Nurturing moral community: A novel moral distress peer support navigator tool

Moral distress is a pervasive phenomenon in healthcare for which there is no straightforward "solution." Rhetoric surrounding moral distress has shifted over time, with some scholars arguing that moral distress needs to be remedied, resolved, and eradicated, while others recognize that moral distress can have some positive value. The authors of this paper recognize that moral distress has value in its function as a warning sign, signaling the presence of an ethical issue related to patient care that requires deeper exploration, rather than evidencing identification of the "right" course of action. Once the experience of moral distress is identified, steps ought to be taken to clarify the moral issue, and, if possible and reasonable, the patient's values ought to be prioritized. This paper offers concrete actions steps, drawn from theory, which can be used in clinical practice to provide peer support or to facilitate self-reflection for morally distressed individuals. This approach empowers morally distressed individuals to explore ethical issues, identify concrete steps that can be taken, and mitigate feelings of powerlessness that are often associated with moral-constraint distress. The questions guide individuals and peers to reflect first on the micro-space and then more broadly on the institutional culture, facilitating meso- and macro-reflection and action.

Ethics education: Nurse educators' main concern and their teaching strategies

BACKGROUND

To practice nursing ethics, students must first understand the ethical concepts and principles of their profession, but despite this knowledge, students face challenges in implementing ethical principles in clinical settings. The educational performance of nurse educators is critical in resolving these challenges. This study focused on the lived experiences of nurse educators.

OBJECTIVE

To address the main concern of educators when teaching ethics to undergraduate nursing students and how they deal with it.

RESEARCH DESIGN

We conducted this qualitative content analysis in Iran in 2020. We used individual semi-structured interviews to collect, record, and transcribe data, as well as Graneheim and Lundman method to analyze them.

PARTICIPANTS

and research context: We used purposive sampling to select 11 nurse educators who either were currently in the position of ethics educators or had taught ethics from Iranian universities of medical sciences.

ETHICAL CONSIDERATIONS

The present study received the code of ethics No. IR.MODARES.REC.1399.036. Participants were aware of the study's purpose and signed a consent form to participate in the study. We considered data confidentiality and the voluntary principle in data collection.

FINDINGS

Nurse educators' main concern was how to sensitize students to ethical principles in clinical settings, so they tried to involve students in the teaching process, to repeat and practice ethical principles and concepts, simplify and simulate ethical principles and concepts, and provide opportunities for students to gain clinical experiences.

DISCUSSION

To sensitize students to ethical nursing care, nurse educators try to institutionalize ethical principles using different teaching methods, including students' involvement in teaching, experiential learning through simulated situations, practice, repetition, and provision of opportunities for practice and experience.

CONCLUSION

Improving students' cognitive ability and objectifying moral concepts and principles for students will institutionalize moral values in them that are fundamental for their moral sensitization.

Attitude of Romanian Medical Students and Doctors toward Business Ethics: Analyzing the Influence of Sex, Age, and Ethics Education

This study investigated the attitude of Romanian medical students and doctors toward business ethics by measuring the preference for a particular ethical philosophy, namely, the preference for Machiavellianism, moral objectivism, social Darwinism, ethical relativism, and legalism. At the same time, this study aimed to explore the influence of sex, age, and ethics education on the attitude toward business ethics. The data collection was performed using a voluntary self-administered online survey including the Attitudes Toward Business Ethics Questionnaire (ATBEQ) instrument. Our findings show that the values based on which Romanian medical students and doctors make business decisions belong predominantly to the moral objectivism philosophy, which is grounded on rational actions based on a set of objective moral standards.

Operationalizing the role of the nurse ethicist: More than a job

The idea of a role in nursing that includes expertise in ethics has been around for more than 30 years. Whether or not one subscribes to the idea that nursing ethics is separate and distinct from bioethics, nursing practice has much to contribute to the ethical practice of healthcare, and with the strong grounding in ethics and aspiration for social justice considerations in nursing, there is no wonder that the specific role of the nurse ethicist has emerged. Nurse ethicists, expert in nursing practice and the application of ethical theories and concepts, are well positioned to guide nurses through complex ethical challenges. However, there is limited discussion within the field regarding the specific job responsibilities that the nurse ethicist ought to have. The recent appearance of job postings with the title "nurse ethicist" suggest that some healthcare institutions have identified the value of a nurse in the practice of ethics and are actively recruiting. Discomfort about the possibility of others defining the role of the nurse ethicist inspired this paper (and special issue). If the nurse ethicist is to be seen as an integral part of addressing ethical dilemmas and ethical conflicts that arise in healthcare, then nurse ethicists ought to be at the forefront of defining this role. In this paper, we draw upon our own experiences as nurse ethicists in large academic healthcare systems to describe the essential elements that ought to be addressed in a job description for a nurse ethicist practicing in a clinical setting linked to academic programs. Drawing upon our experience and the literature, we describe how we perceive the nurse ethicist adds value to healthcare organizations and teams of professional ethicists.

Analyzing the Evolution of Medical Ethics Education: A Bibliometric Analysis of the Top 100 Cited Articles

Ethics education plays a pivotal role in healthcare by providing professionals and students with the essential competencies to navigate intricate ethical challenges. This study conducts a comprehensive bibliometric analysis of the most-cited articles on ethics education, investigating parameters such as citation count, document types, geographical origin, journal analysis, publication year, author analysis, and keyword usage. The findings reveal a substantial impact characterized by high citation counts and the influence of a prominent publication focusing on the hidden curriculum and structure of medical education. Moreover, the analysis demonstrates a discernible increase in research output since 2000, signaling a growing recognition of the significance of ethics education in the healthcare domain. Notably, specific journals, particularly those dedicated to medical education and ethics, emerge as major contributors in this field, publishing many articles. Renowned authors have made noteworthy contributions, and emerging themes encompass the ethical implications of virtual reality and artificial intelligence in healthcare education. Additionally, undergraduate medical education garners significant attention, emphasizing the importance of establishing ethical values and professionalism early. Overall, this study highlights the imperative of interdisciplinary collaboration and the necessity for effective ethics education programs to equip healthcare professionals with the requisite skills to navigate complex ethical challenges. The findings inform educators, curriculum developers, and policymakers about enhancing ethics education and ensuring the ethical competence of future healthcare practitioners.

[Practice of Ethics Education Using a Documentary Film for Pharmacy Students]

In today's world, where clinical options are ever increasing and patients' needs are more diverse, it is not possible to conclude that simply practicing medical care based on pathophysiological data and medical evidence is sufficient for patients, particularly in terms of seeing each patient as an individual. Medical professionals must maintain a close relationship with their patients and seek treatment and care methods that reflect the patient's values and views on life and death, based on their own ethics in medical care. Ethics education should be provided on a continuing basis from the beginning of medical/pharmacy school. However, ethics education in pharmacy departments is often delivered in a lecture format attended by many students and/or as group training using case studies and hypothetical situations, i.e., "paper" patients. With these teaching methods, there are limited opportunities for the students to foster a sense of ethics or to think deeply about their values and views on life and death with respect to the patients they care for. Therefore, in this study, we conducted ethics exercises for pharmacy students in a group study format using a documentary film of real patients who were facing death. By retrospectively analyzing the results of the questionnaires collected before and after the assignments and exercises, we verified the educational effects and changes in the students' sense of ethics from participating in the group learning exercise; moreover, our results revealed the insight gained by the students in examining the experiences and challenges faced by terminally ill patients.

A Mixed-Methods Survey of Veterinary Ethics Teaching in Turkey

With the growth of interest in veterinary ethics, the teaching of ethics to veterinary students has become more important. This study collects comprehensive data about ethics education at veterinary faculties in Turkey to contribute to the international literature. A cross-sectional descriptive survey design is used to collect data via questionnaire. Of the 31 faculty members actively teaching ethics at 24 of the 29 veterinary faculties in Turkey (as of the end of 2021), 30 responded to the survey. By the end of 2021, ethics courses in 24 veterinary faculties in Turkey were conducted between the 7th and 10th semesters with similar content across the examined institutions. Of the 31 faculty members responsible for ethics education, 22 were ethicists. Theoretical lectures and multiple-choice tests were the most preferred methods for teaching and assessment. The most preferred learning outcome to be gained by students was ethical awareness. Integrity by ethicists and morality by faculty members from other departments were considered the most important virtues. The collected qualitative data regarding the strengths of ethics education and areas for improvement were varied and controversial. Ethics training should be an ongoing process throughout veterinary education. Applied ethics education should be comprehensively included in the curricula and carried out with the cooperation of faculty members working in clinical fields.

Exploring the ethics of physical restraints: Students' questioning

BACKGROUND

Physical restraints are routinely employed to ensure patient safety in Japanese acute care. Little is known about nursing students' perspectives and how they begin to question their value and knowledge in the face of restraint experiences in clinical practice.

OBJECTIVE

To investigate nursing students' questions about patient restraints and how they understand the ethics of the use of restraints in nursing.

RESEARCH DESIGN

Qualitative descriptive research using narrative analysis.

PARTICIPANTS AND RESEARCH CONTEXT

Experiential data were generated and thematically analyzed from semi-structured interviews with 16 nursing students who had completed their bachelor's degree program requirements.

ETHICAL CONSIDERATIONS

The study was approved by academic and clinical ethics agencies. Participants provided written informed consent.

RESULTS

Physical restraints were encountered in 16 incidents, 3 with children and 13 with older patients with dementia. Students struggled to comprehend the policies and protocols of restraint use and worried their use was primarily for security rather than therapeutic purposes. Five themes were identified: (1). Questioning the tension between person-centered care, patient autonomy, and restraints, (2). Questioning the nature of restraints in which participants analyzed the policies and protocols around restraint use, (3). Questioning the professional nursing self whereby students reflected on how restraint use challenged their nursing values, and (4). Questioning professional nursing practice, in which students explored how restraints fit within a nursing perspective and positioned themselves as patient advocates. Students encountering physical restraints should ask questions based on values of patient-centeredness, autonomy, and advocacy. There is a need for education that facilitates reflection and questioning so that it informs students' ethical thinking which may enhance nurse advocacy to reduce restraint use.

CONCLUSIONS

Restraints provide contexts in which students must face tensions between nursing values and clinical reality. Further research on nursing education strategies within non-psychiatric settings is needed to reduce physical restraints.

Postgraduate nursing students' experiences of practicing ethical communication

BACKGROUND

Ethics communication has been described as a pedagogical form, promoting development of ethical competence among nursing students. The 'one to five method' was developed by this research group as a tool for facilitating ethical communication in groups among healthcare professionals but has not yet been evaluated.

AIM

To explore post-graduate nursing students' experiences of practicing ethical communication in groups.

RESEARCH DESIGN

The study design is qualitative.

PARTICIPANTS AND RESEARCH CONTEXT

The study comprised 12 nursing students on a post-graduate course for Registered Nurses focusing on palliative care. After education the students engaged as participants and facilitators in ethics communication in groups, with support from the 'one to five method'. Data were derived from the students written reflections and subjected to thematic analysis.

ETHICAL CONSIDERATIONS

The study was performed in accordance with the ethical standards in the 2013 Helsinki Declaration and approved by the Ethics Committee of the Medical Faculty at Umeå University.

RESULTS

An overall theme was identified, 'being supported to achieve a democratic dialogue concerning ethical problems' and five themes, related to each step of the 'one to five method'. The themes concerned: putting the experience of an ethical dilemma into words; being confirmed by shared emotions; defining the value conflict using ethical principles; expressing virtues of empathy and raised awareness; jointly finding various action approaches.

DISCUSSION

Regular ethics communication in groups encourages nursing students to actively seek understanding and clarification of ethically difficult situations.

CONCLUSIONS

The results indicate that ethics communication in groups could be a way of developing virtues during education. Interventions using the 'one to five method' need to be further studied among student groups from other healthcare contexts.

The Multidimensional Nature of Research Ethics: Letters Issued by a French Research Ethics Committee Included Similar Proportions of Ethical and Scientific Queries

Debate is ongoing concerning the activities and functioning of Research Ethics Committees (REC), especially a possible science-or-ethics dichotomy in research ethics review. We retrospectively analyzed 145 letters issued by a French REC over 18 months. All queries were classified in three levels: qualification (definition of the problem), category (aggregation of broader topics) and finally fields (ethical, scientific, or administrative). Overall, 971 queries were identified, of which 407 (42%), 379 (39%), and 135 (14%) were deemed ethical, scientific, and administrative queries, respectively. The most frequent concern was about participants' information. The main influencing factor was the profession of the reporting readers-scientific queries were more frequently raised by a methodologist, whereas ethical queries were more frequently raised by an ethicist. These results indicate that research ethics review is a multidimensional task that should be considered a collaborative effort.

Moral distress interventions: An integrative literature review

Moral distress has been well reviewed in the literature with established deleterious side effects for all healthcare professionals, including nurses, physicians, and others. Yet, little is known about the quality and effectiveness of interventions directed to address moral distress. The aim of this integrative review is to analyze published intervention studies to determine their efficacy and applicability across hospital settings. Of the initial 1373 articles discovered in October 2020, 18 were appraised as relevant, with 1 study added by hand search and 2 after a repeated search was completed in January and then in May of 2021, for a total of 22 reviewed articles. This review revealed data mostly from nurses, with some studies making efforts to include other healthcare professions who have experienced moral distress. Education-based interventions showed the most success, though many reported limited power and few revealed statistically lowered moral distress post intervention. This may point to the difficulty in adequately addressing moral distress in real time without adequate support systems. Ultimately, these studies suggest potential frameworks which, when bolstered by organization-wide support, may aid in moral distress interventions making a measurable impact.

Assessment of ethical competence among clinical nurses in health facilities

BACKGROUND

Ethical competence in nursing practice helps clinical nurses to think critically, analyse issues, make ethical decisions, solve ethical problems and behave ethically in their daily work. Thus, ethical competence contributes to the promotion of high-quality care. However, studies on ethical competence in Malawi are scanty.

OBJECTIVES

The aim of this study was to explore ethical competence among clinical nurses in selected hospitals in Malawi.

METHODOLOGY

A cross-sectional survey was conducted in four selected hospitals in Malawi with a sample of 271 clinical nurses. Data were collected using self-administered questionnaires, which included a Moral Competence Scale for Home Care Nurses. Descriptive statistics and logistic regression were computed for the dataset using STATA version 12.0.

ETHICAL CONSIDERATION

The study protocol complied with all ethical requirements and was approved by the College of Medicine Research Ethics Committee under the University of Malawi.

RESULTS

The clinical nurses in Malawi are ethically competent. However, there is a significantly high number (p < 0.05) of nurses 57% (n = 135) with low ethical competence. There was no significant association between respondents' demographic variables and level of ethical competence (p > 0.05). Three determinants of high ethical competence level (strong will, judgement skills and recognition of discrepancy of intention) were identified through a reduced model after stepwise logistic regression analysis. Furthermore, results show that indicators of ethical competence include caring, confidentiality and observance of nurses dressing code. The study has also confirmed that the Moral Competence Scale for Home Care Nurses is a reliable tool to assess ethical competence in low-resource settings.

CONCLUSION

The majority of nurses who completed the survey had low ethical competence. However, clinical nurses with high ethical competence level are required to competently manage complex ethical challenges in health facilities. Strategies for enhancing ethical competence such as continuing ethics education, establishment of ethics committees and provision of supportive supervision are recommended to enable nurses in Malawi attain a high level of ethical competence.

Factors that influence ethical competence among nurses in health facilities in Malawi

BACKGROUND

Clinical nurses' (CNs) ethical competence (EC) is essential for nursing practice because it facilitates high-quality care to patients.To develop ethically competent nurses, factors that positively affect EC must be explored and promoted. Few studies have explored ethical issues in Malawi and the aim of this study was to explore the factors that affect EC.

METHODS

This study used a qualitative exploratory design to collect data through in-depth interviews from 10 key informants (KI) and 9 focus group discussions (FGD) in the selected government, CHAM and private hospitals in Malawi. It was conducted between April and May 2019.Data were analysed manually using thematic content analysis. The data were coded, and words with similar meaning were organized into categories from which themes and sub themes were developed. The themes and sub themes are reported as the results of the study.

RESULTS

One major theme emerged from the thematic content analysis namely: systems influencing EC among nurses in Malawi. The study has identified continuing professional development in ethics, supportive supervision, availability of resources and leadership to be among the major factors that facilitate EC. Factors that hinder EC among the nurses included; inadequate supervision, inadequate resources, lack of teamwork, increased workload coupled with inadequate nursing staff.

CONCLUSION

This study has exposed the factors that influence EC in health facilities and shown that nurse leaders are key to enhancing EC through continuing ethics education, supportive supervision, staffing and provision of resources. Therefore, all the stakeholders in nursing should support the efforts to remove the factors that hinder EC in the health facilities.

Evaluation of Ethics Curricula and Faculty in Accredited Undergraduate Radiologic Technology Programs

PURPOSE

To investigate the state of ethics curricula in accredited undergraduate radiologic technology programs.

METHODS

A causal-comparative research design was used to collect and analyze data about faculty degrees, their knowledge of the Realm-Individual Process-Situation (RIPS) Model of Ethical Decision-Making, the degree level offered, and the ethics curriculum. Postprimary certification programs and applicant programs for accreditation were excluded.

RESULTS

Analysis was conducted on 226 completed surveys. The findings showed a significant association between teaching strategies and program degree (P = .001) and assessment strategies and faculty degree (P = .006). However, no significant association existed between assessment strategies and program degree (P = .070), ethical course content and program degree (P = .122), teaching strategies and faculty degree (P = .159), or ethics course content and faculty degree (P = .558).

DISCUSSION

Study findings showed reliance of faculty on lectures to present ethical content, tests to assess student understanding, and teaching using the American Registry of Radiologic Technologists Standards of Ethics. A small number used other methods such as case-based studies, group discussions, and other ethical theories. The high variance in responses showed a need for a structured ethics curriculum.

CONCLUSION

In accredited radiologic technology programs, the methods for teaching ethics and assessment techniques might be related to the level of the degree being offered and the education of the instructing faculty member, respectively. These findings demonstrate a need for developing a standardized ethics curriculum in these programs.

Findings from a mixed-methods pragmatic cluster trial evaluating the impact of ethics education interventions on residential care-givers

There has been little previous research regarding the effectiveness of ethics education interventions for residential care-givers. The Researching Interventions to Promote Ethics in social care project responded to the question: Which is the most effective ethics education intervention for care-givers in residential social care? A pragmatic cluster trial explored the impact of three ethics education interventions for: (a) interactive face-to-face ethics teaching; (b) reflective ethics discussion groups; and (c) an immersive simulation experience. There was also a control arm (d). 144 trial participants were recruited from 39 residential care homes for older people in southern England. Change scores compared across intervention arms showed a significant reduction in work-related moral stress in the teaching arm compared with control group (p = .03); there were no significant differences between control and intervention arms in change scores for moral sensitivity, interpersonal reactivity (empathy) or ethical leadership. Qualitative data themes were as follows: ethical care; care challenges; and ethical care inhibitors. Overall findings stimulate reflection on the value of three different ethics education interventions and the most appropriate means to evaluate their impact. Findings suggest the complexity and diverse nature of ethical competence in care. We suggest a way forward for research evaluating ethics education.

Assessing Ethoshunt as a Gamification-Based Mobile App in Ethics Education: Pilot Mixed-Methods Study

Background

Gamification has remarkable potential in the learning space. The process of creating a gamified system and its influence on human behavior reflect the interaction between educators and machines.

Objective

The purpose of this pilot study was to present Ethoshunt as a gamification-based mobile app that can be used in teaching and learning ethics.

Methods

This study involved a mixed-methods research design. The researchers surveyed 39 undergraduate students who were introduced to Ethoshunt in order to examine the relationships between mobile app usability and positive emotions, ethical competency, and user experience. Affinity diagramming was used as a tool to organize the opinions and experiences of participants using featured gamification elements.

Results

Game dynamics and game mechanics explained the functionality of Ethoshunt. In addition, the learning flow through Ethoshunt was discussed. Overall, the findings were positive, and mobile app usability had the strongest relationship with positive emotions (r=0.744, P<.001), followed by ethical competency (r=0.686, P<.001) and user experience (r=0.614, P<.001).

Conclusions

Positive emotions could be perceived as an important dimension in the development and usability of Ethoshunt. The researchers suggest that the gamification-based mobile app advocated in this study may provide ideas for ethics educators who wish to develop a technology-mediated learning environment.

Thinking About Difficulties: Using Poetry to Enhance Interpretative and Collaborative Skills in Healthcare Ethics Education

Viewing difficulty as an opportunity for learning runs counter to the common view of difficulty as a source of frustration and confusion. The aim of this article is to focus on the idea of difficulty as a stepping-off point for learning. The literature on difficulty in reading texts, and its impact on thinking and the interpretive process, serve as a foundation for the use of poetry in healthcare ethics education. Because of its complexity and strangeness compared to the usual scientific and clinical texts health science students encounter, poetry is an excellent means to achieve the aim of thinking through difficulties in ethics. Specific examples of teaching and learning strategies for turning difficulty into opportunities for learning are presented, including the difficulty paper and the triple mark-up method. Both methods require students to examine their process of working through difficulties, reflect on how they make sense of difficult texts and then share their process and interpretations in a collaborative manner with peers. The importance of framing difficulties as a public, visible, collaborative process rather than a personal process is emphasized. Working together to hypothesize reasons for difficulty and map out plans to come to terms with difficulty are equally relevant for reading text as they are for reading complex ethical situations. Finally, I argue that transference of this kind of personal and collaborative learning about difficulties benefits interprofessional clinical practice, particularly when dealing with ethical issues.

Moral dilemmas involving anthropological and ethical dimensions in healthcare curriculum

BACKGROUND

Currently a variety of novel scenarios have appeared within nursing practice such as confidentiality of a patient victim of abuse, justice in insolvent patients, poorly informed consent delivery, non-satisfactory medicine outputs, or the possibility to reject a recommended treatment. These scenarios presuppose skills that are not usually acquired during the degree. Thus, the implementation of teaching approaches that promote the acquisition of these skills in the nursing curriculum is increasingly relevant.

OBJECTIVE

The article analyzes an academic model which integrates in the curriculum a series of specific theoretical concepts together with practical skills to acquire the basic ethic assessment competency.

RESEARCH DESIGN

The project includes designing two subjects, General Anthropology and Ethics-Bioethics, with an applied approach in the nursing curriculum. The sequential structure of the curriculum in both subjects is constituted by three learning domains (theoretical, practical, and communicative) with different educational strategies.

ETHICAL CONSIDERATIONS

No significant ethical considerations as this is a discussion paper.

FINDINGS

The model was structured from the anthropology's concepts and decision-making process, applied to real situations. The structure of the three domains theoretical-practical-communicative is present in each session.

DISCUSSION

It is observed that theoretical domain fosters the capacity for critical analysis and subsequent ability to judge diverse situations. The practical domain reflected two significant difficulties: students' resistance to internalizing moral problems and the tendency to superficial criticism. The communicative domain has frequently shown that the conflicting points are in the principles to be applied.

CONCLUSION

We conclude that this design achieves its objectives and may provide future nursing professionals with ethical competences especially useful in healthcare practice. The three domains of the presented scheme are associated with the same process used in decision making at individual levels, where the exercise of clinical prudence acquires particular relevance.

Strengthening Perceptions of Ethical Competence Among Nursing Students and Graduates

INTRODUCTION

Ethical competence is part of all health-care professionals' general competence. It relates to moral issues and is based on the professionals' knowledge, skills, and attitudes for coping with ethical dilemmas. Ethics education aims to increase nursing students' and nursing graduates' ethical self-confidence. Previous research has found many gaps in ethical education content and poor understanding of how these gaps affect graduates.

OBJECTIVES

This study aims to evaluate an advanced education workshop held in the nursing department in Max Stern Yezreel Valley College aimed at strengthening the self-perceptions of ethical competence, to address the above gap, by raising students' self-efficacy when coping with ethical dilemmas.

METHODS

The effectiveness of the workshop for nursing students was evaluated using the Generalized Self-Efficacy Scale and at three points in time: before the workshop, after the workshop, and after graduation.

RESULTS

Statistically significant differences were found in overall self-efficacy: before the workshop (mean of 2.42), after the workshop (mean of 2.13), and for graduates (mean of 1.58) with p < .000 on a scale ranging from 1 to 5 (1 indicating high self-efficacy). Mean scores for students' evaluation after the workshop and for graduates were 7.8 and 7.25, respectively, on a scale ranging from 1 to 10, where 10 indicates high self-efficacy. Graduates presented a high mean score regarding their ability to cope with ethical dilemmas when compared with other nurses working with them (mean of 7.4, on a scale ranging from 1 to 10).

CONCLUSION

Levels of self-efficacy with regard to coping with ethical dilemmas increased over time, suggesting that the workshop strengthened the self-perception of ethical competence for nursing students and graduates.

Challenges in the ethics review process of clinical scientific research projects in China

Purpose

Ethics review processes have become increasingly complex. The objective of this study was to explore the challenges currently faced in ethics reviews of clinical scientific research projects in China, with the goal of standardizing the structure of medical ethics committees and better protecting the rights and interests of research participants.

Methods

We reviewed and comprehensively analyzed the available literature discussing standardized ethics reviews of clinical scientific research projects.

Results

We identified the following problems: incomplete legislation, absence of supervision, vague review criteria, limitations of ethics committee competence, inadequate ethics consciousness, and poor tracking of reviews. In this paper, we suggest strategies for the development of future ethical reviews of clinical scientific research projects.

Conclusion

To standardize the ethics review process of clinical scientific research projects in China, it is necessary to establish relevant laws and regulations and implement supervisory responsibilities. Professional training of medical ethics committees is suggested as an effective way to improve the quality of ethics reviews.

"I Left the Museum Somewhat Changed": Visual Arts and Health Ethics Education

A common goal of ethics education is to equip students who later become health practitioners to not only know about the ethical principles guiding their practice, but to also autonomously recognize when and how these principles might apply and assist these future practitioners in providing care for patients and families. This article aims to contribute to discussions about ethics education pedagogy and teaching, by presenting and evaluating the use of the visual arts as an educational approach designed to facilitate students' moral imagination and independent critical thinking about ethics in clinical practice. We describe a sequence of ethics education strategies over a 3 year Doctor of Physiotherapy program, focusing on the final year professional ethics assessment task, which involved the use of visual arts to stimulate the exploration of ethics in healthcare. The data (in the form of student essays about their chosen artwork) were analyzed using both thematic and content analysis. Two key themes centered on emotional responses and lateral thinking. The use of artwork appeared to facilitate imaginative, emotional, and conceptual thinking about ethics and clinical experience (both past and future). This study provides some evidence to support the effectiveness of the use of the visual arts in promoting students' recognition of ethical dimensions within their clinical experience and reflection on their emerging professional identity. As one student noted, she left the museum "somewhat changed."

Broadening Our Scope: A Pilot Curriculum in Bioethics for Pathology Graduate Medical Trainees, the Emory University Experience

Despite mandates from the Accreditation Council for Graduate Medical Education and American Board of Pathology, little guidance is available for educating pathology trainees on bioethics. We endeavored to describe the development and implementation of a pathology-specific pilot curriculum in bioethics for pathology trainees at Emory University. After institutional review board review and exemption, we performed a literature search on pathology and ethics, conducted an intradepartmental survey for ethics topics relevant to our trainees and faculty, and referenced the Pathology Milestones related to ethics to develop the framework and materials for the pilot curriculum. The curriculum consisted of 2 introductory and 3 topic-focused sessions over 14 months moderated by pathology faculty with interest and expertise in ethics. Sessions included a short didactic component followed by small group discussions of cases created by the investigators. Surveys were administered to participants before and 16 months after completion of the curriculum. Twenty-nine pathology trainees participated in the curriculum. In baseline surveys, 93% (27/29) of participants believed that ethical dilemmas occur in pathology practice; 62% (18/29) reported having either experienced one or more ethical dilemmas themselves or knowing a pathologist or pathology trainee who had experienced one. In postcurriculum surveys, 87% (13/15) of respondents reported having learned something new, 92% (12/13) anticipated applying this knowledge to pathology practice, and 81% (13/16) would recommend it to a pathology trainee colleague. Limitations include single institution, small sample size, and limited outcome measures for ethics education. Our curriculum may serve as a model for other pathology training programs.

Empowering Graduate Students to Address Ethics in Research Environments

In this article, we present an educational intervention that embeds ethics education within research laboratories. This structure is designed to assist students in addressing ethical challenges in a more informed way, and to improve the overall ethical culture of research environments. The project seeks (a) to identify factors that students and researchers consider relevant to ethical conduct in science, technology, engineering, and math (STEM) and (b) to promote the cultivation of an ethical culture in experimental laboratories by integrating research stakeholders in a bottom-up approach to developing context-specific, ethics-based guidelines. An important assumption behind this approach is that direct involvement in the process of developing laboratory specific ethical guidelines will positively influence researchers' understanding of ethical research and practice issues, their handling of these issues, and the promotion of an ethical culture in the respective laboratory. The active involvement may increase the sense of ownership and integration of further discussion on these important topics. Based on the project experiences, the project team seeks to develop a module involving the bottom-up building of codes-of-ethics-based guidelines that can be used by a broad range of institutions and that will be distributed widely.

Implementation of a responsible conduct of research education program at Duke University School of Medicine

Academic medical centers rarely require all of their research faculty and staff to participate in educational programs on the responsible conduct of research (RCR). There is also little published evidence of RCR programs addressing high-profile, internal cases of misconduct as a way of promoting deliberation and learning. In the wake of major research misconduct, Duke University School of Medicine (DUSoM) expanded its RCR education activities to include all DUSoM faculty and staff engaged in research. The program included formal deliberation of the Translational Omics misconduct case, which occurred at Duke. Over 5,000 DUSoM faculty and staff participated in the first phase of this new program, with a 100% completion rate. The article reports on the program's development, challenges and successes, and future directions. This experience at Duke University illustrates that, although challenging and resource intensive, engagement with RCR activities can be integrated into programs for all research faculty and staff. Formal, participatory deliberation of recent cases of internal misconduct can add a novel dimension of reflection and openness to RCR educational activities.

Clinician, student and faculty perspectives on the audiology-industry interface: implications for ethics education

Objective: Supporting audiologists to work ethically with industry requires theory-building research. This study sought to answer: How do audiologists view their relationship with industry in terms of ethical implications? What do audiologists do when faced with ethical tensions? How do social and systemic structures influence these views and actions? Design: A constructivist grounded theory study was conducted using semi-structured interviews of clinicians, students and faculty. Study sample: A purposive sample of 19 Canadian and American audiologists was recruited with representation across clinical, academic, educational and industry work settings. Theoretical sampling of grey literature occurred alongside audiologist sampling. Interpretations were informed by the concepts of ethical tensions as ethical uncertainty, dilemmas and distress. Results: Findings identified the audiology-industry relationship as symbiotic but not wholly positive. A range of responses included denying ethical tensions to avoiding any industry interactions altogether. Several of our participants who had experienced ethical distress quit their jobs to resolve the distress. Systemic influences included the economy, professional autonomy and the hidden curriculum. Conclusions: In direct response to our findings, the authors suggest a move to include virtues-based practice, an explicit curriculum for learning ethical industry relations, theoretically-aligned ethics education approaches and systemic and structural change.

Normative nursing ethics: A literature review and tentative recommendations

We describe the results and implications of a literature review that identifies the number of normative and empirical articles, respectively, that have appeared in Nursing Ethics in each year from 1994 to 2017. The results of our analysis suggest a powerful trend away from normative scholarship and toward empirical investigation within the field of nursing ethics, both overall and comparatively. We argue that there are several important negative consequences of this trend, and we propose some potential solutions to address them.

Beyond silos: An interprofessional, campus-wide ethics education program

BACKGROUND

Ethics education is essential to the education of all healthcare professionals. The purpose of this study was to evaluate an interprofessional approach to ethics education to all students across an academic health science center.

RESEARCH OBJECTIVES

The objectives were to (1) compare student perception of ethics education before and after the implementation of the campus-wide ethics program and (2) determine changes in student ethical decision-making skills following implementation of a campus-wide ethics program.

RESEARCH DESIGN

This study was a quasi-experimental design with seniors graduating prior to the intervention serving as the control group.

PARTICIPANTS AND RESEARCH CONTEXT

The setting was a comprehensive health science center in the southwestern United States. All students enrolled in the university participated in the intervention; however, 976 graduating students were used for evaluation of the intervention.

ETHICAL CONSIDERATIONS

Study materials for each survey were submitted to the university's IRB, and the project was approved as exempt by the Committee for the Protection of Human Subjects. Student participation in the surveys was voluntary. No names or other identifying information were collected, and responses to the survey questions were kept confidential.

FINDINGS

Students' perception of the adequacy of time spent on the ethics content in course instruction and practical training decreased from the baseline to the fifth-year survey. Students' overall comfort level with their abilities to deal with ethical issues increased from the baseline to the fifth year. Student ethical decision-making skills were higher at the third-year evaluation for all indicators. For the fifth-year survey, responses were also higher scoring on all four indicators.

DISCUSSION

After participation in an interprofessional campus-wide effort on health professions ethics, students demonstrated higher ethical decision-making scores according to the Health Professional Ethics Rubric. However, their scores still did not reach the proficiency level identified in the rubric.

CONCLUSION

Examination of the effectiveness of each part of the intervention is needed.

Curriculum Redesign to Build the Moral Courage Values of Accelerated Bachelor's Degree Nursing Students

The increasing complexities of health care coupled with the decreasing importance of ethical values held by college students, including nursing students, compel nurse educators to step up efforts to strengthen the moral courage values of their students. While the nursing curriculum is the ideal breeding ground for building moral courage values, few studies describe how these values were embedded in any nursing curriculum, much less an accelerated bachelor's degree in nursing (ABSN) curriculum. This study outlines an ABSN curriculum with teaching-learning activities designed to build moral courage values in its classroom and clinical settings. Faculty perceptions of 29 ABSN students' honesty, respectfulness, responsibility, fairness, and compassion were surveyed 4 weeks after beginning, and again at the end of the ABSN program. The ABSN exit questionnaire administered annually by the College Office of Institutional Research, assessed the effectiveness of the ABSN curriculum. Of the 20 learning outcomes on the questionnaire, five related to moral courage values. The 5-point response scale ranged from Not at All, to Somewhat, Moderately, Well, and Extremely Well. t-test calculations revealed significant growth for four of the five values surveyed. Honesty, responsibility, fairness, and compassion were each positively significant at the p < .05 level. For the 27 of the 29 ABSN students who responded to the exit questionnaire, the Well and Extremely Well responses ranged from respectfulness and responsibility at 73%, to compassion and honesty at 78%, and fairness at 82%. Teaching-learning activities to build moral courage values successfully promoted the nursing program objective that the student will demonstrate proficient clinical, technological, and ethical competence in the delivery and management of health care.

Risk Perceptions for Trauma-Related Research: An Exploratory Study of Undergraduate Student Researchers in Psychology

The purpose of this study was to examine student researchers' perceptions of risks associated with trauma-related research. The participants were 92 students enrolled in an introductory Research Methods course. Students evaluated (a) trauma-exposed participants' ability to provide informed consent and (b) the potential consequences of participating in trauma-focused research. Risk perceptions were assessed at the beginning of the course, after completion of the Collaborative Institutional Training Initiative (CITI) ethics education, and at the end of the course. Results show that student researchers' perceptions of risk changed significantly across time. After completing the CITI ethics education, students perceived trauma-exposed individuals as less able to provide informed consent and also perceived greater potential for negative consequences from participation in trauma-focused research, perceptions that were relatively maintained throughout the remainder of the course.

Moral distress in healthcare assistants: A discussion with recommendations

BACKGROUND

Moral distress can be broadly described as the psychological distress that can develop in response to a morally challenging event. In the context of healthcare, its effects are well documented in the nursing profession, but there is a paucity of research exploring its relevance to healthcare assistants.

OBJECTIVE

This article aims to examine the existing research on moral distress in healthcare assistants, identity the important factors that are likely to contribute to moral distress, and propose preventative measures.

RESEARCH DESIGN

This is a survey of the existing literature on moral distress in healthcare assistants. It uses insights from moral distress in nursing to argue that healthcare assistants are also likely to experience moral distress in certain contexts.

PARTICIPANTS AND RESEARCH CONTEXT

No research participants were part of this analysis.

ETHICAL CONSIDERATIONS

This article offers a conceptual analysis and recommendations only.

FINDINGS

The analysis identifies certain factors that may be particularly applicable to healthcare assistants such as powerlessness and a lack of ethical knowledge. We demonstrate that these factors contribute to moral distress.

DISCUSSION

Recommendations include various preventative measures such as regular reflective debriefing sessions involving healthcare assistants, nurses and other clinicians, joint workplace ethical training, and modifications to the Care Certificate. Implementation of these measures should be monitored carefully and the results published to augment our existing knowledge of moral distress in healthcare assistants.

CONCLUSION

This analysis establishes the need for more research and discussion on this topic. Future research should focus on evaluating the effectiveness of the proposed recommendations.

Angels and Devils: Dilemmas in Dual-Use Biotechnology

Dual-use research, which results in knowledge that can be used for both good and ill, has become increasingly accessible in the internet age to both scientists and the general public. Here, we outline some major milestones for dual-use policy and present three vignettes that highlight contemporary dual-use issues in biotechnology.

Ethical values of academic nurses: A pilot study

BACKGROUND

While academics contribute to the development of society through all the subjects that they work on, they also have other important tasks to fulfill, such as being role models for their students and society. Therefore, the place of academic ethical values is a significant topic for academic nurses.

OBJECTIVE

The main objective of this research was to examine the attitudes of academic nurses toward academic ethics.

RESEARCH DESIGN

This descriptive and cross-sectional research study was conducted between March and June 2017 in three different public universities in Turkey. The research sample consisted of 132 nurses in different professional positions at different universities who volunteered to participate in the study. The data were collected with an Information Form and an Academic Ethical Values Scale developed in Turkey.

ETHICAL CONSIDERATIONS

Ethical approval was granted by the institutions involved, and all participants provided informed verbal consent.

FINDINGS

The attitudes of academics participating in the research on academic ethical values were found to be highly positive. When the sub-dimensions of the scale were examined, the dimension with the highest average attitudinal score is found to be "values regarding the teaching process" and the dimension with the lowest average attitude score is found to be "values regarding society." Depending on the participants' academic position, it was determined that the total average score for the Academic Ethical Values Scale and the average scores of the "values regarding scientific research" and "values regarding the teaching process" sub-dimensions differed significantly (p < 0.05).

CONCLUSION

It was found that academic nurses had highly positive attitudes of toward academic ethical values. It can be argued that academics act more responsibly with regard to the ethical values of the teaching process than other areas. In addition, academics who are professors are most sensitive in their perception of academic ethical values.

Commentary on "Regulatory Support Improves Subsequent IRB/REC Approval Rates in Studies Initially Deemed Not Ready for Review: A CTSA Institution's Experience"

In response to researcher concerns a number of initiatives have been developed to support individual researchers seeking ethics review and approval. In this issue, Sonne et al. (2017) outline an example of an intervention to support researchers, which they refer to as a Regulatory Knowledge Support (RKS) service. While the study points to potential benefits, other studies have not had the desired impact on key performance measures. There is a need to develop a community of practice and expand the burgeoning evidence base regarding what interventions work, for whom, and under what circumstances. Advancing the research agenda requires: the development of theoretical models for intervention design and evaluation; developing consensus on key data for collection and measures of effectiveness; conducting evaluations using the strongest possible study designs, and; publishing the findings of evaluations.

Evaluating nurse understanding and participation in the informed consent process

BACKGROUND

Informed consent is fundamental to the autonomous decision-making of patients, yet much is still unknown about the process in the clinical setting. In an evolving healthcare landscape, nurses must be prepared to address patient understanding and participate in the informed consent process to better fulfill their well-established role as patient advocates.

RESEARCH OBJECTIVE

This study examines hospital-based nurses' experiences and understandings of the informed consent process.

RESEARCH DESIGN

This qualitative descriptive study utilized a semi-structured interview approach identifying thematic concerns, experiences, and knowledge of informed consent across a selected population of clinically practicing nurses.

PARTICIPANTS AND RESEARCH CONTEXT

In all, 20 baccalaureate prepared registered nurses practicing in various clinical settings (i.e. critical care, oncology, medical/surgical) at a large northeastern academic medical center in the United States completed semi-structured interviews and a demographic survey. The mean age of participants was 36.6 years old, with a mean of 12.2 years of clinical experience.

ETHICAL CONSIDERATIONS

Participation in this study involved minimal risk and no invasive measures. This study received Institutional Review Board approval from the University of Pennsylvania. All participants voluntarily consented.

FINDINGS

The majority of participants (N = 19) believe patient safety is directly linked to patient comprehension of the informed consent process. However, when asked if nurses have a defined role in the informed consent process, nearly half did not agree (N = 9). Through this qualitative approach, three major nursing roles emerged: the nurse as a communicator, the nurse as an advocate, and the clerical role of the nurse.

DISCUSSION AND CONCLUSION

This investigation contributes to the foundation of ethical research that will better prepare nurses for patient engagement, advance current understanding of informed consent, and allow for future development of solutions. Nurses are at the forefront of patient-provider interactions and they are often presented opportunities to learn about and engage in the informed consent process.

Dignity in nursing care: What does it mean to nursing students?

BACKGROUND:

Despite growing interest in the potential of nursing education to enhance dignity in nursing care, relatively little is known about what dignity means to nursing students.

RESEARCH QUESTION:

What meaning does dignity in nursing care have for nursing students?

RESEARCH DESIGN:

Photo-elicitation was embedded within a Nominal Group Technique and responses were analysed by qualitative and quantitative content analysis.

PARTICIPANTS AND RESEARCH CONTEXT:

Participants were recruited from each year of a 3-year undergraduate preregistration adult nursing programme in Scotland. In total, 31 nursing students participated in the study.

ETHICAL CONSIDERATIONS:

The study was approved by the Ethics Committee of the School of Health, Nursing and Midwifery, University of the West of Scotland.

FINDINGS:

Participants articulated the meaning of dignity in nursing care in terms of the relationships and feelings involved. A total of 10 categories of meaning were identified.

DISCUSSION:

The significance of the nature of the nurse-patient interaction to preserving dignity in nursing care is highlighted.

CONCLUSION:

Understanding the meaning of dignity for nursing students may help prepare future nurses more able to preserve dignity in nursing care.

Academic ethical awareness among undergraduate nursing students

BACKGROUND

Academic ethical awareness is an important aspect especially for nursing students who will provide ethical nursing care to patients in future or try to tread the path of learning toward professional acknowledgement in nursing scholarship.

PURPOSE

The purpose of this study was to explore academic ethical awareness and its related characteristics among undergraduate nursing students.

METHODS

This study commenced the survey with cross-sectional, descriptive questions and enrolled convenient samples of 581 undergraduate nursing students from three universities in South Korea. It was investigated with structured questionnaires including general characteristics and academic ethical awareness related.

ETHICAL CONSIDERATIONS

This study was reviewed and approved by the Institutional Review Board at National University.

FINDINGS

Academic ethical awareness was the highest regarding behaviors violating the respect or confidentiality of patients and cheating on exams, while it was the lowest for inappropriate behaviors in class. From the result of general characteristics difference, male students showed higher score than female students in relative; first-year students showed higher score than other year students; the higher score was rated from students who were highly satisfied with their major than the other not satisfied with their major; and students with low academic stress showed higher ethical awareness score than persons with higher stress.

CONCLUSION

Personal behaviors were rated with low ethical awareness in relative, but items related to public rules and actual effects on patients or others were rated with higher score. Nursing satisfaction and academic stress are main factors on ethical awareness. To improve overall ethical awareness level of nursing students, it is required to provide more education about the importance of personal behaviors in class and need to improve the understanding of how it will be connected with future situation and effect.

The Global Ethics Corner: foundations, beliefs, and the teaching of biomedical and scientific ethics around the world

The profound advances in the biomolecular sciences over the last decades have enabled similar advances in biomedicine. These advances have increasingly challenged our abilities to deploy them in an equitable and ethically acceptable manner. As such, it has become necessary and important to teach biomedical and scientific ethics to our students who will become the researchers, medical professionals, and global citizens of the future. As advances in the biosciences and medicine are made, developed, and used across the globe, our survival on an endangered planet requires global dialog and consensual action. To that end, a group of us from around the world have come together to describe the differing foundations of our ethical beliefs, and how ethical issues in biomedicine and in science are described and confronted in our countries. We hope to show the commonality in our beliefs and practices and to encourage readers from around the world to contribute to a continuing discussion through a new section of the journal, The Global Ethics Corner. © 2017 by The International Union of Biochemistry and Molecular Biology, 45(5):385-395, 2017.

Patient's dignity in intensive care unit: A critical ethnography

BACKGROUND

Maintaining patient's dignity in intensive care units is difficult because of the unique conditions of both critically-ill patients and intensive care units.

OBJECTIVES

The aim of this study was to uncover the cultural factors that impeded maintaining patients' dignity in the cardiac surgery intensive care unit.

RESEARCH DESIGN

The study was conducted using a critical ethnographic method proposed by Carspecken.

PARTICIPANTS AND RESEARCH CONTEXT

Participants included all physicians, nurses and staffs working in the study setting (two cardiac surgery intensive care units). Data collection methods included participant observations, formal and informal interviews, and documents assessment. In total, 200 hours of observation and 30 interviews were performed. Data were analyzed to uncover tacit cultural knowledge and to help healthcare providers to reconstruct the culture of their workplace.

ETHICAL CONSIDERATION

Ethical approval for the study from Ethics committee of Isfahan University of Medical Sciences was obtained.

FINDINGS

The findings of the study fell into the following main themes: "Presence: the guarantee for giving enough attention to patients' self-esteem", "Instrumental and objectified attitudes", "Adherence to the human equality principle: value-action gap", "Paternalistic conduct", "Improper language", and "Non-interactive communication". The final assertion was "Reductionism as a major barrier to the maintaining of patient's dignity".

DISCUSSION

The prevailing atmosphere in subculture of the CSICU was reductionism and paternalism. This key finding is part of the biomedical discourse. As a matter of fact, it is in contrast with dignified care because the latter necessitate holistic attitudes and approaches.

CONCLUSION

Changing an ICU culture is not easy; but through increasing awareness and critical self-reflections, the nurses, physicians and other healthcare providers, may be able to reaffirm dignified care and cure in their therapeutic relationships.

Dual loyalties: Everyday ethical problems of registered nurses and physicians in combat zones

BACKGROUND:

When healthcare personnel take part in military operations in combat zones, they experience ethical problems related to dual loyalties, that is, when they find themselves torn between expectations of doing caring and military tasks, respectively.

AIM:

This article aims to describe how Swedish healthcare personnel reason concerning everyday ethical problems related to dual loyalties between care and military tasks when undertaking healthcare in combat zones.

DESIGN:

Abductive qualitative design.

PARTICIPANTS AND RESEARCH CONTEXT:

Individual interviews with 15 registered nurses and physicians assigned for a military operation in Mali.

ETHICAL CONSIDERATIONS:

The participants signed up voluntarily, and requirements for informed consent and confidentiality were met. The research was approved by the Regional Ethics Review Board in Gothenburg (D no. 816-14; 24 November 2014).

FINDINGS:

Three main categories emerged: reasons for not undertaking combat duties, reasons for undertaking combat duties and restricted loyalty to military duties, and 14 subcategories. Reasons for not undertaking combat duties were that it was not in their role, not according to ethical codes or humanitarian law or a breach towards patients. Reasons for undertaking combat duties were that humanitarian law does not apply or has to be treated pragmatically or that it is a case of force protection. Shortage of resources and competence were reasons for both doing and not doing military tasks. Under some circumstances, they could imagine undertaking military tasks: when under threat, if unseen or if not needed for healthcare duties.

DISCUSSION/CONCLUSION:

These discrepant views suggest a lack of a common view on what is ethically acceptable or not, and therefore we suggest further normative discussion on how these everyday ethical problems should be interpreted in the light of humanitarian law and ethical codes of healthcare personnel and following this, further training in ethical reflection before going on military operations.

Effective Practices in the Delivery of Research Ethics Education: A Qualitative Review of Instructional Methods

In order to delineate best practices for courses on research ethics, the goal of the present effort was to identify themes related to instructional methods reflected in effective research ethics and responsible conduct of research (RCR) courses. By utilizing a qualitative review, four themes relevant to instructional methods were identified in effective research ethics courses: active participation, case-based activities, a combination of individual and group approaches, and a small number of instructional methods. Three instructional method themes associated with less effective courses were also identified: passive learning, a group-based approach, and a large number of instructional methods. Key characteristics of each theme, along with example courses relative to each theme, are described. Additionally, implications regarding these instructional method themes and recommendations for best practices in research ethics courses are discussed.

Curricular Approaches in Research Ethics Education: Reflecting on More and Less Effective Practices in Instructional Content

Over the past decade, the effectiveness of ethics education programs has increased with regard to trainee outcomes, such as knowledge, awareness, and ethical decision making. However, despite the overall improvement in training effectiveness, considerable variability still exists across programs. One potential source of variability arises from the substantial range in instructional training content utilized across ethics training courses. The goal of the present effort was to clarify which approaches in ethics education result in positive training outcomes through the identification of instructional content themes. Through a qualitative review of ethics training courses, we identified key themes in instructional content curriculum associated with effective courses: domain-general, domain-specific, standard compliance, professionalism, and process-based. In addition, we identified key themes associated with less effective courses: mixed-specificity, narrow coverage, and idealized ethics. Descriptions and key characteristics of each theme along with example courses are provided. Implications of the content themes for ethics education are discussed.

Embedding responsible conduct in learning and research into an Australian undergraduate curriculum

Responsible conduct in learning and research (RCLR) was progressively introduced into the pharmacology curriculum for undergraduate science students at The University of Western Australia. In the second year of this undergraduate curriculum, a lecture introduces students to issues such as the use of animals in teaching and responsible conduct of research. Third year student groups deliver presentations on topics including scientific integrity and the use of human subjects in research. Academic and research staff attending these presentations provide feedback and participate in discussions. Students enrolled in an optional capstone Honours year complete an online course on the responsible conduct of research and participate in an interactive movie. Once RCLR became established in the curriculum, a survey of Likert-scaled and open-ended questions examined student and staff perceptions. Data were expressed as Approval (% of responses represented by Strongly Agree and Agree). RCLR was found to be relevant to the study of pharmacology (69-100% Approval), important for one's future career (62-100% Approval), and stimulated further interest in this area (32-75% Approval). Free entry comments demonstrated the value of RCLR and constructive suggestions for improvement have now been incorporated. RCLR modules were found to be a valuable addition to the pharmacology undergraduate curriculum. This approach may be used to incorporate ethics into any science undergraduate curriculum, with the use of discipline-specific topics. © 2016 by The International Union of Biochemistry and Molecular Biology, 45(1):53-59, 2017.

Qualitative Evaluation Methods in Ethics Education: A Systematic Review and Analysis of Best Practices

Although qualitative research offers some unique advantages over quantitative research, qualitative methods are rarely employed in the evaluation of ethics education programs and are often criticized for a lack of rigor. This systematic review investigated the use of qualitative methods in studies of ethics education. Following a review of the literature in which 24 studies were identified, each study was coded based on 16 best practices characteristics in qualitative research. General thematic analysis and grounded theory were found to be the dominant approaches used. Researchers are effectively executing a number of best practices, such as using direct data sources, structured data collection instruments, non-leading questioning, and expert raters. However, other best practices were rarely present in the courses reviewed, such as collecting data using multiple sources, methods, raters, and timepoints, evaluating reliability, and employing triangulation analyses to assess convergence. Recommendations are presented for improving future qualitative research studies in ethics education.

Care-givers' reflections on an ethics education immersive simulation care experience: A series of epiphanous events

There has been little previous scholarship regarding the aims, options and impact of ethics education on residential care-givers. This manuscript details findings from a pragmatic cluster trial evaluating the impact of three different approaches to ethics education. The focus of the article is on one of the interventions, an immersive simulation experience. The simulation experience required residential care-givers to assume the profile of elderly care-recipients for a 24-hr period. The care-givers were student nurses. The project was reviewed favourably by a university ethics committee, and participants provided informed consent. Data from six postsimulation experience focus groups were analysed thematically and three themes were identified: the experience of vulnerability, dignity in care and the organisation of care. Findings suggest that the immersive simulation experience had a powerful immediate impact as participants described epiphanous insights relating to their care experiences. It is suggested that reflecting on and recording epiphanous events has the potential to sustain ethical care practices. Further research is required to evaluate the impact of different ethics education interventions in different cultural contexts. Exploration is also required regarding the meaning and significance of care epiphanies, those "most delicate and evanescent of moments," for the sustainability of ethical care.

Straight from the Horse's Mouth: Using Vignettes to Support Student Learning in Veterinary Ethics

In the last few decades, the importance of imparting ethical competences to veterinary students has been increasingly acknowledged. Despite its relevance, there are few published descriptions of teaching approaches to veterinary ethics and their effect on student learning. At University College Dublin, veterinary ethics is part of a core module on animal behavior and welfare in the pre-clinical teaching program. The present study describes the implementation of a student-centered, skills-based approach to veterinary ethics teaching using vignettes (i.e., case scenarios). Vignettes were inspired by several resources, including a focus group, and designed to represent significant ethical challenges faced by veterinary professionals in Ireland in addition to cases of potential professional misconduct. In small groups, students had to identify the stakeholders and their conflicting interests and to suggest possible solutions and alternative outcomes to the case scenario. Results from qualitative material from the teaching sessions and from a quantitative post-teaching survey show that student understanding of stakeholders increased as a result of the tutorial, which helped them to clarify possible solutions to the scenario and to propose alternative outcomes to either mitigate or avoid future occurrence of the ethical challenges. These findings suggest that incorporating meaningful vignettes into the teaching of veterinary ethics can support student ethical awareness and skills, while promoting a pluralistic approach to considering ethical issues, making the best of available time and human resources.

Ethics teaching in rehabilitation: results of a pan-Canadian workshop with occupational and physical therapy educators

PURPOSE

Ethical practice is an essential competency for occupational and physical therapists. However, rehabilitation educators have few points of reference for choosing appropriate pedagogical and evaluation methods related to ethics. The objectives of this study were to: (1) identify priority content to cover in ethics teaching in occupational therapy (OT) and physical therapy (PT) programmes and (2) explore useful and innovative teaching and evaluation methods.

METHOD

Data for this qualitative descriptive study were collected during a 1-d knowledge exchange workshop focused on ethics teaching in rehabilitation.

RESULTS

Twenty-three educators from 11 OT and 11 PT Canadian programmes participated in the workshop. They highlighted the importance of teaching foundational theoretical/philosophical approaches and grounding this teaching in concrete examples drawn from rehabilitation practice. A wide range of teaching methods was identified, such as videos, blogs, game-based simulations and role-play. For evaluation, participants used written assignments, exams, objective structured clinical examinations and reflective journals. The inclusion of opportunities for student self-evaluation was viewed as important.

CONCLUSION

The CREW Day provided ethics educators the opportunity to share knowledge and begin creating a community of practice. This space for dialogue could be expanded to international rehabilitation ethics educators, to facilitate a broader network for sharing of tacit and experiential knowledge. Implications for Rehabilitation According to the study participants, rehabilitation ethics education should include learning about foundational knowledge related to ethical theory; be grounded in examples and cases drawn from clinical rehabilitation practice; and contribute to building professional competencies such as self-knowledge and critical thinking in students. Regardless of the methods used by occupational therapy (OT) and physical therapy (PT) educators for teaching and evaluation, the value of creating spaces that support open discussion for students (e.g. protected discussion time in class, peer-discussions with the help of a facilitator, use of a web discussion forum) was consistently identified as an important facet. Educators from OT and PT programmes should work with various professionals involved in OT and PT student training across the curricula (e.g. clinical preceptors, other educators) to extend discussions of how ethics can be better integrated into the curriculum outside of sessions specifically focused on ethics. The CREW Day workshop was the first opportunity for Canadian rehabilitation ethics educators to meet and discuss their approaches to teaching and evaluating ethics for OT and PT students. Including international rehabilitation ethics educators in this dialogue could positively expand on this initial dialogue by facilitating the sharing of tacit and experiential knowledge amongst a larger and more diverse group of ethics educators.

An Evaluation of Research Ethics in Undergraduate Health Science Research Methodology Programs at a South African University

The amended research ethics policy at a South African University required the ethics review of undergraduate research projects, prompting the need to explore the content and teaching approach of research ethics education in health science undergraduate programs. Two qualitative data collection strategies were used: document analysis (syllabi and study guides) and semi-structured interviews with research methodology coordinators. Five main themes emerged: (a) timing of research ethics courses, (b) research ethics course content, (c) sub-optimal use of creative classroom activities to facilitate research ethics lectures, (d) understanding the need for undergraduate project research ethics review, and (e) research ethics capacity training for research methodology lecturers and undergraduate project supervisors.

Towards improving the ethics of ecological research

We argue that the ecological research community should develop a plan for improving the ethical consistency and moral robustness of the field. We propose a particular ethics strategy--specifically, an ongoing process of collective ethical reflection that the community of ecological researchers, with the cooperation of applied ethicists and philosophers of biology, can use to address the needs we identify. We suggest a particular set of conceptual (in the form of six core values--freedom, fairness, well being, replacement, reduction, and refinement) and analytic (in the forms of decision theoretic software, 1000Minds) tools that, we argue, collectively have the resources to provide an empirically grounded and conceptually complete foundation for an ethics strategy for ecological research. We illustrate our argument with information gathered from a survey of ecologists conducted at the 2013 meeting of the Canadian Society of Ecology and Evolution.

The changing landscape of care: does ethics education have a new role to play in health practice?

BACKGROUND

In the UK, higher education and health care providers share responsibility for educating the workforce. The challenges facing health practice also face health education and as educators we are implicated, by the way we design curricula and through students' experiences and their stories. This paper asks whether ethics education has a new role to play, in a context of major organisational change, a global and national austerity agenda and the ramifications of disturbing reports of failures in care. It asks: how would it be different if equal amounts of attention were given to the conditions in which health decisions are made, if the ethics of organisational and policy decisions were examined, and if guiding collaborations with patients and others who use services informed ethics education and its processes?

DISCUSSION

This is in three parts. In part one an example from an inspection report is used to question the ways in which clinical events are decontextualised and constructed for different purposes. Ramifications of a decision are reflected upon and a case made for different kinds of allegiances to be developed. In part two I go on to broaden the scope of ethics education and make a case for beginning with the messy realities of practice rather than with overarching moral theories. The importance of power in ethical practice is introduced, and in part three the need for greater political and personal awareness is proposed as a condition of moral agency.

SUMMARY

This paper proposes that ethics education has a new contribution to make, in supporting and promoting ethical practice - as it is defined in and by the everyday actions and decisions of practitioners and people who need health services. Ethics education that promotes moral agency, rather than problem solving approaches, would explore not only clinical problems, but also the difficult and contested arenas in which they occur. It would seek multiple perspectives and would begin with places and people, and their priorities. It would support students to locate their practice in imperfect global contexts, and to understand how individual and collective forms of power can influence healthcare quality.