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The ethical education of an RN.

The Ethical Education of the RN

In a 1977 survey, Mila Aroskar found that 7 percent of accredited bacclaureate programs in nursing required coursework in ethics or medical ethics. But a recent national study of senior RN baccalureate nursing students (registered nurses who had returned to school to complete their baccalaureate) reported by the American Association of Colleges of Nursing indicates a significant increase in the past decade in the prevalence of ethics content in nursing. Almost all RN students reported taking coursework in ethics, and indicated substantial development in their ability to address ethical dilemmas at the completion of their program compared to its beginning. Over 85 percent were applying ethics content in their clinical practice when resurveyed six months after graduation.

The students felt that their skills in recognizing and resolving ethical dilemmas were greatly enhanced by group discussions with colleagues and peers, the ethics content in their nursing coursework, as well as courses in humanities, philosophy, logic, and ethics. Some students rated in-service programs in clinical agencies instrumental in contributing to their abilities, but few perceived ethics rounds to be a significant factor. Still, despite both formal and informal modes of learning, most students felt minimally prepared to use an ethical framework or model to assist in assessing and resolving ethical dilemmas.

In their practice, the most common issues confronted by the nurses were, in order of frequency, informed consent, resuscitation or discontinuation of life-saving treatment, the care of patients with a poor prognosis, evaluation of patient competency, patient refusals of treatment, and withholding information from patients. Most RN graduates reported that the types of action they felt capable of undertaking in dilemmatic situations included indentifying the moral aspects of nursing care, gathering relevant facts, using resources to clarify the issue, and clarifying and applying values to assess and resolve an ethical issue. Almost 50 percent reported being able to propose alternative actions, choose and act on one alterntative, and evaluate its outcome.

The nursing profession's commitment to continued development of instruction in ethics in nursing education flows not only from the complex variety of ethical questions nurses encounter daily in patient care, but also from the particular combination of roles nurses play in health care organizations, such as direct care provider, patient advocate, and nurse executive. The survey results give strong indication that instruction in ethics is being included in baccalaureate nursing curricula and that students benefit significantly from this experience. A task for further inquiry is the students' estimates of their ability to use ethical frameworks in practice. These estimates may not accurately reflect actual practice, or alternatively, suggest that further opportunities for practice in ethical decisionmaking must be incorporated into pre-service and in-service nursing education.
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Title Annotation:registered nurse
Author:Redman, Barbara K.; Cassells, Judith M.
Publication:The Hastings Center Report
Date:Oct 1, 1988
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