"Moral spaces": A feasibility study to build nurses' ethical confidence and competence

Background: Pre-licensure ethics nursing education does not adequately prepare and instill confidence in nurses to address ethical issues, and yet ethics education provides nurses with greater confidence to take moral action, which can mitigate the negative effects of moral distress. Objectives: To assess the feasibility and acceptability of a nursing ethics education program that included simulated case-based ethics competencies as a form of evaluation. The program aimed at building nurses' ethical knowledge and confidence to respond to ethical challenges in practice. Research design: A prospective, longitudinal, correlational, single-cohort feasibility study using an investigator-developed survey and intervention field data. Participants and research context: Registered nurses were recruited from an academic quaternary-care medical center and 9 small- to mid-sized regional hospitals within one health system in the Midwest United States. Ethical considerations: IRB approval was obtained. Participants could complete the educational program regardless of research process participation. Findings: Of 20 participants, 19 (95%) provided post-program surveys and 18 completed competencies. Median (IQR) scores with quartiles for scheduling, timing, and length of sessions were all 10.0 [9.0, 10.0], and participants perceived that the content was interesting, increased knowledge and confidence in ethics, increased skills in providing ethical care, and would recommend the program to colleagues. Of factors, an increase in ethics knowledge had the highest "always agree" (17, 89.5%) response. Most participants reported that ethics competencies were appropriate 9.0 [9.0, 10.0] and sufficiently challenging 10.0 [9.0, 10.0]. Discussion: The education program developed nurses' ethics knowledge and confidence. The single-cohort feasibility design provided early-stage intervention outcomes; however, a larger randomized controlled trial would substantiate program value. Conclusion: This novel ethics education program was highly feasible and acceptable to hospital-based nurses who reported increased knowledge and confidence in providing ethical care. Simulated case-based ethics competencies were an appropriate evaluation method.