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Ethics at Bachelor’s level
Philip Esterhuizen RN, BA(Cur) MScN, PhD
European directives for nurse education leading to registration
The educational programme should guarantee:
Adequate knowledge of science and include sufficient understanding of the structure, physiological functions and behaviour of healthy and sick persons.
The relationship between the state of health and physical and social environment of the human being.
Sufficient knowledge of the nature and ethics of the profession.
Adequate clinical experience. Ability to participate in the training of health personnel. Experience of working with other professions in the
health care sector
European directives for nurse education regarding practice
In a programme of 3 years/4,600 hours, there should be a 50% balance of theory/practice. Practice can take place in hospitals, other health care institutions and in the community and should include:
General and specialist medicine General and specialist surgery Maternity care Mental health and psychiatry Care of the old and geriatrics Home nursing
Entrance to nursing education
In the Netherlands education the general secondary educational system has three main options, the MAVO (four years), the HAVO (five years) and the VWO (six years), the latter being the entry requirement to university degrees.
MAVOHAVO
VWO
Secondary
Professional
Education
MBOV
Higher
Professional
Education
HBOV
Nursing education in the Netherlands
Level 1 nurse:Housekeeping & non-patient activities
Level 2 nurse:Basic nursing activities/assistant to more qualified staff
Level 3 nurseIndependent nursing activities
Level 4 Registered Nurse
Regional EducationalCentres
Level 5 Registered Nurse/BScInstitute forHigher education
MSc Degree
MPhil/PhD Universityeducation
No formal qualification
MSc Degree
Two levels of nurses (NL)Two levels of nurse (Level 4 educated at college level and Level 5 educated at degree level) are both registered as nurses under the Individual Health Care Professions Act.
Both levels of nurses are expected to:(a) recognise and analyse actual and/or threatening consequences of physical, mental pathological processes, (b) recognise and analyse disabilities or developmental disorders (c) recognise and analyse the individual’s vital functions (d) provide counselling and assist the individual in situations when necessary.
The Level 5 nurse: Is capable of assessing the whole situation and deciding the
appropriate level of care. Directs Level 4 nurses.
Competency-based education (NL)
The skill set for the degree level (5) nurse includes the following competencies:
Observation Direct patient care Emotional support Nursing skills Patient information and education Preventative and promotive health Coordination of care
Nursing roles and domains included in the nursing programme
Five roles Three domains Nine domain specifications
• Care provider • Care • Care for the ill, handicapped and dying.
• Care director
• Individual and collective prevention
• Health information and education
• Care developer • Organisation of care
• Programming care
• Coach
• Nursing unit
• Mentorship
• Quality of care
• Professional practitioner • Profession • Professional innovation
• Professional development
Clinical practice (NL)
The practice part of the programme:
Is usually 10 weeks in the first year, 20 weeks in the second, third and fourth years of the programme.
Occurs in nursing homes, mental health settings, general hospital and/or community settings
In the final placement (4th year), the student is expected to undertake a practice-based research project.
Cooperative nursing education (NL)
In addition to the regular BSc Nursing programme, students can choose a second option in the form of a cooperative nursing education programme.
This programme is also 4 years in duration, but here the student is employed by a hospital where all practice placements take place. The theory and practice/work balance shift from 60% practice in the first years to 80% practice in the final years.
The Cooperative nursing programme is based strongly on the concept of workplace learning by means of clinical placements being a way of achieving academic credits.
Position of ethics in the curriculum
Currently: » ‘Informal’ reflections during mentorship in all years» Year 3 - Ethics and value system (16 hours)
Future plans:» ‘Formal’ integration of ethics and value system during
mentorship» Year 1 - Personal philosophy/vision of care (16 hours)» Year 2 - Ethics and value system, palliative care, qualitative
research (36 hours)» Year 3 – Ethics and law (16 hours)» Year 4 – Ethics and research (16 hours)
Learning from experience
Expertise develops when the clinician tests and refines propositions, hypotheses, and principle-based expectations in actual practice situations
Benner (1984)
Educational philosophy
Based on:
• Personal and professional support for the individual
• Methodic and systematic supervision
• The process of personal growth and development
• Respect for the individuality of the person and attention for the search for self-actualization
Approach to schooling on ethics
Principle-based ethics The value of life Goodness/no harm Justice Truth telling Autonomy Beneficence
Care-based ethics Moral attention Sympathetic
understanding Relationship awareness Accommodation Response
Theoretical approach to ethics education
Move in the direction of virtue-based ethics/theory of presence
» Compassion – ‘an awareness of one’s relationship with others’» Competence – ‘having the necessary knowledge, judgement,
skills, energy, experience and motivation’ » Confidence – ‘the quality that fosters trusting relationships’» Conscience – ‘a state of moral awareness’» Commitment – ‘convergence between one’s desires and one’s
obligations and the deliberate choice to act in accordance’
Driscoll: ‘What?’ model of structured reflection (2000)
Having an experience in practice
What? Description of the event
Purposeful reflection on selected aspects of the experience
So what? An analysis of the event
Discovery of what learning emerges from reflection
Now what?Proposed actions
following the event
Actioning the new learning from the experience
Reflection and reflective practice
Reflection-in-action Reflection-on-action Reflection prior to action
Transformational learning (Lingsma & Scholten, 2001)
Choice of motives and values, identity, who are these people?
Assumptionsand strategicactions
Actions Results
Continual improvement
Reassessment
Transformation
Single loop learning
Double loop learning
Triple loop learning
What am I doing?What do I think?What do I want?
UnderlyingUnderlying
Being responsible versus having responsibility
Assist students in setting boundaries
Being responsible - ‘being aware of what is happening and prepared to engage with it and work for its positive advance in society’
Having responsibility - ‘to be answerable to someone or something specific, usually defined by contract’
