Janet Holt M Phil, BA(Hons), PGDipE, RGN, Lecturer, School of Healthcare Studies, University of Leeds, UK. Tel.: +44 113 234 7283; Fax: +44 113 206 5546; E-mail: A.J.Long@Leeds.AC. UK Tony Long MA, BSc(Hons), RSCN, RGN, Senior Nursing Lecturer, School of Healthcare Studies, University of Leeds, UK (Requestsfor offprints to JH) Manuscript accepted: 16 June 1998 Moral guidance, moral philosophy, and moral issues in practice Janet Holt and zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA Tony Long Approaches to teaching ethics to nurses have been debated in literature for some years. Three issues in particular are commonly addressed: the intentions of such teaching; the value of examples and case studies; and the compatibility of philosophical approaches with the clinical reality experienced by students. It is argued here that moral guidance as a strategy is unacceptable, and that a basic introduction to philosophical methods is the key to effective learning of the skills required for autonomous analysis and decision making. A means for including the use of personal experiences and case study material is presented which relies upon the provision of a framework of analysis to facilitate structured thinking and the pursuit of justifiable arguments. The approach suggested is compatible with students’ existing experiences and work-context, and enhances the integration of ethical reasoning into the multi-faceted totality of clinical practice. Introduction zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA There can be little doubt that ethical dilemmas are a recurrent feature in nursing practice and can, in many instances, be directly attributed to advances in science and technology. Scientific, technological and health care related research are important in the development of new knowledge and, therefore, it is likely that nurses in clinical practice will encounter more rather than fewer situations of ethical uncertainty in the new millennium. As preparation for practice, nursing curricula include education in many subjects relevant to nursing, ethics being only one of them, but the subject is clearly of relevance for pre-registration students as well as students undertaking post-registration courses. Debate in the literature over recent years has addressed three main issues regarding the teaching of ethics to nurses: the nature and purpose of such teaching; the role of students’ experiences or other examples from practice; and the dislocation of teaching from the realities of clinical practice. In this paper we intend to clarify and justify our stance on these issues in the School of Healthcare Studies within the University of Leeds. Moral guidance or teaching ethics? There are a variety of educational methods that may and have been used to teach ethics to nurses. For example, Bowman (1995) and Fairbairn (1993) advocate story-telling by students facilitated by teachers, while Langford (1990) describes the use of the Moot Court as part of a wider strategy. However, whether educationalists are actually teaching ethics is questionable and perhaps a distinction needs to be made between what may be termed ‘moral guidance’ and ‘teaching ethics’. It may be argued that in ‘teaching ethics’ it is implied that there are certain types of activities, conduct or decisions which are right and others which are wrong. For example a primary school teacher may teach children that it is wrong to steal the belongings of others. The teacher will be able to give reasons why she holds such a belief 246 Nurse Education Today (1999) 19, 246-249 Q 1999 Harcourt Brace & Co. Ltd