Advanced ethical competence crucial in advanced nursing practice


It is essential to train advanced practice nurses to levels of advanced ethical competence as well as advanced clinical competence, according to Helena Leino-Kilpi, keynote speaker on the third day of the Helsinki APN conference.

by Fran Weaver

Professor Leino-Kilpi, who heads the Department of Nursing Science at the University of Turku, Finland, feels that advanced ethical training may sometimes be neglected in professional programmes.

“Nursing is obviously an ethical profession, and every single nurse has high ethical requirements to enable them to deal with ethical issues in their work, improve the health of patients, and support their colleagues and organisations. When it comes to advanced practice nursing, nurses should also be prepared to deal with advanced ethical requirements,” she explained. “I see ethical competence as just as important as clinical competence.”

Leino-Kilpi feels that advanced ethical competence should cover aspects including an enhanced ability to identify and evaluate ethical questions and solutions. Such competence levels can be built up with the help of structured ethical education, a favourable ethical atmosphere in organisations, and stronger international research programmes addressing professional ethics.

Ethical requirements are becoming increasingly complex in modern health care, particularly in socio-economic contexts that mean nurses must care for increasing numbers of patients suffering from memory disorders. Leino-Kilpi hopes that teachers and administrators will keep a close eye on the latest developments in ethical codes. The ethical code of the International Council of Nurses (ICN) was significantly updated in 2012 to address newly prominent issues and better reflect professional values.

Competence and courage
According to Leino-Kilpi, ethical nursing must be based on a mixture of personal and professional factors. “It involves a combination of nurses’ ethical courage and virtues as human beings and their ethical competence as professionals,” she said. “Ethical courage is both part of competence, and a channel for expressing your competence. A nurse might be very good at clinical investigations, but if she does not act as an ethical human being her work cannot be described as good practice.”

Future focuses in the field of health care ethics are likely to encompass empirical clinical ethics, including the care of dementia patients, the philosophical foundations of nursing ethics, and ethics in nurse training.  

For advanced practice nurses the rights to prescribe medicines and order treatments come with new duties and responsibilities. Ethical issues play a prominent role in decision-making. In many cases ethical problems and challenges may not be totally solvable, but they can be effectively managed.

Constant awareness of ethical responsibilities
 “Nurses must always have a high awareness of the effectiveness of their activities -- and whatever tasks are undertaken, we should consider how important the role of the patient will be,” said Leino-Kilpi.

Ethical requirements are ever-present in nursing, regarding nurses’ relationships with patients, their nursing colleagues and other professional colleagues, and health care institutions and organisations. 

Professor Leino-Kilpi emphasised that whenever outcomes are measured factors related to the ethical quality of care can be considered. “Key factors include the value of patients as a human being, and their experience of being respected,” she explained.

 Leino-Kilpi concluded her keynote presentation by calling on all the advanced practice nurses at the Helsinki conference to re-examine their ethical knowledge base, closely follow research in nursing and health care ethics, and strive to keep their evaluations of the ethical aspects of patient outcomes based on real evidence.

Professor Leino-Kilpi heads the Department of Nursing Science at the University of Turku, Finland. Foto by Tuomo Antikainen.
Professor Leino-Kilpi heads the Department of Nursing Science at the University of Turku, Finland. Foto by Tuomo Antikainen.