| Objective1.Construct a training program for undergraduates nursing ethical decision-making ability based on narrative teaching mode.2.Implement and evaluate the feasibility and effectiveness of the training program.Methods1.The construction phase of the ethical decision-making ability training programFirstly,literature research method was adopted to read and analyze the research on nursing ethical decision-making ability of undergraduates at home and abroad,to understand the status quo and influencing factors of nursing ethical decision-making ability of undergraduates,and to analyze the design and implementation of relevant training research,so as to provide reference and guidance for the construction of nursing ethical decision-making ability training program in this study.Secondly,on the theoretical basis of Rest’s Ethical Decision-making Model,Transformative Learning Theory and Narrative Transportation Theory,combined with the investigation and qualitative interview results of the status quo of nursing ethical decision-making ability of undergraduate nursing students,the first draft of the training program of nursing ethical decision-making ability of undergraduate nursing students based on narrative teaching mode was constructed,and expert consultation and pilot study were conducted.According the expert consultation and nursing students’ feedback results of the pilot study to modify and refine,the implementation draft of the training program was formed.2.The implementation and evaluation phase of the ethical decision-making ability training programBy convenience sampling,this study selected the 2019 sophomore nursing students from a college of nursing in Zhengzhou as the research object.Taking the class as the unit,the students were divided into groups by drawing lots.There were28 nursing students in the experimental group and 29 nursing students in the control group.The experimental group received 6 weeks of training on nursing ethical decision-making ability in addition to participating in normal teaching activities.While the control group participated in normal teaching activities only.The effect evaluation was done by the questionnaire survey and semi-structured interviews.First,the data of survey were collected from both classes with the JAND,MSQ-R-CV,NPVS-R,and MCS before the training,at the ending of training immediately,and 1 month after the training and the data were statistically analyzed by IBM SPSS Statistics 23.0 software.Second,8 nursing students in the experiment group were selected to participate the semi-structured interviews,and the sample size was subject to the saturation of interview information.Finally,the interview data were analyzed through content analysis method to obtain more detailed information about the implementation effect of the training program.Results1.The construction phase of the ethical decision-making ability training program(1)Quantitative survey resultsA total of 280 questionnaires were sent out in this study,of which 263 were valid,with an effective rate of 93.9%.The score range of undergraduates’ nursing ethical decision-making ability was(237～322)points,and the total score was(280.25±15.28)points.The ethical choice dimension was(147.97±9.41)and the ethical action dimension was(132.10±10.31).Through two independent samples t-test,one-way analysis of variance,Pearson correlation analysis,multiple linear regression analysis and other statistical methods to analyze the factors affecting nursing ethical decision-making ability of undergraduate nursing students.The results showed that professional values,teaching methods of nursing ethics,ethical sensitivity,gender,grade and religious belief were the influencing factors of nursing ethical decision-making ability.(2)Qualitative interview resultsA total of 12 undergraduate nursing students were interviewed,and four themes were extracted from the data analysis,including cognitive bias in decision-making,lack of decision-making control,ethical dilemma,and lack of external support.(3)Develop the implementation draft of training programOn the basis of literature analysis,status quo investigation and qualitative interview,the first draft of nursing ethical decision-making ability training program was constructed.The initial draft of the training program was revised and improved through expert consultation and pilot study,and the training program of nursing ethical decision-making ability was finally determined to last for 6 weeks,once a week,90-120 mins each time,including 6 topics.They are “nursing ethical decision-making cognition,clinical nursing ethical practice,death hospice care ethics,special medical technology ethics,public health research ethics,review and common growth”.2.The implementation and evaluation phase of the ethical decision-making ability training programA total of 57 sophomore nursing undergraduates were included in this study,with 1 loss and an effective sample size of 56,including 28 nursing students in the experimental group and 28 nursing students in the control group.(1)Comparison of scores of JAND after intervention in two groupsFor the experiment group,the total score of nursing ethical decision-making ability immediately after intervention and one month after intervention was improved compared with that before intervention,with statistical significance(P<0.05).The total score of nursing ethical decision-making ability of nursing students in the experiment group was higher than that in the control group,and the difference of effect between the two groups was statistically significant(P<0.01).(2)Comparison of scores of MSQ-R-CV after intervention in two groupsFor the experiment group,the total score of ethical sensitivity immediately after intervention and one month after intervention was improved compared with that before intervention,with statistical significance(P<0.05).The total score of ethical sensitivity of nursing students in the experiment group was higher than that in the control group,and the difference of effect between the two groups was statistically significant(P<0.001).(3)Comparison of scores of NPVS-R after intervention in two groupsFor the experiment group,the total score of professional values immediately after intervention and one month after intervention was improved compared with that before intervention,with statistical significance(P<0.05).The total score of professional values of nursing students in the experiment group was higher than that in the control group,and the difference of effect between the two groups was statistically significant(P<0.001).(4)Comparison of scores of MCS after intervention in two groupsFor the experiment group,the total score of moral courage immediately after intervention and one month after intervention was improved compared with that before intervention,with statistical significance(P<0.05).The total score of moral courage of nursing students in the experiment group was higher than that in the control group,and the difference of effect between the two groups was statistically significant(P<0.001).(5)In view of the nursing students’ experience of attending the training program of nursing ethical decision-making ability,four themes and twelve sub-themes were extracted.(1)The improvement of ethical decision-making cognition: improving the consciousness of ethical decision-making;evaluating the ability of ethical decision-making;rationally recognizing the existence of ethical dilemmas;(2)Improvement of ethical decision-making skills: enriching self-ethical decision-making knowledge;improving self-ethical judgment ability;enhancing communication ability;(3)Enhancement of the confidence of nursing ethics practice:increased interest in learning nursing ethics;actively respond to ethical challenges;(4)Suggestions for the training of nursing ethical decision-making ability: affirming the function of narrative teaching;increasing practical teaching items;enriching the content and form of theoretical learning.Conclusion1.The training program of undergraduates nursing ethical decision-making ability based on narrative teaching mode for nursing undergraduates was constructed based on Rest’ Ethical Decision-making Model,Transformative Learning Theory and Narrative Transportation Theory can effectively improve their nursing ethical decision-making ability,ethical sensitivity,professional values and moral courage.2.Combined with the current problems and learning needs,the training program of nursing ethical decision-making ability for nursing undergraduates is significant and feasible in the practice of nursing education. |
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