Moral Philosophy and Nursing Curricula: Indoctrination of the New Breed

Nursing ethics education: are we really delivering the good(s)?

The vast majority of research in nursing ethics over the last decade indicates that nurses may not be fully prepared to 'deliver the good(s)' for their patients, or to contribute appropriately in the wider current health care climate. When suitable research projects were evaluated for this article, one key question emerged: if nurses are educationally better prepared than ever before to exercise their ethical decision-making skills, why does research still indicate that the expected practice-based improvements remain elusive? Hence, a number of ideas gleaned from recent research about the current nature of nursing ethics, and especially teaching nursing ethics to student nurses, are analysed and critiqued in this article, which concludes with a cluster of ideas and conclusions based on that analysis. It is hoped that such a review may serve as a catalyst for nurse educators to re-examine their teaching practices with a view to enhancing good (i.e. ethical) nursing practice through educational means.

Cultural competence in nursing: foundation or fallacy?

Propelled by a national concern with social justice and health disparities, the notion of cultural competency is being incorporated into both government regulation and professional standards. Although most of the standards that are being developed nationally apply at the institutional level, it is in the clinical setting where the expectation of cultural competency is the most demanding. The recommendations for clinicians to become culturally competent generally fall into 2 major categories. The first focuses on the content and structure of the clinical encounter between provider and patient. The second category charges providers with becoming knowledgeable about the cultures of their constituent patients and learning their lifestyles,health beliefs, and behaviors. Although individuals may belong to the same cultural group, the assumption that they are, in fact, the same, is an ecological fallacy. The health care system has nested the accountability for cultural competence with the clinician who provides direct services to individuals, where the application of cultural information is likely to be least useful. We contend that cultural competence is really nursing competence.

Indigenous Nurses and Professional Education: Friends or Foes?

While the importance of cultural issues in nursing practices has been recognized, little attention has been directed to evaluating to what extent nursing education respects the cultural norms and values of students from diverse populations. A survey was used to explore the educational experiences of 40 Native American nurses. Respondents indicated that cultural content in their education was quite limited, they wanted more cultural content, and sometimes they obtained it from other sources. Many respondents found no support for their cultural identity during their nursing education. Those who did find support found it mainly through student groups, tribal or Native-specific programs, and through informal peer support. Many respondents identified struggles with culture shock and cultural differences, stereotypes and racist attitudes, isolation, and assumptions about their own cultural identity. This study makes an important contribution by bringing voices of indigenous nurses to the attention of the profession and by moving beyond practice wisdom to join with the growing body of research that is adding an empirical dimension to transcultural nursing literature.

Educating for interprofessional collaboration: teaching about values

Effective interprofessional collaboration depends upon establishing understanding that respects differences in values and beliefs, and thus differences in response to the multiplicity of patient/client/user needs. To facilitate the latter, this article suggests that health and social care students need a formal knowledge of the meaning of values and the varieties of systems within which values are expressed. Students need especially to understand the genesis of their own professional value system and to recognize the gap that inevitably develops between the values of the professional and those of the society within which a professional may function. The conceptual framework that underpins the approach to teaching values to health and social care professionals advocated here is derived from key concepts identified from the literature relating to education for, and participation in, a democratic, multicultural, multifaith society. These are: tolerance, compromise and education for dialogue. Finally, it is suggested that professional educators must take seriously the tasks of educating for professional pluralism.

Critical Reflections About Professional Ethical Stances: Have We Lost Sight of the Major Objectives?

Increasingly, the professional literature reflects a call for the adoption of a (feminist) "ethic of caring" as a model for moral education is nursing. But what is not clear is the relationship between "care" and "ethics, " or between an "ethic of caring" and "moral education." Has ethics, and the issue of ethics education for nurses, become entangled with what may be a separate issue of an "ethic of caring" for the nursing profession? This article presents an overview of evolving ethical stances of three professions, and shows how the dichotomous views within philosophy and psychology have strongly influenced ethical thought in nursing. Major questions concerning the stances are raised. Nurse educators need to have a critical awareness of the scope and complexity of the discussion, and the ability to closely scrutinize conclusions reached by each profession's theorists. Viewpoints concerning what should comprise ethics education in nursing will depend on the particular ethical stance adopted. Ethics education for nurses will continue in its present confused state until there is focused and directed critical reflection about what is currently known regarding moral development, ethical thought, and the role of education in both.