have investigated the disparities and congruencies pertaining to moral sensitivity and academic ethical awareness among nursing and medical students., Objective: The study compares moral sensitivity and academic ethical awareness of undergraduate nursing and medical students with and without clinical exposure., Research Design: A self-administered cross-sectional survey conducted from January to February 2022 was used to collect data from a medical school in Hong Kong., Participants and Research Context: A total of 545 respondents, including 137 nursing students and 408 medical students, completed the questionnaire., Ethical Consideration: Ethics approval of the study was obtained. Written consent was waived to maintain anonymity because completing the questionnaire was considered implied consent., Findings: Both groups of undergraduates demonstrated a high level of bioethics knowledge. In terms of academic integrity, medical students were found to have a less concerned attitude towards punctuality, attendance, and skipping classes. Regarding moral sensitivity, senior medical students with clinical experience put less emphasis on decision-making involving patient participation, while senior nursing students were more hesitant in withholding treatment for incompetent patients who refused treatment. Both nursing and medical students showed decreased moral sensitivity in the 'conflicts' domain with increased clinical exposure., Conclusion: Study findings contribute to the discussion comparing the ethical attitudes of nursing and medical students. More effort should be made in nursing and medical education to promote practices in line with high academic integrity and to develop the ability to be morally sensitive in professional settings., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Nurses frequently experience ethical issues in their area of practice. In the challenging reality of today's healthcare environment, nursing students need to be prepared to deal with ethical issues in their future roles. Nevertheless, Chinese nursing students' ethical sensitivity status and the factors influencing it have not been described., Objective: This study aims to explore the level of ethical sensitivity and its influencing factors among Chinese nursing students., Research Design: This was a cross-sectional study. We firstly cross-culturally adapted the Japanese version of the Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS) into a Chinese version. Then, we administered the Chinese version of ESQ-NS, the Caring Ability Inventory (CAI), and general information questionnaire to nursing undergraduates., Participants and Research Context: The invitations were sent to 600 nursing undergraduates from four universities in Hunan, China., Ethical Considerations: The study was supported by the Institutional Review Board (IRB) of the lead university. The Approval No. was E202092., Results: A total of 489 undergraduate nursing students participated in the study. The mean score for ethical sensitivity of the samples was 36.34 ± 4.90, and 187.99 ± 22.64 for their humanistic care ability. Pearson's correlation coefficient test indicated a meaningful and positive relationship between the ethical sensitivity and humanistic care ability (r = 0.576 and p < .01). And regression analysis showed that age, school year, experience in studying nursing ethics, how much you like nursing major, and humanistic care ability were of relevance to nursing students' ethical sensitivity., Discussion: Our findings suggest that the mean ethical sensitivity score of Chinese nursing students is 36.34 (13-52). The humanistic caring ability of Chinese nursing students is still at a low level., Conclusion: Future interventions for improving the ethical sensitivity of the nursing students should consider general information of participants and their humanistic care ability., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The urgency of ensuring adequate moral courage in clinical nursing practice is evident. However, currently, there are few formal intervention plans targeted at enhancing the moral courage of nurses., Aim: To develop a training program for improving the moral courage of nurses using the modified Delphi method., Research Design: A modified Delphi study., Participants and Research Context: From November to December 2022, a literature review and expert group discussion were conducted to develop a preliminary training plan framework. From January to March 2023, a two-round Delphi survey was performed, and a consensus was reached regarding the plan through online questionnaires. Descriptive statistics were used to analyze the data., Ethical Considerations: This study was approved by the institutional ethics committee (No. 138, 30 August 2021). All participants provided written informed consent., Results: Consensus was reached on eight themes and 33 items to strengthen the moral courage training program for nurses., Conclusions: Guided by a unified goal of moral education, a multi-level and acceptable intervention plan was designed to enhance the moral courage of nurses., Competing Interests: Declaration of conflicting interestsThe author(s) declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Ensuring morally competent nurses depends on many factors, such as environmental, social, political, and cultural. However, several inadequacies in nursing education have been documented, and no common framework has been established for how nursing ethics should be taught in undergraduate education., Research Questions: What are the different approaches across nursing programmes established in teaching ethics? What are the main similarities and differences across programmes facilitating a common understanding in developing a curriculum capable of preparing a morally competent nurse?, Research Design: International comparative education study in five steps: (1) formulating the initial question; (2) defining the units of comparison; (3) determining the variables of comparison; (4) describing the findings; (5) interpreting the findings. The comparative variables were identified, extracted, and populated in a piloted grid., Participants: Six universities were purposefully selected by the Promoting a Morally Competent Nurse project partners for their nursing education curricula as delivered in 2022-2023., Ethical Considerations: No ethical approval was required, given no human participants and public data regarding nursing curricula., Findings: Variability emerged in the terminologies used in naming the courses, the numbers of credits and hours devoted to teaching ethics, when the courses are delivered (since the initial semesters of nursing education or concentrated in the final years), and their main modes of delivery (a single or separate module or integrated across the curriculum). Contents have some similarities, whereas the teaching methods varied and included (or not) explicit connections with clinical practice. Attendance is mandatory in all courses. The assessment methods used varied from knowledge-based to more competence-based approaches involving multidimensional strategies., Conclusions: This comparative study explored similarities and differences across nursing programmes in six different European countries. The reviewed ethics curricula lack significant clarity, and they offer important areas to consider for future development. Issues emerged regarding terminologies, learning workloads, when to deliver, how to deliver, the main contents, and the teaching and assessment methods that merit further discussion., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Interventions to improve ethical decision-making are available in nursing education. Evidence of its effectiveness is essential., Objective: This review examined the effectiveness of interventions to improve nursing students' ethical decision-making skills., Methods: A structured search was performed in Google Scholar, Web of Science, Science Direct, Pubmed, Scopus, Cochrane Library, Elsevier, CINAHL EBSCO, and ULAKBIM. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instruments (JBI-MAStARI) was used to assess the quality of studies., Ethical Considerations: Ethical approval was not required for this systematic review., Findings: The final review was composed of six studies of published between January 2013 and 2023. Nine different teaching methods applied to students. Although the importance of ethical decision-making skills in solving ethical problems that nurses may encounter at any time is known, it is thought that there is a lack of data in the literature in the last 10 years. The last 10 years were chosen as this aims to provide a review based on the most current, relevant and quality information. The review indicated that all of the teaching methods improved ethical decision-making., Conclusion: Different teaching methods can be used in the nursing education curriculum to meet the learning needs of nursing students in ethical decision-making., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: This article examines teaching the consequences of harm and error to multisite prelicensure baccalaureate, second-degree baccalaureate, and graduate nursing students utilizing the RaDonda Vaught Trial as an exemplar. The Jigsaw Technique (JT) was the chosen learning strategy to empower students with knowledge and understanding through the lens of terms acquired throughout existing concept-based nursing curriculum., Results: Nursing students evaluated the approach to this activity using both quantitative and qualitative feedback. A total of 188 nursing students completed the survey, including undergraduate and graduate nursing students. Qualitative data obtained from students through open comments revealed common perceptions about such focal areas as advocacy, license protection, system failures, medication errors, and legal documentation. Quantitative outcomes related to the utilization of the JT approach were overwhelmingly positive., Conclusion: Results indicate that our approach, combining the RaDonda Vaught case with the JT, was an effective strategy for teaching the consequences of medical errors in nursing practice., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Aim: Compare the effects of Simulation with problem-based learning (SPBL) and Problem-based learning (PBL) in nursing ethics education on nursing students' moral sensitivity, empathy, critical thinking, test scores and teaching satisfaction., Background: Promoting nursing students' individual and ethical and abilities through education is an essential way to improve their ethical performance and build trustful relationship with patients. Despite significant efforts in this area, few have evaluated the effectiveness of Simulation with problem-based learning and Problem-based learning as applied to nursing ethics education., Design: A quasi-experimental design based on a non-equivalent control group pre-test/post-test., Methods: A quasi-experimental design was used. Participants were 161 undergraduate nursing students from two levels of a university, 88 subjects in the experimental group were taught using Simulation with problem-based learning and 73 subjects in the control group were taught using Problem-based learning. A pre-test, post-test and questionnaire were used to assess the effectiveness of student nursing ethics education. χ 2 test was used to examine group differences in students' characteristics and satisfaction with teaching post-intervention. Student's t-test was used to assess group differences in scale scores and test scores., Results: Compared to the pre-test, empathy as well as critical thinking were significantly higher in the PBL group (P<0.05), but there was no significant change in moral sensitivity (P>0.05); moral sensitivity, empathy and critical thinking were significantly higher in the SPBL group (P<0.05). Moreover, this study also showed that improvement in moral sensitivity, empathy, critical thinking and grades was more significant in the SPBL group of nursing students compared to the PBL group (P<0.05) and no statistically significant difference was found between the two groups in terms of teaching satisfaction (P>0.05)., Conclusion: The use of Simulation with problem-based learning in nursing ethics education has a positive impact on nursing students' competency development and knowledge acquisition. Nurse educators should consider this teaching method and promote change to increase the effectiveness of nursing ethics education., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

As the use of artificial intelligence (AI) technologies, particularly generative AI (Gen AI), becomes increasingly prevalent in nursing education, it is paramount to address the ethical implications of their implementation. This article explores the realm of cyberethics (a field of applied ethics that focuses on the ethical, legal, and social implications of cybertechnology), highlighting the ethical principles of autonomy, nonmaleficence, beneficence, justice, and explicability as a roadmap for facilitating AI integration into nursing education. Research findings suggest that ethical dilemmas that challenge these five principles can emerge within the context of nursing education; however, adherence to these very principles, which is essential to improving patient care, can offer solutions to these dilemmas. To ensure the ethical and responsible use of Gen AI in nursing education, these principles must be woven into the fabric of curricula, and appropriate guidelines must be developed. Nurse educators have a pivotal role in strategizing comprehensive approaches for ethical AI integration, establishing clear guidelines, and instilling critical thinking among students. Fostering lifelong learning and adaptability is key to ensuring that future nurses can successfully navigate the constantly evolving landscape of health care technology. Future research should investigate the long-term impacts of AI utilization on learning outcomes and ethical decision-making., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

As healthcare providers, ethical decisions are woven into the fabric of our profession from bedside care to the use of simulation as an educational pedagogy. Simulation as a method for healthcare education began in response to ethical dilemmas in clinical practice. Educators require an interactive approach to education that will keep patients, learners, and faculty psychologically safe, decrease errors in clinical practice, and engage participants, all of which are inherent in simulation-based experiences. Professional integrity and morality are infused throughout simulation design: prebriefing, facilitation, debriefing, and evaluation., Competing Interests: Disclosure The authors have no commercial or financial conflicts of interest or any funding sources., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Moral reasoning in nursing is crucial in delivering high-quality patient care and fostering increased job satisfaction among nurses. Adhering to professional values is vital to this profession, and nurses must modify their actions to align with these values., Objective: This study aimed to examine the correlation between moral reasoning and professional values among undergraduate nursing students., Research Design: A descriptive correlational design was recruited., Participants and Research Context: The research was conducted at three nursing schools located in Tehran, Iran. The sample was recruited through random stratified sampling, specifically targeting undergraduate nursing students. The data collection tool comprised a three-part questionnaire, including a demographic information form, the Nursing Dilemma Test, and the Nurses Professional Values Scale Revised Questionnaire. The distribution of questionnaires encompassed both face-to-face and electronic methods. The analysis of data was conducted using SPSS 16 software. The data was analyzed using the independent samples t-test, Pearson's correlation coefficient, and linear regression analysis. The P value of 0.05 was considered significant., Ethical Considerations: The Ethics Research Center of Shahid Beheshti University of Medical Sciences approved the study., Findings: Data analysis showed that moral reasoning was directly correlated to professional values (r = 0.528, p < 0.001). The mean scores of Principled Thinking (P.T.), Practical Consideration (P.C.), and Familiarity with similar moral dilemmas of the NDT scale were 42.55 (SD = 12.95), 15.72 (SD = 6.85), 16.08 (SD = 6.67), respectively. Also, the total score of professional values of students was 90.63 (SD = 28.80)., Conclusion: The findings indicated that moral reasoning and interest in nursing predict students' professional identity. Thus, any effort to enhance interest in the profession can contribute to developing students' professional identity. This can involve incentivizing, enhancing the professional reputation at the community and university levels, and valuing student preferences and necessities., (© 2024. The Author(s).)

Objectives: This study aims to fill the existing gap by examining the current status of off-the-job nursing ethics training in large hospitals in Japan and its integration with on-the-job training to provide targeted insights for enhancing future ethics training., Method: A cross-sectional study was conducted among the nursing education staff of large Japanese hospitals [N=309] by self-administered questionnaire. The questionnaire was the following main points 1) current trends in nursing ethics training 2) planners' concerns, and 3) the link between training and clinical practice. Descriptive statistics were used, closed-ended questions were analyzed through simple tabulations while open-ended questions underwent textual analysis., Results: The hospitals of 76.6% (309) conducted off-the-job nursing ethics training. Their training consists of a combination of lectures and exercises. The focus was to raise nurses' awareness of ethical problems or improve their analytical ability. The objectives were to be able to participate in discussions from an ethical perspective. The main problems were the lack of connection with on-the-job, and a shortage of training personnel., Conclusions: The key to providing off-the-job and on-the-job is to create a mechanism for circulation. The implications of the results are the necessity of constructing ethics education in medicine to develop medical professionals who can discuss and act from ethical perspectives. Future research is expected to include the creation of a multidisciplinary ethics training program for the hospital.

Aim: This study aims to determine the effect of education based on the Theory of Human Caring on nursing students' caring behaviors and ethical attitudes., Background: It is crucial to plan nursing education holistically, addressing cognitive, psychomotor and affective domains for the comprehensive development of caring behaviors and ethical attitudes., Design: This study employed a convergent mixed-methods approach with randomized pretest-posttest comparisons and qualitative analysis., Methods: This study was conducted with third-year nursing students at a state university in Ankara, Turkey, in 2021. It comprised a total of 95 participants, with 47 students in the case group and 48 students in the video group. Theoretical education based on the Theory of Human Caring was simultaneously provided to both groups. Following this, one group received practical training using a video-supported teaching method, while the other group received it through a case analysis method. The research used the 'Descriptive Characteristics Form', 'Caring Nurse Patient Interaction Scale (CNPIS)', 'Scale for Attitudes of Ethical Principles (SAEP)' and 'Student Opinion Form on Care Behaviors Education' to collect data. Quantitative data were analyzed using t-tests, Mann-Whitney U tests, Wilcoxon paired two-sample tests and Linear Regression Analysis, with a significance level of p<0.05. Qualitative data were evaluated through document analysis. Permissions were obtained before the research., Results: After the education provided, significant differences were found between the pre-test and post-test scores of both groups (p<0.05). It was determined that there was a statistically significant, positive and generally moderate relationship between the caring behaviors and ethical attitudes of the students. Additionally, participating students reported that they were satisfied with the education provided, stating that the teaching methods increased their motivation and positively influenced their perspectives on caring and its ethical dimensions., Conclusions: The research findings show significant improvements in nursing students' care behaviors and ethical attitudes following education based on the Human Care Theory, with both case analysis and video-supported teaching methods yielding notable results. Integration of care theories into the nursing undergraduate curriculum, alongside the use of holistic teaching methods, is recommended, along with further randomized controlled trials to assess teaching effectiveness., Competing Interests: Declaration of Competing Interest Not applicable., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Aim: The aim of the paper is twofold: 1. To present observations based on first-year nursing students' narratives during clinical rotation in gerontological nursing care; and 2. Explore a nursing educator's reflections on these observations in relation to the didactic and ethical challenges that occurred., Background: The teaching of ethics is included in nurse education worldwide. Students are in their first clinical placement in residential care of older persons confronted with the moral complexities of gerontological care, where they get little possibility to share emotions and thoughts about ethically challenging nursing situations with a supervising registered nurse., Design: A critical discussion paper., Method: The educator's reflections in this discussion paper are based on a narrative assignment in ethics where first-year nursing students reflect on and describe a nursing situation during their clinical rotation in the residential care of older persons., Results: Most students were acting as mere spectators in the described nursing situation where an older person, ethical standards, or evidence-based care was violated. Some students acted as advocates to the older person and intervened in the situation and a few as inspirers showing alternative ways of handling ethically challenging situations., Conclusions: Educators in nursing programs at the undergraduate level require time for student-centered formative guidance to foster moral courage and practice. During first-year students' clinical rotation, the learning goals in long-term residential care of older persons are focused on evidence-based basic nursing care. In this, students are confronted with ethically challenging situations, where the possibility to learn from a critical reflective practice is rare. When observing situations where an older person is subjected to unethical or unsafe nursing care it is common that the students take the spectators' role, not knowing how to deal with what is observed. Some students are taking an intervening role by trying to alleviate the vulnerability of the older person. A few are showing moral courage by directly intervening when experiencing unethical or unsafe nursing care or conduct. In this the student can inspire fellow students or staff during their clinical rotation in alternative ways of handling ethically challenging situations. As older persons are the largest demographic group that nurses will experience, educators need a sound knowledge of ethics as well as gerontological care to be able to meet and nurture students' ethical reflections during clinical practice and to foster practical wisdom in nursing., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Nursing faculty and clinicians are leaving the profession due to increased workload and burnout. Evidence-based interventions to build skills in resilience and well-being are encouraged; however, strategies to implement them in nursing curricula and nurse residency programs (NRPs) are not well known., Purpose: To understand the current state of resilience, well-being, and ethics content in the curriculum in schools of nursing and NRPs in the state of Maryland as part of a statewide initiative for Renewal, Resilience and Retention of Maryland Nurses (R 3 )., Methods: A descriptive survey was distributed to leaders of all Maryland nursing schools and NRP directors., Results: Respondents (n = 67) reported minimal resilience, well-being, and ethics content. Teaching modalities included lecture, journaling, mindfulness, and the code of ethics. Barriers included lack of faculty knowledge, low priority, time constraints, and limited resources., Conclusion: Resilience, well-being, and ethics content is limited in nursing curricula. Developing educator skills and best practices to foster resilience and ethical practice are needed., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Exposing new nurses to theoretical teaching strategies that help them to navigate the ethical challenges in clinical practice is essential for retention and long-term job satisfaction. This article explores the rationale for teaching ethics content in nurse residency programs and ways to navigate ethical decision-making in the clinical setting. Examples of evidence-informed teaching strategies that enhance knowledge retention and reduce the gap between ethical theory and practice are included., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Ethical decision-making education in nursing can be taught effectively by combining different teaching models that support the visualisation of taught concepts and integrating theory into practice., Objectives: The study aims to examine the effect of flipped and jigsaw learning models on ethical decision-making and ethical sensitivity in nursing., Research Design: We used a nested mixed design. A pretest-posttest single-group quasi-experimental design was used in the quantitative part, and a case study method was used in the qualitative part., Participants and Research Context: This study was conducted in fall semester with second-year nursing students who studied an ethics course for the first time, using two different collaborative learning models. In the quantitative part, ethical dilemma and ethical sensitivity scales were made as pre-test with 117 and post-test with 128 students. In the qualitative part, a semi-structured three focus group interviews was conducted with 16 students., Ethical Considerations: After obtaining the approval of the University's ethics committee, the study was carried out after obtaining participants' informed written and verbal consent., Findings: Students' perspectives changed positively after training. This was related to six cases in section A of the Ethical Dilemma Scale. In part B, Practical Consideration (PC) and Principled Thinking (PT) mean scores were similar, showing no significant difference. For Familiarity in section C, it was determined that 68.4% of students in the pre-test and 77.3% in the post-test were familiar with similar dilemmas. The ethical sensitivity scale's total scores were in a similar range. In the qualitative stage, ethical decision-making, ethical sensitivity, ethical dilemma and the improvement process were obtained as a theme., Conclusions: There was an increase in the level of ethical sensitivity and familiarity with ethical dilemmas of nursing students after education. Flipped and jigsaw learning models can be used for nursing ethics courses., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: to outline the teaching of ethics in undergraduate Nursing programs in Brazilian public higher education institutions., Methods: descriptive and exploratory study, carried out through the documentary analysis of pedagogical projects of undergraduate Nursing programs in Brazil., Results: 153 active undergraduate Nursing programs were found, of which 106 provide the pedagogical project. In addition to deontological teaching, the teaching of ethics was identified in a transversal way associated with themes such as Social Context, Hospital and Community Care, Pharmacology, Systematization of Nursing Care, Surgical Nursing, Epidemiology, Palliative Care, Management in Nursing, Diversity, Women's, Children's, Adolescent's, Adult's and Older People's Health, and Mental Health., Final Considerations: the challenge in teaching nursing ethics is its integration with each action of caring, teaching and managing.

The COVID-19 pandemic has had a profound impact on health professionals, adding to the moral suffering and burnout that existed prepandemic. The physical, psychological, and moral toll of the pandemic has threatened the well-being and integrity of clinicians. The narrative of self-sacrifice and heroism bolstered people early on but was not sustainable over time. For health professions students, the learning environment changed dramatically, limiting opportunities in direct patient care and raising concerns for meeting training requirements. Learners lost social connections and felt isolated while learning remotely, and they witnessed ethical tensions between patient-centered care and parallel obligations to public health. Worries about transmission of the virus and uncertainty about its management contributed to their moral suffering. Educators adjusted curricula to address the changing ethical landscape. Preparing learners for the realities of their future professional identities requires creation of interprofessional moral communities that provide support and help develop the moral agency and integrity of its members using experiential and relational learning methods. Investing in the well-being and resilience of clinicians, implementing the recommendations of the National Academy of Medicine, and engaging learners and faculty as cocreators of ethical practice have the potential to transform the learning environment. Faculty need to be trained as effective mentors to create safe spaces for exploring challenges and address moral adversity. Ethics education will need to expand to issues related to health systems science, social determinants of health, and public health, and the cultivation of moral sensitivity, character development, professional identity formation, and moral resilience., (Copyright © 2021 by the Association of American Medical Colleges.)

Objective: Ethical dilemmas are an inevitable part of a midwife's experience in clinical care. Midwifery educational programs have an obligation to provide students the opportunities to acquire the skills and knowledge to recognize and negotiate ethical dilemmas. Implementation of strategies for imparting ethical competencies and clinical ethics decision-making skills in formal midwifery curricula have been challenging and inconsistent. The purpose of this study was to gather information and opinions from midwifery educators and clinical preceptors about the essential components of ethics education for midwifery students in the United States (U.S.), aiming for consensus on key content, competencies, learning outcomes, and teaching strategies., Design: This is an online Delphi study conducted in three rounds. Round 1 consisted of open-ended questions to explore and identify key content, competencies, learning outcomes, and teaching strategies for midwifery ethics education. In Rounds 2 and 3, experts rated statements on a 1 to 7 Likert scale, with positive consensus defined as 70% or more of the experts scoring ≥6., Participants: The panel included midwifery educators (midwifery program directors, faculty, and clinical preceptors) from the United States., Findings: Of the 12 statements on key content of ethics education, midwives emphasized that content promoting an understanding of shared decision-making is essential for inclusion. Of the statements regarding competencies, learning outcomes, and teaching strategies, 20 of 21 statements met consensus, including those related to shared decision-making and ethical decision-making, as well as attributes such as compassion and courage. Midwives did not agree that an essential teaching strategy includes a validated assessment tool for evaluating students on any component of ethics learning (knowledge, skills, behaviour)., Key Conclusions: This Delphi study reveals what midwifery educators consider essential components of ethics education for midwifery students, with a particular focus on the professional attributes of shared decision-making., Implications for Practice: Initial insights about optimal ways to incorporate the essential ethics education components into midwifery program curricula are provided, and more research is needed., (Copyright © 2021. Published by Elsevier Ltd.)

There has been little previous research regarding the effectiveness of ethics education interventions for residential care-givers. The Researching Interventions to Promote Ethics in social care project responded to the question: Which is the most effective ethics education intervention for care-givers in residential social care? A pragmatic cluster trial explored the impact of three ethics education interventions for: (a) interactive face-to-face ethics teaching; (b) reflective ethics discussion groups; and (c) an immersive simulation experience. There was also a control arm (d). 144 trial participants were recruited from 39 residential care homes for older people in southern England. Change scores compared across intervention arms showed a significant reduction in work-related moral stress in the teaching arm compared with control group (p = .03); there were no significant differences between control and intervention arms in change scores for moral sensitivity, interpersonal reactivity (empathy) or ethical leadership. Qualitative data themes were as follows: ethical care; care challenges; and ethical care inhibitors. Overall findings stimulate reflection on the value of three different ethics education interventions and the most appropriate means to evaluate their impact. Findings suggest the complexity and diverse nature of ethical competence in care. We suggest a way forward for research evaluating ethics education., (© 2020 The Authors. Nursing Inquiry published by John Wiley & Sons Ltd.)

Background: Social inequities in health systems are threats to global health. Considering the important role of nurses in establishing social justice, identification of factors affecting nurses' participation in this area can contribute to the development of social justice., Objective: This study aimed to identify factors affecting nurses' participation in establishing social justice in the health system., Research Design and Methods: The study was conducted using conventional qualitative content analysis approach. Purposive sampling was used to select 14 participants in 2019. The data were collected through semi-structured interviews and analyzed concurrently with data gathering., Participants and Research Context: In total, six faculty members, five nursing managers, and three clinical nurses from three different universities were interviewed., Ethical Considerations: The research was approved by the Ethics Committee of Urmia University of Medical Sciences in Iran., Findings: Four main themes were found, including inadequate professional authority, insufficient attention to social justice in the area of education, clinical concerns as barriers to professional presence in society, and reflection of personality traits in the profession. These are the main factors affecting nurses' participation in establishing social justice in the health system., Discussion: Authorities need to take effective steps to establish social justice through reforming the health system's policy-making and power-acquisition domains, promoting nurses' involvement in social factors in health issues, and adding professional values as a part of nursing curriculum. The clinical practice environment can also be helpful through providing quality, safe, and cost-effective services. In addition, fair and efficient recruitment process for new nurses can contribute to the establishment of social justice in the health system., Conclusion: Macro-level managerial factors such as policy, education, and clinical environment, along with personal factors, play a significant role in the participation of nursing profession in establishing social justice.

Background: The complexity of the current health care system has resulted in increasing demands on nurses to act as patient advocates and moral agents. Understanding faculty's experiences teaching ethics is instrumental to deliver ethically competent care. The purpose of this study was to explore the experiences of nursing faculty teaching ethics content in the classroom setting to prelicensure baccalaureate nursing students., Method: This qualitative, descriptive phenomenological design asked 11 nursing faculty with recent experience teaching ethics within prelicensure baccalaureate nursing programs to complete qualitative interviews., Results: Participants expressed the importance of teaching ethics in undergraduate nursing curricula but experienced significant challenges. Three main themes were identified in the data analysis: Lacking Prior Preparation, Difficult Content, and No Place Holder for Ethics Content., Conclusion: Intentional curriculum design incorporating ethics content is necessary for the preparation of prelicensure nursing students, along with formal and informal opportunities for faculty to explore ethics including philosophical underpinnings. [J Nurs Educ. 2020;59(9):506-509.]., (Copyright 2020, SLACK Incorporated.)

Background: There are shortcomings in nurses' adherence to ethical principles in practice. The present study aims to investigate the effectiveness of teaching nursing ethics via scenario-based learning and group discussion in nurses' adherence to codes of ethics and patients' satisfaction with nurses' performance., Methods: Using a quasiexperimental design, the present study employed questionnaires which measure nurses' compliance with nursing codes of ethics and patients' satisfaction with nursing care before, immediately after, and one month after intervention. The collected data were analyzed using the independent t -test, ANOVA, and chi-square test in SPSS v.22. The level of significance was set at p < 0.05. The nurses ( n  = 80) and patients ( n  = 160) from various units of two university hospitals in the south-west of Iran participated in the present study., Results: The pretest mean scores of the intervention and control groups in patient rights and patients' satisfaction with nursing care were not significantly different ( p =0.07, p =0.21). Yet, there were statistically significant differences between the groups' mean scores as calculated immediately after ( p < 0.001, p < 0.001) and one month after intervention ( p < 0.001, p < 0.001)., Conclusion: Employment of new approaches to teach nursing ethical principles improves compliance with nursing ethical codes and patients' satisfaction with nurses' performance., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2020 Fatemeh Izadi et al.)

Background: Moral philosophical positions and professional values have been shown to influence nurses' practice behaviours. Understanding nursing students' professional values and ethical ideologies, therefore, is important as they may help inform evidence-informed curriculum decisions and education strategies to develop students' professional reflective competencies. However, there is a dearth in current empirical data on Canadian nursing students' perceptions of professional values and ethical positions., Objectives: This study's purpose was to examine undergraduate nursing student's perceptions of professional values and ethical ideology and explore relationships in data and selected participant demographic variables., Research Design, Participants and Context: A descriptive cross-sectional research design was conducted with a convenience sample of undergraduate nursing students recruited from a university in Canada. An online encrypted survey consisting of two validated instruments was administered to participants who met study eligibility criteria. Descriptive and inferential statistics were employed to analyse the data and classify nursing students' ethical ideologies into four categories based on mean scores for idealism and relativism., Ethical Considerations: This study received ethical approval from the institutional Behavioural Research Ethics Board and was executed in-line with ethical principles for research involving humans., Findings: Nursing students scored high on professional values and ethical idealism and differed significantly on a measure of ethical relativism in terms of age and year of study. Professional values were significantly associated with ethical idealism. Based on mean scores for idealism and relativism, most nursing students in the study were classified as situationists ., Discussion and Conclusion: Findings suggest that faculty pay attention to influences of moral philosophical positions in facilitating nursing students' professional values development. Implications for future research and curriculum are highlighted to strengthen nursing students' professional values.

Background: Simulation can extend ethics education in undergraduate nursing programs beyond the cognitive domain. However, the degree to which nursing students recognize and respond to microethical dilemmas in simulation is unknown., Method: Using a mixed-methods convergent parallel design, 68 third- and fourth-year undergraduate nursing students completed a sensitivity questionnaire. Twelve students also participated in an interview. Data were compared to create meaning., Results: Many students reported having a high level of ethical sensitivity toward microethical dilemmas during simulation. However, some students expressed uncertainty in their ability to identify microethical dilemmas during nurse-patient interactions. Students also reported limited confidence in being able to transfer their ethical knowledge to the practice setting., Conclusion: Nurse educators must be moral agents during simulated learning experiences by helping students learn what microethical dilemmas are and strategies to manage them. [J Nurs Educ. 2020;59(2):88-92.]., (Copyright 2020, SLACK Incorporated.)

Background: Organizations and nurse leaders do not always effectively support nurses' ethical competence. More information is needed about nurses' perceptions of this support and relevant factors to improve it., Purpose: The aim of the study was to examine relationships between nurses' perceived organizational and individual support, ethical competence, ethical safety, and work satisfaction., Methodology: A cross-sectional questionnaire survey was conducted. Questionnaires were distributed to nurses (n = 298) working in specialized, primary, or private health care in Finland. Descriptive statistics, multifactor analysis of variance, and linear regression analysis were used to test the relationships., Results: The nurses reported low organizational and individual support for their ethical competence, whereas perceptions of their ethical competence, ethical safety, and work satisfaction were moderate. There were statistically significant positive correlations between both perceived individual and organizational support, and ethical competence, nurses' work satisfaction, and nurses' ethical safety., Conclusions: Organizational and individual support for nurses' ethical competence should be strengthened, at least in Finland, by providing more ethics education and addressing ethical problems in multiprofessional discussions. Findings confirm that organizational level support for ethical competence improves nurses' work satisfaction. They also show that individual level support improves nurses' sense of ethical safety, and both organizational and individual support strengthen nurses' ethical competence., Practice Implications: These findings should assist nurse leaders to implement effective support practices to strengthen nurses' ethical competence, ethical safety, and work satisfaction.

Background: While ethics education in undergraduate nursing education can be developed using a variety of teaching and learning strategies, consensus on the content and teaching modules for these ethics courses has still not been established and the effect of ethics education has rarely been evaluated., Objectives: The purpose of this study is to compare the effect of debate-based ethics education and lecture-style ethics education on the moral sensitivity and moral judgment of nursing students.., Methods: This was a pre-test and post-test quasi-experimental study with a control group. A total of 64 senior-year nursing students in Korea participated in the study (35 in the debate group and 29 in the lecture group). The debate-based ethics education lasted for eight weeks with one two-hour session per week. The debate-based ethics education consisted of 16 rounds of affirmative and negative sides. Each debate lasted a total of 40 min and consisted of the introduction, cross-examination, rebuttal, conclusion, operation time, and wrap-up. The outcomes were measured by moral sensitivity and moral judgment questionnaires., Results: There was a significant improvement in idealistic moral judgment and realistic moral judgment in the debate group compared to the lecture group. However, no statistically significant difference was found for moral sensitivity between the two groups., Conclusion: Based on this study's findings, it can be concluded that the debate-based ethics education for undergraduate nursing students is very effective in promoting moral judgment and the ability to take ethical decisions., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Aim: The purpose of this study was to identify whether differences exist in nursing professional values based on program type and/or geographic location., Background: Deliberate inclusion of values formation is critical to nursing education and high-quality nursing care. There is limited research comparing professional values development among students in all types of prelicensure RN programs and no research comparing students' professional values between geographic regions., Method: A secondary analysis was completed of original data collected in three descriptive studies using the Nursing Professional Value Scale-Revised®., Results: Findings indicate prelicensure nursing students are educated with the values integrated within the American Nurses Association Code of Ethics. Significant differences (p < .05) were found when comparing geographic locations, program types, and Nursing Professional Value Scale-Revised factor scores., Conclusion: Additional research is needed to identify best practices for overall values formation in all program types.

The Japanese nursing education system only requires a general nursing qualification. After graduation, many Japanese nurses work within pediatric departments where they receive specialized training in pediatric care. An intervention program for promoting ethical nursing practices among patients and their families was implemented for pediatric nurses with 0-5 years pediatric nursing experience. The objective of this study was to clarify changes in nurses' recognition and behaviors, as well as the intervention's post-initiation durability. The pediatric nursing care model (PNCM), defining 24 nursing approaches, was developed to show simple examples of ethical nursing practices for pediatric patients and their families. An intervention program included an initial session that consisted of a 30-minute mini-lecture. Nurses also described details of approaches previously performed and conducted a peer-review. Concerning the PNCM, the frequency of implementing each approach was examined using a 4-point Likert scale both before and at 2-month post-intervention initiation. Recognition of intervention feasibility was evaluated using a 4-point Likert scale at the end of the first session. Furthermore, during the second month, reflection and outcome content was evaluated by examining approaches the nurses performed and described. During the third month, the nurses were asked to describe changes in their behavior in terms of ethical nursing practices, along with those observed by patient and family responses, and any recognition of future challenges. Regarding the care model items, feasible practices were recognized immediately post-intervention, and 18 of 24 items (75.0%) revealed significant improvement. Implementation frequency for 10 out of 18 items (55.6%) was higher than before the intervention, and there was a significant difference among four items. The intervention program led to improvements in highly feasible and basic ethical nursing practices, including an increase in greetings and self-introductions, verbal explanations for children, quantitative and qualitative alterations in order to improve children's coping behaviors, changes in nurses' active attitudes for reducing children's fear and attitudes for feasible future implementation. Changes in practices at 3-month post-initiation corresponded to the four components of "child assent" or the final three goals of our conceptual framework.

Background: Moral reasoning is a vital skill in the nursing profession. Teaching moral reasoning to students is necessary toward promoting nursing ethics., Objectives: The aim of this study was to compare the effectiveness of problem-based learning and lecture-based methods in ethics education in improving (1) moral decision-making, (2) moral reasoning, (3) moral development, and (4) practical reasoning among nursing students., Research Design: This is a repeated measurement quasi-experimental study., Participants and Research Context: The participants were nursing students in a University of Medical Sciences in west of Iran who were randomly assigned to the lecture-based (n = 33) or the problem-based learning (n = 33) groups. The subjects were provided nursing ethics education in four 2-h sessions. The educational content was similar, but the training methods were different. The subjects completed the Nursing Dilemma Test before, immediately after, and 1 month after the training. The data were analyzed and compared using the SPSS-16 software., Ethical Considerations: The program was explained to the students, all of whom signed an informed consent form at the baseline., Findings: The two groups were similar in personal characteristics (p > 0.05). A significant improvement was observed in the mean scores on moral development in the problem-based learning compared with the lecture-based group (p < 0.05). Although the mean scores on moral reasoning improved in both the problem-based learning and the lecture-based groups immediately after the training and 1 month later, the change was significant only in the problem-based learning group (p < 0.05). The mean scores on moral decision-making, practical considerations, and familiarity with dilemmas were relatively similar for the two groups., Conclusion: The use of the problem-based learning method in ethics education enhances moral development among nursing students. However, further studies are needed to determine whether such method improves moral decision-making, moral reasoning, practical considerations, and familiarity with the ethical issues among nursing students.

Background: Undergraduate nursing students have been documented to experience ethical distress during their clinical training and felt poorly supported in discussing the ethical issues they encountered., Research Aims: This study was aimed at exploring nursing students' perceived opportunity to discuss ethical issues that emerged during their clinical learning experience and associated factors., Research Design: An Italian national cross-sectional study design was performed in 2015-2016. Participants were invited to answer a questionnaire composed of four sections regarding: (1) socio-demographic data, (2) previous clinical learning experiences, (3) current clinical learning experience quality and outcomes, and (4) the opportunity to discuss ethical issues with nurses in the last clinical learning experience (from 0 - 'never' to 3 - 'very much')., Participants and Research Context: Participants were 9607 undergraduate nursing students who were attending 95 different three-year Italian baccalaureate nursing programmes, located at 27 universities in 15 Italian regions., Ethical Considerations: This study was conducted in accordance with the Human Subject Research Ethics Committee guidelines after the research protocol was approved by an ethics committee., Findings: Overall, 4707 (49%) perceived to have discussed ethical issues 'much' or 'very much'; among the remaining, 3683 (38.3%) and 1217 (12.7%) students reported the perception of having discussed, respectively, 'enough' or 'never' ethical issues emerged in the clinical practice. At the multivariate logistic regression analysis explaining 38.1% of the overall variance, the factors promoting ethical discussion were mainly set at the clinical learning environment levels (i.e. increased learning opportunities, self-directed learning, safety and nursing care quality, quality of the tutorial strategies, competences learned and supervision by a clinical nurse). In contrast, being male was associated with a perception of less opportunity to discuss ethical issues., Conclusion: Nursing faculties should assess the clinical environment prerequisites of the settings as a context of student experience before deciding on their accreditation. Moreover, the nursing faculty and nurse managers should also enhance competence with regard to discussing ethical issues with students among clinical nurses by identifying factors that hinder this learning opportunity in daily practice.

Background: With developing nursing ethics education, the traditional methods of teaching could not meet the learning needs of undergraduates. Improving ethical decision-making to undergraduates is necessary toward promoting nursing ethics., Objective: The aim of study is to compare the effect of inquiry-oriented teaching and lecture-based approach on nursing ethics education for undergraduates., Design: A quasi-experimental study was conducted for undergraduate nursing students., Settings: Two nursing schools participated in the study in mainland China., Participants: A total of 97 undergraduate nursing students participated in the study., Methods: The study adopted a quasi-experimental design., Results: The inquiry-oriented teaching group was significantly higher on average scoring than the lecture-based group after intervention in 2 aspects including: professional relationship (P = 0.015) and ethical decision making (P = 0.021). Contrarily, this study also showed that in the lecture-based group the score of foundational theories of nursing ethics was higher than Inquiry-oriented group (P = 0.038). A statistically significant difference was not found between the two groups in 3 scenarios: ethics related to nursing practice, ethics related to nursing research and necessity of learning nursing ethics., Conclusion: Combination of inquiry-oriented teaching and lecture-based approach is suggested as part of design for curriculum of nursing ethics education., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Academic ethical awareness is an important aspect especially for nursing students who will provide ethical nursing care to patients in future or try to tread the path of learning toward professional acknowledgement in nursing scholarship., Purpose: The purpose of this study was to explore academic ethical awareness and its related characteristics among undergraduate nursing students., Methods: This study commenced the survey with cross-sectional, descriptive questions and enrolled convenient samples of 581 undergraduate nursing students from three universities in South Korea. It was investigated with structured questionnaires including general characteristics and academic ethical awareness related., Ethical Considerations: This study was reviewed and approved by the Institutional Review Board at National University., Findings: Academic ethical awareness was the highest regarding behaviors violating the respect or confidentiality of patients and cheating on exams, while it was the lowest for inappropriate behaviors in class. From the result of general characteristics difference, male students showed higher score than female students in relative; first-year students showed higher score than other year students; the higher score was rated from students who were highly satisfied with their major than the other not satisfied with their major; and students with low academic stress showed higher ethical awareness score than persons with higher stress., Conclusion: Personal behaviors were rated with low ethical awareness in relative, but items related to public rules and actual effects on patients or others were rated with higher score. Nursing satisfaction and academic stress are main factors on ethical awareness. To improve overall ethical awareness level of nursing students, it is required to provide more education about the importance of personal behaviors in class and need to improve the understanding of how it will be connected with future situation and effect.

Aims and Objectives: To measure the professional values of registered nurses and determine whether these values are significantly related to postlicensure ethics education and years of experience., Background: Nursing guilds in many countries reference the American Nurses Association's code of ethics to define expected professional nursing values. Strong professional values contribute to high-quality patient care and are influenced by complex practice environments., Design: Causal-comparative design., Methods: A convenience sample of actively licensed registered nurses in Washington State, United States of America, participated in an electronically administered survey (N = 2,439). Analyses were conducted using descriptive statistics, analysis of variance and correlation. Reporting utilised the STROBE checklist., Results: Results suggested values of highest and lowest importance to nurses. Scores varied significantly based on years of nursing experience; a higher score indicated stronger orientation toward professional nursing values. Nurses with experience of 10 years or more had the highest scores. There was a modest, positive relationship between professional values and amount of time spent in postlicensure ethics education., Conclusions: Professional values of Washington State nurses are similar to other nurses in national and global workforces. Results suggest key areas of strength in nurses' professional values and areas needing additional focus and support. Professional values are highest among nurses with longer practice experience and among nurses who have had increased ethics education., Relevance to Clinical Practice: Knowledge of nurses' priority values can assist leaders and educators to identify areas of needed support among nursing staff members. Organisational commitment to support of nurses' professional values through investment in ethics education may produce positive enduring consequences, such as workplace retention and high-quality patient care. Healthcare leaders and clinical educators who promote ethics education may help to mitigate negative effects of morally challenging situations, such as moral distress and work leaving., (© 2019 John Wiley & Sons Ltd.)

Background: Ascertaining the relationship between ethical ideology, moral judgment, and ethical decision among academic nurse educators at work appears to be a challenge particularly in situations when they are faced with a need to solve an ethical problem and make a moral decision., Purpose: This study aims to investigate the relationship between ethical ideology, moral judgment, and ethical decision as perceived by academic nurse educators., Methods: A descriptive correlational research design was conducted at Faculty of Nursing, Alexandria University. All academic nurse educators were included in the study (N = 220). Ethical Position Questionnaire and Questionnaire of Moral Judgment and Ethical Decisions were proved reliable to measure study variables., Ethical Considerations: Approval was obtained from Ethics Committee at Faculty of Nursing, Alexandria University. Privacy and confidentiality of data were maintained and assured by obtaining subjects' informed consent., Findings: This study reveals a significant positive moderate correlation between idealism construct of ethical ideology and moral judgment in terms of recognition of the behavior as an ethical issue and the magnitude of emotional consequences of the ethical situation (p < 0.001; p = 0.031) respectively. Also, there is a positive significant moderate correlation between relativism construct of ethical ideology and overall moral judgment (p = 0.010). Approximately 3.5% of the explained variance of overall moral judgment is predicted by idealism together with relativism., Discussion: The findings suggest that variations in ethical position and ideology are associated with moral judgment and ethical decision., Conclusion: Organizations of academic nursing education should provide a supportive work environment to help their academic staff to develop their self-awareness and knowledge of their ethical position and promoting their ethical ideologies and, in turn, enhance their moral judgment as well as develop ethical reasoning and decision-making capability of nursing students. More emphasis in nursing curricula is needed on ethical concepts for developing nursing competencies.

Background:: Despite growing interest in the potential of nursing education to enhance dignity in nursing care, relatively little is known about what dignity means to nursing students., Research Question:: What meaning does dignity in nursing care have for nursing students?, Research Design:: Photo-elicitation was embedded within a Nominal Group Technique and responses were analysed by qualitative and quantitative content analysis., Participants and Research Context:: Participants were recruited from each year of a 3-year undergraduate preregistration adult nursing programme in Scotland. In total, 31 nursing students participated in the study., Ethical Considerations:: The study was approved by the Ethics Committee of the School of Health, Nursing and Midwifery, University of the West of Scotland., Findings:: Participants articulated the meaning of dignity in nursing care in terms of the relationships and feelings involved. A total of 10 categories of meaning were identified., Discussion:: The significance of the nature of the nurse-patient interaction to preserving dignity in nursing care is highlighted., Conclusion:: Understanding the meaning of dignity for nursing students may help prepare future nurses more able to preserve dignity in nursing care.

This study seeks to develop a method of teaching ethics to nursing students using games. We used the one-group pretest-posttest design with 30 undergraduate nursing students as participants. Professional ethics education was provided for 17 weeks in 90-minute sessions. The Lutzen ethical sensitivity questionnaire and a checklist of the satisfaction levels of games used measured the effects of training. Repeated-measures ANOVA and the Greenhouse-Geisser correction were used to measure ethics game satisfaction. After training, total moral sensitivity questionnaire scores increased significantly (p = 0.02). The score on awareness of the relationship with the patient and the application of ethics concepts in ethical decisions from the subdomain of moral sensitivity increased significantly. Card sorting and drawing or art production earned the highest scores of satisfaction. The results show that playing games is a useful approach to developing moral sensitivity among nursing students to make them more sensitive toward ethics issues in their professional environment.

Background: Empathy is of great importance in nursing, as it helps us to see and meet the needs of patients and hence to care for patients in an appropriate way. Therefore, it is of great importance that nursing students and nurses develop their ability to empathize., Objective: The study aimed at gaining knowledge on what characterizes undergraduate nursing students' ability to empathize with patients during their first practice in a nursing home. In addition, the aim of the study was to investigate what nursing students think is important with regard to upholding their ability to empathize with patients in a professional way., Research Design: This research has a phenomenological and hermeneutic design, based on qualitative interviews. Participants and research context: A total of 11 undergraduate nursing students participated in interviews during or right after their first practice in a nursing home. Ethical considerations: Norwegian Social Science Data Services approved the study. Participants were informed that their participation was voluntary. The participants were also assured confidentiality, and they were informed that they could withdraw from the study at any time, without providing any reasons., Findings: What the findings show is that affective empathy is strong among undergraduate nursing students in their first practice. They think the emotions are important to be able to empathize, and they are afraid of becoming indifferent. At the same time, they are afraid that the feelings will hinder them from acting in a professional manner., Discussion: The findings are discussed in light of previous theories on empathy, and especially perspectives on empathy, emotions, and morality., Conclusion: Affective empathy seems to be strong among nursing students, and this may be of great importance to be sensitive to patients' well-being. However, affective and cognitive empathy should be balanced if nurses will have to meet patients in a professional way.

Background: Moral distress (MD) is an emotional and psychological response to morally challenging dilemmas. Moral distress is experienced frequently by nurses in the intensive care unit (ICU) and can result in emotional anguish, work dissatisfaction, poor patient outcomes, and high levels of nurse turnover. Opportunities to discuss ethically challenging situations may lessen MD and its associated sequela., Objective: The purpose of this project was to develop, implement, and evaluate the impact of nursing ethics huddles on participants' MD, clinical ethics knowledge, work satisfaction, and patient care among ICU nurses., Sample and Setting: The sample, 32 nurses from three ICU settings in an 800-bed tertiary academic medical center, participated in six nursing ethics huddles over a two-month period., Methods: Alvita K. Nathaniel's Theory of Moral Reckoning guided development of the nursing ethics huddle process. The Moral Distress Thermometer was administered at three data points: baseline level of MD, and pre- and post-huddle to determine changes in the subjects' level of MD. Focused content analysis was used to analyze qualitative responses from questionnaires about the subjects' perception of the effect of the huddles on work satisfaction and patient care. Knowledge attainment was evaluated via open-ended short-answer questions., Results: Overall, use of nurse-ethicist-led nursing ethics huddles was associated with improved quality of work life, patient care, and clinical ethics knowledge. The change in pre- and post-nursing ethics huddles MD scores was statistically significant., (Copyright 2018 The Journal of Clinical Ethics. All rights reserved.)

Background: Ethics, being a fundamental component of nursing practice, must be integrated in the nursing education curriculum. Even though different bodies are promoting ethics and nursing researchers have already carried out work as regards this concept, it still remains difficult to clearly identify the components of this competence., Objective: This integrative review intends to clarify this point in addition to better defining ethical competence in the context of nursing practice., Method: An integrative review was carried out, for the 2009-2014 period, in the CINAHL, MEDLINE, and EMBASE databases and in the journal Nursing Ethics. The keywords nursing ethics or ethical competence were used in order to make sure to widely encompass the concept of "ethical competence" in the case of a university curriculum in nursing. In the end, 89 articles were selected. Ethical consideration: We have respected the ethical requirements required regarding the sources and authorship. There is no conflict of interest in this literature review., Results: Ethical sensitivity, Ethical knowledge, Ethical reflection, Ethical decision-making, Ethical action, and Ethical behavior are the most frequently used terms with regard to ethical competence in nursing. They were then defined so as to better ascertain the possible components of ethical competence in nursing., Conclusion: Even though ethical competence represents a sine qua non competence in nursing practice, no consensus can be found in literature with respect to its definition. The identification of its components and their relationships resulting from this integrative review adds to the clarification of its definition. It paves the way for other studies that will contribute to a better understanding of its development, especially among nursing students and practicing nurses, as well as the factors that may exert an influence. More adapted education strategies can thus be put forward to support its development.

Background: The formation of everyday ethical comportment is an essential part of nursing education in the 21st century, but the concept is more abstract and confusing than the dominant bioethical models frequently used in nursing education., Method: The purpose of this analysis is to explore the concept of everyday ethical comportment and determine whether the concept remains viable for nursing as a discipline. Rodgers' method of evolutionary concept analysis guided a systematic literature review. Following PRISMA guidelines, 32 articles containing the keywords everyday ethical comportment were identified, and 20 are included in this study., Results: The analysis identified four critical attributes of everyday ethical comportment (embodiment, skilled relational know-how, caring, and salience). The concept's surrogate and related terms, antecedents, and consequences were also identified., Conclusion: Everyday ethical comportment is underrepresented in the literature. Although it remains viable for nursing as a discipline, the concept's future sustainability is questionable. [J Nurs Educ. 2018;57(8):460-468.]., (Copyright 2018, SLACK Incorporated.)

Objectives: The purpose of this study was to explore the effectiveness of learning ethics of nursing practice using narrative writing., Methods: Study design was qualitative descriptive research. The participants were 90 graduate students who took nursing ethics classes, of whom 86 graduate students (4 males and 82 females) agreed to this study. The data gathered for analysis were their narratives described as feeling uncomfortable in clinical settings and their comment sheets after narrative group work in nursing ethics classes. We used qualitative content analysis to identify graduate students' awareness gained through narrative writing and narrative group work., Results: As a feature of the scenes described by graduate students, there were often conflicts that patients' autonomy were not respected, or that they were not able to engage in sincere engagement. The narrative writing was effective to make graduate students aware of the following two aspects: 1) habits and trends in one's own thoughts and 2) organizational and administrative issues related to ethical issues., Conclusions: Learning ethics of nursing practice using narrative writing that focused on nurses' sentiments helped reveal nurses' thoughts as well as their attitudes and approaches to patients. These findings suggest that narrative writing in nursing ethics education could lead to ethical practice. Additionally, our results indicate that narrative writing in research may be helpful as a strategy to clarify ethical issues and the awareness of nurses in clinical settings.

Background: Nurses' ethical competence has been identified as a significant factor governing high quality of care. However, nurses lack support in dealing with ethical problems, and therefore managerial support for nurses' ethical competence is needed., Research Questions: This study aimed to analyse, from the perspective of nurse and nurse leaders, the level of nurses' and nurse leaders' ethical competence, perceptions of support for nurses' ethical competence at the organisational and individual levels and background factors associated with this support., Research Design: A descriptive, cross-sectional study design was employed. The Ethical Competence and Ethical Competence Support questionnaires were used to measure the main components. Descriptive statistics and multifactor analysis of variance were used for data analysis., Participants: The participants were 298 nurses and 193 nurse leaders working in specialised (48%/52%), primary (43%/36%) or private healthcare (5%/7%) in Finland. Ethical considerations: Ethical approval was obtained from the university ethics committee., Results: Nurses estimated their own ethical competence to be at an average level, whereas nurse leaders estimated their own competence at a high level. Nurses' and nurse leaders' perceptions of provided support for nurses' ethical competence was not at a high level. The positive agreement percentage related to organisational support was 44% among nurses and 51% among nurse leaders. The positive agreement percentage related to individual support was lower, that is, 38% among nurses and 61% among nurse leaders. University education had a positive association with some items of individual support., Conclusion: Despite the findings that ethical competence was estimated at a high level among nurse leaders, perceptions of support for nurses' ethical competence were not at a satisfactory level. At the organisational level, nurse leaders need to inform of ethical procedures and practices in orientation; encourage multidisciplinary ethics discussions and collaboration; and support nurses at an individual level to participate in ethics education, multidisciplinary ethics discussions and in solving ethical problems.