Paper short abstract:

Based on ethnographic observations in the simulation laboratory this paper argues that normative notions of “ethic of patient care” in the situated training of nursing competence become a masked system of morals bound by checklists, protocols, and practices of standardization.

Paper long abstract:

Training in clinical skills informed by the ethics of care is central in human simulation in nursing. This paper examines current tensions and difficulties faced by educators in designing nursing laboratory simulations, in which students would benefit from interactions with real humans within the standardized patient (individuals trained to portray a patient) model of clinical simulations. Considering cultural perspectives of care and ethic of care, this paper critiques the programmatic care orientation of nursing clinical skills training in the laboratory.

Based on ethnographic observations in the laboratory I argue that despite institutional assertions of socializing student nurses into acquiring and practicing a caring role, normative notions of "ethic of patient care" in the training for nursing competence become a masked system of morals bound by checklists, protocols, and practices of standardization. The standardized patients' subjectivity is meticulously trained and heavily surveilled, following institutional commitments of objective, reliable and valid measures of the ethical dimension in the students' performances. In effect, simulation educators base their practices on abstract moral principles that can be judged and evaluated based on rational categories that assert care as a universal standard, and not by an ethic of care that takes as central subjective caring, relationships, and compassion of an "interconnected self." I suggest that in nursing simulations an ethic of care is rather situated in the tension between the opposite imperatives of care and justice (Ganis, 2011), privileging the latter under a normative notion of good care stipulated by policy