Journal Title

Journal of Nursing Education

Publication Date

2014

Abstract

Background. Student nurses are frequently exposed to micro-ethical, every-day nursing practice problems during their clinical practicum. Little is known, however, about how students learn, rehearse, and intentionally incorporate ethical principles in the fast-paced and contextual clinical practice environment.

Research objective. The purpose of this qualitative research was to understand the lived-experiences of senior-level baccalaureate nursing students who are faced with making micro-ethical clinical decisions in acute-care clinical practice settings.

Research design. An interpretive phenomenological design was utilized, resulting in the emergence of five central themes. Institutional Review Board (IRB) approval was obtained. Participants (n=7) were senior-level students in the final semester of their baccalaureate program. After obtaining informed consent, data collection occurred via face-to-face semi-structured interviews.

Findings. Findings revealed a web of meanings attributed to learning and applying ethical principles in nursing practice. Participants described taking undergraduate classes where they were exposed to ethical standards, but viewed the academic education as philosophical and detached from every-day clinical decision-making. A dominant finding was the experience of unapplied and neglected ethics education revealing a mismatch between what faculty perceived was being taught and the students’ experience of that education. When faced with micro-ethical decisions, participants readily exhibited trusting and deference toward clinical faculty recommendations, even if the advice contradicted best-practice standards. Participants reported they frequently engaged in reality testing, attempting to reconcile academic knowledge, best practice standards and advice from faculty in the clinical environment. In the midst of reality testing, students’ contextual naivety was brought out of concealment, contributing meanings to further understand prior themes. Finally, participants gave language to the experience of moral disequilibrium, stating they felt conflicted, confused, and torn between best practices learned in school and what they see role-modeled in the clinical environment.

Discussion. This study resulted in theory-guided implications for nursing education, recommendations for future study, and a proposal to modify existing evidence-based practice conceptual frameworks.

Subjects

Ethics; Case Studies; Nursing Education

Publication Information

Archived version is the post-print.

Final published article available at https://doi.org/10.3928/01484834-20140211-05

Funding provided by the University of Portland Dundon-Berchtold Applied Ethics Fellowship.

DOI

10.3928/01484834-20140211-05

Peer-Reviewed

Yes

Document Type

Journal Article

Included in

Nursing Commons

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