Ethical problems regularly arise during daily care in nursing homes. These include violation of patients' right to autonomy and to be treated with respect. The aim of this study was to investigate how caregivers emphasize daily dialogue and mutual reflection to reach moral alternatives in daily care. The data were collected by participant observation and interviews with seven caregivers in a Norwegian nursing home. A number of ethical problems linked to 10 patients were disclosed. Moral problems were revealed as the (...) caregivers acted in ways that they knew were against patients' interest. We used a theoretical interpretation according to Habermas' discourse ethics on the importance of dialogue when deciding moral courses of action for patients. This theory has four basic requirements: communicative competence, equality, self-determination, and openness about motives. (shrink)

Student nurses are confronted by many ethical challenges in clinical practice. The aim of the study was to explore Malawian students’ experiences of ethical problems during their clinical placement. A phenomenological hermeneutic design comprising interviews and qualitative content analysis was used. Ten students were interviewed. Three main themes emerged: 1) Conflict between patient rights and the guardians’ presence in the hospital; 2) Conflict between violation of professional values and patient rights caused by unethical behaviour; and 3) Conflict between moral awareness (...) and the ideal course of action. The students had difficulties ensuring patient rights and acting in accordance with western norms and values which are not always appropriate in the Malawian context. The students require role models who demonstrate professional attitudes towards patients’ rights and values. There is a need to create pedagogical strategies in which a caring attitude and ethical reflection can be learned and cultivated in clinical practice. (shrink)

Background: Nurses and student nurses in Malawi often encounter challenges in taking a moral course of action. Several studies have demonstrated a need for increased awareness of ethical issues in the nursing education. Objective: To explore the challenges experienced by nurse teachers in Malawi in their efforts to enhance students’ moral competence in clinical practice. Research design: A qualitative hermeneutic approach was employed to interpret the teachers’ experiences. Participants and research context: Individual interviews (N = 8) and a focus group (...) interview with teachers (N = 9) from different nursing colleges were conducted. Ethical considerations: Ethical approval was granted and all participants signed their informed consent. Findings: Two overall themes emerged: (1) authoritarian learning climate, with three subthemes: (a) fear of making critical comments about clinical practice, (b) fear of disclosing mistakes and lack of knowledge and (c) lack of a culture of critical discussion and reflection that promotes moral competence; and (2) discrepancy between expectations on learning outcome from nursing college and the learning opportunities in practice comprising three subthemes: (a) gap between the theory taught in class and learning opportunities in clinical practice, (b) lack of good role models and (c) lack of resources. Discussion: Our findings indicated that showing respect was a central objective when the students were assessed in practice. A number of previous studies have enlightened the need for critical reflection in nursing education. Few studies have linked this to challenges experienced by teachers for development of moral competence in practice. This is one of the first such studies done in an African setting. Conclusion: There is a clear relationship between the two themes. A less authoritarian learning climate may enhance critical reflection and discussion between students, teachers and nurses. This can narrow the gap between the theory taught in college and what is demonstrated in clinical practice. Moral competence must be enhanced in order to ensure patients’ rights and safety. (shrink)