Ethics at Bachelor

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Ethics at Bachelors level

• Philip Esterhuizen RN, BA(Cur) MScN, PhD

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European directives for nurse education leading
to registration

• The educational programme should guarantee
• Adequate knowledge of science and include
  sufficient understanding of the structure,
  physiological functions and behaviour of healthy
  and sick persons.
• The relationship between the state of health and
  physical and social environment of the human
  being.
• Sufficient knowledge of the nature and ethics of
  the profession.
• Adequate clinical experience.
• Ability to participate in the training of health
  personnel.
• Experience of working with other professions in
  the health care sector

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European directives for nurse education regarding
practice

• In a programme of 3 years/4,600 hours, there
  should be a 50 balance of theory/practice.
  Practice can take place in hospitals, other
  health care institutions and in the community and
  should include
• General and specialist medicine
• General and specialist surgery
• Maternity care
• Mental health and psychiatry
• Care of the old and geriatrics
• Home nursing

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Entrance to nursing education

• In the Netherlands education the general
  secondary educational system has three main
  options, the MAVO (four years), the HAVO (five
  years) and the VWO (six years), the latter being
  the entry requirement to university degrees.

HAVO VWO
MAVO
Secondary Professional Education MBOV
Higher Professional Education HBOV
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Nursing education in the Netherlands
MPhil/PhD
University education
MSc Degree
MSc Degree
Institute for Higher education
Level 5 Registered Nurse/BSc
Level 4 Registered Nurse
Regional Educational Centres
Level 3 nurse Independent nursing activities
Level 2 nurse Basic nursing activities/assistant
to more qualified staff
No formal qualification
Level 1 nurse Housekeeping non-patient
activities
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Two levels of nurses (NL)

• Two levels of nurse (Level 4 educated at college
  level and Level 5 educated at degree level) are
  both registered as nurses under the Individual
  Health Care Professions Act.
• Both levels of nurses are expected to
• (a) recognise and analyse actual and/or
  threatening consequences of physical, mental
  pathological processes,
• (b) recognise and analyse disabilities or
  developmental disorders
• (c) recognise and analyse the individuals vital
  functions
• (d) provide counselling and assist the
  individual in situations when necessary.
• The Level 5 nurse
• Is capable of assessing the whole situation and
  deciding the appropriate level of care.
• Directs Level 4 nurses.

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Competency-based education (NL)

• The skill set for the degree level (5) nurse
  includes the following competencies
• Observation
• Direct patient care
• Emotional support
• Nursing skills
• Patient information and education
• Preventative and promotive health
• Coordination of care

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Nursing roles and domains included in the nursing
programme
Five roles Three domains Nine domain specifications
Care provider Care Care for the ill, handicapped and dying.
Care director   Individual and collective prevention
    Health information and education
Care developer Organisation of care Programming care
Coach   Nursing unit
    Mentorship
    Quality of care
Professional practitioner Profession Professional innovation
    Professional development
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Clinical practice (NL)

• The practice part of the programme
• Is usually 10 weeks in the first year, 20 weeks
  in the second, third and fourth years of the
  programme.
• Occurs in nursing homes, mental health settings,
  general hospital and/or community settings
• In the final placement (4th year), the student is
  expected to undertake a practice-based research
  project.

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Cooperative nursing education (NL)

• In addition to the regular BSc Nursing
  programme, students can choose a second option in
  the form of a cooperative nursing education
  programme.
• This programme is also 4 years in duration, but
  here the student is employed by a hospital where
  all practice placements take place. The theory
  and practice/work balance shift from 60 practice
  in the first years to 80 practice in the final
  years.
• The Cooperative nursing programme is based
  strongly on the concept of workplace learning by
  means of clinical placements being a way of
  achieving academic credits.

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Position of ethics in the curriculum

• Currently
• Informal reflections during mentorship in all
  years
• Year 3 - Ethics and value system (16 hours)
• Future plans
• Formal integration of ethics and value system
  during mentorship
• Year 1 - Personal philosophy/vision of care (16
  hours)
• Year 2 - Ethics and value system, palliative
  care, qualitative research (36 hours)
• Year 3 Ethics and law (16 hours)
• Year 4 Ethics and research (16 hours)

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Learning from experience

• Expertise develops when the clinician tests and
  refines propositions, hypotheses, and
  principle-based expectations in actual practice
  situations
• Benner (1984)

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Educational philosophy

• Based on
• Personal and professional support for the
  individual
• Methodic and systematic supervision
• The process of personal growth and development
• Respect for the individuality of the person and
  attention for the search for self-actualization

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Approach to schooling on ethics

• Principle-based ethics
• The value of life
• Goodness/no harm
• Justice
• Truth telling
• Autonomy
• Beneficence

• Care-based ethics
• Moral attention
• Sympathetic understanding
• Relationship awareness
• Accommodation
• Response

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Theoretical approach to ethics education

• Move in the direction of virtue-based
  ethics/theory of presence
• Compassion an awareness of ones relationship
  with others
• Competence having the necessary knowledge,
  judgement, skills, energy, experience and
  motivation
• Confidence the quality that fosters trusting
  relationships
• Conscience a state of moral awareness
• Commitment convergence between ones desires
  and ones obligations and the deliberate choice
  to act in accordance

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Driscoll What? model of structured reflection
(2000)
Having an experience in practice
What? Description of the event
Actioning the new learning from the experience
Purposeful reflection on selected aspects of
the experience
Now what? Proposed actions following the event
So what? An analysis of the event
Discovery of what learning emerges from
reflection
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Reflection and reflective practice

• Reflection-in-action
• Reflection-on-action
• Reflection prior to action

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Transformational learning (Lingsma Scholten,
2001)
Underlying
Underlying
What do I think?
What do I want?
What am I doing?
Choice of motives and values, identity, who
are these people?
Assumptions and strategic actions
Actions
Results
Continual improvement
Single loop learning
Reassessment
Transformation
Double loop learning
Triple loop learning
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Being responsible versus having responsibility

• Assist students in setting boundaries
• Being responsible - being aware of what is
  happening and prepared to engage with it and work
  for its positive advance in society
• Having responsibility - to be answerable to
  someone or something specific, usually defined by
  contract

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Contact information

• Philip Esterhuizen
• p.esterhuizen_at_hva.nl