Decision making and ethics : a case study of student nurses

Previous studies have shown that student nurses find the analysis of ethical dilemmas difficult (McAlpine 1996). This
may well be due to the nature of such situations, which are frequently complex and prone to ambiguity. This leads to
uncertainties as to which course of action is the correct one for those involved.

The purpose of this study was firstly to explore the perceptions of a group of student nurses in relation to ethical
dilemmas, which arose in practice both before and after exposure to the clinical environment, and secondly to
evaluate the usefulness of modules dedicated to ethics, which the students undertook as part of the Project 2000
curriculum. The focus of the evaluative process was the development ot moral responsibility and ethical decision -
making skills.

210 students representing two consecutive cohorts on the Project 2000 pathway took part in the study.
An evaluative case study design was used to examine the responses of students using two instruments, a
questionnaire and an in-depth interview.

The results from the questionnaire data indicated that student views had altered significantly after exposure to
practice and theoretical input regarding the decisions taken in response to the ethical scenarios presented. Statistical
analysis was conducted involving the variables student response and age, and student response and gender, but the
results were not statistically significant.

Data generated from the interviews were divided into four major themes. The complexity of ethical issues for the
health care team; the consequences ethical decision-making could have for society; the development of students'
confidence when faced with ethical dilemmas, and finally how their theoretical input had prepared them for their
forthcoming role as qualified nurses.

The results from the interview data suggest that nurses realised the importance of the decisions that are taken in
practice and how these will influence the direction of health care in the future. The results also demonstrated the
importance nurses placed on a theoretical basis in ethical decision-making as this provided a framework that could
be used throughout a nurse's career allowing him or her to enhance their professional status.

The study results indicate that if nurses are to fulfil their role as professionals then the acknowledgement of moral
responsibility and development of ethical decision-making skills are essential. In today's health service nurses will be
involved with the moral decisions taken by colleagues, patients and their relatives. It is important that nurses cannot
only respond to the moral aspects of individual patient situations but also have an in-depth understanding of the
ethical frameworks which direct decision -making.