Nursing students frequently encounter microethical nursing practice problems during their clinical experience. The purpose of this study was to understand the lived experiences of senior-level baccalaureate students faced with making microethical clinical decisions in practice settings. A descriptive qualitative design was used, and five central themes emerged. A dominant finding was the experience of unapplied and forgotten ethics education revealing a mismatch between what faculty perceived was taught and students' experiences of that education. When faced with microethical decisions, participants trusted and deferred to staff nurse recommendations, even if the advice contradicted best-practice standards. Contextual naivete was brought out of concealment, contributing to the experience of moral disequilibrium (i.e., students felt conflicted about what they learned in school as best practice and what they observed being role modeled in the clinical environment). This study resulted in theory-guided implications for nursing education and recommendations for future study. [J Nurs Educ. 2014;53(x):xx-xx.].
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[Show abstract][Hide abstract] ABSTRACT: Because ethics consults are often more about conflict than moral puzzlement, the skills of conflict resolution and communication facilitation are now deemed a core competency for ethics consultants. Those skills range beyond the traditional ambit of "bioethics mediation," as illustrated here by a recent mediation regarding a difficult discharge. As conflict permeates healthcare, often spawning downstream ethical issues, conflict resolution services might be deemed a genre of preventive ethics suitably offered by ethics committees. If so, a strong distinction must be made. "Bioethics mediation" as historically defined is a curious amalgam between a consultant who recommends, and a mediator who facilitates consensus among the parties at the table. On closer examination this approach is problematic, particularly in the clinical setting. A mediator who acts as consultant, telling parties what they should do or directly circumscribing the limits of an "acceptable" decision, quickly becomes just another pair of fists in the fight. At that point the odds for reaching genuine agreement, as opposed to a transient acquiescence, diminish markedly. Accordingly, those who undertake conflict resolution in the clinical setting need to distinguish quite sharply between facilitative mediation, versus a consultant's role.
Full-text · Article · Dec 2015 · The Journal of Law Medicine & Ethics
[Show abstract][Hide abstract] ABSTRACT: Novice post-licensure nurses are frequently exposed to microethical nursing practice problems during their first 24 months of formative practice. Often, novice nurses trust the advice of experienced nurse coworkers, deferring to such advice even when they know the advice contradicts evidence-based practice. This study revealed the prevalence of deference behaviors and associated rationale. Study findings emphasize the importance of incorporating conflict management, effective communication techniques, ethical frameworks, and EBP standards within pre- and post-licensure education.
No preview · Article · Mar 2015 · Journal for nurses in professional development