AN ASSESSMENT OF THE IMPACT OF ETHICAL TRAINING ON NURSING PRACTICE IN CAMEROONIAN HEALTHCARE INSTITUTIONS

CHAPTER ONE

INTRODUCTION

Background of the Study

Ethics includes the moral principles guiding the behavior of individuals and groups (Trobec, 2018). While ethics is often associated with philosophy or theology, it extends to all areas of life, including professional fields like nursing. Although perspectives on ethics have evolved significantly in Western countries, they have not disappeared. Nursing, as a profession, has a unique role within the healthcare team and offers a distinct perspective that enhances the understanding of healthcare ethics. The complexity of nursing work can be challenging for those outside the field to grasp fully. While ethical concepts are interrelated across all healthcare professions, each profession has a unique role that contributes to healthcare ethics, highlighting the need for nursing to develop its own ethical philosophy and address the specific ethical issues nurses encounter. This approach does not diminish the importance of interdisciplinary collaboration but emphasizes how nursing’s distinct role can enrich decision-making within the healthcare team. Fowler (2018) noted that despite growing interest in nursing ethics during the 1970s and 1980s, particularly in bioethics topics like abortion, euthanasia, life support, patient rights, and human research, there has been limited research into the moral identity of nursing. Historically, nursing has often relied on the medical profession for advancements in ethical theory, with nursing ethics frequently evolving as a secondary consideration to medical ethics (Liaschenko & Peter, 2018; Woods, 2019).

Woods (2019) noted that awareness of ethics training has been growing in recent years. One might expect that this would lead to an increase in ethical behavior among current nursing students. However, this expectation is not always met, as observed in clinical practice. There is a clear need for effective ethics training programs for nurses, as evidence shows that those lacking a strong foundation in ethics often experience moral distress, which can impact their motivation and patient care (Oh & Gastmans, 2018; Silverman et al., 2021). The Carnegie Report by Benner (2022) highlighted the need for significant changes in professional nursing education to address the increasing complexity of healthcare environments, emphasizing the importance of cognitive, skill-based, and ethical development in nursing education.

The ICN Code of Ethics (2021) outlines key ethical objectives for nursing education and promotes training in decision-making skills. It also provides guidance on how nurses should communicate ethical principles to other healthcare professionals. Despite recognizing the need for ethics education, the specifics of how students develop this competence during their education remain uncertain.

Cannaerts et al. (2018) found that many nursing courses cover ethical principles, ethics codes, and theories such as the four-principles approach, deontology, and utilitarianism. However, only a few studies included virtue ethics or empathy as frameworks in their ethics courses. This suggests that medical and rationalistic approaches still dominate nursing ethics training (Benner et al., 2022; Cannaerts et al., 2018).

Nurses view their role in healthcare as essential in the provision of optimal healthcare. As a result, nursing and feminist ethics have become intertwined in modern perspectives of nursing philosophy. The subordination of nursing was also evident in education with prominent physicians speaking out against the education of women, even suggesting that education can cause degradation of a woman’s reproductive abilities.A major objective of nursing education at the time was moral development and, as a result, ethics was predominant throughout nursing curricula. This coincides with the image of nursing being intrinsically, morally good. Over the years, the importance of ethics in the nursing curricula has dwindled and in modern nursing, ethics tends to be placed as an afterthought into the curricula, mostly dominated by medical content, even though the importance of ethics training is thoroughly advocated. Therefore, this study seeks to assess the impact of ethical training on nursing practice in Cameroonian healthcare institutions.

Statement of the Problem

Ethical training aims to provide healthcare professionals with the essential skills and knowledge needed to address complex ethical issues, adhere to professional standards, and promote a culture of ethical conduct. Despite its recognized importance, there is a lack of empirical evidence evaluating its actual impact on nursing practices within Cameroon’s healthcare system. Cameroon's healthcare sector faces several challenges, such as limited resources, diverse patient populations, and varying levels of access to services (Njom Nlend et al., 2022). Additionally, nurses frequently encounter ethical dilemmas that necessitate a deep understanding of professional ethics and patient rights. This highlights the need for comprehensive ethical training programs that not only cover theoretical concepts but also offer practical guidance for real-world situations. However, the effectiveness of these programs in enhancing nursing practices and maintaining ethical standards is still unclear. 

A major issue is the absence of standardized ethical training programs across Cameroonian healthcare institutions. This lack of uniformity can lead to varying levels of ethical awareness and practice among nurses, potentially affecting the overall quality of care. Moreover, there is a gap in understanding how ethical training influences nurses' day-to-day decision-making, particularly in resource-limited settings where ethical challenges are common. As highlighted by Amougou and Kinkpe (2023), disparities in ethical training and its implementation can result in inconsistent care practices and may compromise patient outcomes. Research suggests that while ethical training is intended to improve healthcare professionals' ethical decision-making (Ajufo, 2021), its impact within Cameroonian healthcare institutions has not been thoroughly assessed. Hence, it is in the light of these challenges, the study seeks to assess the impact of ethical training on nursing practice in Cameroonian healthcare institutions.

 1.3  Objectives of the Study

The main purpose of this study is to assess the impact of ethical training on nursing practice in Cameroonian healthcare institutions. Specifically, the study will;

Assess the level of awareness of ethical principles among nurses in Cameroon as a result of their ethical training.

Assess the extent to which ethical training influences decision-making and patient care among nurses in Cameroonian healthcare institutions.

Examine whether ethical training reduces the incidence of ethical violations among nurses in Cameroonian healthcare institutions.

1.4  Research Questions

The following questions have been prepared for the study:

What is the level of awareness of ethical principles among nurses in Cameroon as a result of their ethical training?

To what extent does ethical training influence decision-making and patient care among nurses in Cameroonian healthcare institutions?

Does ethical training reduce the incidence of ethical violations among nurses in Cameroonian healthcare institutions?

1.5 Research Hypotheses

H0: Ethical training has no significant impact on nursing practice in Cameroonian healthcare institutions.

Ha: Ethical training has a significant impact on nursing practice in Cameroonian healthcare institutions.

1.6 Significance of the Study

The study will provide valuable information about how ethical training programs work to improve nurses' ethical decisions and professional conduct. This research will also help healthcare institutions in Cameroon identify gaps in current training programs and develop more comprehensive and effective ethical training modules. Additionally, it will enhance patient care, lower instances of unethical behaviour, and raise the standard of healthcare services overall by enhancing the ethical abilities of nurses. The results will also serve as a guide for healthcare executives and legislators as they put rules into place that guarantee ongoing ethical education for medical staff, promoting a more moral and patient-centered healthcare environment. 

Furthermore, subsequent researchers will use it as a literature review. This means that other students who may decide to conduct studies in this area will have the opportunity to use this study as available literature that can be subjected to critical review. Invariably, the result of the study contributes immensely to the body of academic knowledge with regard to the impact of ethical training on nursing practice in Cameroonian healthcare institutions.

1.7 Scope of the study   

The scope of this study is boarded on the impact of ethical training on nursing practice in Cameroonian healthcare institutions. Empirically, the study will assess the level of awareness of ethical principles among nurses as a result of their ethical training,assess the extent to which ethical training influences decision-making and patient care among nurses and examine whether ethical training reduces the incidence of ethical violations among nurses in healthcare institutions.

Geographically, the study will be delimited to nurses in healthcare institutions Cameroon.

1.8 Limitation of the study

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. In addition, there was the element of researcher bias. Here, the researcher possessed some biases that may have been reflected in the way the data was collected, the type of people interviewed or sampled, and how the data gathered was interpreted thereafter. The potential for all this to influence the findings and conclusions could not be downplayed. More so, the findings of this study are limited to the sample population in the study area, hence they may not be suitable for use in comparison to other schools, local governments, states, and other countries in the world.

 1.9 Definition of Terms

Nursing: profession and practice of providing care to individuals, families, and communities to maintain or improve their health and quality of life.

Ethics: set of principles and standards that guide moral conduct and decision-making.