Journal of Qualitative Research in Health Sciences

Journal of Qualitative Research in Health Sciences

Current Issue

By Issue

By Author

By Subject

Author Index

Keyword Index

About Journal

Aims and Scope

Editorial Board

Publication Ethics

Peer Review Process

Editorial Policy

Indexing and Abstracting

Related Links

Journal Metrics

FAQ

News

Guide for Authors

Galley Proof

Ethical Conflict in Clinical Education of Nursing Students: A Conceptual Analysis

Document Type : Review Article

Authors

1 Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran

2 Department of Military Nursing, Faculty Member, AJA University of Medical Sciences, Tehran, Iran

3 Trauma Research Center Clinical Sciences Institute Baqiyatallah University of Medical Sciences, Tehran, Iran

4 Department of Medical–Surgical Nursing, Faculty of Nursing, Aja University of Medical Sciences, Tehran, Iran

5 Behavioral Sciences Research Center Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran

10.34172/jqr.2024.31

Abstract

Background: Ethical conflict is a complex concept referring to the inability to perform an ethical act or the failure to recognize the correct ethical course of action. Nursing students, similar to other healthcare team members, encounter numerous ethical conflicts during their clinical training. These conflicts encompass various aspects that underscore the significance of examining and analyzing this concept. Accordingly, the present study aimed to analyze the concept of ethical conflict in the clinical education of nursing students.
Methods: This review study was conducted using a conceptual analysis approach based on the 8-step method proposed by Walker and Avant in 2023 to clarify the dimensions and characteristics of ethical conflict. A systematic search was conducted in PubMed, SID, Scopus, Embase, Web of Science, Google Scholar, and ProQuest databases using a combination of keywords including ‘nursing’, ‘concept analysis’, ‘clinical education’, ‘dilemma’, ‘conflict’, ‘nursing student’, ‘concept’, ‘clinical practice’, ‘moral’, and ‘ethical’ without time limits. After reviewing 3023 articles, 23 relevant articles were selected and included in the results section of the study. This approach facilitated the identification of the characteristics, premises, and consequences of the concept.
Results: The conflict between student rights and patient rights in education represents a notable concern. One of the prominent factors contributing to moral conflicts and low-quality clinical education is the inadequate development of students’ moral competence within an inappropriate learning setting.
Conclusion: By clarifying the educational rights of students and the rights of patients, educational and medical administrators would be able to manage ethical conflicts. Thus, it is recommended to explore the strategies for managing ethical conflicts by analyzing the relevant experiences through both qualitative and quantitative studies.

Keywords

References
  1. Dadashi N, Pazokian M, Motamedzadeh M. The experiences of nursing internship students during the COVID-19 pandemic in Iran. J Qual Res Health Sci. 2023;12(2):60-7. doi: 10.34172/ jqr.2023.10.
  2. Mangolian Shahrbabaki P, Nouhi E. Explaining professionalism and professional socialization process in nursing students. J Qual Res Health Sci. 2023;12(1):1-8. doi: 10.34172/ jqr.2023.01.
  3. Boozaripour M, Abbaszadeh A, Shahriari M, Borhani F. Ethical values in nurse education perceived by students and educators. Nurs Ethics. 2017;25(2):253-63. doi: 10.1177/0969733017707009.
  4. Sabet Sarvestani R, Khani Jeihooni A, Fereidouni Z, Moradi Z, Amirkhani M, Karimi S. The effect of teaching ethical principles through role playing on nursing students internship skills. Journal of Medicine Spiritual Cultivation. 2017;26(3):159-70. [Persian].
  5. Farahbakhsh F, Nouhi E, Zolali F. The importance of ethics in education and the level of complying with it from the perspective of nursing students of Kerman University of Medical Sciences. J Educ Ethics Nurs. 2016;5(1):1-7. doi: 10.52547/ethicnurs.5.1.1. [Persian].
  6. Escolar-Chua RL. Moral sensitivity, moral distress, and moral courage among baccalaureate Filipino nursing students. Nurs Ethics. 2016;25(4):458-69. doi: 10.1177/0969733016654317.
  7. Ghadermazi M, Shamsaei F, Tapak L, Sadeghian E. Investigation of ethical reasoning and related factors in nursing students of Hamadan University of Medical Sciences in 2020. J Nurs Educ. 2021;10(2):33-41. [Persian].
  8. Goli R, Jasemi M, Esmaeili R, Khalkhali H. Nursing codes of ethics education based on lecture on moral performance of nursing students: a quasi-experimental study. Nurs Midwifery J. 2020;18(5):369-78. [Persian].
  9. Baghdadi N, Alsomali Z, Alanazi ME, Alasmari M, Alfaqi R, Alsofayan R, et al. Moral distress among nursing students during clinical training. Novelty Journals. 2020;7(3):269-76.
  10. Piryani RM, Piryani S. Conflict management in healthcare. J Nepal Health Res Counc. 2019;16(41):481-2.
  11. Jia Y, Chen O, Xiao Z, Xiao J, Bian J, Jia H. Nurses’ ethical challenges caring for people with COVID-19: a qualitative study. Nurs Ethics. 2020;28(1):33-45. doi: 10.1177/0969733020944453.
  12. Mehdipour Rabori R, Dehghan M, Nematollahi M. Nursing students’ ethical challenges in the clinical settings: a mixed-methods study. Nurs Ethics. 2018;26(7-8):1983-91. doi: 10.1177/0969733018810766.
  13. Garity J. Fostering nursing students’ use of ethical theory and decision-making models: teaching strategies. Learn Health Soc Care. 2009;8(2):114-22. doi: 10.1111/j.1473- 6861.2009.00223.x.
  14. Hassanzadeh Naeini M, Nasiriani KH, Fazljoo SE. Moral courage of the nursing students of Yazd University of Medical Sciences, Iran. Iran Journal of Nursing. 2020;33(127):35-44. doi: 10.29252/ijn.33.127.35. [Persian].
  15. Shayestehfard M, Torabizadeh C, Gholamzadeh S, Ebadi A. Ethical sensitivity in nursing students: developing a context-based education. Electron J Gen Med. 2020;17(2):em195. doi: 10.29333/ejgm/7812.
  16. Obeid S, Man M. Strengthening perceptions of ethical competence among nursing students and graduates. SAGE Open Nurs. 2020;6:2377960820924170. doi: 10.1177/2377960820924170.
  17. Azadian M, Momennasab M. Nursing students’ perception of professional challenges: a qualitative study. J Med Educ Dev. 2015;10(1):12-25. [Persian].
  18. Habibi H, Bigdeli S, Sohrabi Z, Ebadi A. Professionalism among academic educational leaders: a concept analysis. J Adv Med Educ Prof. 2022;10(4):259-66. doi: 10.30476/ jamp.2022.93131.1517.
  19. Walker L, Avant K. Strategies for Theory Construction in Nursing. Boston, MA: Prentice Hall; 2011.
  20. PRISMA statement. 2023. Available from: https://www.prisma-statement.org/.
  21. Davoudi M, Afrazandeh SS, Yazdanparast E, Ghorbani SH, Sadeghian AH, Jebreili K. The effects of professional ethics workshop on nursing students’ perspective of caring behaviors. J Med Ethics. 2020;14(45):88-99. [Persian].
  22. Bahrami M, Faramarz Gharamaleki A. Conceptual analysis of moral dilemmas. Iran J Med Ethics Hist Med. 2012;5(2):32-44. [Persian].
  23. Usberg G, Uibu E, Urban R, Kangasniemi M. Ethical conflicts in nursing: an interview study. Nurs Ethics. 2020;28(2):230- 41. doi: 10.1177/0969733020945751.
  24. Mahmoudi H, Nezamzadeh M. Presenting the view of virtue-based ethical theory in resolving ethical conflicts in nursing education: review study. Journal of Medicine Spiritual Cultivation. 2023;31(4):260-71. [Persian].
  25. Araghian Mojarad F, Hosseini Karnami SH, Malekzadeh R, Assadi T, Khazaee-Pool M, Abedi G, et al. Nurses’ experiences of moral conflicts in the educational and medical centers of Mazandaran University of Medical Sciences in 2019. Journal of Religion and Health. 2021;9(1):24-36. [Persian].
  26. Jahanshahi R, Rajabpur Arefi M, Chorli F, Sanagoo A, Jouybari L, Rezapour Esfahani M. Ethical challenges in the clinical and educational environment of the university: experiences of nursing and midwifery students. Educ Ethics Nurs. 2018;7(1- 2):383-90. doi: 10.52547/ethicnurs.7.1.2.383. [Persian].
  27. Sanagoo A, Kalantari S, Taheri T, Jouybari l. The nursing students’ perspective and experiences of patients’ interest in receiving care by trainees. Daneshvar Medicine. 2016;23(123):51-60. [Persian].
  28. Park HA, Cameron ME, Han SS, Ahn SH, Oh HS, Kim KU. Korean nursing students’ ethical problems and ethical decision making. Nurs Ethics. 2003;10(6):638-53. doi: 10.1191/0969733003ne653oa.
  29. Bremer A, Holmberg M. Ethical conflicts in patient relationships: experiences of ambulance nursing students. Nurs Ethics. 2020;27(4):946-59. doi: 10.1177/0969733020911077.
  30. Cameron ME, Schaffer M, Park HA. Nursing students’ experience of ethical problems and use of ethical decision-making models. Nurs Ethics. 2001;8(5):432-47. doi: 10.1177/096973300100800507.
  31. Schneider DG, Ramos FR, Saioron I, Bruggmann MS, da Silva F, de Pádua Lorençoni B. Ethical problems in hospital clinical experiences of nursing students and professionals. Rev Enferm Ref. 2022;6(1):e21111. doi: 10.12707/rv21111.
  32. Çevik Durmaz Y. Ethical dilemma in nursing students: a case study. Int J Caring Sci. 2022;15(1):77-86.
  33. Sierra M, Cianelli R. Health literacy in relation to health outcomes: a concept analysis. Nurs Sci Q. 2019;32(4):299- 305. doi: 10.1177/0894318419864328.
  34. Albert JS, Younas A, Sana S. Nursing students’ ethical dilemmas regarding patient care: an integrative review. Nurse Educ Today. 2020;88:104389. doi: 10.1016/j.nedt.2020.104389.
  35. Caldwell ES, Hongyan L, Harding T. Encompassing multiple moral paradigms: a challenge for nursing educators. Nurs Ethics. 2010;17(2):189-99. doi: 10.1177/0969733009355539.
  36. Palacios-Ceña D, Velarde-García JF, Espejo MM, González- Hervías R, Álvarez-Embarba B, Rodríguez-García M, et al. Ethical challenges during the COVID-19 pandemic: perspectives of nursing students. Nurs Ethics. 2021;29(2):264- 79. doi: 10.1177/09697330211030676.
  37. Eckardt M, Lindfelt M. An analysis of nursing students’ ethical conflicts in a hospital. Nurs Ethics. 2018;26(7-8):2413-26. doi: 10.1177/0969733018784730.
  38. Erdil F, Korkmaz F. Ethical problems observed by student nurses. Nurs Ethics. 2009;16(5):589-98. doi: 10.1177/0969733009106651.
  39. Escolar Chua RL, Magpantay JC. Moral distress of undergraduate nursing students in community health nursing. Nurs Ethics. 2018;26(7-8):2340-50. doi: 10.1177/0969733018819130.
  40. Feeg VD, Mancino DJ, Rushton CH, Waligora Mendez KJ, Baierlein J. Ethical dilemmas for nursing students and faculty: in their own voices. Nurs Educ Perspect. 2021;42(1):29-35. doi: 10.1097/01.Nep.0000000000000730.
  41. Lindseth G. Practicing invasive procedures on students and patients: an ethical dilemma in nursing education. Nurs Forum. 1994;29(1):18-24. doi: 10.1111/j.1744-6198.1994. tb00147.x.
  42. Macpherson I, Roqué MV, Segarra I. Moral dilemmas involving anthropological and ethical dimensions in healthcare curriculum. Nurs Ethics. 2020;27(5):1238-49. doi: 10.1177/0969733020914382.
  43. Ramos FR, de Farias Brehmer LC, Vargas MA, Trombetta AP, Silveira LR, Drago L. Ethical conflicts and the process of reflection in undergraduate nursing students in Brazil. Nurs Ethics. 2015;22(4):428-39. doi: 10.1177/0969733014538890.
  44. Sadeghi R, Ashktorab T. Ethical problems observed by nursing students: a qualitative approach. J Med Ethics. 2011;5(15):43-62.
  45. Snopek P, Popovičová M, Plisková B. Moral dilemma in clinical practice of nursing students. In: 2nd International Conference on Health and Health Psychology (ICH&HPSY). Porto: Future Academy; 2016. doi: 10.15405/epsbs.2016.07.02.18.
  46. Solum LL, Schaffer MA. Ethical problems experienced by school nurses. J Sch Nurs. 2003;19(6):330-7. doi: 10.1177/10598405030190060501.
  47. Heydari A, Meshkinyazd A. Ethical challenges in nursing profession. Journal of Multidisciplinary Care. 2018;7(1):84- 95. [Persian].
  48. Dehghani A, Ordoubadi N, Shamsizadeh M, Parviniyan Nasab A, Talebi M. Perspective of patients about compliance with standards of professional ethics in nursing practice. J Nurs Educ. 2014;3(2):76-84. [Persian].
  49. Sajadi S. Disciplines and methods of moral and value education. Theological Philosophical Research. 2000;3(2):144-65. [Persian].
  50. Ghurchiani F, Barati Martati A, Abolghasem Gorji H, Khatami Firoozabadi A, Haghani H, Goldoost Marandi F. Ritual observance of ethics and patient care nurses in teaching hospitals of Tehran University of Medical Sciences. Med Ethics. 2013;23:63-79. [Persian].
  51. Arvanitis A, Kalliris K. Consistency and moral integrity: a self-determination theory perspective. J Moral Educ. 2020;49(3):316-29. doi: 10.1080/03057240.2019.1695589.
  52. Paulo N. Moral Consistency Reasoning Reconsidered. Ethic Theory Moral Pract. 2020;23(1):107-23. doi: 10.1007/ s10677-019-10037-3.
  53. Falcó-Pegueroles A, Lluch-Canut T, Guàrdia-Olmos J. Development process and initial validation of the ethical conflict in nursing questionnaire-critical care version. BMC Med Ethics. 2013;14:22. doi: 10.1186/1472-6939-14-22.
  54. Jahandar F, Mohtashami J, Atashzadeh-Shorideh F, Pishgooie SA. Effectiveness of the negotiating style on ICU nurses’ moral conflict in selected hospitals of Guilan University of Medical Sciences. Iran J Med Ethics Hist Med. 2016;9(1):37-49. [Persian].
  55. Perngyai C, Chaowalit A, Nasae T, Scheider JK. Development and psychometric evaluation of the Moral Commitment Scale for Thai baccalaureate nursing students (MCS-Thai). J Res Nurs Midwifery Health Sci. 2020;40(1):15-29.
  56. Evans BC, Bendel R. Cognitive and ethical maturity in baccalaureate nursing students: did a class using narrative pedagogy make a difference? Nurs Educ Perspect. 2004;25(4):188-95.
  57. Zeynaly S, Mozafari M, Khorshidi A. Evaluating and comparing the ability of ethical reasoning for nursing students and nurses working in the teaching hospitals affiliated to Ilam University of Medical Sciences in 2017. Int J Pharm Res. 2019;11(1):159- 65. doi: 10.31838/ijpr/2019.11.01.016.
  58. Gibson E, Duke G, Alfred D. Exploring the relationships among moral distress, moral courage, and moral resilience in undergraduate nursing students. J Nurs Educ. 2020;59(7):392- 5. doi: 10.3928/01484834-20200617-07.
  59. Muhaimin A, Willems DL, Utarini A, Hoogsteyns M. What do students perceive as ethical problems? A comparative study of Dutch and Indonesian medical students in clinical training. Asian Bioeth Rev. 2019;11(4):391-408. doi: 10.1007/s41649- 019-00101-6.
  60. Taghadosi M, Valiee S, Aghajani M. Nursing faculty’s point of view regarding noncompliance with ethics in academic environments: a qualitative study. BMC Nurs. 2021;20(1):15. doi: 10.1186/s12912-021-00537-y.
  61. Gandossi C, De Brasi EL, Rosa D, Maffioli S, Zappa S, Villa G, et al. How do nursing students perceive moral distress? An interpretative phenomenological study. Nurs Rep. 2023;13(1):539-48. doi: 10.3390/nursrep13010049.
  62. Losa Iglesias ME, Becerro de Bengoa Vallejo R, Palacios Ceña D, Fuentes PS. Knowledge and positions on bioethical dilemmas in a sample of Spanish nursing students: a questionnaire study. Contemp Nurse. 2011;38(1-2):18-23. doi: 10.5172/conu.2011.38.1-2.18.
Journal of Qualitative Research in Health Sciences
Volume 13, Issue 4
December 2024
Pages 219-227
Files
History
  • Receive Date: 09 December 2023
  • Revise Date: 17 July 2024
  • Accept Date: 22 July 2024
Share
How to cite
Statistics