培养道德洞察力：探索护理专业学生的道德能力发展历程。
Nurturing ethical insight: exploring nursing students' journey to ethical competence.
作者信息
Hansen Sylvia, Hessevaagbakke Elisabeth, Lindeflaten Katrin, Elvan Kaja, Lillekroken Daniela
机构信息
Department of Nursing and Health Promotion, Oslo Metropolitan University, PB 4 St. Olavs plass N, Oslo, 0130, Norway.
出版信息
BMC Nurs. 2024 Aug 15;23(1):568. doi: 10.1186/s12912-024-02243-x.
BACKGROUND
Ethical competence is a key competence in nursing and the development of the competence is a central part in nursing education. During clinical studies, nursing students face ethical problems that require them to apply and develop their ethical knowledge and skills. Little is known about how ethical competence evolves during students' initial clinical placements. This study explored the development of ethical competence in first-year nursing students during their first clinical placements in nursing homes.
METHODS
This exploratory-descriptive qualitative study used focus group interviews to collect data and a phenomenological hermeneutical method for analysis. Twenty-eight first-year nursing students participated in six focus groups. The data were collected between March and April 2024 at Oslo Metropolitan University in Norway.
RESULTS
The naïve reading of the data involved an awareness of the students applying their prior knowledge, modifying their prior knowledge and developing skills that allowed them to manoeuvre ethical practices that, in some cases, appeared excellent and, in other cases, grim. The structural analysis identified three themes: (i) ethical competence forges in practice, (ii) ethical competence evolves at the intersection of knowledge and skills and (iii) ethical competence unfolds through meaningful discussions. A comprehensive understanding of the data was formulated as 'Being on a journey towards ethical competence'. This presents a metaphor illustrating that nursing students embark on a journey towards ethical competence; from their point of departure, their clinical experiences forge the essential waypoints along their path, knowledge and skills fuelling their navigation in rugged terrain towards their destination.
CONCLUSIONS
Nursing students' ethical competence evolved in intricate ways during their initial clinical period. Being informed bystanders or participants in the care of nursing home residents in situations of ethical tension may be a unique position enabling students to evaluate care options differently from those immersed in the ward culture. The findings indicate that organised professional development in nursing homes needs to focus on more reflexively driven ways of supervising students in their first clinical study period. Educational institutions need to continue and further develop reflection-based learning activities and meeting points with students and their peers during their clinical placement periods.
背景
伦理能力是护理领域的一项关键能力，其培养是护理教育的核心组成部分。在临床学习期间，护理专业学生面临伦理问题，这要求他们应用并发展自己的伦理知识和技能。对于伦理能力在学生初次临床实习期间如何演变，我们知之甚少。本研究探讨了一年级护理专业学生在养老院进行首次临床实习期间伦理能力的发展情况。
方法
本探索性描述性定性研究采用焦点小组访谈收集数据，并运用现象学诠释学方法进行分析。28名一年级护理专业学生参加了6个焦点小组。数据于2024年3月至4月在挪威奥斯陆都市大学收集。
结果
对数据的初步解读发现，学生们意识到自己在应用先前的知识、修正先前的知识并发展技能，这些技能使他们能够应对伦理实践，在某些情况下表现出色，而在其他情况下则严峻。结构分析确定了三个主题：（i）伦理能力在实践中形成，（ii）伦理能力在知识与技能的交叉点上演变，（iii）伦理能力通过有意义的讨论得以展现。对数据的全面理解被表述为“踏上通往伦理能力的旅程”。这呈现了一个隐喻，说明护理专业学生踏上了通往伦理能力的旅程；从他们的出发点开始，他们的临床经验在其道路上塑造了重要的路标，知识和技能助力他们在崎岖地形中朝着目的地前行。
结论
护理专业学生的伦理能力在其初次临床实习期间以复杂的方式演变。在伦理紧张的情况下，作为养老院居民护理的旁观者或参与者，可能是一个独特的位置，使学生能够以不同于沉浸在病房文化中的人的方式评估护理选择。研究结果表明，养老院有组织地开展专业发展需要更加注重以反思为驱动的方式，在学生的首次临床学习期间对其进行监督。教育机构需要在学生临床实习期间继续并进一步开展基于反思的学习活动以及与学生及其同伴的交流活动。
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