Midwifery students' experiences of support for ethical competence.

BACKGROUND: Midwifery students are confronted with several ethical dilemmas and challenging situations during clinical midwifery care practice. Since ethical competence of midwifery students is under development, it is important to support the students' learning progress of ethical issues from diverse viewpoints. OBJECTIVE: From the perspective of didactics of caring science and the context of midwifery students, to explore how midwifery students' experience supports for ethical competence in midwifery education and investigate how ethically challenging situations have been carried out during clinical midwifery care practice. DESIGN: Qualitative, explorative and descriptive design with inductive nature. METHODS: Focus group interviews with nine Swedish midwifery students. Hans-Georg Gadamer's philosophical hermeneutics was applied to guide the interpretation. ETHICAL CONSIDERATIONS: Ethical principles and scientific guidelines were followed. Informed consent was obtained from the participants. Confidentiality was respected and quotations anonymised. RESULTS: Receiving support when ethically challenging situations occur in clinical midwifery practice is important and necessary. One main theme, such as support is a human and caring factor in the midwifery students' Bildung process on ethical competence, and four subthemes, such as supporting through trust and responsibility; supporting through dignity and respect; supporting through truthfulness and justice; and supporting through dialogue and reflection, were created from the hermeneutical interpretation. DISCUSSION: Teaching ethics should be carefully planned, consistent and continue throughout the midwifery education. There is dispersion in the pedagogy of ethical situations, the methods and perceptions associated with it, and in obtaining possible support for students. Developing well-experienced methods could benefit the support of midwifery students' ethical competence when they experience ethically challenging situations in midwifery care practice.

Women's experiences of cultural and traditional health beliefs about pregnancy and childbirth in Zambia: An ethnographic study.

Zambian women's pregnancy and childbirth are linked to a variety of cultural and traditional practices, activities and beliefs. These existential events affect the women's health and the newborn's care. In this study we used an interpretative ethnographic design. Individual deep interviews with eight Zambian women were carried out. The formation of family, pregnancy and childbirth are important for strengthening generational traditions and preserving culture. Having many children is especially important for Zambian men as it increases their status in the society. Family continuity is related to the legacy of generations through the spirits of the ancestors.

Ethics simulation in nursing education: Nursing students' experiences.

BACKGROUND: Ethics stimulation in nursing education focuses on human, non-technical factors in a clinical reality. Simulation as a teaching method began in the 1930s with flight simulators. In the beginning of the 1990s, simulations developed further in tandem with other technological and digital inventions, including touchscreen and three-dimensional anatomical models. Medical science first used simulation as a pedagogical teaching tool. In nursing education, simulation has been used for approximately a hundred years. Teaching has mainly focused on medical-technical, patient-specific interventions and their management. OBJECTIVE: The objective of this study was, from a caring science didactic perspective, to deepen the understanding of ethics simulation in nursing education. DESIGN: Qualitative design and explorative, descriptive and hermeneutic approach of an inductive character. METHODS: Semi-structured face-to-face interviews in 2016-2017 with six Norwegian nursing students who were encouraged to narrate about their experiences of ethics simulation in nursing education. ETHICAL CONSIDERATIONS: Informed consent was obtained from the participants. Anonymity and confidentiality regarding data material were guaranteed. RESULTS: Interpretation of the nursing students' narratives resulted in the following meaning units: ethical being and ethos, nursing students' formation process, bridge-building between theory and clinical practice, and teacher and ethics simulation. CONCLUSION: Through ethics simulation, nursing students can obtain an increased knowledge and a sense of being able to handle difficult ethical situations. Nursing students' values, moral actions and ethical value base offer a positive point of departure, for both theoretical and practical ethics teaching, and an awareness of the unique human being, the patient, in clinical reality. The implementation of ethics simulation needs more attention in nursing education.

Nurse Anesthetists' and Operating Theater Nurses' Experiences with Inadvertent Hypothermia in Clinical Perioperative Nursing Care.

PURPOSE: To deepen the understanding of and describe nurse anesthetists' and operating theater nurses' experiences with inadvertent hypothermia in clinical perioperative nursing care. DESIGN: Qualitative, explorative, and descriptive study that carries an inductive nature. METHODS: Focus group interviews with 16 nurse anesthetists and operating theater nurses from four hospitals in Norway. Gadamer's hermeneutics has guided the study's interpretation. FINDINGS: Taking the temperature and measures against inadvertent hypothermia perioperatively are not always systematically implemented. In the data material, three thematic units emerged: routines and habits, the culture of the perioperative unit, and silent suffering. CONCLUSIONS: Complications caused by inadvertent hypothermia in surgical patients can lead to unnecessary suffering and prolong the hospital stay. The surgical team's cooperation and responsibility are linked to routine nursing interventions. These depend on the nurses' knowledge and experience as well as their clinical and subjective assessment of the patient's physical condition and the surgical techniques used.

Nursing students' perspective on a caring relationship in clinical supervision.

BACKGROUND: Nursing students spend approximately half of their time in clinical practice. It is important that clinical supervisors understand nursing students' path of learning and can support their growth and development during the different and multifaceted learning situations offered in the clinical-practice period. OBJECTIVE: Based on nursing students' perspective and rooted in the didactics of caring science, to examine how a learning and constructive caring relationship between nursing students and supervisors in clinical practice can be formed. DESIGN: Qualitative and quantitative concurrent triangulation design of mixed methods. METHODS: Focus group interviews with Finnish nursing students (n = 21) in the qualitative part of the study. In the quantitative part, a closed questionnaire with closed answers was analysed using descriptive statistics. The analysis process was conducted using inductive content analysis. ETHICAL CONSIDERATIONS: Ethical issues were considered throughout the research process according to ethical principles and scientific guidelines. Informed consent was obtained from the informants, confidentiality regarding the data material was guaranteed and quotations were anonymized. RESULTS: A caring relationship between nursing students and supervisors is based on mutual respect, the ethos of responsibility, motivation, willingness and professionalism. Dignity and a caring ethical approach, where nursing students feel they belong, are recognized, seen and heard enables learning and professional development. It is also significant that the supervisor's actions and reflections are ethically defensible, equal and protect nursing students from suffering and various power relationships in clinical practice. CONCLUSION: A good cooperative relationship and shared responsibility between the nurse education institution, which offers theory and prepares nursing students for the encounter with clinical practice and the healthcare organizations is crucial for enabling a caring relationship in clinical supervision.

The history of ideas of Nordic midwives' excursions from the early 19th century to the millennium.

The midwifery art has emphasised the uniqueness of human beings throughout its Nordic history. The educated Nordic midwife has in the last decade celebrated several hundred years of memories. This article studies how the key ideas of the midwifery art and patterns of ideas become evident in the zeitgeist from the beginning of the 19th century to the millennium in the Nordic countries. The legacy and pattern of ideas of the art of midwifery are interpreted in relation to the texts of the selected historical sources and based on Ricoeur's phenomenological-hermeneutic approach to the text and further to the dedication of understanding and interpretation. The historical sources refer to unprinted primary sources from historical archives and printed secondary and tertiary sources. The patterns of ideas include a tripartite whole: the true cultivation of the head, the philosophy and aesthetics of the hand, the strength of the heart and the drive of calling. These ideas open for unique visions and attest to the evident in modern midwives. Today's midwives have academic training with examinations, and the education is based on scientific evidence. The midwife profession is authorised by the state and supervised by the authorities.

Discovering the ethos of serving in nursing leadership from the first half of the 20th century in three Nordic countries - an idea-historical research approach.

The history of ideas may contribute to an awareness and an opening up of deep-seated currents of thought that have shaped the inner core of the caring culture and an ethical value base - the ethos of serving in nursing leadership. This article studies how serving as an ethos is represented, which becomes visible and evident in Sophie Mannerheim's, Bertha Wellin's and Bergljot Larsson's nursing leadership. This article also seeks to describe the main features of the idea-historical research approach the way in which it is represented within the caring science-tradition. An idea-historical methodological approach informed by Gadamer's philosophy was used for the hermeneutical interpretation within a caring science perspective. Primary and secondary historical sources were explored in the light of nursing praxis and serving. Three general idea patterns were discovered: the innermost room of the heart as the idea of serving, the action of the hand as acts of love and a cultivation of the head towards nursing leadership. These ideas open for a new vision that can bring out new patterns for action in the present and in the nursing leadership of the future.

Nurse leaders' responsibilities in supporting nurses experiencing difficult situations in clinical nursing.

AIM: To make nurse leaders aware of different kinds of difficult situations in clinical nursing that may cause suffering to nurses and to discuss how nurse leaders can approach and alleviate this suffering. BACKGROUND: Difficult situations are a part of clinical nursing. Nurses are repeatedly exposed to situations that may cause them suffering and reduce their ability to serve the patients. METHOD: Data collection was based on a sample of semi-structured face-to-face deep interviews with eight nurses who were encouraged to narrate their lived experiences of difficult situations in clinical nursing. RESULTS: Nurses want to discuss issues connected to nursing and caring science that emerge in clinical nursing with their nurse leaders. Painful memories and thoughts are often related to patients struggling between life and death, the despair of families and friends, and their hovering between hope and hopelessness. The results do not support the notion that nurses would request other kinds of support or debriefing. CONCLUSIONS: The mission of nursing is to serve, console and alleviate human suffering. Nurse leaders carry a responsibility to create such evidence-based caring cultures that support the mission of nursing. Nurse leaders' understanding, sympathetic attitude, ethical value basis, personality and ability to discuss are important aspects for nurses. Through the support from nurse leaders, it seems possible to alleviate the nurse's suffering in clinical nursing. Implications for Nursing Management Nurse leaders' support creates a foundation for the nurses' professional development.