Undergraduate nursing students who are learning about ethics often find themselves confused regarding the practical application of ethical principles in objectively presenting both sides of an ethical dilemma. Faculty teaching Maternal Newborn Nursing at a university setting in northeast Texas found that students had problems choosing an ethical question and then finding ways of presenting the points of view regarding it in a way that did not reflect bias. Students reported these difficulties to faculty. Students were taught ethical principles in a previous course (Therapeutic Communication) but also had issues when applying an ethical decision making framework to the ethical question chosen and reported that problem to faculty as well.
Over the course of four years, faculty worked on changing the grading rubric and assisting students with this process. Faculty also established inter-rater reliability in grading papers by having each faculty in the course blind grade a sample of papers for that year. That inter-rater reliability process continued throughout. After the first year, when the problems with the papers were identified, the faculty sought other solutions by reviewing the literature and a group problem solving process.
Ultimately, the faculty decided to find assistance in a somewhat unorthodox, yet collaborative, manner. A local high school speech and debate teacher, who was quite successful with student outcomes in debate, was solicited to provide a class to students. Since debate requires the ability of the debater to present both sides of an issue, it seemed that debate theory might be an intriguing way to teach nursing students the same concepts and then assisting them to apply that theory, along with an ethical decision making model, to the unbiased presentation of a chosen ethical question. Those questions were to be consistent with topics reflecting ethical dilemmas in maternal newborn nursing.
The class originally consisted of ways to present both sides of an argument and support those arguments with research. After two years, a tabletop simulation was added with students interacting regarding a selected situation, first on one side and then on the other. The debate teacher was able to interact effectively with the students and generate enthusiasm and interest in the presentation.
Grades on the ethics papers were evaluated to determine progress and course evaluations were also reviewed to determine students’ response to the presentation. The average grade on the course assignment improved incrementally each year of the project and response to the presentation of content was perceived positively, with students indicating they understood the assignment itself better and understood how to present the content in an unbiased manner.
Faculty are now recommending continuing this approach to teaching undergraduate nursing students and continuing the evaluation of grades and responses. The use of collaboration with another field provided an innovative and fresh approach and piqued the students’ continued interest in and use of this method. It also reinforced the use of evidence in supporting nursing care around ethical issues.