Journal of Nursing Education

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RESEARCH BRIEFS 

Ethical Problems Encountered in the Teaching of Nursing: Student and Faculty Perceptions

Kathleen Schmitz, RN, MPH; Marjorie Schaffer, RN, MS

Abstract

Positive relationships between nursing faculty and students are an important aspect of the learning experience. However, situations arise in the educational context that stimulate tension and conflict in these relationships. Some of these situations are recurrent and readily recognized by experienced nursing faculty: the student with the late paper because of family problems, disagreements about grades or grading procedures, and disagreements about the appropriate degree of clinical supervision.

Faculty-student conflict in nursing education can be conceptualized in ethical terms. An ethical situation, or problem, is a real-life occurrence that creates conflict about the morally right thing to do (Cameron, 1991a). One reason for this conflict may be differences in the way in which students and faculty perceive these problems as ethical issues. The purpose of this study was to determine what action nursing students and faculty would propose to take in recurrent problematic educational situations, the ethical basis for taking that action, and predicted barriers to implementing the proposed action.

Review of Literature

Rests ( 1986) Four-Component Model of the psychological processes of morality provides a framework for the ethical analysis of interactions between nursing faculty and students. These psychological processes include the awareness and interpretation of a situation as having ethical meaning (ethical sensitivity), the judgment about which action is morally right (moral judgment), the choice to give priority to moral values over other values (moral commitment), and the implementation of the chosen action (moral action).

Moral sensitivity occurs when a teacher or student examines a teaching-learning interaction by considering what the involved participants ought to do and how their actions may affect the involved parties. As students and teachers consider what they ought to do in a particular situation, they may use a variety of ethical perspectives to guide moral judgment.

Justice, beneficence, autonomy, truthtelling, and caring are perspectives which may be used in the process of making moral judgments. The justice perspective requires that good and evil be distributed fairly among individuals according to merit, needs, abilities, or equality (Thiroux, 1986). A beneficence perspective requires one to promote good for others, as well as prevent harm from occurring (Beauchamp & Childress, 1989; Thiroux, 1986). Autonomy is freedom of choice and self-determination (Beauchamp, 1989), and honesty is foundational to the development of trust and meaningful communication between people (Thiroux).

Controversy exists as to whether caring is a principle which guides moral reasoning or is purely emotional and intuitive (Cameron, 1991b; Gilligan, 1977; Rest, 1990). Noddings (1984) describes the caring process as stepping out of one's personal frame of reference and acting to promote the well-being of the other. Gilligan emphasizes that moral action is guided by concerns for the preservation and promotion of relationships which she terms caring. This study viewed caring as a potential rationale for moral action.

Once a commitment to a moral action has been made, both teacher and student may encounter obstacles to carrying out the chosen action. For example, department policies may interfere with a faculty judgment regarding the appropriate action to take with an individual student.

Research related to ethical behavior irl the educational setting has focused oi either student or faculty perceptions of th< ethicality of the other's behavior. Numer ou8 studies address unethical behavior or the part of students or faculty: cheating plagiarism, paper mills (Connell, 1981 David & Kovach, 1979; Josephson, 1990 Tauber, 1984), grading favoritism discrimination, failure to teach (Keefe 1982; Theis, 1988), or inappropriate sex ual behavior (Glaser & Thorpe, 1986; Lit tie & Thompson, 1989; Wishnietsky, 1991) Keefe (1982) reported the most frequent and most unethical teacher behaviors were to show lack of care about students,…

Positive relationships between nursing faculty and students are an important aspect of the learning experience. However, situations arise in the educational context that stimulate tension and conflict in these relationships. Some of these situations are recurrent and readily recognized by experienced nursing faculty: the student with the late paper because of family problems, disagreements about grades or grading procedures, and disagreements about the appropriate degree of clinical supervision.

Faculty-student conflict in nursing education can be conceptualized in ethical terms. An ethical situation, or problem, is a real-life occurrence that creates conflict about the morally right thing to do (Cameron, 1991a). One reason for this conflict may be differences in the way in which students and faculty perceive these problems as ethical issues. The purpose of this study was to determine what action nursing students and faculty would propose to take in recurrent problematic educational situations, the ethical basis for taking that action, and predicted barriers to implementing the proposed action.

Review of Literature

Rests ( 1986) Four-Component Model of the psychological processes of morality provides a framework for the ethical analysis of interactions between nursing faculty and students. These psychological processes include the awareness and interpretation of a situation as having ethical meaning (ethical sensitivity), the judgment about which action is morally right (moral judgment), the choice to give priority to moral values over other values (moral commitment), and the implementation of the chosen action (moral action).

Moral sensitivity occurs when a teacher or student examines a teaching-learning interaction by considering what the involved participants ought to do and how their actions may affect the involved parties. As students and teachers consider what they ought to do in a particular situation, they may use a variety of ethical perspectives to guide moral judgment.

Justice, beneficence, autonomy, truthtelling, and caring are perspectives which may be used in the process of making moral judgments. The justice perspective requires that good and evil be distributed fairly among individuals according to merit, needs, abilities, or equality (Thiroux, 1986). A beneficence perspective requires one to promote good for others, as well as prevent harm from occurring (Beauchamp & Childress, 1989; Thiroux, 1986). Autonomy is freedom of choice and self-determination (Beauchamp, 1989), and honesty is foundational to the development of trust and meaningful communication between people (Thiroux).

Controversy exists as to whether caring is a principle which guides moral reasoning or is purely emotional and intuitive (Cameron, 1991b; Gilligan, 1977; Rest, 1990). Noddings (1984) describes the caring process as stepping out of one's personal frame of reference and acting to promote the well-being of the other. Gilligan emphasizes that moral action is guided by concerns for the preservation and promotion of relationships which she terms caring. This study viewed caring as a potential rationale for moral action.

Once a commitment to a moral action has been made, both teacher and student may encounter obstacles to carrying out the chosen action. For example, department policies may interfere with a faculty judgment regarding the appropriate action to take with an individual student.

Research related to ethical behavior irl the educational setting has focused oi either student or faculty perceptions of th< ethicality of the other's behavior. Numer ou8 studies address unethical behavior or the part of students or faculty: cheating plagiarism, paper mills (Connell, 1981 David & Kovach, 1979; Josephson, 1990 Tauber, 1984), grading favoritism discrimination, failure to teach (Keefe 1982; Theis, 1988), or inappropriate sex ual behavior (Glaser & Thorpe, 1986; Lit tie & Thompson, 1989; Wishnietsky, 1991) Keefe (1982) reported the most frequent and most unethical teacher behaviors were to show lack of care about students, to show favoritism in grading, to give students an unreasonable amount of work, and to show prejudice because of race, religion, gender, attire, or major.

The nursing literature explores ethics! primarily in clinical nurse-patient situations. Few studies were found investigating ethical behavior in the nursing education context. A study of the involvement of 101 baccalaureate nursing students in unethical classroom and clinical behavior by Hilbert (1985) found some disagreement between students and faculty as to what constituted unethical behavior (ethical sensitivity), and many students reported engaging in an activity even when they considered it to be unethical (commitment to moral values). A qualitative study of nursing students' perceptions of unethical teaching behaviors found a lack of respect for students and patients as the most prevalent unethical teacher behavior (Theis, 1988).

No studies were found that investigated disparate ethical viewpoints of students and faculty or impediments to moral action in the educational context. This investigation proposed to answer the following three questions: What actions do students and faculty propose for the resolution of an ethical problem in the educational setting? What ethical reasoning is used to support the proposed action? What barners do students and faculty predict will interfere with the implementation of their proposed action?

Methodology

The sample consisted of two groups: 34 second semester senior students and 12 faculty from two small midwestern, private, baccalaureate nursing programs. Reresponses were initially analyzed separately for each school; when no differences were found, data were pooled. All respondents were female, the majority of students were traditional college-aged, and the faculty had a mean of 11.03 years of nursing education experience. A response rate of 60% for students and 60% for faculty was achieved.

Moral sensitivity and moral reasoning were elicited by a written description of recurrent educational situations which generate student-faculty conflict. Accounts in studentjournals, as well as personal experiences of the authors, provided the basis for the development of two parallel surveys reflecting both the student and faculty perspectives for each of six recurring problems. The six problems posed in the surveys were: a) inconsistent grading between faculty on the same assignment, b) conflict between late paper policy and student personal issues, c) disagreement regarding the amount of clinical supervision needed, d) students complaints about an instructor to other students and faculty, e) unexpected tow grade in clinical, and 0 students' cover-up for classmate's incomplete nursing care.

Survey respondents were asked to predict how they would resolve (moral sensitivity) each of the six student/faculty problems and to provide rationale for their chosen action (moral reasoning). In order to assess the third component, moral commitment, respondents were then asked to check from a list of potential barriers to action, those that might keep them Mim pursuing the ethical action they deemed appropriate. Finally, the respondents were asked to indicate whether or not they had ever been in a similar situation.

Coding categories for the proposed action in each situation and types of reasoning were identified after careful reading of each survey by each investigator. Responses for these variables were then categorized. A unique set of student-proposed and faculty-proposed actions were identified for each problem.

Reasons given for selection of a particular action were coded according to ethical perspectives and nonethical reasoning. Although the rationale of most respondents reflected primarily one type of reasoning, a few also exhibited a secondary reasoning process. Only the primary reasons were coded. The perspectives used for analyzing reasons for actions were: justice, beneficence, autonomy, honesty, caring, and nonethical responses. Examples of nonethical responses were those reflecting conflict resolution strategies, self-serving behavior, or avoidance of the problem. Both investigators coded all responses, achieving an interrater reliability of r = .86. Frequencies and means of barriers were calculated for students and faculty both within and across situations.

Results and Discussion

Although six problems were posed to respondents, the findings of only four will be discussed as the other two situations added no new information over that described below. The four problems discussed below include: 1) inconsistent grading, 2) late paper, 3) low grade, and 4) cover-up.

Respondents indicated past experience with all of the situations, verifying the frequent occurrence of these problems for both students and faculty. The most common problem for students (70.6%) and faculty (91.7%) was inconsistent grading. Faculty (25%) and students (29%) described the least experience with the problem of students covering up for the incomplete nursing care provided by a classmate. Since students had, at most, 2 years experience in nursing education and faculty averaged 11.03 years, one would expect fewer students or more faculty to have experienced such cover-up problems. The question arises whether similar situations are going unnoticed by faculty, but are more frequently encountered by students. Actions proposed by faculty and students varied in number and type and were sometimes in direct opposition. Across situations, faculty and students seemed to generate fairly equivalent numbers of options for action, although within problems, some discrepancies were apparent. The inconsistent grading problem stimulated students to generate four possible actions, while faculty suggested only two. For some problems, faculty-proposed actions seemed fairly rigid and rule bound. Most students thought providing the instructor with an explanation for the late submission of the paper ought to result in a grade increase. Half of the faculty, on the other hand, expected to maintain the grade as given, upholding the established policy. In the cover-up problem, faculty and student actions were diametrically opposed. Faculty action focused on talking about the problem, while students chose to avoid talking about it.

Lack of action was an unanticipated choice among students. Some students chose to do nothing in the inconsistent grading (12%) and late paper situations (17.6%). They may have felt the instructor was justified in applying the a priori consequences, and therefore, these were nonissues, or they may have felt powerless to affect the situation.

Across problems, students and faculty used fairly comparable patterns of moral reasoning, although again, marked differences were apparent within problems. Justice reasoning dominated the rationale of faculty action in all but the cover-up problem. This perspective is illustrated by the following comment: "I would want to be fair to the student - so I would reevaluate."

Students emphasized justice reasoning, but also used autonomy and beneficence more frequently than did faculty. Two student responses illustrate these perspectives: "Each human being is different. Naturally, papers corrected by two different individuals will not be graded the same" and "Letting the instructor know will allow her to evaluate the situation. The student needs more help from the instructor and will not get it if we continue to cover up for her."

Caring reasoning seemed underrepresented in the ways both students and faculty thought about these educational problems, particularly for individuals claiming/seeking membership in a caring profession. A response typifying the caring perspective was offered by one faculty member: "I believe that students are human too and circumstances do arise which should be listened to." Although few respondents noted caring rationale for their proposed action in any of the problems, the caring perspective was strongly evident in the predicted barriers to action.

Students identified more than twice as many barriers to ethical action (mean = 16) as did faculty (mean = 6.92). This may reflect their developmental status, a sense of decreased power, or be an artifact of the small number of faculty responding to the survey. The top five barriers to action reported by students across problems were: 1) might increase tension, 2) might harm relationships with faculty, 3) lack of assertiveness by the student, 4) power differential, and 5) might harm relationships with other students. Faculty barriers included: 1) might harm relationships with students, 2) lack of time, 3) fear of being categorized as difficult, 4) power differential, and 5) might harm relationships with other faculty. Four of the top five barriers reported by students and three of the top five barriers reported by faculty reflect concerns about relationships. This finding is consistent with Keefe s (1982) observation that the most frequent and serious unethical teacher behavior was showing a lack of care about students.

Implications

Caution must be used in interpreting these data because of the small sample size, the hypothetical nature of the stimulus, and a lack of external validation of data coding. The results of this study highlight the need for both nursing faculty and students to be sensitive to recognizing ethical situations in teaching-learning interactions. Case studies or real-life conflict from the educational environment can provide the stimulus for discussion of ethical perspectives and mutually acceptable solutions. This discussion is likely to lead to a recognition of differences in the perspectives among students and faculty. Educators can challenge students to consider a variety of ethical perspectives as, together, they examine what one ought to do in problematic interactions. Including students in the process of resolving an ethical problem is not only an ideal learning opportunity, but also is likely to lead to a more creative and satisfying conclusion.

Clearly, the caring aspect of human interaction is of major concern to both students and faculty when determining barriers, but not as distinct a part of their reasoning. Relationships between educators and students are likely to benefit from a greater emphasis on the caring perspective in the consideration of what ought to be done in problematic educational situations. Educators can formally address caring as content and process and examine the balance between the justice and caring perspectives in the curriculum, departmental policies, and the way in which they interact with students. Research is also needed on teaching and evaluation strategies which use a deliberate caring perspective.

Particular attention must be given to barriers which prevent both faculty and students from committing to and implementing moral action. Both parties may be unaware of the role their behavior plays in impeding the moral action of the other. The striking difference between the number of potential barriers to moral action cited by students as compared to educators found in this study suggests a need for further research. Is this imbalance related to developmental status or academic power structure? Would male respondents select the same barriers to moral action as female respondents have? Can barriers be reduced by modifying the educational environment?

The analysis and resolution of conflictuel problems in nursing education, from an ethical perspective, can contribute to a sense of hopefulness and satisfaction in the teaching and learning of nursing. Understanding differences in perspectives and reducing barriers to moral action can strengthen student/faculty interactions and relationships.

References

  • Beauchamp, T.L., & Childress, J.F. (1989). Principles of biomedical ethics. (3rd ed.) New York: Oxford University Press.
  • Cameron, M. (1991a). Ethical problems experienced by persons with AIDS. Unpublished doctoral dissertation, University of Minnesota, Minneapolis.
  • Cameron, M. (1991b). Justice, caring and virtue. Journal of Professional Nursing, 7(4), 206.
  • Connell, C. (1981). Term paper mills continue to grind. Educational Record, 62(3), 19-28.
  • David, R., & Kovach, J. (1979). Attitudes of unethical behavior as a function of educational commercialization. College Student Journal, 13(4), 338-344.
  • Fry, S.T. (1989). Toward a theory of nursing! ethics. Advances in Nursing Science, 11(4} 9-22.
  • Gilligan, C. (1977). In a different voice: Women'sl conception of the self and morality. Harvarc Educational Review, 47, 481-517.
  • Glaser, R., & Thorpe, J. (1986). Unethical intimacy: A survey of sexual contact and ad vanees between psychology educators anc female graduate students. American Psychologist, 41(1), 43-51.
  • Hilbert, G. (1985). Involvement of nursing students in unethical classroom and clinica behaviors. Journal of Professional Nursing, 1(4), 230-204.
  • Joeephson, M. (1990). The IDIs are coming: The! DDIs are coming. Ethics: Easier Said Than Done, 10, 34-46.
  • Keefe, C. (1982). The ethical decision-points for the teacher in relation to student perception of unethical teacher behavior. Paper pre sented at the 68th Annual Meeting of the Speech Communication Association, Louis ville, KY, November 6.
  • Little, D., & Thompson, J. (1989). Campus policies, the law and sexual relationships Thought and Action, 5(1), 17-24.
  • Noddings, N. (1984). Caring: A feminine approach to ethics and moral education. Berkeley, CA: University of California Press
  • Rest, J. (1986). Moral development: Advances in research and theory. New York: Praeger.
  • Rest, J. (1990, October). Caring revisited. Paper! presented at the conference The Care Justice Puzzle: Education for Ethical Nurse ing Practice, Minneapolis, MN.
  • Tauber, R. (1984). Cheating and plagiarism. Matters beyond a faculty member's right to decide? Paper presented at the Annual Meeting of the National Association of Teacher Educators, New Orleans, LA, January 30.
  • Theis, E.C. (1988). Nursing students' perspectives of unethical teaching behaviors. Journal of Nursing Education, 27(3), 102-106.
  • Thiroux, JP. (1986). Ethics: Theory and practice. New York: Macmillan Publishing Co.
  • Wishnietsky, D. (1991). Reported and unreported! teacher-student sexual harrassment. Journal of Educational Research, 84(3), 167-169.

10.3928/0148-4834-19950101-10

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