Teaching ethics with narrative to enhance patient-centered decision making and meaning making

Historically, ethics education for advance practice nurses has relied on a principle based framework that may prompt health care decisions, but can obscure and constrict the patient/family's ability to integrate suffering and meaning. Through collaboration with an ethics-trained theologian and a hospice chaplain, nurse practitioner faculty introduced narrative ethics using case studies of increasing complexity and difficulty. Student were assigned case studies to work on independently and then subsequently in small groups. Students were guided by faculty to discover multiple options or solutions to the narrative case studies, to weigh courses of action, and to explore the meaning inherent in the patient/family's struggle, expecially as it relates to change in health status.

The effectiveness of employing narrative case studies for ethics education was assessed with scores on the Ethical Discrimination Ability Scale and a critical thinking assessment, both pre and post session.Student were also surveyed on their level of satisfaction with the learning activities, the level of intellectual stimulation, the depth of self-reflection, as well as their confidence to deal with complex, intense, ethical patient encounters. This pilot tested a teaching method for building narrative capacity in nurse practitioner students to meet both the needs of the health care system for improved shared decision making among patient, family, and providers, and the human need to discover meaning and to make sense of suffering.