Table 2: Acquisition level of capacity for ethical judgment as part of continuous nursing education.
Ladder Code Reference Level
Ladder I Art. 1 *Feeling resistance to the situation where nursing work takes precedence over the respect for human life [6] Awareness
Art. 4 *Feeling the dilemma of having to carry out a procedure by holding down the patient because of family consent, even when the patient is refusing the procedure [7]
*Sufficiently recognize “Informed Consent” as knowledge [8]
Awareness
Awareness
Art. 5 *Feeling that a walking conference does not protect privacy [7]
*Sufficiently recognize confidentiality, protection of a patient’s personal information, and disclosure of information as knowledge [8]
Awareness
Awareness
Art. 6 *Feeling the dilemma over having to hold down a patient due to risk of self-extubation or falling [7] Awareness
Art. 8 *Recognizes the importance of continuing to learn as a professional person [7]
*Attitude towards patient safety becomes more positive after receiving an educational program related to safety ethics using a DVD [6]
Awareness
Action
Art. 10 *Identify desirable nursing care using senior nurses as a model [9] Awareness
Ladder II Art. 1 *Knowledge related to protection of privacy is being used actively in clinical practice [10] Awareness
Ladder IV Art. 2 *Nurses regard the discriminatory behavior of TB patients as an ethical problem because of infringement of rights [11] Judgment
Art. 4 *Nurses regard the refusal of treatment of disabled newborns by parents to be a problem because the patient’s will is not being respected [11] Judgment
Art. 6 *Nurses regard excessively holding down patients to prevent risks as an ethical problem [11] Judgment
Art. 11 *Nurses are providing care using methods that do not harm patient rights, based on knowledge gained from the literature [11] Action
*No classification by years of experience Art. 1 *Nurses feel the dilemma with treatments that restrict physical activity among older adult patients [12]
*Nurses regard inappropriate speech and conduct towards patients as a problem, due to lack of respect for patient dignity [13]
*Nurses recognize the need for “Respecting the patient” and “Paying attention to the patient’s value” as a way to respect the human being while providing palliative care for cancer patients [14]
Awareness
Judgment
Awareness
Art. 2 *Nurses recognize matters relating to resource allocation and equity in care as a problem [15]
*Nurses harbor doubts that patients whose conditions become severe due to treatment complications have clear differences in content and frequency of care compared to other patients and that this may be a cause for special treatment [16]
Awareness
Awareness
Art. 3 *Nurses feel the dilemma when communication with older adults, patients, and families is not smooth [12,17]
*Nurses feel an ethical dilemma after recognizing a difference between the necessity of treatment and the patient's feelings [16]
*Nurses engage with patients with an empathic attitude when patients are suffering or in pain [16]
Awareness
Awareness
Action
Art. 4 *Nurses feel an ethical dilemma with strong family requests asking not to tell or express the family’s will to the patient [16]
*Nurses regard the signing of consent form(s) by patients, that do not sufficiently understand the explanations, as an ethical problem [18]
Awareness
Judgment
Art. 5 *Nurses value patient confidentiality and protection of privacy [19] Awareness
Art. 7 *Looking back to when they were only able to make records of physician’s instructions at the time of sudden changes in a patient’s condition, nurses recognized that they had not been able to fulfill the loyalty and duty of their profession [16] Awareness
Art. 8 *By learning from experience the ways to analyze the everyday scene of nursing practice from an ethical viewpoint, nurses had improved their knowledge needed to reach a particular resolution in situations that they felt were “odd” [21]
*Nurses are aware that arrangement of an organizational system, as well as the implementation and continuation of ethical education for all staff, is necessary so that actions to resolve ethical problems can be taken by all staff [22]
*By discussing the cases related to ethical problems that occur in sessions to which they are affiliated, nurses raised their awareness related to nursing ethics and had gained many ways of thinking and solving problems [23]
Awareness
Awareness
Awareness
Art. 9 *Nurses deal with ethical problems by consulting a colleague [24]
*Despite having the dilemma of potentially interfering with a patient’s will or desire, nurses had the experience of not being able to tell their opinion to senior nurses [25]
Awareness
Judgment
Art. 10 *Nurses regard the situation of not being able to sufficiently provide nursing care to patients as a problem [24] Judgment