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Embedding ethics in practice

While nurses and healthcare professionals frequently top the list of the most trusted professions, it is critical for universities to challenge the status quo of ethics education, writes Sandy Lynch.

One would argue with the proposition that healthcare professionals ought to be ethical practitioners or that universities ought to promote ethical awareness and ethical competence in their nursing and medical students.

We all recognise the importance of the social contribution healthcare professionals make in their roles as practitioners and that best practice in healthcare is underpinned by values such as respect, integrity, kindness, honesty, trust, confidentiality and a commitment to truth.

In fact healthcare professionals are rated as among the most ethical and honest professionals in Australia. Roy Morgan’s annual Image of Professions Survey for 2011 found 90 per cent of Australians aged 14 and over rated nurses as the most ethical and honest professionals (nurses have taken first place in this poll since 1994, when they were first included).

Other healthcare professionals also rate highly for ethics and honesty (doctors at 87 per cent; dentists at 76 per cent) by comparison with lawyers at 38 per cent, stockbrokers at 14 per cent and car salesmen at 3 per cent.

The propensity of healthcare professionals for ethical behaviour may be explained by a self-selection bias, given that those who feel a responsibility for the welfare of others may be more likely to choose a career in healthcare. Alternatively, this propensity might be explained by the demands of the profession, since practitioners find themselves faced with vulnerable people in need of assistance that they expect to receive; it may also be partly explained by the training practitioners receive. But despite what is unarguably an impressive set of statistics relating to the ethical behaviour of healthcare professionals, there are good reasons to suggest that we could improve the nature of the training healthcare professionals receive.

Current teaching texts and subject outlines in the area of healthcare ethics often suggest that professionals need to develop both the theoretical knowledge and the necessary skills to provide them with a foundation for good practice and the development of moral character. The requisite knowledge is said to include an understanding of ethical terms, theories and principles that will help students to identify and analyse ethical dilemmas.

The interaction between ethical decision-making models and the nature of care in the face of particular ethics dilemmas is often not explicitly explored. Advice to remain in communication with patients and be careful to protect patients’ rights to privacy and confidentiality is insufficient assistance to students engaged in reflection on complex issues. Too often inadequate scaffolding is provided to assist students in analysing the various approaches which are taken to particular ethical dilemmas and on which they are expected to reflect in the process of coming to a view of their own.

The Centre for Faith, Ethics and Society at the University of Notre Dame Australia has recently received an award from the Mary Philippa Brazill Foundation. The award will help further the centre’s mission to support the teaching and integration of ethics throughout the university curriculum, by providing funding for exploration and training in a new and innovative approach to the teaching of ethics in healthcare contexts. The approach is based on the curriculum, Giving Voice to Values, which was developed by US academic Dr. Mary Gentile and is designed to facilitate values-driven leadership and development. It began as a cross-disciplinary business curriculum and action-oriented pedagogical approach for developing the skills, knowledge and commitment required to implement values-based leadership. The applicability of Giving Voice to professions other than business soon became clear and it is being used in a number of professional contexts.

Rather than taking more traditional approaches to training in ethical analysis and decision-making, the Giving Voice curriculum focuses on ethical implementation and asks the question: What would I say and do if I were going to act on my values?

Giving Voice is innovative in that its focus is not on ethical theorizing. Rather it begins from the premise that as members of society we do in fact have a set of shared values. It accepts as a starting point our assumptions about ethical behaviour generally and within the professions, including the healthcare professions – assumptions which are reflected in references to respect, integrity, honesty, trust and confidentiality in professional codes of conduct. Giving Voice focuses on the practical implementation of the values we share as members of communities. Its methodology is to help develop the skills, attitudes, strategies, confidence and competence to allow practitioners to act upon those values and to avoid the tendency to rationalisation or inaction in the face of ethical difficulties and dilemmas.

Drawing on the actual experiences of practitioners as well as multi-disciplinary research, Giving Voice to Values helps students and practitioners to collaboratively identify the many ways to voice their values in the workplace. It provides the opportunity to script and practice in front of peers, equipping students and practitioners not only to develop their awareness of what is right, but also to become proficient in knowing how to make act on that awareness in complex situations – situations which healthcare professionals regularly face.

Gentile will work with the University of Notre Dame’s medical and nursing staff on both the Fremantle and Sydney campuses of the university in April next year to train them in the methodology of the Giving Voice curriculum and to assist staff in developing curricula which employs this methodology in teaching and learning. We believe this will be a fruitful collaboration which will develop future curricula in healthcare education and influence the development of curricula in other professional schools of the university.

Associate Professor Sandra Lynch is the director of the Centre for Faith, Ethics and Society at the University of Notre Dame.

For more information visit: www.GivingVoiceToValues.org and the Mary Philipa Brazill Foundation: http://brazill.mercy.org.au/

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