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The ethics of ‘Nudge’ in professional education

2018, Nursing Ethics

Abstract

In the 1700s, Frederick the Great of Prussia had a dilemma. His people were in danger of starvation and they were resisting one nutritious food on offer, complaining: 'the things have neither smell nor taste, not even the dogs will eat them, so what use are they to us?' Frederick tried threats to begin with-anyone who refused to plant the crop in question would have their noses and ears cut off. And then he tried another approach. He ordered his soldiers to mount a visible guard around the fields where the crop was grown so his people would be aware of the high esteem in which the crop was held. Before long, they were stealing and planting the 'royal crop' and the potato became the salvation of the Prussian people. Frederick's change of tactic is highlighted as one of the earliest examples of a shift from 'shove' to 'nudge'. 1 The academic beginnings of nudge theory are credited to a book by Thaler and Sunstein 2 in 2008. The theory was embraced by politicians and policy-makers leading to the setting up of the Behavioural Insights Team or 'Nudge Unit' in the United Kingdom. 1 The approach has been embraced in public health, markets, medicine and even in public toilets. The positioning of a fake fly in the Amsterdam airport urinals, an example of what has become known as 'choice architecture', is cited by Thaler and Sunstein. The fly, strategically placed in the urinals, reduced spillage by 80%. 2 How then might nudge theory impact on some of the challenges encountered in professional education? Is an educator well-placed to be a 'choice architect'? How might we discern between ethical interventions that come under the umbrella of 'nudge' and those that would be better described as 'shove', manipulation or coercion? We three authors are involved in a range of educational initiatives-face to face, online and blended approaches-designed to enhance student engagement with professional education. It will come as no surprise to readers that students do not always engage as well as hoped and are not always as enthusiastic about educational innovations as educators are. Some educational innovations which, for example, use online teaching materials are under-used and accessed only near assessment time. So what to do? Could we use some of the insights from nudge theory to encourage more engagement? Which strategies are ethical? And which are unethical? It might be argued that ethical nudge strategies include those which are respectful of student autonomy, those which are beneficial in promoting learning and those which are fair. It might be argued that unethical strategies are those which are disrespectful of student autonomy, those which are harmful, those which are overly burdensome and coercive and those which are unfair. In professional education, such as with undergraduate nurse education programmes, student autonomy is curtailed, whether or not 'nudges' are used, so that learning outcomes are achieved and regulatory requirements are met. Students are required to read (or listen) and reflect on professional knowledge, they are required to engage in educational activities at the university and to complete assessments to demonstrate that they are able to apply knowledge to health and social care practices.