Rocking theboat—nursing students'
qualitativedescriptive study☆ a, b b Aim:Thispaperproﬁles aqualitative study that examinedhowundergraduatenursing studentsdemonstrate Received4September2015 moral couragewhen confrontedwith clinical situations thatnegatively impact thequalityofpatient care and/ Received in revised form14March2016 orpatientexperienceand the factors thatencouragedor inhibited theirwillingness tospeakupwhen they iden- Accepted18March2016 tiﬁedpoorpractice. Availableonlinexxxx Background:
Clinicalplacementsareanessentialcomponentofnursingprogrammes.However,placementsarea reportedsourceofstress forstudents,withmanywitnessing,or feelingcompelled toparticipate in,poorpractice. In these instances,nursingstudentsrequire themoralcourage toraiseconcerns inorder toprotectpatientsafety anddignity. Methods: Thiswas aqualitativedescriptive study.Ninenursing students and onenursing graduate from one semi-metropolitanuniversity inAustraliawere interviewedand thedatawere thematicallyanalysed. Findings:Fourkey themesemerged: (1)
identity,whichhad two sub-themesofknowingone's ownmoral code andprevious lifeexperiences;
(2) consequences to thepatient and to theparticipant;
(3) the impactofkey individuals;and
Conclusion:Thisstudydemonstratesthe importanceofundergraduatenursingstudents identifyingaspatientad- vocates, themultitudeofconsequencesstudents facewhenquestioningthepracticeofaregisterednurse,andthe inﬂuencesupervisingnursesandclinical facilitatorshaveona student'sdecisions to intervene toprotectpatient safety.Furtherresearch isrequiredtoexamine the factors,both intrinsicandextrinsic, that inﬂuencenursingstu- dents'moral courage and theirdecisions to intervenewhenpoorpractice iswitnessed. ©2016Elsevier
Ltd.All rights reserved
patient safety can be jeopardised and students can experience on- goingmoraldistress (Callisteretal.,2009). Clinicalplacements are a vital componentofnursingprogrammes providingstudentswith theopportunity to integrate theoreticalknowl
edge intopractice (O'Maraet al.,2014).They aredesigned to assist in building students' conﬁdence,knowledge andprofessional identity, as Moral courage is theability to riseabove fearand take actionbased well as consolidatingand/ordeveloping clinical skills (Gunther,2011). on one's ethical beliefs (Lachman, 2007).Moral courage bridges the However, placements have been identiﬁed as an ongoing source of gapbetween knowingone'spersonal values andprofessional obliga- stress and anxiety formany students (Bradbury-Jones et al., 2007; tions,andactingon themdespite risks suchas socialostracism,embar-
Monrouxeetal.,2014),particularly if theyarewitness to,or feel com- rassmentor lossofemployment (Aultman,2008; Lachman,2007). For pelled to participate in, poor practice (Bellefontaine, 2009). Rather morally courageous individuals,upholding their corevalues is judged than challengeunsafeorunethicalpractices,many students choose to worthexposing themselves toharmorvulnerability (Lachman,2010). be silentand to conform to theexpectationsof theirnursingcolleagues Moral courage is a crucial virtue fornurses (Kidder,2005;Purtilo, (Levett-Jones and Lathlean,2009;O'Mara et al.,2014).Consequently, 2000) and considered fundamental to professional practice when confrontedwith ethicalmisconduct regardless of thepractice setting (Murray,2010).
Nurseswhodemonstratemoral courage areunwaver-
☆ Acknowledgements/Contribution/Funding statements: This review received no ing in their commitment tohonouringand respectingpatients and self speciﬁcgrant fromany fundingagency in thepublic,commercial,ornot-for-proﬁtsectors. (Sekera andBagozzi,2007).Whenpressured to conform tounethical ⁎ Corresponding author at:POBox904,Terrigal,NSW2260Australia. E-mailaddresses: laurie@deﬁningnursing.com (L.Bickhoff), or outdatedpractices,nurses require themoral courage to overcome Tracy.Levettemail@example.com (T.Levett-Jones),Peter.Sinclair@newcastle.edu.au their fears, endure the consequences, and act in amanner consistent (P.M.Sinclair). with theirprofessionalvalues (Miller,2005). http://dx.doi.org/10.1016/j.nedt.2016.03.030 0260-6917/©2016Elsevier Ltd.All rights reserved.
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