National study of Quad Council competencies: Integration of ethics and diversity education in baccalaureate nursing programs

Background: Little is known about how ethical decision-making or diversity awareness are taught in Public Health Nursing (PHN) curricula. This is important to ascertain, as the next generation of the PHN workforce will need strong ethical skills grounded in an awareness of diversity. The New York Public Health Summit Workgroup, whose goal is to develop a strong academic/workforce partnership, was concerned about how ethical decision making and diversity were taught in the PHN curricula of Baccalaureate granting programs across the United States. Therefore, these topics were the focus of a special section in a recent national survey of BSN programs.

Purpose: The aim of this study was to identify how BSN programs integrated Quad Council recommendations of diversity awareness and ethics education into PHN curricula. The study also measured interest in Symphonology, a new ethical theory applicable to public health.

Methods: A descriptive study surveyed BSN programs in the United States (n=263), and identified how public health curricula integrated the Quad Council domains of cultural competency in terms of diversity awareness, ethical decision making skills, and social justice.

Results: The majority of respondents integrated cultural competency into PHN curricula, but not necessarily within a context of diversity awareness or social justice. Only 38% of respondents indicated they taught students a specific method to make bioethical decisions. Overall, 89% of respondents were interested in learning about the theory of Symphonology.

Conclusions: Since there is no consistent framework to deliver ethics education in PHN curricula, problems arise. Few students learn a specific method to make ethical decisions. Consequently, many nurses choose a solution to a problem that “feels right.” This creates undue moral distress when what “feels right” is in conflict with the reality of a population based problem. At the global level, students need a clear grasp of an objective, contextual method to solve ethical problems. Educative practices related to systems thinking in diversity awareness and social justice varied widely, indicating a need for further study. Ethics education and diversity awareness are vital skills needed to build a strong public health nursing workforce.