Assignment

 Rocking theboat—nursing students'

storiesofmoral courage:A

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)

patientadvocate

identity,whichhad two sub-themesofknowingone's ownmoral code andprevious lifeexperiences;

(2) consequences to thepatient and to theparticipant;

(3) the impactofkey individuals;and

](4)pickingyourbattles.

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 

1 Introduction

patient safety can be jeopardised and students can experience on- goingmoraldistress (Callisteretal.,2009). Clinicalplacements are a vital componentofnursingprogrammes providingstudentswith theopportunity to integrate theoreticalknowl

2.Background

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.Levett-jones@newcastle.edu.au (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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