Values‐based practice is deemed essential for healthcare provision worldwide. In England, values‐based recruitment methods, such as multiple mini interviews (MMIs), are employed to ensure that healthcare students’ personal values align with the values of the National Health Service (NHS), which focus on compassion and patient‐centeredness. However, values cannot be seen as static constructs. They can be positively and negatively influenced by learning and socialisation. We have conceptualised students’ perceptions of their values over the duration of their education programme as (...) a ‘values journey’. The aim of this hermeneutic longitudinal focus group study was to explore the ‘values journey’ of student nurses and midwives, recruited through MMIs, across the 3 years of their education programme. The study commenced in 2016, with 42 nursing and midwifery students, originally recruited onto their programmes through multiple mini interviews. At the third and final point of data collection, 25 participants remained. Findings indicate that students' confidence, courage and sense of accountability increased over the 3 years. However, their values were also shaped by time constraints, emotional experiences and racial discrimination. We argue that adequate psychological support is necessary as healthcare students embark on and progress through their values journey, and propose a framework for this. (shrink)

MIRÓ M, GASTALDO D, NELSON S and GALLEGO G. Nursing Inquiry 2012; 19: 270–280 Spanish nursing under Franco: reinvention, modernization and repression (1956–1976)This article examines Spanish nursing during a critical 20‐year period (1956–76) when, under the dictatorial government of General Franco, nursing became the target of a modernization strategy. In the national standardized system of state‐run schools, the previously distinct nursing and midwifery programmes were merged into a new training programme which created the single professional denomination of ATS–Ayudante (...) Técnico Sanitario (Technical Sanitary Assistant). Under the leadership of medicine, and with the blessing of the Catholic Church and the Sección Femenina (Women’s Section of the Falangist Party), nursing was positioned as feminized and subordinate to medicine, a predominantly male profession in mid‐twentieth century Spain. This article discusses this crucial phase of Spanish nursing history by focusing on one influential historical document (published in 1956), Professional Moral Orientation for the Sanitary Technical Assistants, a nursing textbook on professional morals for first‐year nursing students written by Rosamaria Miranda, a Catholic nun and a trained nurse. Our analysis reveals that gender‐related and technical discourses concerning disciplinary and pastoral power relations presented in this textbook legitimate the core beliefs of Franquism put forward by the politically powerful women’s branch of the ruling Falangist Party in mid‐twentieth century Spain. (shrink)

Nursing and midwifery is, in the UK, regulated by the Nursing and Midwifery Council (NMC). Regulatory duties include establishing standards for education, and from January 2019, new educational programmes will be approved against standards detailed in the document Future nurse: Standards of proficiency for registered nurses (NMC, 2019—hereafter “the standards”). This publication lists “the knowledge and skills that registered nurses must demonstrate when caring for people” (NMC, 2019, p.3), and from September 2020, registration (licence) will require the successful (...) completion of programmes that have been ratified against these standards. The importance of this document in a UK context cannot be understated. However, less parochially, learning outcomes contained in section 7 of the standards raise questions that require educator attention whenever politically sensitive topics (broadly conceived) are discussed. This study explores these questions insofar as they relate to the stance (neutrality or partisanship) that educators adopt in politicized discussion, and the management of student speech/expression. Pratt, Boll and Collins’ (2007) paper Towards a plurality of perspectives for nurse educators is recruited to structure argument. (shrink)

The early withdrawal of students from healthcare education programmes, particularly nursing, is an international concern and, despite considerable investment, retention rates have remained stagnant. Here, a regional study of healthcare student retention is used as an example to frame the challenge of student attrition using a concept from policy development, wicked problem theory. This approach allows the consideration of student attrition as a complex problem derived from the interactions of many interrelated factors, avoiding the pitfalls of small‐scale interventions and over‐simplistic (...) assumptions of cause and effect. A conceptual framework is proposed to provide an approach to developing actions to reduce recurrent investment in interventions that have previously proved ineffective at large scale. We discuss how improvements could be achieved through integrated stakeholder involvement and acceptance of the wicked nature of attrition as a complex and ongoing problem. (shrink)

The study reported in this paper focused on nursing students' learning and, in particular, their integration of caring science in theory and practice. An educational model incorporating educational drama was developed for implementation in three different teaching contexts within the nursing and midwifery study programmes at a Swedish college. A central aim was to understand the dynamics of educational drama in the healthcare context and its impact on learning and teaching. Using a phenomenological approach, seventeen students and six teachers (...) were interviewed and their experience of drama as an educational method explored.The research findings illustrate the meaning of learning and teaching that is sensitive to students' lifeworld experiences. In order to be a successful method for closing the gap between caring science theory and practice, not only the educational drama, but teaching in general, must be anchored in the lived world of the students - that is, their experiences of health and care. While embodied reflection, as a key factor in integrating theory and practice, was shown to be well supported by educational drama, it was also found that "the method" tends too readily to take over and govern teaching and learning. The findings of this study further indicate how learning in practice and embodied reflection can be supported by the inclusion of well-chosen caring science theory to cast light on caring practice dilemmas. (shrink)

In this article it is argued that there are barriers to effective and non-discriminatory practice when mentoring overseas nurses within the National Health Service (NHS) and the care home sector. These include a lack of awareness about how cultural differences affect mentoring and learning for overseas nurses during their period of supervised practice prior to registration with the UK Nursing and Midwifery Council. These barriers may demonstrate a lack of effective teaching of ethical practice in the context of cultural (...) diversity in health care. This argument is supported by empirical data from a national study. Interviews were undertaken with 93 overseas nurses and 24 national and 13 local managers and mentors from six research sites involving UK health care employers in the NHS and independent sectors in different regions of the UK. The data collected showed that overseas nurses are discriminated against in their learning by poor mentoring practices; equally, from these data, it appears that mentors are ill-equipped by existing mentor preparation programmes to mentor overseas-trained nurses from culturally diverse backgrounds. Recommendations are made for improving mentoring programmes to address mentors’ ability to facilitate learning in a culturally diverse workplace and thereby improve overseas nurses’ experiences of their supervised practice. (shrink)

The following text explores performative art works commissioned within a specific “arts and health” cultural setting, namely that of a medical school within a British university. It examines the degree to which the professional autonomy of the artists was “instrumentalized” and diminished as a result of having to fit into normative frames set by institutional agendas. We ask to what extent do such “entanglements,” feel more like “enstranglements,” suffocating the artist’s capacity to envision the world afresh or any differently? What (...) kinds of pressures allow for certain kinds of “evidence” to be read and made visible,? Are You Feeling Better? was a 2016 programme curated by Frances Williams, challenging simplistic expectations that the arts hold any automatic power of their own to make “things better” in healthcare. It included two performative projects – The Secret Society of Imperfect Nurses, by Anthony Schrag with student nurses at Kings College London, and Hiding in Plain Sight by Becky Shaw with doctoral researchers in nursing and midwifery. These projects were situated in a climate of United Kingdom National Health Service cuts and austerity measures where the advancement of social prescribing looks dangerously like the government abnegating responsibility and offering art as amelioration. The text therefore examines the critical “stage” on which these arts-health projects were performed and the extent to which critical reflection is welcomed within institutional contexts, how learning is framed, expressed aesthetically, as well as understood as art practice. It further examines how artistic projects might offer sites of resistance, rejection and mechanisms of support against constricting institutional norms and practices that seek to instrumentalise artistic works to their own ends. (shrink)

This paper brings together ideas from two perspectives on ethics and health promotion. A discussion of the ethical dimension of the health promotion practice of community nurses is set in the wider context of health policy, with particular reference to health gain and individual responsibility. It is widely held that nurses have a key role to play in health promotion and that this is particularly the case for nurses working in primary health care. This assumption is reinforced by policy documents (...) from the World Health Organization, the Department of Health and statutory bodies such as the United Kingdom Central Council for Nursing, Midwifery and Health Visiting. The approach of many nurses to health promotion has tended on the one hand to be somewhat naive and on the other to be authoritarian and didactic; there has been little discussion in the nursing literature of the ethical aspects of health promotion. However, recent developments in nurse education, such as Project 2000 and the consequent changes to preregistration programmes, have resulted in increased attention to both ethics and health promotion within the curriculum. (shrink)

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. (shrink)

Background: Ethical care in maternity is fundamental to providing care that both prevents harm and does good, and yet, there is growing acknowledgement that disrespect and abuse routinely occur in this context, which indicates that current ethical frameworks are not adequate. Care ethics offers an alternative to the traditional biomedical ethical principles. Research aim: The aim of the study was to determine whether a correlation exists between midwifery-led care and care ethics as an important first step in an action (...) research project. Research design: Template analysis was chosen for this part of the action research. Template analysis is a design that tests theory against empirical data, which requires pre-set codes. Participants and context: A priori codes that represent midwifery-led care were generated by a stakeholder consultative group of nine childbearing women using nominal group technique, collected in Perth, Western Australia. The a priori codes were applied to a predesigned template with four domains of care ethics. Ethical considerations: Ethics approval was granted by the Edith Cowan University research ethics committee REMS no. 2019-00296-Buchanan. Findings: The participants generated eight a priori codes representing ethical midwifery care, such as: 1.1 Relationship with Midwife; 1.2 Woman-centred care; 2.1 Trust women’s bodies and abilities; 2.2. Protect normal physiological birth; 3.1. Information provision; 3.2. Respect autonomy; 4.1. Birth culture of fear (midwifery-led care counter-cultural) and 4.2. Recognition of rite of passage. The a priori codes were mapped to the care ethics template. The template analysis found that midwifery-led care does indeed demonstrate care ethics. Discussion: Care ethics takes into consideration what principle-based bioethics have previously overlooked: relationship, context and power. Conclusion: Midwifery-led care has been determined in this study to demonstrate care ethics, which suggest that further research is defensible with the view that it could be incorporated into the ethical codes and conduct for the midwifery profession. (shrink)

Background: Midwives are required to make ethical decisions with the support of respective codes of professional ethics which provide a framework for decision making in clinical practice. While each midwife should be ethically aware and sensitive to the ever-changing issues within reproduction, few empirical studies have examined the views of student midwives in relation to reproductive ethical dilemmas. Objective: The aim of this study was to explore midwifery students’ reactions to a number of ethical dilemmas relating to women’s experiences (...) of reproductive decision making. Design: A series of focus groups were conducted with midwifery students who were asked to discuss five culturally significant scenarios including issues of knowledge acquisition regarding methods of family planning, removal or insertion of an intrauterine device, and abortion. Setting: A University in Turkey was the setting for this study. Participants: Purposeful sampling was adopted which resulted in five focus groups with a total of 57 midwifery students. Ethical considerations: The study was reviewed and granted formal ethical approval by an ethical committee at the Faculty of Health Science in Atatürk University. The head of the Faculty of Health Science approved the investigation. The participants received both oral and written information about the study and they gave their consent. Results: Five themes were identified from the analysis of the focus group data related to all five scenarios. These themes were ‘the right to information’, ‘choice and protection’, ‘parental rights and welfare of the women’, ‘make a decision’ and ‘women rights and sexual abuse’. Conclusion: This study has shown that while students respected women’s choice, they also expressed great ambivalence in some situations when personal values conflict with dominant societal beliefs and professional ethics. A focus on ethics education to include human rights is suggested as a means to enable students to explore their own social-value judgements, and as a means to limit the possible development of ethical confusion and moral distress. (shrink)

Background The principle of human dignity is woven into the ethical principles of the midwifery profession, noted as both an obligation and a human right. Research Objectives The aim of this study is to explore the experiences of midwifery students regarding threats to women's dignity during childbirth. Research Design This is a qualitative study with explorative design. Participants and Research Context: The research was carried out in 2022 at Kermanshah University of Medical Sciences, involving 32 midwifery students (...) in individual interviews that lasted between 30 and 90 minutes. These participants aged 21 to 28 years, with an average age of 23.5 years, provided their perspectives on the matter. Results Four key themes described the threats to women’s dignity during childbirth: 1) professional incompetence, 2) abuse of power imbalance, 3) caring only for physical and not mental health, and 4) structural issues within the healthcare system. Professional incompetence was characterized by outdated practices and lack of adherence to evidence-based medicine. Abuse of power imbalance was demonstrated in instances where the authoritative position of healthcare providers was misused, thereby disrupting the respectful care that women are entitled to receive. The disproportionate emphasis on physical health over mental health was evidenced by the disregard for mothers' psychological well-being during childbirth. Lastly, systemic structural issues emerged as significant impediments, revealing the need for system-wide changes. Ethical considerations: This study was approved by the Ethics Committee of the Research Deputy at Kermanshah University. Participation was voluntary and the confidentiality were maintained. Conclusion The findings underscore the role that unprofessional behavior, ethical lapses in medical practices, and systemic challenges play in undermining maternal dignity during childbirth. These threats necessitate urgent attention and must be adequately addressed in policy development and program implementation to safeguard the dignity of mothers during childbirth. (shrink)

The Theaetetus’s midwife metaphor contains a puzzling feature, often referred to as the “midwife paradox”: the physical midwives must have first given birth to their own children in order to have the necessary experience to practice their art. Socrates, however, seems to disavow having any children of his own and thus appears to be unqualified to practice philosophical midwifery. In this paper, I aim to dissolve the midwife paradox by arguing that it rests on problematic assumptions, namely, that Socrates (...) never gave birth to a child at all or the child of wisdom in particular, and that he is primarily an intellectual midwife. I offer a new interpretation of Socratic midwifery, arguing that what Socrates may have birthed in the past which qualifies him for midwifery is his virtuous recognition of his ignorance, and that this “epistemic virtue” is also the proximate goal of Socratic midwifery. (shrink)

Midwifery work and the making of narrativeThis paper draws on a study of birth support conducted across three Melbourne maternity units. Midwife informants were asked to participate in semistructured interviews with two researchers and describe the activity and role of lay birth support people. In the course of the study, the activity of the midwives themselves became a research focus. The study found that one of the key tasks midwives described was assisting birthing women to develop and negotiate satisfactory (...) birth narratives that could encompass the intense and sometimes difficult experience of birth. Midwife informants offered strategies for the development of such narratives as part of their professional and personal labour in the birth room. (shrink)

Field-Programmable Gate Arrays (FPGAs) have emerged as an attractive means of implementing logic circuits, providing instant manufacturing turnaround and negligible prototype costs. They hold the promise of replacing much of the VLSI market now held by mask-programmed gate arrays. FPGAs offer an affordable solution for customized VLSI, over a wide variety of applications, and have also opened up new possibilities in designing reconfigurable digital systems. Field-Programmable Gate Arrays discusses the most important aspects of FPGAs in a textbook manner. It provides (...) the reader with a focused view of the key issues, using a consistent notation and style of presentation. It provides detailed descriptions of commercially available FPGAs and an in-depth treatment of the FPGA architecture and CAD issues that are the subjects of current research. The material presented is of interest to a variety of readers, including those who are not familiar with FPGA technology, but wish to be introduced to it, as well as those who already have an understanding of FPGAs, but who are interested in learning about the research directions that are of current interest. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Environmental Midwifery and the Need for an Ethics of the Transition:A Quick Riff on the Future of Environmental EthicsStephen M. Gardiner (bio)It is worth remembering that in many ways environmental ethics is a very successful field. Over the course of only thirty or forty years, we have reached a point at which almost every significant philosophy program in the country offers a course in environmental ethics, there are (...) several established and well respected journals, and the subject is regarded as one of the core areas of "applied ethics." This is quite an achievement; and one that is easy to forget. (When I listen to the complaints of environmental colleagues in other disciplines, or of philosophers working in many areas of applied ethics, I am vividly reminded.)Still, there is a sense that the job is only half done. For one thing, although environmental ethics classes are ubiquitous, they are usually undergraduate survey courses taught by nonspecialists. For another, although good work appears in the specialist journals, it rarely makes it into the "mainstream" journals that most philosophers read. Finally, although environmental ethics counts as one of three or four core areas of applied ethics, environmental philosophers are rarely hired by (so-called) top departments (and if they are, it is often not because they are environmental philosophers, but because of the other things they do).Now, many questions arise about this situation. One of them, of course, is whether there is some kind of "glass ceiling" on environmental ethics, and if there is, what causes it? Another is whether the core problem [End Page 122] is that we're just not all that good at environmental ethics (yet)? These are reasonable worries (about which my own views would be rather sanguine). But I am more concerned about another issue, which one might call that of "interfacing".The claim that environmental ethics has some problems in interacting with philosophy more generally, with allied disciplines, and with the wider public has been widely discussed in recent years, especially in the emergence of what has come to be called "environmental pragmatism." There is something important about this debate, but my own sense is that it can become overblown. For example, when I teach my undergraduate survey course, mainly to nonphilosophers, they are, if anything, more excited about the Land Ethic, Biocentric Egalitarianism, and the worth of species than about climate change and sustainability. Still, there is something going on. However sympathetic they are to philosophy, I have the sense that my students (as well as my colleagues in other disciplines and the wider public) are dissatisfied. Having heard the critiques and the first set of grand visions, the new challenges and their problems, they want more. Irritatingly, they want to know what to do now—either how to turn grand visions into actions, or (more usually) how to successfully muddle through in the absence of a compelling grand vision. In short, they want an ethics for the transition.For what it is worth, my sense is that the main task of an ethics for the transition lies somewhere between grand theory and pragmatism. What people are hoping for is a way to transform serious environmental concern into social change. But they want this transformation to be responsive to, reflective of, and integrated with wider values. Sensing that modern life has significant vices, but also major virtues, they wish to see environmental ethics synthesize their concerns in new and creative ways. In short, like a Socratic midwife, they want environmental philosophy to help them to articulate the way forward.I'm sympathetic to the need for an ethics for the transition. I also think that taking on the task of articulating such an ethic may help the field to break through some of the institutional constraints now restricting it. But mainly it just seems to be a worthy topic in its own right. Environmental ethics should try to become an ethics for living now. In the nicest sense of the phrase, it should seek to "grow up."Stephen M. Gardiner Stephen M. Gardiner is an Associate Professor in the Department of Philosophy and the Program on Values in Society at the... (shrink)

Medical malpractice has attracted the attention of people and the media all over the world. In Turkey, malpractice cases are tried according to both criminal and civil law. Nurses and midwives in Turkey fulfill important duties in the distribution of health services. The aim of this study was to reveal the legal procedures followed in malpractice allegations and malpractice lawsuits in which nurses and midwives were named as defendants. We reviewed 59 nursing and midwifery lawsuits reported to the Higher (...) Health Council between 1993 and 1998. Health professionals were held liable in 59% of the lawsuits. Midwives had the highest percentage of malpractice liability (52%), followed by physicians (29%) and nurses (19%). To reduce potential liability, nurse education should be improved, a nursing malpractice law should be enacted, and instructions for nursing procedures should be formulated. (shrink)

This book offers a distinctive interpretation of Hegel's Phenomenology of Spirit. It suggests that Hegel's approach in the 1807 Phenomenology is akin to Socratic 'midwifery'. The book starts from the midwife figure in Plato's dialogue Theaetetus. There Socrates elicits from Theaetetus his views on the nature of knowledge, without imposing on him his own ideas thereof. Similarly, in the 1807 Phenomenology Hegel elicits a series of shapes of consciousness and spirit, and uncovers the implications of each one of them. (...) In the same way as Socrates subjected in his interlocutor's views to an internal criticism to see whether they were valid or not, Hegel subjects the various 'shapes of consciousness' to an immanent critique, in the course of which each oneof them proves to be inadequate on its own terms. Like the Platonic dialogue Theaetetus, Hegel's Phenomenology does not end in a positive doctrine. So the Phenomenology of Spirit introduces us to philosophical science in a negative sense, that is, by showing what philosophical science is not. In this way it prepares the ground for science proper, namely, Hegel's Science of Logic. (shrink)

Research suggests that the incidence of moral distress experienced by health professionals is significant and increasing, yet the concept lacks clarity and remains largely misunderstood. Currently, there is limited understanding of moral distress in the context of midwifery practice. The term moral distress was first used to label the psychological distress experienced following complex ethical decision-making and moral constraint in nursing. The term is now used across multiple health professions including midwifery, nursing, pharmacy and medicine, yet is used (...) cautiously due to confusion regarding its theoretical and contextual basis. The aim of this study is to understand the concept of moral distress in the context of midwifery practice, describing the attributes, antecedents and consequences. This concept analysis uses Rodgers’ evolutionary framework and is the first stage of a sequential mixed-methods study. A literature search was conducted using multiple databases resulting in eight articles for review. Data were analysed using NVivo12©. Three core attributes were identified: moral actions and inactions, conflicting needs and negative feelings/emotions. The antecedents of clinical situations, moral awareness, uncertainty and constraint were identified. Consequences of moral distress include adverse personal professional and organisational outcomes. A model case depicting these aspects is presented. A midwifery focused definition of moral distress is offered as ‘a psychological suffering following clinical situations of moral uncertainty and/or constraint, which result in an experience of personal powerlessness where the midwife perceives an inability to preserve all competing moral commitments’. This concept analysis affirms the presence of moral distress in midwifery practice and provides evidence to move towards a consistent definition of moral distress. (shrink)

Background: Most undergraduate midwifery curricula comprise ethics courses to strengthen the moral competences of future midwives. By contrast, surprisingly little is known about the specific moral competences considered to be relevant for midwifery practice. Describing these competences not only depends on generic assumptions about the moral nature of midwifery practice but also reflects which issues practitioners themselves classify as moral. Objective: The goal of this study was to gain insight into the ethical issues midwives encounter in their (...) daily work, the key competences and resources they consider indispensable to understand and deal with them, and to assess phenomena linked to moral distress. Methods: We conducted individual semi-structured interviews with eight midwives and two other health professionals, varying in terms of years of experience and work setting. Interview transcripts were analyzed in an interdisciplinary research group, following thematic analysis. Ethical considerations: This study was not subject to approval according to the Swiss Law on Research with Humans. Participants were informed about the study goals and gave written informed consent prior to participation. Results: External constraints limiting the midwife’s and the patient’s autonomy and resulting interpersonal conflicts were found to be the most relevant ethical issues encountered in clinical practice and were most often associated with moral distress. These conflicts often arise in the context of medical interventions midwives consider as not appropriate and situations in which less experienced midwives in particular observe a lack of both interprofessional communication and trust in their professional competence. Ethical issues related to late abortions or prenatal diagnostics and selective abortions were also frequently addressed, but many midwives involved had learned to cope with them. Discussion: In the light of the ethical issues and factors contributing to phenomena of moral distress, an empirically grounded profile of moral competences is drafted. Curricular implications in the light of possible adaptations within undergraduate midwifery education are critically discussed. (shrink)

The introspective devices framework proposed by Kammerer and Frankish (this issue) offers an attractive conceptual tool for evaluating and developing accounts of introspection. However, the framework assumes that different views about the nature of introspection can be easily evaluated against a set of common criteria. In this paper, I set out to test this assumption by analysing two formal models of introspection using the introspective device framework. The question I aim to answer is not only whether models developed outside of (...) philosophy can be successfully evaluated against the set of conceptual criteria proposed by Kammerer and Frankish, but also whether this kind of evaluation can reveal some limitations inherent to the framework. (shrink)

Background: This study was developed as a result of a court case involving conflicts between midwives’ professional practice and their faith when caring for women undergoing abortions in Scotland. Research questions: What are practising Roman Catholics’ perspectives of potential conflicts between midwives’ professional practice in Scotland with regard to involvement in abortions and their faith? How relevant is the ‘conscience clause’ to midwifery practice today? and What are participants’ understandings of Canon 1398 in relation to midwifery practice? Research (...) design: The theoretical underpinning of this study was Gadamer’s hermeneutic out of which the method developed by Fleming et al. involving a five-stage approach was utilised. Participants and research context: The research was conducted in the south of Scotland. A purposive sampling method was used. Eight participants who were practising Roman Catholics familiar with the subject of conscientious objection who were either midwives, lawyers (civil, canon or both) or priests contributed. Ethical considerations: The major ethical issues related to respect for autonomy, maintaining confidentiality and obtaining voluntary informed consent. Parish priests agreed to act as gatekeepers to prospective participants. All legal requirements were addressed regarding data collection and storage. Approval was given by the ethics committee of the university with which one of the researchers were associated. Findings: Three key themes provide an understanding of the situation in which midwives find themselves when considering the care for a woman admitted for an abortion: competing legal systems, competing views of conscience and limits of participation. Conclusion: Clear guidelines for practice should be developed by a multi-professional and consumer group based on an update of the abortion law to reflect the change from a surgical to medical procedure. Clarification of Canon 1398 in relation to what is and is not participation in the procurement of abortion would be of benefit to midwives with a conscientious objection. (shrink)

Qualitative research, particularly phenomenology, is increasingly popular as a method for midwifery and health-related research. These approaches enable rich and detailed explanations to be uncovered and bring experience to life. Important recommendations and practice- based implications may then be raised and debated for future use. This book brings together a range of phenomenological methods and insights into one accessible text. Illustrated with plenty of examples of successful phenomenological research, Qualitative Research in Midwifery and Childbirth keeps the focus applied (...) to midwifery and childbirth and makes clear the links to practice throughout. The book introduces three key phenomenological approaches âe" descriptive, interpretive and the life world âe" and includes a comparative chapter which discusses the differences between these varied perspectives and methods. Each chapter focuses on how these approaches are used within midwifery research. The remaining chapters present a number of different research projects. These demonstrate how different phenomenological approaches have been used to explore and uncover experiences of childbirth and maternity as well as offering important insights into how women experience different facets of the birth experience during the antenatal, intra-partum and postnatal period. Designed for researchers and students undertaking research projects on midwifery and childbirth, this text includes contributions from a range of international and highly regarded phenomenological authors and researchers. (shrink)

In this editorial, we argue that midwives should focus on climate change, a link which has been underexplored.

In Plato's Theaetetus Socrates is portrayed as a midwife of the intellect. The comparison of Socratic questioning to midwifery had until recently been commonly attributed to Socrates himself. In 1977 M. F. Burnyeat published Socratic Midwifery, Platonic Inspiration, which transformed the way in which the dialogue has since been perceived. The author maintains that the midwife comparison is in no sense to be attributed to the historical Socrates.

Background: Ethics education is a basic part of midwifery education program. However, there is no evidence to show that ethics education has been able to meet the educational needs of midwifery students. Purpose: This study aimed to explore the educational needs of students for ethics in midwifery program with a focus on the course of history, ethics, and rules of midwifery. Research design and participants: The present study is qualitative descriptive content analysis research, exploring midwifery (...) students’ needs of ethics education in bachelor’s degrees. We conducted in-depth semi-structured interviews with 11 undergraduate midwifery students, seven midwives working in hospitals and health centers, and seven midwifery faculty members in Urmia University of Medical Sciences. The participants were selected using a purposeful sampling method and invited to join the study from December 2021 to June 2022. The sampling continued until data saturation. Findings: Content analysis identified four categories and associated subcategories: 1. “The client’s rights”: respecting the dignity of clients, confidentiality, the client’s right to choose and make decisions; 2. “Legal and ethical requirements of fertility”: abortion, alternative treatment for infertility, domestic violence; 3. “Communication skills”: communication with the client, communication with clients’ caregivers and communication with colleagues; and 4. “ethical principles in research”: compliance with ethical principles in the research process and ethical principles in publishing research findings. Ethical considerations: The study was approved by the Ethics Committee of Urmia University of Medical Sciences. Before filling the questionnaires, written informed consent was obtained from the participants. The participants were assured of the confidentiality of personal information. Conclusion: The educational needs of midwifery students can be met by providing theoretical and practical training on respecting the pregnant mother, communication skills, legal and ethical aspects of the reproductive period, and incorporating ethical principles in related courses. (shrink)

Background: As a normative theory, care ethics has become widely theorized and accepted. However, there remains a lack of clarity in relation to its use in practice, and a care ethics framework for practice. Maternity care is fraught with ethical issues and care ethics may provide an avenue to enhance ethical sensitivity. Aim: The purpose of this scoping review is to determine how care ethics is used amongst health professions, and to collate the information in data charts to create a (...) care ethics framework and definition for midwifery practice. Method: The scoping review was conducted according to the Preferred Reporting Items for Scoping reviews (PRISMA-ScR) and Joanna Briggs Institute (JBI) recommendations. The search was applied to the databases CINAHL, MEDLINE, PschInfo and Pubmed which were searched in September 2019 and again in July 2021. The inclusion criteria were guided by the mnemonic for search terms: Participants, Concept, and Context (PCC) and included variations of health care professionals, care ethics and utilization. The search was limited to qualitative studies published in English between 2010 and 2021. A data extraction tool was used to extract and synthesize data into categories. The articles were screened for eligibility by title, abstract and full text review, by two independent reviewers. Ethical Considerations: The scoping review was guided by ethical conduct respecting authorship and referencing sources. Results: Twelve of the initially identified 129 studies were included in the scoping review. Data synthesis yielded four categories of care ethics use by health professionals: relationship, context, attention to power and caring practices. In combination, the evidence forms a framework for care ethics use in midwifery practice. Conclusion: Care ethics use by health professionals enhances ethical sensitivity. A framework and definition for care ethics for midwifery practice is proposed. This review will be of interest to midwives and other health practitioners seeking to enhance ethical sensitivity. (shrink)

This book offers a distinctive treatment of Hayek's ideas as a "research program". It presents a detailed account of aspects of Hayek's intellectual development and of problems that arise within his work, and then offers some broad suggestions as to ways in which the program initiated in his work might be developed further. The book discusses how Popper and Lakatos' ideas about "research programs" might be applied within political theory. There then follows a distinctive presentation of Hayek's intellectual development up (...) to The Road to Serfdom, together with critical engagement with his later ideas. The discussion draws on a full range of his writings, makes use of some neglected earlier work on social theory and law, and also draws on archival material. This book should appeal to anyone with an interest in Hayek's work, as well as to those with a concern for twentieth century intellectual history. (shrink)

Julius Tomin has recently questioned the new orthodoxy, stemming from Burnyeat's impressive article, that Socratic midwifery is not genuinely Socratic. I understand that many will feel the need to question Burnyeat's position, but I am unhappy that Aristophanes' comedy has once again been thought to give support to the view that Socrates had been known as an intellectual midwife. Thus my response will concentrate on our understanding of Clouds, and in particular on the key passage at 135ff.

Professional ethics is one of the important topics, which includes various rights such as respecting the patient’s right to choose, being useful, being harmless, and respecting the justice, integrity, and confidentiality of information. Adherence to these principles can increase the quality of care and patient satisfaction. Since determining the current attitude of students towards ethics plays an important role in educational programs, this study was conducted to evaluate the attitude of nursing and midwifery students of Kermanshah University of Medical (...) Sciences towards six principles of professional ethics. In this cross-sectional study, 76 undergraduate nursing and midwifery students were selected to participate in this study by census method. The data collection tool was a valid and reliable questionnaire on the principles of medical ethics. Data were analyzed using descriptive and inferential statistics. The study sample consisted of 49 nursing and 27 midwifery students with an average age of 23 ± 1.4 years. The mean score of nursing and midwifery students’ attitude towards medical ethics was 95.01 ± 4.8 in basis of 100, and was 94.56 ± 4.9 for nursing students and 96.04 ± 4.7 for midwifery students. Majority of the samples had positive attitude towards medical ethics and 3.73% had a relatively positive attitude. No statistically significant relationship was found between the attitude of students and variables of gender, field of study, marital status, and age. All students in this study had a positive attitude towards the principles of medical ethics, and this is a valuable asset for clinical environments. To increase the generalizability of the study, further studies with bigger sample size on the students of various disciplines of medical sciences is recommended. (shrink)

In the renewed Russian Fundamental Law, in addition to a number of provisions introducing changes to the political system, there are also statements of programmatic importance, as well as several provisions with symbolic and identity function. In this article these provisions are subject to functional and semiotic-cultural analysis. Particular emphasis has been placed on legally irrelevant content transmitted by the new regulations, on their semantic connections with the content of the preamble and on their cultural context. The research procedure carried (...) out allows us to state that, compared with the 1993 text, the Russian Constitution in its current version participates to a much greater extent in the complex system of transmission of symbolic content, as well as the narratives that contribute to social memory, cultural and historical identity. In doing so, it goes beyond its genre limitations, opening the basic text to the functions assigned to the preamble. In the fragments I have analysed in the paper there are undoubtedly functional and genre disturbances, and with them changes the mode of semiosis of the legal text, both in its normative and programmatic form. Renewed Constitution is the case in which a legal text, by its very nature designing the possible future world, does so through ideas about the past. (shrink)

Sociologists have increasingly adopted the insight that ‘modern societies’ undergo major historical transformations; they are not stable or undergoingonly smooth social change once their basic institutional structure has been established. There is even some broad agreement that the late twentieth century witnessed the most recent one of those major transformations leading into the present time – variously characterized by adding adjectives such as ‘reflexive’, ‘global’ or simply ‘new’ to modernity. However, neither the dynamics of the recent social transformation nor the (...) characteristic features of the present social constellation have been adequately grasped yet.Rather than assuming a socio-structural or politico-institutional perspective, as they dominate in sociology and political science respectively, this articleconcentrates on the way in which current social practices are experienced and interpreted by the human beings who enact them as parts of a common worldthat they inhabit together. It will be suggested that current interpretations are shaped by the experience of the dismantling of ‘organized modernity’ from the 1970s onwards and of the subsequent rise of a view of the world as shaped by parallel processes of ‘globalization’ and ‘individualization’, signalling the erasure of historical time and lived space, during the 1990s and early 2000s. In response to these experiences, we witness today a variety of interconnected attempts at re-interpretation of modernity, aiming at re-constituting spatiality and temporality. The re-constitution of meaningful time concerns most strongly questions of historical injustice, in terms of the present significance of past oppression and exclusion and in terms of the unequal effects of the instrumental transformation of the earth in the techno-industrial trajectory of modernity. The re-constitution of meaningful space focuses on the relation between the political form of a spatially circumscribed democracy and the economic practices of expansionist capitalism as well as on the spatial co-existence of a plurality of ways of world-interpretation. (shrink)

Shared decision making has become the standard of care, yet there remains no consensus about how it should be conducted. Most accounts are concerned with threats to patient autonomy, and they address the dangers of a power imbalance by foregrounding the patient as a person whose complex preferences it is the practitioner's task to support. Other corrective models fear that this level of mutuality risks abdicating the practitioner's responsibilities as an expert, and they address that concern by recovering a nuanced (...) but genuinely directive clinical role. Cribb and Entwistle helpfully categorize models of shared decision making as ‘narrower’ and ‘broader’ and praise the latter's ‘open‐ended and fully dialogical ways of relating’. However, they stop short of providing a philosophical account of how that dialogue works. In this paper, a nurse–midwife and a philosopher collaborate to argue that the Socratic model of dialogue offers a solution to the practitioner–patient dilemma. In the Theaetetus, Socrates compares dialogical reasoning to ‘midwifery with all its standard features’. By means of a three‐way analogy, elements of midwifery practice are used to illuminate features of Socrates' claim that his dialogue is like midwifery; those features are then translated into an approach to shared decision making as the ‘midwifery of good thinking’ which both midwives and physicians would do well to adopt. A key concept that emerges is the need for practitioners to make a risk‐confidence assessment of the particular content of any decision to appropriately modulate their role in the practice of shared decision making. (shrink)

Background In August 2017, Chile lifted its complete ban on abortion by permitting abortion in three limited circumstances: 1) to save a woman’s life, 2) lethal fetal anomaly, and 3) rape. The new law allows regulated use of conscientious objection in abortion care, including allowing institutions to register as objectors. This study assesses medical and midwifery students’ support for CO, following legal reform. Methods From October 2017 to May 2018, we surveyed medical and midwifery students from seven universities (...) located in Santiago, Chile. Universities included 4 secular and 3 private religiously-affiliated universities; all offering medical degrees with a specialization in obstetrics and gynecology and five offering midwifery degrees. We used generalized estimating equations to identify characteristics associated with student support for CO, intentions to use CO to refuse to care for someone seeking abortion, and support for CO at the institutional level. Results 333 of the 413 eligible students who opened the survey, completed the questions on conscientious objection; 26% were seeking medical degrees with an ob-gyn specialty, 25% were seeking midwifery degrees, and 49% were seeking medical degrees and had not yet decided their specialty. While nearly all endorse requirements for conscientious objecting clinicians to inform and refer abortion-seeking patients, a minority would personally use conscientious objection to avoid caring for a patient seeking abortion. About half of religious-university students and one-fifth of secular-university students support objections at the institutional level. Conclusions Most students support the regulated use of CO which preserves patients’ access to abortion care. Religious-university student views on the use of conscientious objection in abortion care are discordant with those of their institutions which currently support institutional-level objections. (shrink)