Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge S-141 52, Sweden.
Nurse Educ Pract. 2024 Aug;79:104089. doi: 10.1016/j.nepr.2024.104089. Epub 2024 Aug 2.
The aim of the paper is twofold: 1. To present observations based on first-year nursing students' narratives during clinical rotation in gerontological nursing care; and 2. Explore a nursing educator's reflections on these observations in relation to the didactic and ethical challenges that occurred.
The teaching of ethics is included in nurse education worldwide. Students are in their first clinical placement in residential care of older persons confronted with the moral complexities of gerontological care, where they get little possibility to share emotions and thoughts about ethically challenging nursing situations with a supervising registered nurse.
A critical discussion paper.
The educator's reflections in this discussion paper are based on a narrative assignment in ethics where first-year nursing students reflect on and describe a nursing situation during their clinical rotation in the residential care of older persons.
Most students were acting as mere spectators in the described nursing situation where an older person, ethical standards, or evidence-based care was violated. Some students acted as advocates to the older person and intervened in the situation and a few as inspirers showing alternative ways of handling ethically challenging situations.
Educators in nursing programs at the undergraduate level require time for student-centered formative guidance to foster moral courage and practice. During first-year students' clinical rotation, the learning goals in long-term residential care of older persons are focused on evidence-based basic nursing care. In this, students are confronted with ethically challenging situations, where the possibility to learn from a critical reflective practice is rare. When observing situations where an older person is subjected to unethical or unsafe nursing care it is common that the students take the spectators' role, not knowing how to deal with what is observed. Some students are taking an intervening role by trying to alleviate the vulnerability of the older person. A few are showing moral courage by directly intervening when experiencing unethical or unsafe nursing care or conduct. In this the student can inspire fellow students or staff during their clinical rotation in alternative ways of handling ethically challenging situations. As older persons are the largest demographic group that nurses will experience, educators need a sound knowledge of ethics as well as gerontological care to be able to meet and nurture students' ethical reflections during clinical practice and to foster practical wisdom in nursing.
本文旨在：1. 呈现基于护理专业一年级学生在老年护理临床轮转期间叙事的观察结果；2. 探讨护理教育者在与教学和伦理挑战相关的这些观察结果方面的反思。
在全球范围内，护理教育都包含了伦理学的教学。学生在他们的第一个临床实习中，在老年人的居住护理中面临着老年护理道德复杂性的挑战，他们几乎没有机会与注册护士主管分享有关具有伦理挑战性的护理情况的情感和想法。
批判性讨论论文。
本讨论论文中的教育者反思是基于一项伦理叙事任务，在该任务中，护理专业一年级学生反思并描述了他们在老年人居住护理临床轮转期间的护理情况。
大多数学生在描述的护理情况中仅仅是旁观者，在这种情况下，老年人、伦理标准或基于证据的护理受到了侵犯。一些学生充当老年人的拥护者并干预这种情况，少数学生充当激励者，展示处理伦理挑战情况的替代方法。
本科护理课程的教育者需要时间进行以学生为中心的形成性指导，以培养道德勇气和实践能力。在一年级学生的临床轮转期间，老年人长期居住护理的学习目标侧重于基于证据的基本护理。在这种情况下，学生面临着具有伦理挑战性的情况，很少有机会从批判性反思实践中学习。当观察到老年人受到不道德或不安全的护理时，学生通常会采取旁观者的角色，不知道如何处理所观察到的情况。一些学生通过试图减轻老年人的脆弱性来采取干预措施。少数人通过直接干预不道德或不安全的护理或行为来展示道德勇气。在这种情况下，学生可以在临床轮转期间以替代方式处理伦理挑战情况，激励其他学生或工作人员。由于老年人是护士经验中最大的人口群体，教育者需要具备伦理学和老年护理方面的扎实知识，以便能够在临床实践中应对和培养学生的伦理反思，并培养护理方面的实践智慧。
