Iranian Journal of Medical Ethics and History of Medicine

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Nurses are confronted with numerous situations calling for moral decision-making in their workplace every day. Nursing students should therefore attain a satisfactory level of moral development during their university years. The present study was conducted to determine nursing students’ level of moral development, as there seems to be a shortage of similar studies throughout the country. This descriptive, correlational research was performed in 2010 study samples were 115 junior and senior students of the Department of Nursing and Midwifery of Tabriz University of Medical University who were selected by census. These students’ level of moral development was evaluated through the Nursing Dilemma Test (NDT), which has been created based on Kohlberg’s theory of ethical development. NDT assesses nurses’ moral development in three levels: pre-conventional, conventional and post-conventional, and evaluates their observance of clinical considerations at the same time. A number of the participants’ sociodemographic characteristics were also collected through a questionnaire. Data analysis was performed using SPSS statistical software, and descriptive and inferential statistics. According to the findings of this study, 13 students (11.3%) were in the pre-conventional, 33 (28.7%) in the conventional, and 55 (47.8%) in the post-conventional level, and 14 (12.1%) took clinical considerations into account more than others. There seemed to be no meaningful statistical relationship between the students’ moral development and their age (P = 0.49), sex (P = 0.21), marital status (P = 0.79), place of education (P = 0.32), and year of education (P = 0.92). These results showed that although approximately half of the students under study were in the post-conventional level, which is an acceptable level of moral development, a great percentage were still in the lower levels. This means that those in administrative positions in nursing departments need to pay more attention to the moral education of nursing students.

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Narrative ethics is an approach that is well known for ethical education and moral development.  In narrative ethics, by using a story, its components and characters, ethical knowledge and awareness can be achieved. This approach is very useful in medical ethics education and is helpful in dealing with ethical dilemmas. In fact, part of ethical development, in addition to moral judgment, is to reinforce the ethical sensitivity in which narrative ethics can play a significant role for this purpose.This approach has been widely used for teaching morality in Persian literature and history telling, such as Mathnavi. Narrative ethics can be applied by telling stories about patients' life and their experience of illness. It can also be used to criticize and analyze the clinical situation and explore ethical challenges that healthcare providers face in their daily practice. Thus, it can help to prevent ethical conflicts by establishing interaction between ethical principles and patients' values. This paper emphasizes the application of this method in medical ethics education and ethical decision-making.    

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The principal objective of the nursing profession is to provide evidence-based and competent care mainly based on humanitarian and ethical principles. Ethical care is contingent on a proper level of moral reasoning, which can be categorized into pre-conventional, conventional and post-conventional reasoning. At the pre-conventional level, individuals are mostly self-oriented and prefer obedience to avoid blame. At the conventional level people apply laws and social principles to decision-making, and at the post-conventional level they try to guide their actions and behaviors with regard to ethical principles and make humanist and ethical decisions. This study aimed to assess the level of moral reasoning in nurses and nursing students by providing an analysis of the existing literature on moral reasoning.For the purpose of this study, we conducted an extensive search of the papers published between 1980 and 2014 on international electronic databases including Scopus, Google scholar, Science Direct, PubMed, Proqust and Elsevier. We also reviewed papers published between 1985 and the autumn of 2014 on Persian electronic databases Sid, Magiran and Iran Medex. A broad range of search keywords were used such as: ethical growth, moral growth, ethical development, moral development, ethical reasoning, moral reasoning, nurse, and nursing student. In total, 35 studies were reviewed at this stage.Based on the results of the above-mentioned studies, most nursing students and nurses reason at the conventional and post-conventional level, and nursing students reason at a higher ethical level in comparison with nurses. We also found that teaching ethical concepts helps improve ethical reasoning, and that an inverse relationship exists between clinical experiences and ethical reasoning.Although in most studies, the level of moral reasoning in nursing students and nurses was found to be at the conventional and post-conventional level, this is not enough to provide superior professional care. It is therefore essential to apply the necessary measures such as improving clinical environments and the ethical education system to further promote the reasoning ability of nurses and nursing students, so that they can make their decisions based on ethical principles and at the post-conventional level