Effects of Nursing Ethics Education on Moral Reasoning and Ethical Decision Making for Student Nurses

간호윤리 교육이 간호학생의 도덕적 사고와 윤리적 딜레마 상황에서의 의사결정에 미치는 효과

This study was designed to test effects of nursing ethics education (NEE) on moral reasoning and ethical decision making of subjects. This NEE that was teached for 10 hours course was composed of these : Nurses' ethical code, moral responsibility, Moral value and professional accountability, Respect for human life, General ethics, Theory and Norms of biomedical ethics, Ethical decision making model and Discussion about hypothetical ethical dilemmas Twenty-five senior student nurses were sampled from four year college of nursing from Nov. 3rd, 1993 to Nov. 24th, 1993. Data were collected through self-reported questionnaires included two kinds of tests. Rest's Defining Issues Test was adopted to measure the stage of moral development, which was classified with the stage 2 (instrumental relativist orientation), the stage 3 (interpersonal concordance), the stage 4 (law and order), the stage 5A (societal consensus), and the stage 5B (intuitional humanism), the stage 6 (universal ethical practice). In particular, the level of principled thinking (P) was measured by summing these scores of the stages 5A, 5B, and 6. The possible range of P is 0 to 95. As for measuring the levels of morality and nursing dilemma, Crisham's Nursing Dilemma Test was adopted. This test generated the morality score(MS) and the dilemma score (DS). The data were analyzed by t-test, ANOVA, Kruskal-Wallis test, Mc Nemar's test and Pearson correlation coefficients. The results were as follows ; 1. For the Moral Reasoning both before and after NEE, The Mean score of the stage 5A was significantly higher than that of other stages.(P=0.0001) Before NEE, the mean score of the stage 4 was significantly different from stage 2, 3, 5A, and after NEE, different from stage 2, 5B,6. 2. The analysis of change of moral development level revealed that the score of stage 4 increased after NEE.(P=0.0004) 3. The Effect of NEE for the mean score of 5A, 6, P after education was significantly different by birth place. 4. With regard to the five dilemmas postulated such as forcing medication performing cardiac pulmonary resuscitation, reporting a medication error, informing diagnosis to terminally ill adult, and providing new-nurse orientation, the mean score of the MS and the DS was no significant difference with general characteristics of the students. Effect of NEE morality score and dilemma score after education was no significant difference. 5. As for the correlations between moral reasoning and decision making, the score of the stage 2, 5A, 6, DS was positively correlated with the scores of before and after. Positive correlation was also observed between the scores of stage 2 and stage 4, stage 3 and 6. On the other hand, the score of P was negatively correlated with the scores of stage 2 and of stage 4 and of stage 5A. The score of the stage 5A was also negatively correlated with the score of the sge 6.