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 face challenges regarding professional identify. Being unaware of these challenges and not owning positive professional identify leads to a lack of self-confidence. Thus, nurses face problems in interpersonal communication and lose their attachment to their profession. Few studies have engaged with impediments to forming positive professional identity in relation to intensive care nurses. Objective: The purpose of this study is to investigate the impediments to forming positive professional identity in nurses working in intensive care unit. Research design: In (...) this study, the conventional content analysis method was used in order to obtain the impediments to forming positive professional identities in nurses. Data were collected through 15 semi-structured interviews and 2 focus group interviews from March 2015 to June 2016. Purposive sampling was used and participants were recruited until data saturation was reached; they were then analyzed using the conventional content analysis method. Participants and research context: In total, 24 intensive care unit nurses from one hospital in Northern Iran were selected through purposive sampling. Ethical consideration: This study was approved by the Ethics Committee of Shiraz University of Medical Sciences. Findings: Four main themes of professional identity challenges were extracted from the analysis of the data: neglect of professional status of nursing; distrust of nursing knowledge; unprofessional performance; and low professional attraction. Discussion and conclusion: Nurses stated that the neglect of the professional status of nursing and distrust of nursing knowledge have always been a hindrance in forming a positive professional identity. They also mentioned that unprofessional performance and low professional attraction are the other influencing factors in this regard. Thus, detecting these factors can guide nurses and their managers towards creating positive professional identity, and as a result, will improve their job satisfaction, professional advancement, and durability. (shrink)

The aim of this study was to explore the existence of moral distress among nurses in Lilongwe District of Malawi. Qualitative research was conducted in selected health institutions of Lilongwe District in Malawi to assess knowledge and causes of moral distress among nurses and coping mechanisms and sources of support that are used by morally distressed nurses. Data were collected from a purposive sample of 20 nurses through in-depth interviews using a semi-structured interview guide. Thematic analysis of qualitative data was (...) used. The results show that nurses, irrespective of age, work experience and tribe, experienced moral distress related to patient/nursing care. The major distressing factors were inadequate resources and lack of respect from patients, guardians, peers and bosses. Nurses desire teamwork and ethics committees in their health institutions as a means of controlling and preventing moral distress. There is a need for creation of awareness for nurses to recognize and manage moral distress, thus optimizing their ability to provide quality and uncompromised nursing care. (shrink)

The governance of pharmaceutical medicines entails complex ethical decisions that should, in theory, be the responsibility of democratically accountable government agencies. However, in many Low- and Middle-Income Countries (LMICs), regulatory and health systems constraints mean that many people still lack access to safe, appropriate and affordable medication, posing significant ethical challenges for those working on the “front line”. Drawing on 18 months of fieldwork in Ghana, we present three detailed case studies of individuals in this position: an urban retail pharmacist, (...) a rural over-the-counter medicine retailer, and a local inspector. Through these case studies, we consider the significant burden of “ethical labour” borne by those operating “on the ground”, who navigate complex moral, legal and business imperatives in real time and with very real consequences for those they serve. The paper ends with a reflection on the tensions between abstract, generalised ethical frameworks based on high-level principles, and a pragmatic, contingent ethics-in-practice that foregrounds immediate individual needs – a tension rooted in the gap between the theory and the reality of pharmaceutical governance that shifts the burden of ethical labour downwards and perpetuates long-term public health risks. (shrink)