Clinical training is a setting where nursing students develop the required sense of ethics while providing patient care and observing the behavior of nurses. It’s also a perfect educational opportunity for instilling nursing ethics where students can learn methods to cope with ethical problems. We believe people’s behaviors reflect the sense of ethics of the person, and behaviors to cope with ethical problems encountered during clinical training provide a mirror that reflects the sense of ethics of students. To understand this better, we conducted a study by focusing on what sense of ethics students displayed and how they may be expected to be influenced by the clinical training.
Our purposes were to clarify the ethical problems which the nursing student faced during training in a clinical setting, and to identify the characteristics of the coping behavior and to explore how the sense of ethics differ among nursing students.
The findings in this study are new, and findings like these have not been published previously. It is hoped that the findings will contribute to nursing education in present day Japan, where ethics education has not been systematically pursued so far, but has been left to the competence of the teacher. In addition, our findings will be useful to establish a basic methodology that shows how to deal with issues in nursing ethics education and what it is necessary to do to develop the understanding of the ethics points and attitudes of the students.
Our sample is 11 Nursing students who have had the experience of participating in training in a clinical setting. We conducted semi-structured interviews and created transcriptions based on our own guidelines, and made use of the narrative approach to analyze the qualitative data.
We identified 23 ethical problems in the narratives of the students. They are mostly about interactions between nurses and patients, and about the behaviors or attitudes of nurses towards patients. When encountering a problem, students will be surprised and wonder if this can be right? and result in reactions like “I don’t like it”. Then, what coping behavior do they fall back on? We found that many of the students do not engage in any active behavior when encountering ethical problems. Many nursing students wondering if something is really right, or “just watched”, and “thinking how they should do something.” Some students asked teachers for opinions, but those were only few. Most students conformed to this kind of unquestioning behavior. We explored the sense of ethics of nursing students based on their coping behaviors when encountering ethical problems. From these considerations we feel that students are worried about what to consider most important, the "relationships with nurses" or the "relationships with patients". Here, they lean towards valuing the relationship with nurses who cause a particular problem rather than concern themselves about the patients involved in the problem. We came to understand that most students place value on the "relationship with nurses", and refrain from voicing their opinions to the nurses even when thinking that there is “something wrong” in the way of dealing with problems. They rationalize that “This is a rule here”, and that “Students should not express their opinions”. To think and accept that “This is a rule here” involves a change of their existing sense of ethics, and it results in a displacement of the “pre-clinical training” sense of right and wrong. This is what may happen when students put a higher value on the relationship with nurses than on that with patients.
In this way, understanding what students rely on in making decisions in clinical training and the sense of ethics they bring to the work will make a significant contribution to the concept of nursing education in the future.
We are planning to develop this research into a quantitative study and also to make cross-cultural comparisons. When a clear sense of ethics is a determinant for good nursing practices, we may expect that through this study there will be many nurses who would play active roles in the future.