What are the factors that affect your ethical decision making as a student?

A high standard of ethical conduct is a fundamental expectation of all professional engineers. Potentially all design and operational decisions have ethical implications so ethical thinking should be high in the minds of engineers in their operational as well as strategic thinking in their individual activities, team working and interactions with outside companies. Today organizations typically have a set standard of professional conduct and values expected of their engineers and many offer forms of ethical training and support as part of their professional development. Higher Education Institutes (HEIs) also have strategies to initiate ethical awareness and professional conduct among undergraduate engineers through specific training and curriculum interventions. There is however, some lack of clarity on the ethical development of engineering students. Can university curricula and ethics education influence the ethical decision making capabilities of students? Do students address difficult ethical situations with a refined professional approach after undertaking a course or workshop on ethics? This research study aims to address these issues by investigating the key factors that influence decision making competences of engineering students. Using two focus groups: one with students who have undertaken an ethics based workshop and a second, as a control group, with students who haven’t. This study explores the differences in their skills and approaches to decision making. According to Rest (1986), there are four key stages involved in the ethical decision making process: Recognising moral issues (ETHICAL AWARNESS); Making a moral judgement (ETHICAL JUDGEMENT); Prioritising moral issues ahead of other issues (ETHICAL INTENT); and Acting on the moral concerns (ETHICAL BEHAVIOUR). This study adopts this model as part of the analysis to determine what shapes the decision making capabilities and competences of the participants and whether distinct patterns are followed. The analysis shows no significant differences in the level of ethical awareness and intentions of the participants in the two focus groups. However, the findings do highlight that the factors influencing their responses did vary between the groups. Factors such as job and financial motivation, personal commitment to friendship, fear of academic punishment heavily influenced the decision making competences among these groups. The two key motivation themes that emerge are external and internal rewards. Participants from the group which had no experience of ethics education showed preference towards external rewards (money, salary and job) in their decision making whereas participants who had undertaken a workshop on ethics sought internal rewards (being happy and guilt-free). The study makes a contribution to the literature of ethics education and curriculum design by bringing clarity on the factors influencing students’ decision making skills. It also reflects on the effectiveness of ethics education in HEIs. Educators can use the findings of this study to build and reform ethical awareness and professional conduct among student. Students can utilize this study to understand the ethical norms and expectations in a profession like engineering as part of their career development.

@InProceedings{ATESH2017ANA,
author = {Atesh, M. and Baruah, B. and Ward, A.},
title = {ANALYZING THE FACTORS INFLUENCING THE ETHICAL DECISION MAKING SKILLS AMONG ENGINEERING STUDENTS},
series = {11th International Technology, Education and Development Conference},
booktitle = {INTED2017 Proceedings},
isbn = {978-84-617-8491-2},
issn = {2340-1079},
doi = {10.21125/inted.2017.1364},
url = {https://dx.doi.org/10.21125/inted.2017.1364},
publisher = {IATED},
location = {Valencia, Spain},
month = {6-8 March, 2017},
year = {2017},
pages = {5819-5825}}

TY - CONF
AU - M. Atesh AU - B. Baruah AU - A. Ward
TI - ANALYZING THE FACTORS INFLUENCING THE ETHICAL DECISION MAKING SKILLS AMONG ENGINEERING STUDENTS
SN - 978-84-617-8491-2/2340-1079
DO - 10.21125/inted.2017.1364
PY - 2017
Y1 - 6-8 March, 2017
CI - Valencia, Spain
JO - 11th International Technology, Education and Development Conference
JA - INTED2017 Proceedings
SP - 5819
EP - 5825
ER -

M. Atesh, B. Baruah, A. Ward (2017) ANALYZING THE FACTORS INFLUENCING THE ETHICAL DECISION MAKING SKILLS AMONG ENGINEERING STUDENTS, INTED2017 Proceedings, pp. 5819-5825.

1Dilek Sari, Associate Professor, Department of Fundamentals Nursing, Ege University School of Nursing, Izmir, Turkey

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Ebru Baysal

2Ebru Baysal, Research Assistant, Department of Fundamentals Nursing, Ege University School of Nursing, Izmir, Turkey

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Gul Gunes Celik

3Gul Gunes Celik, Research Assistant, Department of Fundamentals Nursing, Ege University School of Nursing, Izmir, Turkey

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Ismet Eser

4Prof. Ismet Eser, Department of Fundamentals Nursing, Ege University School of Nursing, Izmir, Turkey

Find articles by Ismet Eser

Author information Article notes Copyright and License information Disclaimer

1Dilek Sari, Associate Professor, Department of Fundamentals Nursing, Ege University School of Nursing, Izmir, Turkey

2Ebru Baysal, Research Assistant, Department of Fundamentals Nursing, Ege University School of Nursing, Izmir, Turkey

3Gul Gunes Celik, Research Assistant, Department of Fundamentals Nursing, Ege University School of Nursing, Izmir, Turkey

4Prof. Ismet Eser, Department of Fundamentals Nursing, Ege University School of Nursing, Izmir, Turkey

Correspondence: Dilek Sari, Associate Professor, Department of Fundamentals Nursing, Ege University School of Nursing, Izmir, Turkey. Email: moc.liamg@iraslid

Received 2018 Feb 23; Revised 2018 Apr 8; Accepted 2018 May 7.

Copyright : © Pakistan Journal of Medical Sciences

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective:

The present study was conducted to determine nursing students’ levels of ethical decision-making.

Methods:

The sample of the descriptive study consisted of 240 nursing students. The data were collected using the Student Information Form and “Nursing Dilemma Test”.

Results:

It was found that Principled Thinking (PT) mean score (48.38±7.97) of nursing students was above average while their Practical Consideration (PC) mean score (17.87±4.13) was close to average. It was also determined that the nursing students participated in the study were not familiar (17.75±2.77) with the dilemmas included in the Nursing Ethical Dilemma Test.

Conclusion:

The students paid attention to consider ethical principles when making decisions about ethical dilemmas; however, they are also affected by environmental factors as well. Sex and class level were found to be influential in the process of ethical decision making.

Keywords: Nursing, nursing students, Ethical decision making, Ethical dilemma, Ethics education

INTRODUCTION

Advances in science and technology have made patient care more and more complicated.1,2 As a result decision making responsibilities in nursing care to increase as well. Thus, nurses have begun to face many ethical problems such as initiating heart-lung resuscitation, ending a life-supporting treatment and patients rejecting treatment.2 Ethical decision making is a logical process which involves making the best moral decisions through systematic reasoning in a situation that brings about conflicting choices.3

Professional decisions of nurses affect their ethical problem solving skills and professional development of nursing students as well as the quality of patient care.4,5 If nurses fail to act in accordance with the principles taught at school in their practical applications, nursing students may fall into ethical conflict.6 Nursing students attend practical applications in the guidance of nurses and professors and make decisions in care. Therefore, nurses and professors must be role models for nursing students in clinical practices.4,5 Ethics education cannot be effective alone unless students have good role models. Practical norms and hierarchical structures may adversely affect new-graduates’ enthusiasm for ethical behavior.7

Studies conducted on nurses’ ethical sensitivity and ethical decision making levels have shown that they are not at the desired levels in ethical decision making.8,9 Likewise, studies carried out with student nurses have presented similar results.3,10,11 It has been found by studies on the ethical dilemmas experienced by nursing students and ethical decision making that the most frequent ethical dilemmas are telling the truth to incurable patients and their relatives,4 euthanasia, privacy,10,11 tapering of therapy,4,11 resuscitation of patients and patient rights.11

In order to improve nurses’ ethical decision making skills, they have to be undergo through basic education.2 Courses on ethics need be included within nursing curriculum. In-service training should cover ethical thinking skills and decision making process after graduation.1,12 It will enable them to identify when faced with an ethical problem, make the decisions in conflicts of ethical principles and develop solutions.13

It has been seen that the related literature includes few studies on the ethical decision making levels of nursing students.5,11,12,14,15 Considering the importance and necessity of ethical decision making, we believe that our study in which we measured nursing students’ levels of moral reasoning and ethical decision making will contribute to the literature.

METHODS

The present descriptive cross-sectional study was consisted of the 637 students receiving education and training in the second and fourth years of the College of Nursing in the academic year 2016-2017. The formula [n=(Nx2xpxq)/(d2x(N-1)+t2xpxq)] was used to calculate the size of the sample over the population.16,17 The calculation showed that the appropriate sample size would be minimum 240 students (105 students from second year and 135 students from fourth year). A stratified random sampling method was used in selecting the students to be taken in the sample according to class.16

Data Collection Student Information Form

The form included four questions on students’ personal characteristics (class level, age, sex) and six questions about ethics and ethical dilemmas.

Nursing Dilemma Test

Nursing Dilemma Test was developed by Patricia Crisham in 1981. The Turkish version of the test was analyzed for validation and reliability by Cerit (2010). The test formulated six scenarios. In each scenario, a situation is presented to possibly generate moral confusion for nurses offering care to the patient and family. The ethical dilemmas include: (a) newborn with anomalies considering the issue of defining and promoting the quality of life; (b) forcing medication; (c) adults’ requests to die; (d) orientation of a new nurse; (e) medication errors and (f) terminally ill adults. Each of the ethical dilemmas consists of three sections. The first section asks about the necessary action to be taken in case of the ethical dilemma given in the scenario and wants the answerer to mark one of the three options provided for each ethical dilemma. In the second section, six statements are presented which could be taken into consideration in the approach to the given scenario including the ethical dilemma. The participants are asked to choose the most important statement among these six and to put the statements in order of importance for themselves. The responses given in this section of the test aim at determining the levels of Principled Thinking” (PT) and “Practical Consideration” (PC). The possible minimum PT score on the test is 18, while the maximum PT score is 66. The lowest PC score that could be obtained on the test is 6 and the highest PC score is 36. PT shows the importance attached to considering moral principles when making a moral decision in nursing. PC, on the other hand, measures the importance given to environmental factors such as the number of patients, the number of available resources, institutional policies, the degree of nurses’ perception of the support given by the administration and the doctor’s control when making decisions about ethical problems. In the third section, the participants are asked to state whether they have any past experience with a similar dilemma or not. Based on the answers given to the question in this section, the state of having experience with a similar dilemma was assessed on a likert type scale and the “Familiarity” score was obtained. A familiarity score between 6 and 17 shows that the participants are familiar with a similar dilemma, while a score falling within the 18-30 range reveals no familiarity with a similar dilemma.8

Ethical Considerations

Prior to data collection, an approval was obtained from X University College of Nursing Ethics Committee. Permission to use the Turkish version of the Nursing Dilemma Test was obtained from Birgül Cerit. Written approval was taken from school administrators to conduct the study. The study was conducted according to the Helsinki Declaration. Verbal consent was obtained from each student who agreed to participate after they were informed about the study content.

Statistical Analysis

Statistical analysis was performed by using SPSS (version 17.0, SPSS Inc, Chicago, Illinois). General subject characteristics were analyzed using descriptive analysis through frequency, percentage, and means. Categorical variables were tested with Student t test and p<0.05 was considered statistically significant.

RESULTS

It was found that the mean age of the students was 22.18 ± 1.41 years, a great majority of them (81.2%) were female and 18.8% were male. More than the half of the students (56.2%) was in their fourth year. Most of the students (62.9%) knew the definition of ethical dilemma, more than one third of them (38.4%) defined ethical dilemma as the conflict of values, very few students (6.2%) experienced ethical dilemma during their clinical internship and that the greatest ethical dilemma they experienced (33.5%) was in the case that the practices performed were different from what had theoretically been explained.

The data obtained from the second section of the Nursing Dilemma Test were evaluated and mean scores of PT, PC and familiarity that student nurses could get over this test were calculated. Accordingly, it was determined that the mean PT score 48.38±7.97 was a little above the average level, while the mean PC score 17.87±4.13 had a close value to average. The mean Familiarity score was 17.75±2.77 which showed that they were unfamiliar with similar dilemmas (Table-I).

Table-I

Mean Scores of Students in Nursing Dilemma Test.

Nursing Dilemma TestM (SD)MinimumMaximumNursing Principled Thinking48.38±7.972762Practical Consideration17.87±4.13830Familiarity17.75±2.77630

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The data obtained from section A of each scenario of Nursing Dilemma Test, 52.1% of the students were in favor of resuscitation of a newborn with abnormalities, nearly one third (31.2%) supported administering medication against the will of the patient while, and 38.8% of them remained undecided. As for the third scenario, 71.7% of the students stated that they would provide respiratory support although a competent adult patient requested to die. According to fewer than half of the students (40.4%) there is no time for the orientation of new nurses into the pediatric nursing clinic 40.4% remaining undecided. A great majority of the students (74.2%) stated that medication errors must be informed. The last scenario presented a dilemma about a terminally ill adult who asked his diagnosis despite his doctors’ and family members’ wishes. One third of the students (33.3%) thought that patients questions must be answered, 26.7% agreed with the doctor and family and 40.0% remained undecided (Table-II).

Table-II

Nursing student’s responses to section A of the Nursing Dilemma Test (n= 240).

Dilemmas‘What should nurse do?’n%Newborn with anomaliesShould resuscitate the newborn12552.1Cannot decide7330.4Should not resuscitate the newborn4217.5Forcing medicationShould forcefully give the medication7531.2Cannot decide9338.8Should not forcefully give the medication7230.0Adult’s request to dieShould provide assistance for artificial respiration17271.7Cannot decide5623.3Should not provide assistance for artificial respiration125.0New nurse orientationShould allocate time for orientation of the nurse9740.4Cannot decide9740.4Should not allocate time for orientation of the nurse4619.2Medication errorShould report the medication error now17874.2Cannot decide4820.0Should not report the medication error now145.8Terminally ill adultsShould answer the patient’s questions8033.3Cannot decide9640.0Should not answer the patient’s questions6426.7

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While second year students’ Familiarity and PT scores were good, PC scores of the fourth year students were found to be higher (p<0.05). It was observed that female students’ Principled Thinking scores were high while male students had their PC scores higher (p<0.05). The students who knew the definition of ethical dilemma had higher Familiarity and PT scores whereas those who did not know the definition of ethical dilemma had higher PC scores (p<0.05) (Table-III).

Table-III

The Distribution of the Score of Nursing Dilemma Test by Several Variables.

Principled Thinking ScorePractical Consideration ScoreFamiliarity Score


ClassnMean±SDTPMean±SDtpMean±SDtpSecond year10551.09±6.864.9550.00016.92±3.75-3.2570.00118.21±1.602.5230.012Fourth year13546.28±8.1718.61±4.2717.38±3.38SexMale4545.31±8.37-2.9140.00420.11±4.833.574.00117.57±3.48-.3840.702Female19549.09±7.7317.35±3.7817.78±2.59To know definition of ethical dilemmaKnowing15149.64±7.303.1170.00217.19±3.85-3.4080.00118.04±2.132.1710.031Unknowing8946.24±8.6319.03±4.3417.24±3.57

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DISCUSSION

When the ethical dilemmas experienced by nursing students in their clinical practices were examined, it was seen that the most frequently faced dilemmas included the fact that clinical practices did not comply with the standards in theoretical education, not telling the truth to the patient and making the decision of not applying CPR. These findings are similar to the results of previous studies carried out with student nurses.4,11

Principled Thinking show the importance attached to considering moral principles when making a moral decision in nursing. The present study found that mean PT scores of nursing students were a little above the average level (Table-I). In this respect, it could be said that - albeit not at the desired levels-student nurses think by taking ethical principles into consideration when faced with ethical problems. In some studies conducted with nurses,9,12,15,19,20 and nursing students5,12,18,15 PT scores were found to be above average, which supports our findings as well.

Moreover, students’ mean PT scores vary by their class levels, sex and their knowledge of the definition of ethical dilemma in the study. It was found that fourth year students, male students and those who fail to define ethical dilemma had lower mean PT scores (p<0,05) (Table-III). Fourth year nursing students are expected to have faced more ethical dilemmas and solutions since they have more experience in clinical practices.12 However, our study found that second year nursing students had higher mean PT scores than those students in their fourth year. As ethics courses are included in the first and second years in our school curriculum, this difference may have been affected by the fact that second year students have more recent knowledge of ethics. The study conducted by Ham (2004) support those obtained in our study. In the study they carried out with experienced nurses and graduate nursing students, it was found that the more years of experience the nurses had, the lower their mean PT scores got.18 On the other hand, Crisham (1981) stated that class levels of nursing students did not affect their man PT scores while Park et al. (2003) showed that PT scores of fourth year students were higher.6,19 In their study, Kurt et al. (2013) determined that male students had lower PT scores, but that their scores did not vary by class level.5

Practical consideration measures the importance given to environmental factors such as the number of patients, the number of available resources, institutional policies, the degree of nurses’ perception of the support given by the administration and the doctor’s control when making decisions about ethical problems.8 It was found in the present study that students’ mean PC scores were close to average (Table-I). Based on this finding, it could be asserted that students relatively remain under the influence of environmental factors when making decisions about the solutions of ethical dilemmas. Mean PC scores in our study are similar to those obtained in previous studies.12,14,21 On the other hand, in two different studies conducted with students5 and one study with nurses, mean PC scores are higher than those obtained in our study.8

In addition, mean PC scores of the students vary by their class level, sex and their knowledge of ethical dilemma. It was found that fourth year students, male students and those who were unable to define ethical dilemma had significantly higher mean PC scores (p< 0,05) (Table-III). Since they have more experience in clinical practice, fourth year students are considered to include environmental factors into the evaluation process when making decisions on ethical dilemmas.

It is seen in the study that, students with lower PT scores have higher PC scores. This could have resulted from the fact that the students are not familiar with similar ethical dilemmas. Familiarity may help nurses be able to discuss an ethical problem they are faced with, find appropriate solutions and make ethical decisions. Being unfamiliar with ethical dilemmas make is difficult to make ethical decisions and cause the nurse to use practical thinking.5 In our study, students’ mean familiarity score was 17.75±2.77, which showed that they were not familiar with similar ethical dilemmas (Table-I). In this respect, it could be said that students do not face with situations that are similar to those included in the scale in their real-life clinical practices. One study with students support our findings, while in studies conducted with nurses4,9 it is seen that nurses come across similar dilemmas more frequently in their clinical practices.

Also, familiarity scores of the students vary by their class level, sex and their knowledge of ethical dilemma. It was found that second year students, and those who were able to define ethical dilemma had significantly higher mean familiarity scores (Table-III).

It can be said that familiarity scores of the fourth year students might be affected by the fact that although they have more clinical experience, they took ethical courses in their second year.

When the responses of the students given to the sample ethical dilemmas in the scenarios were looked into. (Table-II), it was seen them most students assess patients’ well-being with a paternalist point of view and support survival instead of respecting patient autonomy and quality of life. In the field of healthcare, the concept of paternalism is mostly used to refer to professionals who restrict others’ autonomy in order to protect them from an anticipated or perceived damage. Sometimes professionals tend to make a dangerous assumption that they are the only ones who can make decisions on healthcare due to their professional knowledge and even that the sole knowledge required to decide for patients is professional knowledge.22 Previous studies showed that nursing students act as supporters of patient rights and behave more traditionally instead of using autonomy in the process of ethical decision making.23 Although students sometimes support the wholeness of the patients and their rights to designate their own destiny, they may perceive their authority insufficiently as students and fail to take action. Moreover, they may be afraid to be accused by others when they consider the patient’s will and personal values.18 In addition, nurses are officially responsible for fulfilling the written duties by doctors in Turkey. It is not the nurses’ legal obligation to inform the patient about the disease due to the respect for patient rights and, answering the questions about the diagnosis or situation of a terminally ill patient is beyond the official duties of a nurse in Turkey. Because of all these restrictions, nurses may think that they would be unable to make their own ethical decisions when they are faced with ethical dilemmas due to environmental conditions or professional and official responsibilities.9 These reasons may have caused the students to remain undecided about the given scenarios.

CONCLUSION

The dilemmas most frequently faced by the student nurses included the fact that clinical practices did not comply with the standards in theoretical education, not telling the truth to the patient and making the decision of not applying CPR. Student nurses, albeit rarely, face with ethical dilemmas in the clinical environment, but that they are not familiar with similar ethical dilemmas from their previous experience. It was also concluded that they consider ethical principles at a level above average when deciding on ethical dilemmas and environmental factors are influential on their decisions. In our study, ethical decision making process of the students was found to be affected by sex, class level and the students’ knowledge of the definition of ethical dilemma. In order to improve nursing students’ critical thinking and ethical decision making skills, ethics courses must be included in the nursing curriculum and students need to discuss ethical dilemmas with their instructors during clinical practices. Ethics classes should be based on sample cases instead of explanation through traditional method to increase course efficiency and help students internalize them better.

What are the factors affecting ethical decision making?

Factors influencing ethical behaviour? School/ Education Desire to preserve/ enhance status Loyalty to Family/ Friends/ Company Company Ethos Professional Ethics … Cultural/ societal values Media influences/ coverage Legal constraints (Government) Enforcement (Legal/ Professional/ Religious) … …

What are the ethical issues faced by students?

The Main Ethical Issues in Education.
Social Inequity. One of the biggest ethical issues that schools face is social inequity. ... .
Cheating. Cheating has been a prominent historical issue in every school. ... .
Find out what's in your copy. Get started with Copyleaks for free today! ... .
Special Treatment. ... .
Grading Exams. ... .
Bullying. ... .
Uniforms..

How will you apply ethics and decision

Skills involved in ethical decision-making and responsibility include: Demonstrating curiosity and open-mindedness. Learning how to make a reasoned judgment after analyzing information, data, and facts. Making ethical decisions based upon mutual respect and appropriate culturally-relevant social norms.

How does your moral values influence your decision

Moral values give children perspective, make them strong, and transpire firm beliefs in them, which makes them work hard and have courage when they are facing challenges in life.