Reframing ethical alarm in clinical nursing education: A reflexive-action framework for practice-based ethics learning

To develop a clinically embedded pedagogical framework that reconceptualizes ethical alarm as a resource for ethics learning in nursing education.

Nursing ethics education continues to face a gap between classroom instruction and clinical practice, where students encounter emotionally charged, relational and structurally complex ethical situations. Ethical discomfort is commonly discussed through moral distress, yet its potential value as an entry point for guided learning remains underdeveloped.

Discussion paper.

Contemporary literature on nursing ethics education, ethical sensitivity, moral distress, moral agency, transformative learning, relational ethics and reflective pedagogy was purposively reviewed and theoretically synthesized to inform development of the conceptual framework.

The resulting Reflexive-Action Framework proposes ethical alarm as a clinically embedded starting point for ethical learning through five recursive phases: recognition, validation, reflexive interpretation, dialogical engagement and ethical action and integration. The framework links ethically significant clinical encounters with bedside ethical noticing, guided reflection, supportive supervision, dialogue and proportionate advocacy. These processes are proposed as potential supports for ethical sensitivity, reflexivity, relational competence, moral agency and professional identity formation.

The framework extends ethics education beyond isolated classroom instruction by positioning clinical practice as a site for deliberate ethical learning. Its feasibility, acceptability, conceptual distinctiveness and educational outcomes require empirical evaluation across diverse clinical and cultural settings.