An ethical issue is defined by Numminen and Leino-Kilpi (2007) as a situation in which values are in conflict and which requires the selection of alternatives that can be evaluated as right.
On the other hand, Pauly, Varcoe, Storch and Newton (2009) view an ethical issue as a situation faced by nurses during their daily contact with patients, that emerges when the loyalty of the nurse is in conflict with his/her responsibilities, hindering their decision-making process. They further state that ethical issues expose nurses and student nurses to moral distress, which is a situation that prevents them from practising ethically and they feel compelled to compromise the standards and values of the profession (Pauly et al., 2009).
Literature highlights that ethical issues differ from one clinical practice to another and from unit to unit (Park et al., 2014; Ramos, de Farias Brehmer, Vargas, Trombetta, Silveira and Drago, 2014; Aitamaa, Leino-Kilpi, Puukka and Suhonen, 2010).This implies that although student nurses experience common ethical issues, there are ethical issues occurring in medical wards that differ from those occurring in maternity wards, intensive care units, operating rooms and metal health units. Therefore, learning about specific ethical issues that frequently occur in nursing practice can enhance a student nurse’s decision-making skills (Park et al., 2014).
Knowledge of ethical issues that are reported as frequently occurring in clinical practice can encourage nurse educators to search for innovative teaching strategies that promote the critical thinking and problem-solving skills of their students (Numminen and Leino-Kilpi, 2007).
Furthermore, this information can assist nurse educators to consider ethics and professionalism
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as essential subjects in the curriculum for different programs, with greater emphasis placed on the ethical issues frequently reported in clinical practice (Moe, 2015; Department of Health, 2013; Yeh et al., 2010).
As student nurses practice under the supervision of professional nurses in clinical practice they frequently encounter ethical problems that require them to implement their own personal and professional judgement (Sinclair et al., 2016). Their decision making should be based on the value of the situation, taking into consideration the impact of the decision and not necessarily following instructions from a senior person (Stagg, 2010).
Their professional judgement, however, needs to be guided by the ethical principles stated in the South African Nursing Council’s Code of Ethics, which includes social justice, beneficence, non-maleficence, veracity, fidelity, autonomy, caring and altruism (South African Nursing Council, 2013). The student nurses are expected to understand these ethical principles as they provide guidance on how to act in the best interest of the patients’ care and advocate for the patients’ rights.
As literature indicates that ethical issues and dilemmas are part of clinical practice, it is imperative for student nurses to learn about those issues, in order to solve them as they occur (Sinclair et al., 2016; Park et al., 2014; Pauly et al., 2009). Despite awareness of these ethical principles, however, literatures have reported on situations where student nurses have failed or been afraid to stand up for the rights of their patients in the clinical practice setting (Yeh et al., 2010; Callister, Luthy, Thompson and Memmott, 2009; Erdil and Korkmaz, 2009). This is believed to be caused by lack of ethical maturity among student nurses that is manifested by high degree of autonomy in decision making Casterlé et al. (2008), which suggests that they still practice under conventional morality; where their behaviour and actions are guided by loyalty and conformity (Casterlé et al., 2008).
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Ethical maturity encourages creativity and critical thinking when faced with ethical issues in clinical practice (Casterlé et al., 2008). Studies suggest that the perceptions of student nurses regarding ethical issues, including their response to them, are influenced by their attitudes towards issues they perceive as ethically important, including factors in the organisations as well as their decision-making skills in dealing with ethical issues (Rikhotso, Williams and De Wet, 2014; Mabuda et al., 2008; Numminen and Leino-Kilpi (2007). Park et al. (2014) are therefore of the opinion that the first step suitable for ethical decision making depends on their full understanding of the ethical issues involved in patient care and their ability to diagnose them as they occur.
Sinclair et al. (2016) further argue that it is also imperative for nurse educators to have knowledge of the ethical issues occurring frequently in clinical practice, so that ethics education can be directed appropriately towards the current issues. Contrary to this, Iacobucci et al. (2013) argue that ethical practice is not about knowledge and understanding of the events in the clinical situation, but concur with the aforementioned authors that ethical practice lies in the ability of the nurses to recognise and implement the appropriate actions to meet the needs of patients. Stagg (2010) is of the opinion that ethical knowledge improves with an increase in ethical experience while similarly, Trobec and Starcic (2015) report that ethical values that are supported by ethical knowledge are a prerequisite for making decisions about what is ethical and morally healthy.
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