Threading Ethics Into a Graduate Curriculum

Threading Ethics into a Graduate Curriculum
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I Narrative Paper Ethics       Ethics is a branch of philosophy that deals with moral principles, values and motivations that guide human behaviour in decision-making (Haddad & Geiger., 2022). Fundamentally, it involves the process of thinking and reflection to determine what is right or wrong. Ethical values are universal rules of conduct that provide a practical basis for identifying what kind of actions, intention, and motives are valued. In the context of nursing, ethics is an inherent and inseparable part of clinical medicine as the physician has an ethical obligation (i) to benefit the patient, (ii) to avoid or minimize harm, and to (iii) respect the values and preferences of the patient (Varkey, 2021). Ethics should be taught to student nurses for several reasons. First, it helps nurses to provide patient-centred care (Ekman, 2022). The subject of nursing ethics revolves around caring and advocating for the well-being of patients. It also helps nurses to make sound decisions in the face of ethical dilemmas. In practice, nurses face ethical dilemmas that need balancing of conflicting interests, need to respect autonomy and confidentiality, how to navigate cultural and religious considerations etc. Ethics help nurses to create and develop a framework to navigate these issues professionally, morally and within the provisions of the law (Haddad & Geiger., 2022). Thirdly, ethics help nurses to maintain the highest levels of professionalism. Ethics help nurses to make appropriate decisions when they are addressing ethical issues that have a direct or indirect impact on patient safety such as medication errors, informed consent, end of life care etc. Fourthly, nurses have a code of ethics that has been developed by their respective licensing bodies. Nurses are required to learn, understand and adhere to the code of ethics for their licensure. Finally, nurses are expected to learn about ethics because it teaches critical and ethical reasoning. Nurses need to be able to analyze and evaluate issues from multiple perspectives and consider their consequences and weigh the implications of each action versus the related consequence to deliver patient centred care and improve healthcare outcomes (Kieft, Brouwer, Francke, & Delnoij, 2014). Threading ethics into nurses’ training helps a holistic approach to the discipline. Students are able to understand how ethics is interwoven with all the other aspects of nursing and how they relate to real world clinical scenarios. It is an essential component of all nursing practice (Hemberg & Hemberg, 2020). Secondly, nursing programs are designed to provide a comprehensive education that includes not only clinical skills but also critical thinking, leadership, and professionalism (Papathanasiou, et al., 2014). Incorporating nursing ethics within the broader nursing curriculum helps nursing students develop a well-rounded skill set that encompasses both clinical and ethical aspects of nursing practice. Therefore, this is an important skill for professionals who are involved in the business of alleviating pain and prolonging life.  Ethics in nursing is a fundamental and unavoidable subject that must be threaded into the curriculum because it is interrelated with all aspects of patient care.  
  II Strategies for Threading Content Simulation Based learning This teaching strategy entails creating a realistic scenario to simulate real life clinical situations. This strategy helps students to practice and develop their clinical skills in a controlled environment (Alinier & Oriot, 2022). Students use props to simulate clinical situations and are expected to apply skills learnt in class to address the situation. For example, nursing students can simulate how to intubate a patient. Simulation based learning allows students to engage in experiential learning without the risks associated with real patients ‘ex vivo’ (Alinier & Oriot, 2022). Secondly, Simulation-based learning promotes active and engaging learning experiences. Students are actively involved in hands-on activities, such as performing procedures, making decisions, and solving problems, which encourages higher levels of engagement and participation. Thirdly, simulation-based learning offers opportunities for formative and summative assessment of student performance (Arrogante, et al., 2021). Educators can assess students' knowledge, skills, and clinical reasoning abilities during simulations, providing immediate feedback for improvement. This teaching method is most appropriate to intermediate and advanced level of graduate nursing students who have already acquired foundational and basic nursing knowledge and skills. Ethics can be taught through this method by role playing. Students can role play as family, healthcare providers etc. And engage in discussions about ethical issues from various perspectives. For instance, Simulation based learning would be instrumental in teaching ethical issues by creating scenarios that address different ethical issues like patient autonomy, informed consent and confidentiality. For instance, a scenario could entail a patient refusing treatment for her child because of religious grounds. The student would be required to navigate the ethical implication of respecting such a decision, while also ensuring the safety of the child. Problem Based Learning This is a pedagogical approach that presents students with real life problems to solve. This strategy encourages students to apply their knowledge and skills to develop solutions.  This teaching approach emphasizes learning behaviour that leads to problem-solving, communication, collaborative skills such as finding the solution as a group (Azril Shahreez Abdul Ghani, Yusoff, & Hadie, 2021). Students are encountered with authentic clinical problems which require them to analyze, synthesize and apply their knowledge to solve these problems. Problem based learning is an important strategy when used in groups and encouraged to do collaboration and deliberate the problems (Lestari, Stalmeijer, Widyandana, & Scherpbier, 2019). This collaborative learning approach reflects the interprofessional nature of healthcare practice, where nurses often work as part of a healthcare team (Lestari, Stalmeijer, Widyandana, & Scherpbier, 2019). Students also learn from their peers and learn how to share their perspectives and knowledge. This helps to develop collaboration skills which are essential in modern healthcare practice. Real-world problems or cases also reflect the complexities and uncertainties of nursing practice, allowing students to develop a deep understanding of the challenges and nuances of patient care. This pedagogical approach is appropriate across all levels of nursing training depending on the learning objectives. In basic training it helps students to gain solid foundational nursing knowledge and skills. In intermediate and advanced training, problem-based learning can be used to facilitate the application of advanced knowledge and skills to solve complex clinical cases. Ethics can be taught through this method by giving ethical dilemma case studies centred around ethical themes for students to discuss in groups. The approach could be used to present the learners with complex ethical issues that need immediate solutions. For instance, students could be exposed to a case where a 13-year-old girl reveals that she underwent an abortion and does not want her parents to know about it. The case would allow the nurses to explore what it means to ensure the confidentiality of information especially for teenagers. Through problem based learning, students will understand how to make decisions that touch on ethical issues, while not compromising the quality of care provided. Flipped Classroom Flipped classroom is a teaching strategy that advocates for students to be exposed to the information before class then class-time is used for interactive activities such as discussions, case studies and hands-on demonstrations. In nursing, students are pre-assigned class readings to review before coming to class. ...