Personal evaluuations of midwifery students regarding ethical competency

Abstract

Ethical competence, understood as the ability to identify and enact right actions within a specific spatial and temporal context, is ascribed to a nursing ethics educational approach that encourages self-reflection and guides toward personal growth. It is difficult for ethics educators to know whether the students who have undergone a specific training perceive themselves as confident and competent in handling ethical dilemmas. This knowledge is significant, especially for nursing and midwifery graduates who have undergone training that stipulates adherence to a code of ethics and professional norms. In the face of contemporary ethical challenges, the way that traditional codes of ethics or rule ethics are taught in midwifery practice without contextualization has been hotly debated by many authors. There is a consensus that rules or codes of ethics are inadequate in substantiating the moral decision making of the practising nurses and midwives. This study argues that current strategies that rely heavily on Principlism and codes in teaching nursing ethics without appraising the context of an ethical situation are ineffective in fostering ethical competence amongst students. The acquisition of ethical competence amongst the midwifery students in terms of the current approach of teaching Principlism and codes of ethics may be described in terms of compliance and limited reflection.

This study makes use of a set of self-reflection reports in which the midwifery nursing students narrated their experiences in handling ethical issues. The reports detailing their experiences were analysed for evidence of ethical competence. The aim of the research report is twofold: first, to highlight the limitations of current nursing ethics education in fostering ethical competence; and second, to inform nursing ethics curricula regarding strategies to foster ethical competence amongst midwifery students, based on existing literature on the subject.

Analysis of the reflection narratives revealed that one of the three dimensions of ethical competence was limited. There was evidence of moral perception, moral action and substandard moral reasoning. The principles selected by the majority were limited to autonomy and beneficence. The findings support the argument that teaching Principlism and enforcing a code of ethics without contextualising it, obligates the student to conform without arguing their assertions. The current teaching approach that consist of abstract concepts of ethical framework, limit the acquisition of ethical competence. It is recommended that nursing education institutions should consider approaches that are aligned with the goals of care, and pertinent to the practice of nursing and midwifery, if ethical competence is to be attained.