Chantal Caux

Ethical competence: An integrative review.

Background: Ethics, being a fundamental component of nursing practice, must be integrated in the nursing education curriculum. Even though different bodies are promoting ethics and nursing researchers have already carried out work as regards this concept, it still remains difficult to clearly identify the components of this competence. Objective: This integrative review intends to clarify this point in addition to better defining ethical competence in the context of nursing practice. Method: An integrative review was carried out, for the 2009–2014 period, in the CINAHL, MEDLINE, and EMBASE databases and in the journal Nursing Ethics. The keywords nursing ethics or ethical competence were used in order to make sure to widely encompass the concept of “ethical competence” in the case of a university curriculum in nursing. In the end, 89 articles were selected. Ethical consideration: We have respected the ethical requirements required regarding the sources and authorship. There is no conflict of interest in this literature review. Results: Ethical sensitivity, Ethical knowledge, Ethical reflection, Ethical decision-making, Ethical action, and Ethical behavior are the most frequently used terms with regard to ethical competence in nursing. They were then defined so as to better ascertain the possible components of ethical competence in nursing. Conclusion: Even though ethical competence represents a sine qua non competence in nursing practice, no consensus can be found in literature with respect to its definition. The identification of its components and their relationships resulting from this integrative review adds to the clarification of its definition. It paves the way for other studies that will contribute to a better understanding of its development, especially among nursing students and practicing nurses, as well as the factors that may exert an influence. More adapted education strategies can thus be put forward to support its development.

923 Occupational health and safety issues of ethical dilemmas faced by nurses in clinical practice settings: a qualitative study

Introduction During their practice, nurses regularly encounter ethical dilemmas. The sources of these dilemmas, according to the literature, seem mainly related to clinical practice settings, such as emergency, intensive, palliative, oncology, etc. However, as part of a graduate clinical ethics course for nurses, we also noticed that the sources of nurse ethical dilemmas seem to be very much related to occupational safety and health (OSH) considerations as opposed to clinical situations. This research aimed to highlight these sources of ethical dilemmas that can be attributed to contexts and aspects other than those found in the literature, particularly those related to OSH. Methods Ethical dilemmas were assessed qualitatively by analysing 250 written descriptions presented by students in the graduate clinical ethics course for nurses. Each description was analysed using the continuous comparison technique in order to produce an emergent model, which reconstructed the nurses’ representations of ethical dilemmas pertaining to OSH. Results The results provide a much broader picture of the ethical dilemmas faced by nurses. The model shows that the majority of ethical dilemmas described has underlying dynamics related to OSH. They described ethical dilemmas arising from an explicit risk to their physical or psychological health such as exposure to biological agents, bullying or threats from the patient‘s family. Moreover, many of the ethical dilemmas are expressed by the nurses primarily in terms of consequences for herself and not for the patient. Conclusion This model emphasises that OSH issues have a significant impact on ethical dilemmas experienced by nurses. Consequently, these issues should be part of the discussions regarding ethical climate in nursing management and education.