Introduction and implementation

Ethical Coffee Room (ECR) is an electronic platform, where the students, nurses, and teachers can discuss ethical issues anonymously during students’ clinical practice. The ethical coffee room offers 1 credit of 27 working hours for the students. This work includes reading theoretical material, students’ contributions for the discussion of ethical dilemmas and reflections on their own learning. The students, mentor nurses and teachers have their own login codes. Every user, either student, mentor nurse or teacher, can choose her/his pseudonym. The main idea is that each user may free discuss and reflect on her/his “deep” feelings and ideas. The ethical coffee room includes theoretical material and articles, ethical standards, collegiality norms, ideal cases, examples, and guidelines for the discussion forums. The forums are:

1. Example patient cases: there are cases, which the teachers have developed for the students. The teachers and the mentor nurses lead the discussion, give references for the discussion and share and give advice on new perspectives.

2. Student’s patient cases: patient cases, ethical dilemmas that the students have faced during clinical practice and that they wanted to share with others. The teachers and mentor nurses lead the discussions and help the students develop their ideas further.

Evaluation: Active participation in the platform, working and sharing ideas and perspectives with peer students. Accepted/not accepted.

The technical application that you use can be an free application which can be modified for the course purposes. A WordPress-application has been used in the testing of the ECR.

Note that the point is not a fancy electronic platform application, but the content and discussion. ECR is not a serious game, it’s a discussion chat forum.

The ECR structure (four weeks):

  • Orientation lecture before clinical practice weeks will be held and evaluation session in the end.
  • Students will be allocated to smaller groups by the technical moderator during the clinical practice weeks.
  • The course will start and end working with bigger groups and in the middle students will be working in smaller groups.

o The course will start and end working with bigger groups and in the middle students will be working in smaller groups.

Week and student working Nature of working, approximately 1 hour/day
#1 Big group n=12-15

 

Pre-course material

Two example patient cases

#2 Small group n=3-5

 

Two example patient cases

Student’s patient cases

#3 Small group n=3-5

 

Three example patient cases

Student’s patient cases

#4 Big group n= 12-15

 

Three example patient cases

Evaluation session

Picture of the ECR electronic platform:

Learning objectives

Students’ learning goals and aims:
Students:

  • will point out some ethical questions per week from their clinical practice experience
  • will follow the norms and laws respecting anonymity, privacy etc. when writing their own cases and participating in the joint discussion forum
  • will actively participate in the reflection discussion
  • will learn ethical discussion, ethical thinking, sensitivity and moral courage
  • will ”open her/his eyes” and see more broadly and widely ethically sensitive issues in clinical practice
  • with help of the ECR platform

Helpful bedside questions to orientate the ethical discussions:

  • What kind of care is good care?
  • What kind of care is below ethical standards?
  • How can I follow ethical standards?
  • How can I promote good care?
  • What makes nursing care ethically at a high level or standard?
  • What is right and wrong in nursing care?

Implementation

Before the clinical practice, an orientation lecture (1.5 hours) will be held/organised where all the details of the Ethical Coffee Room working and guidelines will be described. All technical and practical issues will be discussed. The guidelines on how to get usernames and create the nick names will be communicated.

Students will be allocated to groups (n=12 – 15 group) and during the period of the ECR to three smaller groups by the technical moderator.

The course will start and end working in the bigger groups and in the middle period time will be spent working in the smaller groups.

At the end of the clinical practice period a feedback lecture will be organised. Also When a period lasts longer than 4 weeks, it is suggested that a seminar lecture be organised where the students, teachers and mentor nurses can discuss learning ethics in clinical practice face to face.

Practical tips:

  • visit the Ethical Coffee Room learning environment discussion groups as a teacher and mentor nurse regularly every day. The students are expecting and waiting for comments especially from the mentor nurse and also the teacher
  • allow enough time, following and commenting onthe students’ discussions is time consuming, you will need approximately 1-1.5 hours per day
  • allocate the cases to the students per week, 1-3 cases open at the same time. This helps students to focus on the cases in parallel
  • bring and describe the course implementation table to the students
  • advise the staff in clinical practice what the point of ECR work is, and enable them to participate in ECR work e.g. print a poster for the staff coffee room at the ward or clinic

Reading material

Advise the students to read ethical literature as orientation before the ECR work. Note that reading the ethical material is not sufficient, the point is the ethical reflection, discussion with peers, teachers and mentor nurses in practice.

Some examples of material:

Article:

Ethical problems and moral sensitivity in physiotherapy: A descriptive study, https://journals.sagepub.com/doi/abs/10.1177/0969733012468462

Ethical codes:

THE ICN CODE OF ETHICS FOR NURSES (www.icn.ch)

Nurses’ collegiality guidelines (www.nurses.fi/collegiality)

Mentor and Teacher guidelines

Mentor nurse:

  • will comment on professional practice from the point of view of experience
  • will enrich the discussion sessions from the point of view of an experienced nurse
  • will reflect on the pre-course materials in the discussions
  • will work on deepening the reflection discussion with help of the teacher
  • will ensure that the discussion and reflection is professional and broad enough

Teacher:

  • will comment on points of ethical theory and literature
  • will extend the discussion when needed
  • will ensure that the discussion and reflection is professional and broad enough
  • will evaluate course 2 according to evaluation criteria,
  • will bring articles on ethics for students as references when necessary

Students’ patient cases

Instructions for students own cases:

This discussion forum is for student’s own experiences of clinical practice. What does the student want to share? Has the student got some cases in mind now or in her/his history which she/he wants to discuss here and now?

The students will be encouraged to look back over their experience and to find ethical issues or decision making situations where the student has followed ethical standards. Those cases can be ideal cases where everybody has acted well and ethically or there can have been something that might have been done differently. As a summary, complicated cases are not needed, just good cases that we can face in everyday care.

Express yourself, what did you feel in this situation? How will you act when you face something that is wrong? What do you think is the ideal way to act or handle issues correctly?

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