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Ethics at Bachelor’s level. Philip Esterhuizen RN, BA(Cur) MScN, PhD. European directives for nurse education leading to registration. The educational programme should guarantee:

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ethics at bachelor s level

Ethics at Bachelor’s level

Philip Esterhuizen RN, BA(Cur) MScN, PhD

european directives for nurse education leading to registration
European directives for nurse education leading to registration

The educational programme should guarantee:

  • Adequate knowledge of science and include sufficient understanding of the structure, physiological functions and behaviour of healthy and sick persons.
  • The relationship between the state of health and physical and social environment of the human being.
  • Sufficient knowledge of the nature and ethics of the profession.
  • Adequate clinical experience.
  • Ability to participate in the training of health personnel.
  • Experience of working with other professions in the health care sector
european directives for nurse education regarding practice
European directives for nurse education regarding practice

In a programme of 3 years/4,600 hours, there should be a 50% balance of theory/practice. Practice can take place in hospitals, other health care institutions and in the community and should include:

  • General and specialist medicine
  • General and specialist surgery
  • Maternity care
  • Mental health and psychiatry
  • Care of the old and geriatrics
  • Home nursing
entrance to nursing education
Entrance to nursing education

In the Netherlands education the general secondary educational system has three main options, the MAVO (four years), the HAVO (five years) and the VWO (six years), the latter being the entry requirement to university degrees.












nursing education in the netherlands
Nursing education in the Netherlands




MSc Degree

MSc Degree

Institute for

Higher education

Level 5 Registered Nurse/BSc

Level 4 Registered Nurse




Level 3 nurse

Independent nursing activities

Level 2 nurse:

Basic nursing activities/assistant to more qualified staff

No formal


Level 1 nurse:

Housekeeping & non-patient activities

two levels of nurses nl
Two levels of nurses (NL)

Two levels of nurse (Level 4 educated at college level and Level 5 educated at degree level) are both registered as nurses under the Individual Health Care Professions Act.

Both levels of nurses are expected to:

(a) recognise and analyse actual and/or threatening consequences of physical, mental pathological processes,

(b) recognise and analyse disabilities or developmental disorders

(c) recognise and analyse the individual’s vital functions

(d) provide counselling and assist the individual in situations when necessary.

The Level 5 nurse:

  • Is capable of assessing the whole situation and deciding the appropriate level of care.
  • Directs Level 4 nurses.
competency based education nl
Competency-based education (NL)

The skill set for the degree level (5) nurse includes the following competencies:

  • Observation
  • Direct patient care
  • Emotional support
  • Nursing skills
  • Patient information and education
  • Preventative and promotive health
  • Coordination of care
clinical practice nl
Clinical practice (NL)

The practice part of the programme:

  • Is usually 10 weeks in the first year, 20 weeks in the second, third and fourth years of the programme.
  • Occurs in nursing homes, mental health settings, general hospital and/or community settings
  • In the final placement (4th year), the student is expected to undertake a practice-based research project.
cooperative nursing education nl
Cooperative nursing education (NL)

In addition to the regular BSc Nursing programme, students can choose a second option in the form of a cooperative nursing education programme.

This programme is also 4 years in duration, but here the student is employed by a hospital where all practice placements take place. The theory and practice/work balance shift from 60% practice in the first years to 80% practice in the final years.

The Cooperative nursing programme is based strongly on the concept of workplace learning by means of clinical placements being a way of achieving academic credits.

position of ethics in the curriculum
Position of ethics in the curriculum
  • Currently:
    • ‘Informal’ reflections during mentorship in all years
    • Year 3 - Ethics and value system (16 hours)
  • Future plans:
    • ‘Formal’ integration of ethics and value system during mentorship
    • Year 1 - Personal philosophy/vision of care (16 hours)
    • Year 2 - Ethics and value system, palliative care, qualitative research (36 hours)
    • Year 3 – Ethics and law (16 hours)
    • Year 4 – Ethics and research (16 hours)
learning from experience
Learning from experience

Expertise develops when the clinician tests and refines propositions, hypotheses, and principle-based expectations in actual practice situations

Benner (1984)

educational philosophy
Educational philosophy

Based on:

  • Personal and professional support for the individual
  • Methodic and systematic supervision
  • The process of personal growth and development
  • Respect for the individuality of the person and attention for the search for self-actualization
approach to schooling on ethics
Principle-based ethics

The value of life

Goodness/no harm


Truth telling



Care-based ethics

Moral attention

Sympathetic understanding

Relationship awareness



Approach to schooling on ethics
theoretical approach to ethics education
Theoretical approach to ethics education
  • Move in the direction of virtue-based ethics/theory of presence
    • Compassion – ‘an awareness of one’s relationship with others’
    • Competence – ‘having the necessary knowledge, judgement, skills, energy, experience and motivation’
    • Confidence – ‘the quality that fosters trusting relationships’
    • Conscience – ‘a state of moral awareness’
    • Commitment – ‘convergence between one’s desires and one’s obligations and the deliberate choice to act in accordance’
driscoll what model of structured reflection 2000
Driscoll: ‘What?’ model of structured reflection (2000)

Having an experience in practice

What? Description of the event

Actioning the new learning

from the experience

Purposeful reflection

on selected aspects

of the experience

Now what?

Proposed actions

following the event

So what?

An analysis of the event

Discovery of what learning

emerges from reflection

reflection and reflective practice
Reflection and reflective practice
  • Reflection-in-action
  • Reflection-on-action
  • Reflection prior to action
transformational learning lingsma scholten 2001
Transformational learning (Lingsma & Scholten, 2001)



What do I want?

What do I think?

What am I doing?

Choice of

motives and



who are

these people?


and strategic




Continual improvement

Single loop learning



Double loop learning

Triple loop learning

being responsible versus having responsibility
Being responsible versus having responsibility

Assist students in setting boundaries

  • Being responsible - ‘being aware of what is happening and prepared to engage with it and work for its positive advance in society’
  • Having responsibility - ‘to be answerable to someone or something specific, usually defined by contract’
contact information
Contact information

Philip Esterhuizen