caring in nursing education

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ETHICS IN NURSING EDUCATION
BURNETT CHIONA
SHYREEN MAGWIRA
DALITSO ZOLOWERE
MWAIWAWO KAULULA
Out line of the presentation
• Brief description of caring
• Conceptualizing caring from and education
perspective
• Identifying from literature what constitute good
and bad virtues of nurse educators
• Approaches to the caring centered curriculum
• Application of 5 Cs of caring to nursing education
• Importance of ethics in clinical supervision of
nursing students
• Discuss other relavant practical ethical issues
which apply to nursing education
Brief description of caring
• Roach (2002) described caring as a total way of being, of
relating, of acting; a quality of investment and
engagement in the other person, idea and things which
one expresses the self fully and through which one
touches most intimately and authentically what it
means to be human (P. 39)
• Baines et al.(1991) defined caring as ‘the mental,
emotional and physical effort involved in looking
after, responding to, and supporting others’ (as
cited in Msiska, Smith, & Fawcett, 2013)
• Therefore in caring ethics an action is right when
it is a genuine response to the perceived need of
another
• The moral relationship that exist between two
parties is always between
–The one caring and the one cared for
–Both have equal responsibility (one caring has
obligation to care, while the one cared for
should be able to acknowledge the care

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• When a nursing curriculum satisfactorily
addresses ethics, providing nurses with the tools
to help them reflect critically on what nursing care
implies, nursing education can contribute to the
development of nurses as skilled companions
(Vanlaere & Gastmans, 2007).
–Nurse educators, are in a key position to role model
for perspective nurses the role of caring. (Labrague,
McEnroe-Petitte, Papathanasiou, & Edet, 2016)
Conceptualizing caring from and education
perspective
• Caring in nursing education refers to student-
teacher interactions that are formed on the basis
of human values and focused on the unique needs
of the students (Salehian, Heydari, Aghebati, &
Moonaghi, 2017)
• The role of a teacher in caring is to meet
individual student needs and develop positive
relationships that show nurturing and care for
students (Mathur & Corley, 2014).
• Beck, 2001; Paterson and Crawford(1994)
described Caring in nursing education as a
multidimensional concept expressed through
interactions among the nursing faculty, between
the faculty and nursing students, among nursing
students, and between nursing students and
patients
–Caring in education has been emphasized as the first
place for teaching and learning the values of the
nursing profession (Salehian, Heydari, & Aghebati,
2016)
Literature description of what constitute good and bad
virtues of nurse educators
• Moral virtue is a state of character positioned
within the character of the person (Vanlaere,
coucke, & gastmans, 2010)
• Lewenson et al. (2005); stated that Nurse
educators' strong competence of professional
ethics is important in providing an ethical role
model to the nursing students and to
professionals of the field of health care
–The nursing students adopt their professional
ethics during their education, and for this
reason it is important that the nurse educator
provides a high-level role model in ethical issues
(Thorkildsen and Råholm, 2010) cited in
(Salminen, Rinne, Stolt, & Leino-Kilpi, 2017)
• Lindgren and Athlin (2010) established that an
educator who works ethically respects the
student's privacy, treats the student equally and
assumes the responsibility for the student's
learning outcomes
• Lyndaker (1992), Luhanga et al,(2010), Salminen
et al.(2013) described that fair and honest
assessment of students' learning is the most
important virtue for educators

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• Gillespie (2005) emphasized that good
interactional relationship between educator and
students is an important practice as it appreciated
and valued by the students
• Hanson and Stenvig (2008) stated that the
professional attitude and encouraging feedback is
students expectation of the educator
• In separate studies by Dinc Kelly (2007) and Klunklin et
al( 2011) established that the students expect the
educators to listen to them, respect them and appreciate
their views
• Klunklin et al., (2011) argues that nurse educator should
work in good cooperation with her colleagues
– The educator can promote highly ethical atmosphere and
competence in the work community by behaving in a socially
suitable way
Approaches to the caring centered curriculum
• Noddings (1992) explained that the fist thing to
instill caring in students is that schools should be
able to develop a morally defensible mission.
• He stated that the main aim of education should
be to produce competent, caring, loving, and
lovable people
• He further argued that education should be
organized around themes of care rather than the
traditional disciplines.
–All students should be engaged in a general education
that guides them in caring for self, intimate others,
global others, plants, animals, the environment,
objects and instruments, and ideas.
(Noddings, 2002)
• Noddings (2002) suggested 6 approaches to care
centered curriculum
1. Be clear and unapologetic about the goal.
2. Take care of affiliative needs.
3. Relax the impulse to control.
4. Get rid of program hierarchies.
5. Give at least part of every day to themes of care.
6. Teach students that caring in every domain
implies competence.
• Be clear and unapologetic about our goal
–The main aim of education should be to
produce competent, caring, loving, and lovable
people.
• Take care of affiliative needs.
–keep students and teachers together (by mutual
consent) for several years, and we must keep
students together when possible.

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–strive to keep students in the same building for
considerable periods of time and help students
to think of the school as their own
–Finally, we must legitimize time spent on
building relations of care and trust
• Relax the impulse to control.
–Give teachers and students more responsibility
to exercise judgment
–At the same time, we must get rid of
competitive grading and reduce the amount of
testing that we do
–Those well-designed tests that remain should
be used to assess whether people can
competently handle the tasks they want to
undertake
–We also need to encourage teachers to explore
material with students.
• Get rid of program hierarchies.
–This will take time, but we must begin now to
provide excellent programs for all our children
–We must abandon uniform requirements for
college entrance.
–What a student wants to do or to study should
guide what is required by way of preparation.
• Give at least part of every day to themes of care.
–Discuss existential questions—including
spiritual matters—freely
–Educators need to help students learn to treat
one another ethically by giving them practice in
caring.
–We must help students understand how groups
and individuals create rivals and enemies and
help them learn how to “be on both sides.”
• Teach students that caring in every domain
implies competence.
–When we care, we accept the responsibility to
work continuously on our competence so that
the recipient of our care; person, animal, object,
or idea is enhanced

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Application of 5 Cs of caring to nursing education
• Compassion
–Compassion means to be with another in their
suffering.
–It is empathy and sensitivity to human pain and
joy that allows one to enter into the experience
of another.
–It is the understanding of whom that person
truly is for whom one is caring.
–Simone Roach (1992) stated that with
compassion, one becomes a colleague of
humanity
–Compassion is an essential component of the
nursing education
• Competence
–Competence is acquiring and using evidence-based
scientific and humanistic knowledge and skill in the
application of therapeutic interventions in the current
practice of nursing.
–Competence is reflected in the cognitive, affective
and psychomotor domains of learning.
–It is the knowledge of the role of the nurse in the
health care delivery systems of the hospital and the
community (Adam & Taylor 2013)
–In nursing education It is important to improve
ones skills in order to develop competence.
–The nurse educator has to make an effort to
improve in the knowledge needed to deliver
the best to the students while keeping up-to-
date with new industry developments.
– Nurse educators have to know that learning is a
lifelong activity that will serve nurses well in the
ever-evolving health care field.
• Conscience
–Conscience directs moral, ethical and legal
decision-making.
–It motivates us to increase the knowledge and
skills needed to respond appropriately to moral,
ethical and legal issues faced by one and others.
–It directs us to adhere to the standards of
professional nursing practice. It directs us to
respond to social injustices.
–It is the increased awareness of local, national
and global health concerns and current trends
in health care that affect all ages and
populations.
– It is the sense of accountability, responsibility
and leadership for patient care.

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• Confidence
–Confidence is trust in one’s ability to care for
others.
– It is the belief that our skilled, professional
presence can make a difference.
–Confidence is necessary to effectively
implement the roles of the nurse as caregiver,
teacher, counsellor, advocate, leader, manager
and researcher.
–Confidence in our own ability to create caring
environments serves as a catalyst for change.
–Confidence empowers both us and others to
define and accomplish goals.
– Confidence is developed through the successful
utilization of knowledge and experience.
–Crooks and Carpio, (2005) explained that Self-
confidence has been reported as being a key
component for effective clinical performance,
and confident students are more likely to be
more effective nurses.
–Clinical skill performance is reported to be the
most influential source of self-confidence.
Student preparation and skill acquisition are
therefore important aspects in ensuring students
have successful clinical placements, especially in
areas of high acuity.
–Curriculum development should aim to assist
students with their theoretical and clinical
preparedness for the clinical environment
• Commitment
–Commitment is maintaining and elevating the
standards and obligations of the nursing
profession and assuring the delivery of
excellence in nursing care
–It assures that caring will be part of every nurse
patient interaction.
–It is a conscious effort to grow within the
nursing profession through dedication to
continuing education, life-long learning, and
becoming more skilled, socially conscious,
ethical, politically competent and caring (Adam
& Taylor, 2013)
–In nursing education an effective educator
needs to be committed not only to their
students, but to the teaching profession as a
whole.
–This means abiding by the rules and regulations,
embracing the principles of the teaching
profession as well as the requirements.
–Committed teachers put their students first in
the teaching profession

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–Cox (2010) commented that committed nurse
educators always put their students’ wants,
needs, and interests first.
–He continued to say these nurse educators
meet the needs of each individual learner by
providing a variety of unique teaching methods
and techniques.
–They strive to motivate and engage students, and
they understand that not every child will learn in the
same way.
–Above all, they advocate for their students to ensure
they are getting everything that they need in order to
be a successful, educated student
–Cox (2010) still argued that committed nurse
educators devote their time to continuing education.
–Educators who are dedicated to their profession
never stop learning new strategies to engage
and teach their students.
–They understand that teaching is a career that
changes standards and regulations quite
regularly, and are committed to keeping up with
these ever-changing methods.
• He further said that nurse educators do not only
devote themselves to their students and their job,
but their emotional selves as well.
–When their students are hurting, they are hurting.
–When something isn’t going right at school, then they
are the ones who advocate for change.
–For a devoted teacher, nothing is ever left undone.
–Teaching is a process and they will always be an active
contributor to that process.
Importance of ethics in clinical supervision of
nursing students
• Caring, as a moral principle, guides the nurses’
performances in clinical practice and is fostered in the
academic environment
– In fact, if nursing students are expected to exhibit caring
behavior in their clinical practices, an atmosphere of caring
should be created during their training
• When students see the atmosphere of caring in
education, they learn a professional way of behaving
(Vanlaere & Gastmans, 2007)
• Nylund and Lindholm (1999) found that students call
implicitly for an ethical attitude to be evident in their
supervisors, and also to some extent in themselves.
• They further justified the thought that ethical reflection
and an ethical mode of action should be made part of
the clinical supervision process.

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• There is an increased sense of security and self pride in
students.
– A student’s sense of security is based on the fact that he or
she knows where the supervisor is and when he or she is
available.
– Asking questions without the supervisor displaying a negative
attitude also gives a sense of security (Nylund & Lindholn
1999)
• Ethics helps teachers to create opportunities to
demonstrate independence.
• Students wished a supervisor who could create
opportunities for them to ‘take responsibility and play
an independent role in the nursing care’.
• Many students considered that they were allowed to
take responsibility, while others thought that this was
not the case (Nylund & Lindholn 1999)
• Formation of a realistic picture of self in students
is another importance .
–Many students called for constructive criticism by
their supervisors, such as make it possible for them to
obtain a realistic idea of how they were managing on
the ward
Other relevant practical ethical issues which apply to
nursing education
• Decision making
–In a study done by Mathur and Corley (2014) a
teacher was assigned to teach a self-contained
classroom for second and third grade children
identified as having emotional and behavioral
disorders (EBD
• EBD is one of the special education categories
characterized by one or more of the following
characteristics: an inability to build or maintain
satisfactory interpersonal relationships; an inability to
learn; consistent or chronic inappropriate type of
behavior or feelings under normal conditions; pervasive
mood of unhappiness or depression; physical symptoms
or behaviors associated with personal or school
problems.
• When these students have misbehaved at school the
teacher has to know that education is more than
imparting knowledge of subject matter but that
education also influences the development of ethical
decision making.
• The first step toward making ethical choices in school
settings requires awareness of the relationship between
actions and ethics..

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• Since ethical issues are complex and individuals bring
their own values and prior experiences to each
encounter, people must also recognize the need to
consider issues and dilemmas from multiple
perspectives.
• Such awareness results from engaging in open, honest
and explicit discussion
References
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moral profession: Nurse educators’ selected narratives
of care and compassion. Nursing Ethics, 1–11.
Noddings, N. (2002). Educating Moral People. Amsterdam
Avenue, New York: Teachers College Press.
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• Labrague, L.J., 2012. Caring competencies of
baccalaureate nursing students of Samar State
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