Abstract
There is a need to explore educational strategies that translate ethics knowledge into ethical behavior. Commonly used pedagogical approaches steeped in traditional normative ethical theory are less powerful than sensemaking in preparing clinicians to respond to ethical problems in practice. This integrative review of 15 articles explores the use of sensemaking as an instructional method for clinical ethics. Whittemore and Knafl’s (Journal of Advanced Nursing 52(5):546–553, 2005) integrative review method guided a systematic appraisal of data from both qualitative and quantitative research traditions, synthesizing disparate studies in analyzing literature about the use of sensemaking as a pedagogical approach in teaching ethics. Findings supported the use of Weick’s sensemaking theory to develop instructional methods that encourage ethical decision making in students as well as promote ethical response by health care providers. The review reveals important theoretical and training implications for introducing sensemaking as a means to promote ethical action in clinical practice.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bagdasarov, Z., C.E. Thiel, J.F. Johnson, S. Connelly, L.N. Harkrider, L.D. Devenport, and M.D. Mumford. 2013. Case-based ethics instruction: The influence of contextual and individual factors in case content on ethical decision-making. Science and Engineering Ethics 19 (3): 1305–1322. https://doi.org/10.1007/s11948-012-9414-3.
Bagdasarov, Zhanna, James F. Johnson, Alexandra E. MacDougall, Logan M. Steele, Shane Connelly, and Michael D. Mumford. 2016. Mental models and ethical decision making: The mediating role of sensemaking. Journal of Business Ethics 138 (1): 133–144. https://doi.org/10.1007/s10551-015-2620-6.
Bazerman, Max H., and Francesca Gino. 2012. Behavioral ethics: Toward a deeper understanding of moral judgment and dishonesty. Annual Review of Law and Social Science 8 (1): 85–104. https://doi.org/10.1146/annurev-lawsocsci-102811-173815.
Bazerman, Max H., and Ann E. Tenbrunsel. 2011. Blind spots : why we fail to do what's right and what to do about it. Princeton: Princeton University Press, ©2011.
Brown, Andrew D., Ian Colville, and Annie Pye. 2015. Making sense of Sensemaking in organization studies. Organization Studies 36 (2): 265.
Browning, David M. 2012. Sturdy for common things: Cultivating moral sensemaking on the front lines of practice. Journal of Medical Ethics 38 (4): 233–235. https://doi.org/10.1136/medethics-2011-100084.
Caughron, J.J., A.L. Antes, C.K. Stenmark, C.E. Thiel, X. Wang, and M.D. Mumford. 2011. Sensemaking strategies for ethical decision-making. Ethics and Behavior 21 (5): 351–366. https://doi.org/10.1080/10508422.2011.604293.
Crutchfield, P., Johnson, J. C., Brandt, L., & Fleming, D. (2016). The limits of deontology in dental ethics education. International Journal of Ethics Education, 1(2), 183–200. https://doi.org/10.1007/s40889-016-0018-7
Gagnou-Savatier, E., and S. Mercier. 2015. A sensemaking approach to a discursive ethical skill in healthcare management: The case of an oncopaediatric service. International Journal of Services and Standards 10 (1–2): 32–48. https://doi.org/10.1504/IJSS.2015.068063.
Harkrider, Lauren N., Alexandra E. MacDougall, Zhanna Bagdasarov, James F. Johnson, Chase E. Thiel, Michael D. Mumford, Shane Connelly, and Lynn D. Devenport. 2013. Structuring case-based ethics training: How comparing cases and structured prompts influence training effectiveness. Ethics & Behavior 23 (3): 179–198. https://doi.org/10.1080/10508422.2012.728470.
James, F. Johnson, Bagdasarov Zhanna, Connelly Shane, Lauren Harkrider, D. Devenport Lynn, D. Mumford Michael, and E. Thiel Chase. 2012. Case-based ethics education: The impact of cause complexity and outcome favorability on ethicality. Journal of Empirical Research on Human Research Ethics 7 (3): 63–77. https://doi.org/10.1525/jer.2012.7.3.63.
Johnson, J.F., Z. Bagdasarov, A.E. MacDougall, L. Steele, S. Connelly, L.D. Devenport, and M.D. Mumford. 2014. Improving ethical knowledge and sensemaking from cases through elaborative interrogation and outcome valence. Accountability in Research 21 (5): 265–299. https://doi.org/10.1080/08989621.2013.848803.
Kligyte, V., R.T. Marcy, E.P. Waples, S.T. Sevier, E.S. Godfrey, M.D. Mumford, and D.F. Hougen. 2008. Application of a sensemaking approach to ethics training in the physical sciences and engineering. Science and Engineering Ethics 14 (2): 251–278. https://doi.org/10.1007/s11948-007-9048-z.
Kligyte, Vykinta, Shane Connelly, Chase Thiel, and Lynn Devenport. 2013. The influence of anger, fear, and emotion regulation on ethical decision making. Human Performance 26 (4): 297–326. https://doi.org/10.1080/08959285.2013.814655.
Lanham, Holly Jordan, Luci K. Leykum, Barbara S. Taylor, C. Joseph McCannon, Curt Lindberg, and Richard T. Lester. 2013. How complexity science can inform scale-up and spread in health care: Understanding the role of self-organization in variation across local contexts. Social Science & Medicine 93: 194–202. https://doi.org/10.1016/j.socscimed.2012.05.040.
Leykum, L.K., and K. O'Leary. 2017. Web exclusives. Annals for hospitalists inpatient notes - sensemaking-fostering a shared understanding in clinical teams. Annals of Internal Medicine 167 (4): HO2–HO3. https://doi.org/10.7326/M17-1829.
MacDougall, Alexandra E., Lauren N. Harkrider, Zhanna Bagdasarov, James F. Johnson, Chase E. Thiel, Juandre Peacock, Michael D. Mumford, Lynn D. Devenport, and Shane Connelly. 2014. Examining the effects of incremental case presentation and forecasting outcomes on case-based ethics instruction. Ethics & Behavior 24 (2): 126–150. https://doi.org/10.1080/10508422.2013.824819.
Mecca, Jensen T., Kelsey E. Medeiros, Vincent Giorgini, Carter Gibson, Michael D. Mumford, and Shane Connelly. 2016. Biases and compensatory strategies: The efficacy of a training intervention. Ethics & Behavior 26 (2): 128–143. https://doi.org/10.1080/10508422.2014.997878.
Milkman, Katherine L., Todd Rogers, and Max H. Bazerman. 2008. Harnessing our inner angels and demons: What we have learned about want/should conflicts and how that knowledge can help us reduce short-sighted decision making. Perspectives on Psychological Science 3 (4): 324–338. https://doi.org/10.1111/j.1745-6924.2008.00083.x.
Mumford, M.D., S. Connelly, R.P. Brown, S.T. Murphy, J.H. Hill, A.L. Antes, E.P. Waples, and L.D. Devenport. 2008. A sensemaking approach to ethics training for scientists: Preliminary evidence of training effectiveness. Ethics & Behavior 18 (4): 315–339.
Ness, A.M., and S. Connelly. 2017. Situational influences on ethical sensemaking: Performance pressure, interpersonal conflict, and the recipient of consequences. Human Performance 30 (2–3): 57–78. https://doi.org/10.1080/08959285.2017.1301454.
Olson, M.E. 2009. The “millennials”: First year in practice. Nursing Outlook 57 (1): 10–17. https://doi.org/10.1016/j.outlook.2008.06.001.
Park, H.-A., M. Cameron, S.-S. Han, S.-H. Ahn, H.-S. Oh, and K.-U. Kim. 2003. <Korean nursing Students_Bank_Nurs Ethics-2003-Park-638-53.pdf>. Nursing Ethics 10 (6): 638–653.
Peacock, J., L.N. Harkrider, Z. Bagdasarov, S. Connelly, J.F. Johnson, C.E. Thiel, A.E. Macdougall, M.D. Mumford, and L.D. Devenport. 2013. Effects of alternative outcome scenarios and structured outcome evaluation on case-based ethics instruction. Science and Engineering Ethics 19 (3): 1283–1303. https://doi.org/10.1007/s11948-012-9402-7.
Pellico, L.H., C.S. Brewer, and C.T. Kovner. 2009. What newly licensed registered nurses have to say about their first experiences. Nursing Outlook 57 (4): 194–203. https://doi.org/10.1016/j.outlook.2008.09.008.
Sandberg, Jörgen, and Haridimos Tsoukas. 2015. Making sense of the sensemaking perspective: Its constituents, limitations, and opportunities for further development. Journal of Organizational Behavior 36: S6.
Thiel, C.E., S. Connelly, L. Harkrider, L.D. Devenport, Z. Bagdasarov, J.F. Johnson, and M.D. Mumford. 2013. Case-based knowledge and ethics education: Improving learning and transfer through emotionally rich cases. Science and Engineering Ethics 19 (1): 265–286. https://doi.org/10.1007/s11948-011-9318-7.
Vovides, Y., and S. Inman. 2016. Elusive learning-using learning analytics to support reflective sensemaking of ill-structured ethical problems: A learner-managed dashboard solution. Future Internet 8 (2). https://doi.org/10.3390/fi8020026.
Weick, Karl E. 1988. Enacted sensemaking in crisis situations. Journal of Management Studies (Wiley-Blackwell) 25 (4): 305–317. https://doi.org/10.1111/j.1467-6486.1988.tb00039.x.
Weick, Karl, and Kathleen Sutcliffe. 2015. Managing the unexpected: sustained performance in a complex world. 3rd ed. Aufl: Jossey-Bass.
Weick, Karl E., Kathleen M. Sutcliffe, and David Obstfeld. 2005. Organizing and the process of Sensemaking. Organization Science 16 (4): 409.
Whittemore, R., and K. Knafl. 2005. The integrative review: Updated methodology. Journal of Advanced Nursing 52 (5): 546–553. https://doi.org/10.1111/j.1365-2648.2005.03621.x.
Wilson, A.M. 2014. Application of Heideggerian phenomenology to mentorship of nursing students. Journal of Advanced Nursing 70 (12): 2910–2919. https://doi.org/10.1111/jan.12453.
Zeni, T.A., M.R. Buckley, M.D. Mumford, and J.A. Griffith. 2016. Making “sense” of ethical decision making. Leadership Quarterly 27 (6): 838–855. https://doi.org/10.1016/j.leaqua.2016.09.002.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Brandt, L., Popejoy, L. Use of sensemaking as a pedagogical approach to teach clinical ethics: an integrative review. International Journal of Ethics Education 5, 23–37 (2020). https://doi.org/10.1007/s40889-020-00089-w
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40889-020-00089-w