Evaluation of an interactive education workshop on hospital pharmacists' ethical reasoning: an observational study.

BACKGROUND: Pharmacists are often faced with scenarios in practice that require application of ethical reasoning and decision-making skills. There is limited research on the ethical decision-making processes of hospital pharmacists. Pharmacists who are compassionate and put the interests of their patients first are thought to positively impact on patient care, but there are often complex health-care system pressures in the hospital setting that cause pharmacists to behave in ways that may conflict with professional values and behaviours. This multisite study aimed to evaluate an interactive education workshop on hospital pharmacists' ethical reasoning skills and explore the need for ongoing training and support. METHODS: This mixed-methods study was carried out across two health services including three hospitals. It incorporated a pre-workshop survey, a feedback survey immediately post-workshop and a third survey four weeks after the workshop. Semi-structured interviews were conducted with hospital pharmacists at least four weeks after the ethics workshop. RESULTS: In total, 32 participants completed the pre-workshop survey, nominating peers/colleagues as the most common source of support they would consult to inform ethical decision-making (17/118 sources of support). Almost all (n = 31/33; 94%) strongly agreed/agreed that the education session provided them with ethical reasoning skills and a process/framework which they could use when faced with an ethical issue. Pre- and post-survey responses showed increased self-confidence in identifying the regulatory frameworks applicable to pharmacy privacy requirements (p = 0.011) and ethical issues applicable to pharmacy privacy requirements (p = 0.002), as well as applying ethical reasoning to scenarios that involve pharmacy privacy dilemmas/issues (p = 0.004). Participants' self confidence in knowing where to find support when faced with clinical and non-clinical ethics questions was improved (p = 0.002 and p = 0.003 respectively). Participants supported the introduction of quarterly ethics cafes after the workshop, compared to before the workshop (p = 0.001). CONCLUSION: Hospital pharmacists rely on discussions with colleagues to brainstorm how to address ethical issues. This study showed that a targeted interactive education workshop facilitated familiarity with ethics resources and decision-making processes. It also demonstrated that this approach could be used to enhance hospital pharmacists' readiness, confidence, and capabilities to recognise and respond to challenging ethical issues.

Improvement and implementation of central sterile supply department training program based on action research.

BACKGROUND: This study aimed to improve and implement the central sterile supply department (CSSD) training program through action research and to evaluate its effect. MATERIALS AND METHODS: The project was underpinned by action research. The problems that occurred in training were identified following scenario analysis, interviews, group discussions, and expert consultation to develop improvement measures. The training program characterized by CSSD was developed in the spiral circular process of "Plan-Act-Observe-Reflect". RESULTS: After the two rounds of training, the CSSD nurses significantly improved their professional knowledge, skills, and satisfaction with training compared with those before improvement. The nurses' overall satisfaction with the training and their performance improved. CONCLUSIONS: The implementation of the training program designed based on action research can improve CSSD nurses' professional knowledge and skills and increase their enthusiasm for learning, laying the foundation for CSSD talent development.

Explaining the process of learning about dignity by undergraduate nursing students: A grounded theory study.

BACKGROUND: The learning process about dignity and how undergraduate nursing students experience and use this ethical knowledge is an under-represented field in nursing research. To overcome the lack of conceptual clarity, it is important to understand what processes and dimensions students develop to support this learning outcome. OBJECTIVE: This study aimed to explain the process of learning about dignity by undergraduate nursing students. RESEARCH DESIGN AND METHODS: A qualitative study was conducted using the grounded theory method. PARTICIPANTS AND RESEARCH CONTEXT: Data was collected through free reports and in-depth semi-structured interviews with 20 participants. A focus group was held for the selective coding. Sampling began purposefully and evolved into theoretical. Reflective and theoretical memos were generated from the data collection and constant comparison. Data analysis was performed using qualitative data analysis software using Corbin and Strauss' method. ETHICAL CONSIDERATIONS: The research was approved by a specialized research ethics committee from a Health School. FINDINGS: The process of learning about dignity by undergraduate nursing students revealed 'recognition of dignity' as the core category, supported by five main categories: 'proto-conscience of dignity', 'pathway to nursing', 'consciousness of dignity', 'ways of learning', and 'becoming capable'. These categories illustrate the processes and dimensions involved in nursing students' concept translation of dignity learning, allowing a theory to emerge. CONCLUSIONS: The 'Recognition of Dignity' theory aims to contribute to developing educational, training, and supervision processes for nursing programs. It seeks to enhance the ethical and moral development of undergraduate nursing students by helping them understand the concept of dignity and its fundamental importance in nursing.

Brave spaces in nursing ethics education: Courage through pedagogy.

BACKGROUND: Nursing students must graduate prepared to bravely enact the art and science of nursing in environments infiltrated with ethical challenges. Given the necessity and moral obligation of nurses to engage in discourse within nursing ethics, nursing students must be provided a moral supportive learning space for these opportunities. Situating conversations and pedagogy within a brave space may offer a framework to engage in civil discourse while fostering moral courage for learners. RESEARCH OBJECTIVE: The aim of this research is to explore the influence of a structured self-assessment tool called the ESA "Engagement Self-Assessment" on the alignment and creation of a brave space in a nursing ethics course. RESEARCH DESIGN: This study used an exploratory, cross-sectional survey design. PARTICIPANTS AND STUDY SETTING: Data from 39 undergraduate nursing students enrolled in a nursing healthcare ethics & law course using the ESA were recruited. ETHICAL CONSIDERATIONS: Participation was voluntary and informed without coercion. Written consent was obtained prior to participation. Research ethics approval was obtained by the Institutional Research Ethics Board of the recruited participants (Ethics # 2022-23-03). FINDINGS: The ESA provided structured self-reflection on the impact of shared vulnerability within a brave space. However, commitment to a brave space was not strongly influenced by the ESA, but rather by a mutual "commitment to others." CONCLUSION: A teaching tool such as an ESA can be used to facilitate instructor expectations of civil discourse and discussion of difficult topics. Rules of engagement such as those found in brave spaces can help transform fear of vulnerability into authentic growth for learners. A morally supportive learning space can support critical opportunities for ethical development. This study provides insight into how self-assessment and the use of a brave space in nursing ethics education can facilitate a morally supportive learning space.

"Moral spaces": A feasibility study to build nurses' ethical confidence and competence.

Background: Pre-licensure ethics nursing education does not adequately prepare and instill confidence in nurses to address ethical issues, and yet ethics education provides nurses with greater confidence to take moral action, which can mitigate the negative effects of moral distress. Objectives: To assess the feasibility and acceptability of a nursing ethics education program that included simulated case-based ethics competencies as a form of evaluation. The program aimed at building nurses' ethical knowledge and confidence to respond to ethical challenges in practice. Research design: A prospective, longitudinal, correlational, single-cohort feasibility study using an investigator-developed survey and intervention field data. Participants and research context: Registered nurses were recruited from an academic quaternary-care medical center and 9 small- to mid-sized regional hospitals within one health system in the Midwest United States. Ethical considerations: IRB approval was obtained. Participants could complete the educational program regardless of research process participation. Findings: Of 20 participants, 19 (95%) provided post-program surveys and 18 completed competencies. Median (IQR) scores with quartiles for scheduling, timing, and length of sessions were all 10.0 [9.0, 10.0], and participants perceived that the content was interesting, increased knowledge and confidence in ethics, increased skills in providing ethical care, and would recommend the program to colleagues. Of factors, an increase in ethics knowledge had the highest "always agree" (17, 89.5%) response. Most participants reported that ethics competencies were appropriate 9.0 [9.0, 10.0] and sufficiently challenging 10.0 [9.0, 10.0]. Discussion: The education program developed nurses' ethics knowledge and confidence. The single-cohort feasibility design provided early-stage intervention outcomes; however, a larger randomized controlled trial would substantiate program value. Conclusion: This novel ethics education program was highly feasible and acceptable to hospital-based nurses who reported increased knowledge and confidence in providing ethical care. Simulated case-based ethics competencies were an appropriate evaluation method.

Interprofessional Ethics Simulations and Debriefing to Develop Collaborative Skills.

The Interprofessional Education Collaborative's (IPEC's) core competencies are accreditation standards of most, if not all, healthcare professions (Interprofessional Education Collaborative Expert Panel [2016, Core Competencies for Interprofessional Collaborative Practice: 2016 Update. Washington, DC: IPEC]). Limited literature exists on interprofessional (IP) learning outcomes in healthcare ethics; even fewer studies include debrief sessions. Interprofessional education (IPE) case discussion using web-based technology is a promising way to incorporate ethics content. This article summarizes a model for healthcare programs to create, conduct, and assess synchronous IPE ethics discussions and debrief sessions. Specifically, this article highlights debrief sessions that followed a standardized patient (SP) IP interaction with students from pharmacy and advanced practice nursing. Qualitative analysis of debrief comments identified four themes: the benefit of IP collaboration, the importance of patient-centered care, the need to adapt clinical recommendations with ethical challenges, and the importance of trust among team members. The findings indicate web-based, synchronous IP/SP ethics simulations and debrief sessions are an effective, albeit laborious, method for collaboration and reflection.

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.

Educational approach for public health ethics in nursing: Focusing on COVID-19.

Background: With the increasing ethical challenges and dilemmas faced by nurses due to various disasters such as COVID-19 worldwide, there is a need for a new public health ethics education curriculum to strengthen competencies for ethical responses in the nursing field. Objectives: This study was aimed to identify the impact of a teaching method utilizing news articles and panel discussion material in the public health ethics education program on nursing students' thinking regarding ethical issues. Design: This was an exploratory study to identify the thinking styles inherent in ethical reflection by analyzing the reflection contents written by nursing students using text mining techniques. Participants: 73 among the students taking a nursing ethics course at a university in Seoul, South Korea, voluntarily participated in this study after providing informed consent. Methods: The public health ethics program was conducted with sessions held once a week for a total of 7 weeks, and reflections written by nursing students were collected as text files during session 5 to 7. In this study, data preprocessing process, keyword analysis, and LDA topic modeling were sequentially conducted utilizing the R program according to the data analysis procedure of text mining techniques. Ethical considerations: This study was conducted under ethics approval from the institution where participants were recruited. Findings and discussion: The results of this study show that the teaching method utilizing news articles enhanced rational ethical deliberation from the cognitive aspect, whereas the teaching method utilizing panel discussion material strengthened the response to emotions on a more internal level. Conclusions: The teaching method utilizing news articles and panel discussion materials in public health ethics education is expected to be mutually complementary and effective, so further studies are recommended.

Everyday Clinical Ethics: Essential Skills and Educational Case Scenarios.

Bioethics conjures images of dramatic healthcare challenges, yet everyday clinical ethics issues unfold regularly. Without sufficient ethical awareness and a relevant working skillset, clinicians can feel ill-equipped to respond to the ethical dimensions of everyday care. Bioethicists were interviewed to identify the essential skills associated with everyday clinical ethics and to identify educational case scenarios to illustrate everyday clinical ethics. Individual, semi-structured interviews were conducted with a convenience sample of bioethicists. Bioethicists were asked: (1) What are the essential skills required for everyday clinical ethics? And (2) What are potential educational case scenarios to illustrate and teach everyday clinical ethics? Participant interviews were analyzed using qualitative content analysis. Twenty-five (25) bioethicists completed interviews (64% female; mean 14.76 years bioethics experience; 80% white). Five categories of general skills and three categories of ethics-specific skills essential for everyday clinical ethics were identified. General skills included: (1) Awareness of Core Values and Self-Reflective Capacity; (2) Perspective-Taking and Empathic Presence; (3) Communication and Relational Skills; (4) Cultural Humility and Respect; and (5) Organizational Understanding and Know-How. Ethics-specific skills included: (1) Ethical Awareness; (2) Ethical Knowledge and Literacy; and (3) Ethical Analysis and Interaction. Collectively, these skills comprise a Toolbox of Everyday Clinical Ethics Skills. Educational case scenarios were identified to promote everyday ethics. Bioethicists identified skills essential to everyday clinical ethics. Educational case scenarios were identified for the purpose of promoting proficiency in this domain. Future research could explore the impact of integrating educational case scenarios on clinicians' ethical competencies.

Training nurses to facilitate and implement CURA in palliative care institutions: development and evaluation of a blended learning program.

BACKGROUND: Healthcare professionals in palliative care are found to be confronted with moral challenges on a frequent basis. CURA is a low-threshold instrument for dialogical ethical reflection that was developed to deal with these challenges. A previous study identified the need of healthcare professionals to be trained to introduce CURA in their organization, initiate and facilitate reflections with CURA, and contribute to the implementation of CURA. The aim of this study was to develop and evaluate a training for professionals to become 'CURA-ambassadors'. METHODS: The training was developed in a participatory way in two cycles. We trained 72 healthcare professionals. The training was evaluated by means of a questionnaire and six semi-structured interviews. RESULTS: The study resulted in a blended learning training combining training sessions with an e-module and with practicing with organizing and facilitating CURA in daily healthcare practice. The main objectives of the training are to enable CURA-ambassadors to introduce CURA within their organization, initiate and facilitate ethical reflections using CURA, and contribute to the implementation of CURA. Participants were generally positive about the training program and the trainers. Technical difficulties related to the e-module were mentioned as main point of improvement. DISCUSSION: The training program can generate ownership, responsibility, and competency among CURA-ambassadors, which are essential foundations for implementing complex interventions in healthcare practice. The training program received positive evaluations shortly after completing the program. This study adds to our understanding of what is needed for healthcare professionals to use CURA, in order to support them in dealing with moral challenges and to foster their moral resilience. Further research is needed to assess whether participants experience the training as sufficient and effective when using and implementing CURA structurally in their organizations over a longer period of time.

Ethical sense, medical ethics education, and maieutics.

CONTEXT: The toolbox of instructional methods available to medical ethics educators is richly stocked and well-catalogued. However, the history of ideas relating to its contents is relatively under-researched in the medical education literature. HISTORY: This paper proposes an approach to professional medical ethics education that adapts the ancient maieutic, question-asking method associated with Socratic dialogue, and particularly its uptake in educational theory developed by nineteenth and twentieth century American pragmatic philosophers, who in turn were profoundly influenced by the eighteenth century Common Sense school of philosophy from the Scottish Enlightenment. THEORY: The 'ethical sense' postulated in this article is a distant echo of moral sense in Scottish Enlightenment thought. However, ethical sense as posited here is not the natural faculty variously theorised by Scottish Enlightenment philosophers such as Francis Hutcheson and Thomas Reid, but derives from the pre-understandings of students with respect to professional medical ethics. CONCLUSIONS: The ethics educator can engage the ethical sense of students through maieutic 'teaching and learning by asking' in relation to actual clinical narratives, beginning not with the teacher's questions but importantly with those of the learners based on what they would need to know in order to determine the professional ethical obligations entailed.

Professional Identity Formation in Medical Education: Some Virtue-Based Insights.

Issue: In 2010, the Carnegie Foundation published a call to reorient medical education in terms of the formation of identities rather than mere competencies, and the medical education literature on professional identity formation (PIF) has since grown rapidly. As medical learners navigate a hectic clinical learning environment fraught with challenges to professionalism and ethics, they must simultaneously orient their skills, behaviors, and evolving sense of professional identity. The medical education literature on PIF describes the psychosocial dimensions of that identity formation well. However, in its conceptual formulations, the literature risks underappreciating the pedagogical significance of the moral basis of identity formation-that is, the developing moral agencies and aspirations of learners to be good physicians. Evidence: Our conceptual analysis and argument build on a critical review of the medical education literature on PIF and draw on relevant insights from virtue ethics to deepen the conceptualization of PIF in moral, and not just psychosocial, terms. We show that a narrowly psychosocial view risks perpetuating institutional perceptions that can conceive professionalism norms primarily as standards of discipline or social control. By drawing on the conceptual resources of virtue ethics, we highlight not just the psychosocial development of medical learners but also their self-reflective, critical development as particular moral agents aspiring to embody the excellences of a good physician and, ultimately, to exhibit those traits and behaviors in the practice of medicine. Implications: We consider the pedagogical relevance of this insight. We show that drawing on virtue theory can more adequately orient medical pedagogy to socialize learners into the medical community in ways that nurture their personal growth as moral agents-in terms of their particular, restless aspirations to be a good physician and to flourish as such.

Ethics education among obstetrics and gynecologists in Saudi Arabia: a cross-sectional study.

There are a lot of efforts to promote ethics education and training at an undergraduate and postgraduate level around the world, including in Saudi Arabia. However, there is still a lack of structured ethics education curricula in obstetrics and gynecology residency programs in Saudi Arabia. In the current scenario, where new ethical dilemmas are emerging, an ethics education that only focuses on teaching the ethical principles does not enhance the competence to deal with the ethical challenges in daily practice. This study evaluates the lack of ethics education and training in obstetrics and gynecology residency programs in Saudi Arabia. A cross-sectional survey of working obstetricians and gynecologists in Saudi Arabia was conducted among all working levels of doctors (the residents, registrars, consultants, and program directors) from various hospitals of Saudi Arabia. 391 practitioners responded to the survey, representing a response rate of 39.1%, including 257 (66.4%) females and 130 (33.6%) males. 74 (23.0%) received formal education (medical school = 35%; residency programs = 11.8%; sub-specialty programs = 4.3%; postgraduate programs = 7.4%), 85 (26.4%) received informal education (online training = 12.8%; conferences = 18.9%; courses and workshops = 13.3%; self-learning = 31.7% and daily practices = 20.7%), and 78 (19.95%) received no ethics education. Almost all the respondents had a positive attitude towards ethical principles, but a least percent were competent to deal with the ethical challenges. The bottom line of this survey is the imperativeness of reinforcement of formal ethics education in obstetrics and gynecology postgraduate programs in Saudi Arabia.

Go Big or Go Home? A New Case for Integrating Micro-ethics and Macro-ethics in Engineering Ethics Education.

In this paper, I make a novel case for an expansive approach to engineering ethics education, one that regards micro-ethics and macro-ethics as essentially complementary. Although others have voiced support for including macro-ethical reflection within engineering ethics education, I advance a stronger claim, arguing that isolating engineering ethics from macro-level issues risks rendering even micro-ethical inquiry morally meaningless. I divide my proposal into four parts. First, I clarify the distinction between micro-ethics and macro-ethics as I am construing it, defending my characterization against a potential worry. Second, I consider but reject some arguments for a restrictive approach, one that excludes macro-ethical reflection from engineering ethics education. Third, I offer my central argument for an expansive approach. Finally, I suggest that macro-ethics education can learn something valuable from micro-ethics pedagogy. On my proposal, students consider both micro- and macro-ethical problems from the deliberative perspective, situating micro-ethical problems within a broader social framework but also situating macro-ethical problems within an engaged, practical framework. By emphasizing the value of the deliberative perspective, my proposal contributes to a growing call to broaden the scope of engineering ethics education while maintaining its practical relevance.

Problem-based learning versus reflective practice on nursing students' moral sensitivity.

BACKGROUND: Moral sensitivity is one of the prerequisites for nurses' professional competency and patient care. It is critical to teach professional ethics in a student-centered manner in order to increase students' moral sensibility. This study evaluated the effects of professional ethics education via problem-based learning and reflective practice on nursing students' moral sensitivity. METHODS: This experimental study was performed on 74 nursing students who were randomly divided into three groups of problem-based learning, reflective practice and control. Principles of professional ethics were presented for the two intervention groups in four 2-hour sessions using ethical dilemmas scenarios. Participants completed the Moral Sensitivity Questionnaire before, immediately, and three months after the intervention. Data were analyzed using SPSS16. RESULTS: Demographic characteristics of the three groups were similar (p > 0.05). The total moral sensitivity score significantly differed between the groups immediately and three months after the intervention (p < 0.001). The total mean score for moral sensitivity was significantly different between the two groups of problem-based learning and reflective practice, with the mean scores in the problem-based learning group being higher (p = 0.02). The mean score of moral sensitivity decreased statistically significantly in both experimental groups three months after the intervention as compared to immediately after the intervention (p < 0.001). CONCLUSION: Nursing students' moral sensitivity can be increased through reflective practice and problem-based learning. While the results indicated that problem-based learning was more successful than reflective practice, additional research is recommended to confirm the influence of these two strategies on moral sensitivity.

Pedagogical Orientations and Evolving Responsibilities of Technological Universities: A Literature Review of the History of Engineering Education.

Current societal changes and challenges demand a broader role of technological universities, thus opening the question of how their role evolved over time and how to frame their current responsibility. In response to urgent calls for debating and redefining the identity of contemporary technological universities, this paper has two aims. The first aim is to identify the key characteristics and orientations marking the development of technological universities, as recorded in the history of engineering education. The second aim is to articulate the responsibility of contemporary technological universities given their different orientations and characteristics. For this, we first provide a non-systematic literature review of the key pedagogical orientations of technological universities, grounded in the history of engineering education. The five major orientations of technological universities presented in the paper are technical, economic, social, political, and ecological. We then use this historical survey to articulate the responsibilities of contemporary technological universities reflecting the different orientations. Technological universities can promote and foster the development of scientific, professional, civic, legal, or intra- and inter- generational responsibility. We argue that responsibility is not specific to any particular orientation, such that the concept is broadened to complement each orientation or mix of orientations of a technological university. Our contribution thus serves as a call for technological universities to self-reflect on their mission and identity, by offering a lens for identifying the orientations they currently foster and making explicit the responsibility arising from their current orientation or the ones they strive to cultivate.

The effect of flipped-jigsaw learning models on ethical decision-making.

BACKGROUND: Ethical decision-making education in nursing can be taught effectively by combining different teaching models that support the visualisation of taught concepts and integrating theory into practice. OBJECTIVES: The study aims to examine the effect of flipped and jigsaw learning models on ethical decision-making and ethical sensitivity in nursing. RESEARCH DESIGN: We used a nested mixed design. A pretest-posttest single-group quasi-experimental design was used in the quantitative part, and a case study method was used in the qualitative part. PARTICIPANTS AND RESEARCH CONTEXT: This study was conducted in fall semester with second-year nursing students who studied an ethics course for the first time, using two different collaborative learning models. In the quantitative part, ethical dilemma and ethical sensitivity scales were made as pre-test with 117 and post-test with 128 students. In the qualitative part, a semi-structured three focus group interviews was conducted with 16 students. ETHICAL CONSIDERATIONS: After obtaining the approval of the University's ethics committee, the study was carried out after obtaining participants' informed written and verbal consent. FINDINGS: Students' perspectives changed positively after training. This was related to six cases in section A of the Ethical Dilemma Scale. In part B, Practical Consideration (PC) and Principled Thinking (PT) mean scores were similar, showing no significant difference. For Familiarity in section C, it was determined that 68.4% of students in the pre-test and 77.3% in the post-test were familiar with similar dilemmas. The ethical sensitivity scale's total scores were in a similar range. In the qualitative stage, ethical decision-making, ethical sensitivity, ethical dilemma and the improvement process were obtained as a theme. CONCLUSIONS: There was an increase in the level of ethical sensitivity and familiarity with ethical dilemmas of nursing students after education. Flipped and jigsaw learning models can be used for nursing ethics courses.

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.

Teaching and learning in interprofessional ethics education: Tutors' perspectives.

BACKGROUND: Ethical dilemmas that arise in the clinical setting often require the collaboration of multiple disciplines to be resolved. However, medical and nursing curricula do not prioritize communication among disciplines regarding this issue. A common teaching strategy, problem-based learning, could be used to enhance communication among disciplines. Therefore, a university in southern Taiwan developed an interprofessional ethics education program based on problem-based learning strategies. This study described tutors' experience teaching in this program. AIM: To explore the phenomenon of teaching and learning in interprofessional ethics education for medical and nursing students from the perspectives of tutors. DESIGN: Phenomenological qualitative research. METHODS: Medical and nursing students completed a 6-week interprofessional ethics education program moderated by either physician or nurse tutors. At the conclusion of the ethics education program, all 14 tutors were invited to participate in focus group interviews. Among them, six tutors (three nursing tutors and three physician tutors) participated in additional individual interviews. All of the contents from the focus group interviews and individual interviews were recorded and transcribed. Using the phenomenological approach, the phenomenon of teaching and learning in interprofessional ethics education were generated. ETHICAL CONSIDERATION: The study was approved by the Institutional Review Board. FINDINGS: Three themes emerged from the tutors' teaching perspectives, including the instructor's motivation to teach, the use of narrative case scenarios, and the emphasis on improving interprofessional ethics communication. DISCUSSION: Problem-based learning creates an interprofessional communication platform in interprofessional ethics education. The phenomenon of value convergence between tutors and students, between different students' professions, and between different students' professional maturities is observed. CONCLUSION: Problem-based learning is an effective teaching strategy for creating a communication platform for interprofessional ethics education. Ethic curriculum should emphasize motivating instructor, use narrative case scenarios, and focus on interprofessional communication.

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.