To the management of the university where I work, for the excellent opportunity they offered me to further my studies, and to my editor, Pauline Fogg. Appendix F: Consent letter from the Ministry of Health (Free State) Appendix G: Consent letter from Dean of Campus.
Introduction and Background of the Study
According to the International Council of Nurses, nurses are entrusted with creating an environment that promotes client/patient safety. Similarly, in the United States, the new revised American Nurses Association Code along with the International Council of Nurses Code assures the public that nurses are committed to providing the best patient care, states (Winland-Brown et al., 2015).
Problem Statement
Although the existence of these ethical issues and their implications for the nursing profession have been expressed, the perceptions of student nurses who are expected to eventually engage in discussions with patients regarding ethical issues in clinical practice are not known. Studies on ethical issues in clinical practice are moreover limited in the Free State, and therefore the researcher's interest is to explore the student nurses' perceptions of ethical issues in clinical practice at a selected college in the Free State.
Purpose of the study
Furthermore, the South African Nursing Council's report on professional misconduct for the period 2003-2008 shows an increase in the number of reported cases against professional nurses and nurses in clinical practice (Department of Health, 2013). Furthermore, there are several cases of academic misconduct reported among nursing students, which may indicate a poor understanding of ethical issues.
Research Questions
Research Objectives
Significance of the Study
Nursing Education
The findings have the potential to influence undergraduate curriculum developers to consider including the frequently occurring ethical issues reported in clinical practice in the curriculum to prepare students for clinical practice. The findings of the study have the potential to sensitize nursing educators at the various colleges of nursing to search for teaching strategies that will promote student autonomy in decision-making, critical thinking and problem-solving skills when dealing with ethical issues.
Clinical Practice
Students Nurses
This can then help the students to be proactive in leaning on ethical ways of acting when they are confronted with ethical situations in the clinical environment.
Conceptual Framework
Kohlberg’s Theory of Moral Development
People in these stages accept the conventions of the society or group because they know and understand those conventions (Casterlé et al., 2008). According to Casterlé et al. 2008), they have developed ethical maturity characterized by autonomy in ethical decision-making.
South African Nursing Council Code of Ethics
Nurses are expected to act in a manner that prevents harm to the patient (South African Nursing Council, 2013). The principle of beneficence can be confused with nonmaleficence in the sense that both focus on preventing harm to the patient.
Definition of Key Concepts
For the purpose of this study, ethics means rules of conduct that are morally considered good or bad, right or wrong. For the purpose of this study, clinical practice means the hospitals and clinics where students are assigned for learning practical skills.
Overview of Dissertation Chapters
Conclusion
Introduction
The Concept ‘Ethical Issue’
Because student nurses practice in clinical practice under the supervision of professional nurses, they often encounter ethical issues that require them to implement their own personal and professional judgment (Sinclair et al., 2016). Ethical maturity encourages creativity and critical thinking when confronted with ethical issues in clinical practice (Casterlé et al., 2008).
Factors Contributing to the Occurrence of Ethical Issues
Complexity of the Current Clinical Practice and Ethical Issues
The prevailing conditions in clinical practice therefore encourage nurses to remain silent when they observe unethical behavior by members of the multidisciplinary team (Yeh et al., 2010). Student nurses point out that this situation contributes to their high level of distress in clinical practice.
Lack of Role Models in Clinical Practice and Ethical Issues
2014), but they believe that extensive experience in clinical practice enhances decision-making skills compared to nurses with fewer years of clinical experience and that therefore clinical practice is the most appropriate period to offer students opportunities to learn practical skills as part of their professional training. This includes the need to develop national and international strategies and standardize policies to address various ethical issues in clinical practice (Kulmala, 2016).
Student Nurses’ Lack of Confidence in Decision Making
Literature Yeh et al., (2010); Erdil and Korkmaz (2009) confirm that nursing students lack knowledge, skills and confidence regarding ethical decisions during clinical practice. Through clinical exposure, student nurses are exposed to ethical issues that strengthen their decision-making skills.
Ethical Issues and Student Nurses in Clinical Practices
Ethical Issues Related to Patient Care
After a study conducted by Park et al. 2014) which reports increasing incidents of conflict between nurses and doctors on issues related to patient care, as Sinclair et al., (2016);. Park et al., (2014) suggest that effective communication between nurses and doctors can reduce conflict in their professional relationships and prevent conflicts from developing into ethical problems.
Distress Level among Nursing Students and Ethical Issues
Sinclair et al., (2016); Park et al., (2014) state that the high level of stress experienced by nurses in training is related to their lack of ethical knowledge, ethical experience and feelings of powerlessness in clinical practice. Kulmala (2016) has found that conflict between nurses and doctors causes high levels of moral distress among nurses, while Wojtowicz et al. 2014) in their research into mental health care, point out that nurses and student nurses experience increased levels of stress when circumstances prevent them from making decisions they consider ethical.
Measures to Improve the Ethical Competence of Student Nurses in Clinical
Ethical Issues Related to Patient’ Rights
Violation of the principles of beneficence, justice and truth are reported to be common in clinical practice in studies by (Sinclair et al., 2016; Park et al., 2014; Ramos et al., 2013; Solum et al., 2012) . In Botswana, Barchi et al. 2014) report that the ethical principles violated by nurses include truth, respect for person, dignity, equality, justice and paternalism.
Ethics Education and Ethical Issues
The literature highlights the poor decision-making skills of nurses and the increase in reporting of cases of violation of human dignity (including failure to obtain informed consent) in clinical practice (Sinclair et al., 2016; Park et al., 2014; Ramos et al., 2013; Solum et al. ., 2012). This is thought to be due to a perceived lack of connection between ethical theory and its application in clinical practice, as reported by nurses, resulting in inconsistency in ethical decision-making demonstrated by nurses (Callister et al., 2009).
Re-establishment of a Clinical Teaching Department
According to Thurling (2016), simulations help students practice patient scenarios discussed in class; and Chauke et al. 2015) believe that the use of innovative educational strategies can change the negative image of nursing among student nurses and restore the positive image of the nursing profession.
Conclusion
Introduction
Research Paradigm
In order to answer the epistemological question about what kind of relationship the researcher has with those they are researching, the researcher decides to separate herself from those she is researching (objectively) in order to avoid bias ((Polit and Beck, 2012) .This also showed the researcher's philosophy in terms of answering the questions of interest to the study, in terms of how the research was designed, how the data was collected and analyzed, and the way in which the findings of the study were presented.
Research Approach
The investigator used deductive reasoning which involves dividing the whole into parts that can be studied (Polit and Beck, 2012). According to the quantitative approach, the subjectivity of the researcher is believed to bias or control the study towards the values and views of the researcher.
Research Design
Therefore, in this study, the researcher maintained objectivity, progressed logically and followed a series of steps according to a predetermined action plan, and used a structured instrument to gather information. This approach was chosen because it supports researcher objectivity, avoids Polit and Beck's (2012) bias, and is most appropriate for this study investigating female nursing students.
Research Setting
Target Population
Sampling and Sampling Technique
Inclusion Criteria
Polit and Beck (2012) describe inclusion criteria as the characteristics that qualify the participants for inclusion in the study. Participants had at least eight weeks or more of exposure to clinical practice before they could be included in the study.
Exclusion Criteria
Research Instrument
Validity
The validity of an instrument refers to the accuracy of the instrument in measuring what it is supposed to measure (Botma et al., 2010; Brink et al., 2006). The content and the construct validity of the instrument were tested by examining the items in the questionnaire against the objectives of the study and concepts in the conceptual framework to determine whether all elements to be examined were fully measured.
Reliability
The researcher used convenient sampling only because the participants were available and ready during data collection.
Data Collection Method
The purpose of the study was explained in detail to the potential participants and they were also given information sheets that explained the purpose of the study and the rights of the participants in relation to the study. Participants were given clear instructions on how to complete the questionnaire; those who needed clarity on completing the questionnaire were assisted as the researcher was nearby.
Data Analysis
Ethical Considerations
Respect for Person
To ensure confidentiality, the respondents who voluntarily agreed to participate in this research were given a written assurance of confidentiality that was accompanied by the principle of anonymity.
Principle of Justice
Principle of Beneficence
Data Management
Other electronic data were stored on the researcher's computer, which can only be accessed with a password. Data sheets, questionnaires and signed consent forms are kept under lock and key for five years, after which the researcher will destroy them by shredding.
Data Dissemination
The university's backup system was also used to ensure the security of the information by storing the information on it. The data stored on the computers will be erased from both the program files and the recycle bins.
Conclusion
Introduction
Sample Realisation
Section A: Demographic Data of the Respondents
Gender Distribution of the Respondents
Age Distribution of the Respondents
Distribution of Respondents’ Year of Study
Section B: Ethical Issues that Student Nurses Report as Frequently Occurring in
Ethical Issues Related to Patients’ Rights
The results suggest that the use of chemical or physical restraints to control patients' behavior when they believed that the restraint was not in the patients' best interests never occurred in the clinical practice studied. In relation to medical or nursing treatment that is given against the patient's wishes; most respondents 37.7% (n=43) have never seen patients treated against their will.
Ethical Issues Related to Patient Care
Of the respondents, 14.9% (n=17) indicated that they have never been asked to provide care in these circumstances. This was followed by providing care to patients who put the nursing students' own safety at risk, being reported by 40.4% of respondents as being very common in clinical practice in the study.
Ranking of the Frequency of Ethical Issues Related to Patient care and
The results suggest that unhealthy dialogue between healthcare providers in the presence of patients often occurred in the clinical practice under study. The findings showed that ethical issues related to patient care were those that frequently occur in the clinical practice studied.
Section C: Level of Distress among Student Nurses in Relation to Ethical Issue
Level of Distress: Patient Care
The results suggest that the respondents experienced very high concerns when they encountered unsafe working conditions that the respondents considered unsafe, i.e. the results suggest that unreported medical or treatment errors caused respondents very high concern.
Ranking of Levels of Distress
The findings further showed that ethical issues related to patient care also caused respondents a great deal of distress compared to those related to patients' rights. Ethical issues related to patients' rights, which caused high distress to the majority of 33.3% of respondents, include disrespectful statements made by medical staff about the patient, followed by discriminatory treatment of patients by medical staff.
Conclusion
Introduction
Discussion of Findings
Ethical Issues Related to Patient’s Right and Patient Care
Therefore, the findings of this study suggested that this ethical issue rarely occurred in the clinical practice studied. Therefore, the findings suggested that this ethical issue had a high frequency of occurrence in the clinical practice studied.
Level of Distress Among Student Nurses in Relation to Ethical Issues
Although this ethical issue rarely arises in the clinical practice studied, it caused considerable concern among respondents who participated in this study. The findings suggest that respondents in this study lack knowledge and understanding of ethics.
Recommendations
Nursing Education
Nursing Practice
Nursing Research
In addition, there is a need for further study on the impact of the shortage of staff and equipment on students' training in the nursing education institutions.
Limitation of the Study
Conclusion of the Study
Investigating student nurses' perceptions of ethical issues in clinical practice at a selected college in the Free State. The title of my study is: Exploring Student Nurses' Perceptions of Ethical Issues in Clinical Practice at a Selected College in the Free State.
Letter Requesting Permission to Duplicate the Study
This report serves to state that the dissertation submitted by Disebo Joyce Mofokeng has been edited to meet the requirements for the degree Master's Degree in Nursing (Nursing Education). The thesis has been edited for errors in syntax, grammar, punctuation and the referencing system used.
