Ethics and moral competence: 30 students from across Europe in Udine for an international discussion

On May 29^th and 30^th, 2025, the international conference "Nursing Ethics in our Days" was held in Udine, organized by the University of Udine in collaboration with the Azienda Sanitaria Universitaria Friuli Centrale. The accredited event, dedicated to healthcare professionals and master's degree students, represented an important opportunity for discussion on the issues of ethics in nursing care.

The conference was attended by 30 students from seven European universities (University of Maribor, Angela Boskin University, University of Primoska, University of Turku, University of Tartu, Technical University of Cyprus, University of Patras) supported by 15 professors, researchers and healthcare professionals from 10 academic institutions, including Trinity College Dublin (Ireland), University of Turku (Finland), University of Leuven (Belgium), Cyprus Nurses and Midwifes Association (Cyprus) and University of Patras (Greece), who are already partners in the European project PROMOCON (Promoting a Morally Competent Nurse). The main objective was to reflect on the present and future of nursing ethics supporting the development of moral competences and fostering international cooperation in this field.

The program featured presentations over two days aimed to updating knowledge on emerging ethical challenges in nursing practice, exploring the factors that promote moral competence and the tools to evaluate it, enhancing teaching strategies to develop ethical skills in university courses and in continuing education, discussing emerging ethical dilemmas in clinical, organizational, educational and research contexts, showcasing the results of the European PROMOCON project and initiating new scientific collaborations between European Universities.

The conference opened with welcome by Prof. Alvisa Palese and lectio magistralis by Prof. Chris Gastmans (University of Leuven) on "Nursing ethics today and tomorrow". This was followed by presentations on tools for assessing moral competence, innovative teaching strategies and results from the development of the Massive Open Online Course (MOOC) dedicated to ethics in nursing, presented by Dr. Johanna Wiisak, Prof. Michael Igoumenidis and Prof. Nikos Stefanopoulos and moderated by Prof. Melita Persolja and Prof. Minna Stolt.

A particularly significant moment was the presentation of the results of the interviews conducted by the master's degree students with experts within the Blended Intensive Programme (BIP) project, together with Dr. Maria Dimitriadou. They illustrated situations and ethical dilemmas experienced in clinical, organizational, training and research contexts.

During the second day, ample space was reserved for the European PROMOCON project, coordinated by the University of Udine. The results of the project – including the toolkit to support teachers in using MOOC and the Good Practice Guide – were presented by the participating faculty memebers, including Dr. Stefania Chiappinotto, Prof. Catherine McCabe, Prof. Brian Keogh and Prof. Evridiki Papastavrou, moderated by Dr. Renzo Moreale and Prof. Riitta Suhonen.

The conference concluded with a round table discussion on methods of teaching ethics at the participating universities.

The event served as a virtuous example of international, multidisciplinary and interprofessional cooperation, providing students and professionals with concrete tools to competently address the ethical challenges of the nursing profession.

The University of Udine thus confirms its role as a promoter of European-wide initiatives, capable of combining research, training and professional practice in the ethical and shared vision of care.

On 28^th, 29^th and 30^th April 2025, the PROMOCON partners participated in the three-days Summer School at Trinity College Dublin, Ireland, dedicated to educators that teach ethics at the university and post-graduation level. 

During these days, educators coming from the partner countries learned about the objectives and the main ongoing activities of the PROMOCON project. In particular, prof. Alvisa Palese (University of Udine) presented an overview of the project; dr. Johanna Wiisak (University of Turku) the review concerning the interventions to promote moral competences in the nursing field; dr. Stefania Chiappinotto (University of Udine) the results of the systematic review regarding the instruments assessing moral and ethical competence; prof. Evridiki Papastavrou (Cyprus Nurses and Midwifes Association) the state of the art regarding the results of the comparative analysis of the nursing ethics courses curricula among the six countries partners and the Good Practice Guide; prof. Michael Igoumenidis and prof. Nikos Stefanopoulos (University of Patras) an overview of the Massive Open Online Course development and its contents; finally, the hosting professors of the Trinity College Dublin, Catherine McCabe and Brian Keogh, presented the results of the pilot of the course and the Train the Trainer Toolkit. Moreover, two key presentations were provided: prof. Chris Gastmans gave a presentation on the future of nursing ethics, while prof. Ann Gallagher suggested the optimal strategies to teach nursing ethics. 

During the first day, partners also had the opportunity to collect suggestions and comments from all the participants regarding the outcomes of the project and the Massive Open Online Course. They are now ready to finalize the outputs of the project.

The Summer School was also the occasion for all the members of the PROMOCON partnership to meet and discuss specific issues related to the project and its conclusion. A transnational project meeting was therefore organized on 30^th April 2025, in which the partners discussed forthcoming activities, the contents of future scientific publications and the last dissemination activities, which are the International Conference in Udine on 29^th-30^th May and the International Ethics Conference in Turku on 28^th-29^th August.

During a specific Symposium dedicated to the project and lead by the PROMOCON partners, participants from all over the world had the opportunity to get acquainted with the objectives and the main outcomes achieved by the project. In particular, they were welcomed by Prof. Alvisa Palese, scientific coordinator of the project and full professor at the University of Udine. Prof. Palese gave the floor to dr. Johanna Wiisak, from the Finnish team, who presented the main characteristics of a morally competent nurse. Then, dr. Stefania Chiappinotto, from the Italian team, presented the results of the qualitative study on the main components of ethical and moral competence in nursing, while Prof. Minna Stolt from the Finnish team showed how this moral competence can be supported in practice. In the second part, Prof. Nikos Stefanopoulos from the University of Patras presented the advanced methods in ethics learning/teaching that were used for creating the PROMOCON MOOC and Prof. Brian Keogh, from the Irish team, addressed the quality control and assessment of pedological approaches used in the online course. Finally, prof. Michael Igoumenidis from Greece discussed a piloted grid used to assess the Codes of Conduct created by the consortium.

On the 11^th and 12^th of March 2024, all members of the PROMOCON team have met in Athens to discuss the next phases of the project. PROMOCON (Promoting a morally competent nurse) is an Erasmus+ funded project, that started in 2022 in the framework of KA2 Cooperation Partnership in Higher Education. The aim is to promote a deeper understanding of the importance of moral values and ethical principles in nursing and to increase moral and ethical competences among nurses and nursing students.

Alvisa Palese and Stefania Chiappinotto (University of Udine, Italy), together with Michael Igoumenidis and Nikos Stefanopoulos (University of Patras, Greece), Evridiki Papastavrou andParaskevi Charitou (Cyprus Nurses and Midwives Association), Chris Gastmans (University of Leuven, Belgium), Catherine Mc Cabe (Trinity College Dublin School of Nursing & Midwifery, Ireland) and Riitta Suhonen, Johanna Wiisak and Minna Stolt (Univeristy of Turku, Finland) have resumed the outcomes already achieved and have started to finalize the Massive Online Open Course, which will be soon tested on a group of nursing students and nurse educators of Italy, Ireland, Cyprus, Finland and Greece and then distributed extensively.

The MOOC will address topics that are relevant to increase patients' confidence through the development of moral competence and skills. The course will include case studies on ethical dilemmas, digital exercises on empathy development and on individualized care, as well as digital critical thinking exercises. It will be composed of 4 modules: basic ethical knowledge, basic ethical skills basic ethical attitudes, and methods and tools to develop ethical skills and attitudes. It will be tailored for undergraduate and postgraduate students, as well as practicing nurses involved in continuing education, and potential educators.

The meeting was the occasion to start organizing the Summer School and the Train the trainers event to be held in Ireland in April 2025. The event will bring together nurse educators across Europe to disseminate information about the MOOC, develop their knowledge about moral competences and facilitate critical discussion about how moral frameworks and the MOOC can be integrated and standardized across EU nursing programs.

On the 14^th and 15^th July 2023, the PROMOCON partners have participated in the two-days International Conference in Nursing Ethics in Genoa, Italy, titled "Thirty years of nursing ethics: looking back, looking forward".

During a specific Symposium hosted at the Conference on 14^th July 2023 and lead by the PROMOCON partners, participants from all over the world learned about the objectives and the main ongoing activities of the PROMOCON project. They were welcomed by Prof. Alvisa Palese, scientific coordinator of the project and full professor at the University of Udine. Prof. Palese gave the floor to dr. Georgios Efstathiou, from the Cyprus team, who presented the state of the art regarding the results of the comparative analysis of the nursing ethics courses curricula among the six countries partners. Then, dr. Johanna Wiisak, from the Finnish team, presented an overview regarding the interventions to promote the moral competencies in nursing field, while dr. Stefania Chiappinotto and dr. Jessica Longhini showed the results of the systematic review regarding the instruments that assess moral and ethical competence. Finally, prof. Riitta Suhonen presented the preliminary findings of the professionals and laypersons focus groups leading in all countries, underlining some suggestions to create a moral competent nurse profile.

Prof. Chris Gastmans was invited as key note speaker during the closing session of the Conference and other member of the PROMOCON team participated to some parallel sections (dr. Johanna Wiisak presented the two abstracts "Early-career nurses' moral courage – A six country longitudinal study" and "A conceptual model of reasoning for whistleblowing in health care"; prof. Michael Igoumenidis presented the abstract "Positive duties and aspirational ethics in nursing").

The international Conference was also the occasion to meet among all the members of the PROMOCON partnership to discuss specific issues related to the project. A transnational project meeting was therefore organized in Genoa on 15^th July 2023, in which the partners discussed forthcoming activities and the contents of the future scientific publications.

The complete programme is available at the following link: 

https://dissal.unige.it/Thirty_Years_Nursing_Ethics-Looking_Back_Looking_Forward  

Which are the moral competencies of nursing profession internationally? Is the knowledge offered in the bachelor degree sufficient to support nurses in facing the ethical and moral challenges they are exposed to in their daily practice? How can the continuous development of competences be promoted?

The challenge of developing the moral and ethical skills of the nurses, made even more evident by the COVID-19 pandemic, has been translated into a concrete project led by Prof. Alvisa Palese (University of Udine– Department of Medicine), together with her collaborators Dr. Jessica Longhini and Dr. Stefania Chiappinotto, with 5 other countries: University of Patras (Greece, Ass. Prof. Michael Igoumenidis), University of Leuven (Belgium, Prof. Chris Gastmans), University of Turku (Finland, Prof. Riitta Suhonen), Trinity College Dublin (Ireland, Prof. Catherine McCabe) and Cyprus Nurses and Midwives Association (CYNMA-Cyprus, Prof. Evridiki Papastavrou). PROMOCON Project (Promoting a morally competent nurse) is an Erasmus + funded project that have started in 2022 and will last two years. The aim is to promote a deeper understanding of the importance of moral values and ethical principles in nursing and to increase moral and ethical competences among nurses and nursing students. Nurses, when providing care, are involved in complex decision-making processes that often imply and activate a moral and ethical dimension. Recent global events, such as the COVID-19 pandemic, have put professionals to the test, enhancing pressure on their physical and emotional workload. The health crisis is exacerbating some pre-existing problems such as shortage of resources, the risk of having to ration them, all of which can increase nurses' moral unease and negatively affect their mental health.