Ethics-in-the-Round: A Guided Peer Approach for Addressing Ethical Issues Confronting Nursing Students

Abstract

With the increasingly complex nature of care and provider demands in health care settings, the potential for ethical conflicts for nurses and nursing students continues to rise. As such, nursing education must keep pace by updating ethics curricula (American Association of College of Nursing [AACN], 2008) and employing innovative strategies to ensure that nursing students possess the knowledge, attitudes, and skills necessary to address ethical situations that arise during clinical training and when they begin nursing practice. Teaching ethics is a complex endeavor requiring an in-depth grounding in nursing's codes of ethics (Fowler, 2008; International Council of Nurses [ICN], 2012). Ethics-in-the-Round is a student-led, faculty-facilitated voluntary educational activity designed to facilitate ethical decision-making skills in undergraduate nursing students. Roundtable sessions provide students with a safe, confidential environment in which to discuss ethical quandaries, practice collaborative problem solving, and receive support from peers and faculty. Participation assists students to develop their skills as ethical nurses and their voices as patient advocates. Although ethical situations often arise during clinical practice, the need to discuss nursing care planning and technical patient care issues may take precedence over in-depth discussion of these ethical matters in traditional clinical postconference sessions. Moreover, students may hesitate to raise ethical questions during postconference for a variety of reasons, including time constraints, observations of potentially unethical behaviors that do not pertain to their assigned patients, and concerns over getting someone in trouble. In contrast, the Ethics-in-the-Round sessions focus specifically on ethical issues, including the grey area where ethics and clinical practice intersect. They allow time for self-reflection and provide opportunities for students to discuss concerns in a confidential environment. BACKGROUND Nurses are expected to act as direct care providers and patient advocates (AACN, 2008; Park, 2009). As such, they fill unique and complex roles that demand not only excellent clinical assessment, knowledge, and practice skills, but also the ability to broker, in a sense, the space between patient and the health care system. To do this effectively, nurses must understand the culture, interpersonal and professional norms of the practice environment, the scopes of practice of interdisciplinary colleagues, and the ethical responsibilities of nurses as outlined in codes of ethics for nurses (Fowler, 2008; ICN, 2012). Codes of Ethical Conduct The basis of the nursing profession's first informal code of ethics was Florence Nightingale's 1893 pledge (Fowler, 2008). Since then, codes have evolved as nursing has evolved (Liaschenko & Peter, 2004; Numminen, van der Arend, & Leino-Kilpi, 2009). The ICN Code of Ethics for Nurses is described as a guide for action based on social values and needs... applied to the realities of nursing and health care in a changing society (2012, p. 4). It outlines standards for ethical conduct in four main areas, including the nurse's obligations to other people and patients, to coworkers and interdisciplinary colleagues, to competent practice, and to the nursing profession. Key elements of the code are: a) maintaining cooperative collaborations with co-workers and colleagues; b) promoting a health care environment that respects the rights, values, and needs of diverse and vulnerable populations and maintains their safety, privacy, and dignity; and c) taking action to protect others when their health is endangered by a co-worker or another person. The American Nurses Association (ANA) Code of Ethics for Nurses (Fowler, 2008) outlines the ethical obligations of nurses in nine provisions: respect for human dignity; primacy of the patient's interests; patient privacy and confidentiality; accountability and responsibility; maintaining competence and professional growth; maintaining and improving the health care environment; advancement of the profession; interdisciplinary collaboration; and professional involvement and social reform. …