Bern University of Applied Sciences, Switzerland.
Bern University of Applied Sciences, Switzerland; University of Zurich, Switzerland.
Nurs Ethics. 2019 Aug;26(5):1373-1386. doi: 10.1177/0969733018761174. Epub 2018 Mar 27.
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.
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.
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.
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.
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.
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.
大多数本科助产课程都包含伦理学课程，以增强未来助产士的道德能力。相比之下，人们对助产实践中认为相关的具体道德能力却知之甚少。描述这些能力不仅取决于对助产实践道德本质的一般假设，还反映了从业者自身将哪些问题归类为道德问题。
本研究旨在深入了解助产士在日常工作中遇到的伦理问题、他们认为理解和处理这些问题不可或缺的关键能力和资源，并评估与道德困境相关的现象。
我们对 8 名助产士和 2 名其他卫生专业人员进行了个体半结构化访谈，这些专业人员在工作经验和工作环境方面存在差异。在跨学科研究小组中，根据主题分析对访谈记录进行了分析。
根据瑞士人类研究法，本研究无需获得批准。在参与之前，参与者被告知了研究目的，并在书面知情同意书上签字。
在临床实践中，外部限制助产士和患者自主权并导致人际冲突的因素被认为是最相关的伦理问题，并且这些冲突往往与道德困境相关。这些冲突常常出现在助产士认为不合适的医疗干预以及经验较少的助产士观察到缺乏跨专业沟通和对其专业能力的信任的情况下。与晚期流产或产前诊断和选择性流产相关的伦理问题也经常被提及，但许多涉及的助产士已经学会了应对这些问题。
根据伦理问题和导致道德困境现象的因素，制定了道德能力的实证基础概况。批判性地讨论了本科助产教育中可能进行的课程调整的课程影响。
