Academic journal article Nursing Education Perspectives

CONFIDENCE and KNOWLEDGE: Regarding Ethics among Advanced Practice Nurses

Academic journal article Nursing Education Perspectives

CONFIDENCE and KNOWLEDGE: Regarding Ethics among Advanced Practice Nurses

Article excerpt


ABSTRACT As the scope of advanced practice nursing expands and the educational requirements increase, so do the ethical responsibilities. How prepared are advanced practice nurses (APNs) to manage the ethical challenges in advanced practice? The purpose of this study was to determine APNs' ethics knowledge and perceived level of confidence in their ability to manage ethical problems in advanced practice. Assuming ethics knowledge and abilities of APNs are similar to those of medical residents, a survey instrument for medical residents was modified for use with APNs. Responses to the modified survey indicated a fairly high level of confidence but a fairly low level of knowledge. Studies show that ethics education can be effective in improving knowledge, confidence, and ethical behavior. Given the expanding role of APNs as doctors of nursing practice, research is needed to determine the ethics knowledge needs and teaching strategies to better prepare nurses for the challenges of advanced practice.

Key Words Ethics Education - Advanced Practice Nursing - Ethical Decision-Making - Ethics Confidence - Ethics Knowledge

COMPARED TO NURSING STUDENTS IN BACCALAUREATE PROGRAMS, THE ETHICS EDUCATION OF ADVANCED PRACTICE NURSES (APNS) HAS RECEIVED LITTLE ATTENTION. As the scope of APN practice expands and educational requirements increase to the level of doctor of nursing practice (DNP), so do the ethical responsibilities of APNs. As curricula are developed to prepare nurses for the DNP degree, it is important to know which areas of ethics education need to be addressed to help APNs in the management of ethical challenges.

Ketefian (1999) reported extreme variation in the outcome competencies of nursing students at the graduate level regarding ethics content. This is unfortunate. Studies have shown that some APNs experience moral distress when managing ethical problems in clinical practice that lead to negative consequences for them and for their patients (Butz, Redman, Fry, & Kolodner, 1998; Godfrey & Smith, 2002; Laabs, 2005, 2007). It has been suggested that ethics education may increase nurses' confidence (Grady et al., 2008; Wocial, 2008) and serve as an antidote to the professional ill of moral distress (Lang, 2008, p. 19).

Given the problem of moral distress and its contribution to the ongoing nursing shortage, along with the increasing demands of a complex health care environment and the trend toward APN educational preparation at the DNP level, attention needs to be given to ethics education of advanced practice nurses. This article reports on a cross-sectional descriptive survey of APNs regarding their knowledge of ethics and their perceived level of confidence in their ability to manage ethical problems in clinical practice. It is hoped that findings from this study will help lay the groundwork for ensuring that appropriate ethics content is included in the essential elements of curricula, both for experienced APNs who return for doctoral degrees and for individuals entering DNP programs directly from baccalaureate programs. It is hoped also that these findings will begin to remedy the problem of moral distress that continues to afflict nursing at all levels.

Review of the Literature and Conceptual Framework No studies on ethics knowledge and confidence were found concerning APNs. However, studies have been conducted among interns entering medical residency, a group that would have similar ethics knowledge requirements. These studies found that, despite ethics education in medical school, ethics knowledge and confidence among medical interns were generally low; and, while confidence was high among surgical interns, their requisite ethics knowledge was low (Sulmasy, Ferris, & Ury, 2005). Studies among practicing physicians and physicians in residency programs have demonstrated that ethics education following medical school can be effective in improving knowledge, confidence, and behavior in ethical decision-making (Sulmasy & Marx, 1997; Sulmasy, Dwyer, & Marx, 1995; Sulmasy, Geller, Levine, & Faden, 1990, 1993; Sulmasy, Terry, Faden, & Levine, 1994). …

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