training and inconsistent with the further stated NMC requirement that nurses should be
autonomous and accountable ethical practitioners. Hence, the requirement for an ethical
practitioner is a requirement for the moral education of nurses. O’Hear describes moral
education as enabling freely chosen internalisation and if this is correct then attempts at
the moral education of nurses must deal with the authoritarian problem expressed by
O’Hear as
“.. .how a moral educator can avoid being an authoritarian indoctrinator, trying
to enforce a morality on an agent who should ideally be freely and rationally
deciding for himself.”
(O’Hear 1998 p. 15)
Thus those involved in the education of nurses cannot ignore the fact that their own
practice (be it nursing or teaching practice) has an impact, for good or ill, on the moral
education of nursing students. For moral education is not the province of specialist
teachers of morality but is part of the fabric of the environment in which learning to be a
nurse takes place. Only some of this learning to be a nurse will occur as part of the
formal educational curriculum where students pursue achievement of pre-set and
detailed learning outcomes. It is the morality of the academy and of health care as
institutions together with the morality of individual practitioners as much as, or perhaps
even instead of, the teachings of nurse teachers (be they mentors, practice educators or
lecturers) that shapes student nurses’ understanding of the morality of nursing practice.
This means that students’ internalisation of the code is most likely where this does not
lead to dissonance between the virtue requirements and the values inherent in the code
on the one hand and, on the other, those values and virtues (or vices) they see expressed
by nurses and nurse teachers in everyday practice. Similarly, nurses and nurse teachers
will be more likely to have internalised the tenets of the code where institutional
arrangements encourage rather than discourage the expression of those tenets. Thus, the
general morality of the institutions of health care provision and of health care education
have an important part to play in the moral education of nurses. Both MacIntyre (1985)
and Potter (2002) warn of the potential for institutional arrangements to undermine
ethical practice and those nurse teachers who adopt managerial rather than professional
ideals of service (those, in MacIntyre’s terms, who pursue the goods of effectiveness
rather than the goods of excellence) will not only distort the traditions of nursing as a
practice but will also add to the dissonance students experience between the code and
practice.
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