Ethikbildung in der Pflege – strukturelle Besonderheiten und didaktische Implikationen der Pflegeausbildung

Abstract

ZusammenfassungDie Pflegeausbildung weist die Besonderheit auf, dass die berufliche Bildung an unterschiedlichen Lernorten erfolgt. Die jeweils beteiligten Lernorte (Lernort Theorie, Lernort Praxis, zunehmend erweitert durch den dritten Lernort, das Skillslab) beeinflussen und fördern die Entwicklung der Ethikkompetenzen der angehenden Pflegfachpersonen – lernortspezifisch als auch lernortübergreifend – in unterschiedlicher Weise. Diese besonderen strukturellen Gegebenheiten des Lehrens und Lernens wirken sich sowohl auf die Ausgestaltung der Ethikbildung als auch auf die Förderung der Ethikkompetenzentwicklung im Ausbildungsverlauf aus.Die Ausführungen leitet die folgende Frage: Welche spezifischen pädagogischen und didaktischen Anforderungen, aber auch welche bildungsrelevanten Rahmungen ergeben sich angesichts der unterschiedlichen Lernorte für die Ethikbildung und die Ethikkompetenzentwicklung zukünftiger Pflegefachpersonen?Der Beitrag unterstreicht die Relevanz einer systematischen, methodisch reflektierten und lernortabgestimmten Ethikbildung im Bereich der Pflegeausbildung wie auch die Relevanz der bewussten Einbindung ethischer Reflexionsräume in die Prozesse der Ethikkompetenzentwicklung an den jeweiligen Lernorten. Die Besonderheiten der Ethikbildung erschließen sich hierbei aus den pflegeberuflichen Anforderungen an das professionelle Pflegehandeln und aus den Erfahrungen der Lernenden an den unterschiedlichen Lernorten im Verlauf der Pflegeausbildung.

Legal Regulations and the Anticipation of Moral Distress of Prospective Nurses: A Comparison of Selected Undergraduate Nursing Education Programmes

“…What is more, due to its fundamental nature underpinning all aspects and actions of the nursing profession, ethical competency development should be an area of utmost importance within the schools of nursing and it should be supported, addressed and reflected upon cross-sectionally throughout nursing education [ 6 , 24 , 107 ]. While legal regulations solely operate as a foundation for ethics education, Riedel et al [ 8 ] strongly suggested that the comprehensive development of ethical competence was a crucial step in the prevention and professional management of moral distress. Nevertheless, while building ethical competence is an important contribution to preventing and managing moral distress, a higher sensitivity for morally challenging situations simultaneously bears an increased risk for the experience of moral distress if it is impossible to relieve the experienced moral unease.…”

“…In summary, moral decision-making is fundamental to the nursing profession as patient cases are becoming increasingly complex in the contemporary context of nursing [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. Simultaneously, in all of the three presented countries, the professional requirements and responsibilities of nurses are increasing.…”

“…The ethical complexity of nursing care bears the risk for the individual nurses’ experience of moral distress which in turn may have negative consequences such as nurse burnout [ 65 , 77 ] and withdrawal from the nursing profession [ 43 , 72 , 92 ], as well as a reduced quality of patient care [ 43 , 44 , 80 , 81 , 82 , 83 ]. Hence, it is crucial that nurses are provided with the appropriate ethical toolset to professionally prevent and manage moral distress early on in their careers [ 6 , 8 , 24 , 25 , 26 ]. While ethical competencies appear to play an important role in the introduced undergraduate nursing education programmes, the main focus is being put upon the ability of prospective nurses to provide high-quality patient care which is based on ethically justified decisions and to participate in interdisciplinary ethical decision-making.…”

“…Moreover, the quality of patient care may be impacted negatively [ 43 , 44 , 80 , 81 , 82 ] due to the feeling of powerlessness, emotional fatigue, depletion and burnout that may limit nurses in their ability to stand up for patients’ needs [ 83 ]. Because of these drastic possible consequences of moral distress, it is crucial to foster appropriate competencies to prevent and professionally manage moral distress as early as during the course of undergraduate nursing education programmes [ 8 ].…”

“…It is widely accepted that moral decision-making is a fundamental component of professional nursing care which cannot be avoided but needs to be dealt with by healthcare professionals [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. The professional responsibility of nurses to act in a way that is morally appropriate arises from the vulnerability of the individuals to whom they deliver nursing care, and who should be the primary focus of their nursing practice [ 7 ].…”