BackgroundConsidering ethical issues in midwifery care is essential for improving the quality of health services and the client's satisfaction. This study aimed to develop and validate the code of ethics for Midwives in Iran (ICEM).Materials and methodsThis was a mixed sequential study that was performed in three phases including a qualitative study, a review, and the content validity assessment. The first phase was a qualitative study with a content analysis approach. The data were collected by conducting in-depth semi-structured individual interviews (...) with 14 midwifery and ethics experts. The purposive sampling method was used to recruit the participants and sampling continued until data saturation. The data were analyzed using the conventional content analysis described by Graneheim and Lundman. Lincoln and Guba’s criteria were used to confirm the trustworthiness of the data. Then, a narrative review of the selected national and international codes of ethics for Midwives was performed to complete the items of the ICEM. For validity assessment, the face and content validity of the items of ICEM was assessed by 15 experts to calculate the content validity ratio (CVR) and index (CVI).ResultsFourteen experts were interviewed in the qualitative phase, and 207 codes were extracted from a content analysis which were categorized into 23 sub-categories and 6 main categories. The extracted codes were considered as the items for ICEM that were completed by a review of the selected national and international code of ethics for Midwives. The content validity and ratio assessment of the items demonstrated an average CVI = 0.92 and CVR = 0.85. Then, the final version of ICEM was developed with 92 items in 6 domains about; 1) "professional Commitments" with 30 items; 2) "providing midwifery services to the client and her companions” with 26 items; 3) “relationship with colleagues" with 11 items; 4) “herself” with 6 items; 5) “education and research” with 8 items; and, 6) “management” with 11 items.ConclusionICEM was prepared with 92 items in six sections that facilitate its use for midwives who are working in the different fields of care, counseling, education, research, and management. In this new version of the ICEM, the items related to recent social-, scientific, and technical improvements were considered for providing ethical midwifery care. (shrink)

Practitioners’ ethical orientation and responses vary between practice settings. Yet, currently, the ethics for midwifery practice that is explicit in the literature and which provides the ideals of socialization into practice, is that of bio(medical)ethics. Traditional bioethics, developed because of World War II atrocities and increased scientific research, is based on moral philosophy, normative theory, abstract universal principles and objective problem solving, all of which focus on right and wrong ‘action’ for resolving dilemmas. They exclude context and relationship. Personal narratives (...) of mothers and midwives contest the appropriateness of these accepted values and systems for childbirth because they induce conflict between work-place/service provider ethics and personal/professional midwifery ethics. In contrast to the disembedded and disembodied approach of biomedical ethics, an ethically adequate response in midwifery practice resonates more with the ethics of intimates, such as feminist virtue ethics. (shrink)

The purpose of this study was to determine the professional and personal values among midwifery students in Turkey and to identify whether the years of study affected these values. A total of 192 participants were asked to prioritize 16 professional and 36 personal values. The relationship between the year of study and value ranking was analyzed by Kruskal–Wallis test. The first three of the professional values were justice, equality, and human dignity. Equality ranked sixth among the personal terminal values, and (...) it increased with the years of study. Of personal instrumental values, responsibility and cleanliness ranked second and fifth, which are of central importance for the profession of midwifery. However, the other two important values, privacy and preventing unnecessary suffering, ranked lower when the years of study increased, in other words when the students confront clinics. Since these values are important for midwifery, ethics courses should be given throughout the midwifery education to prepare students for the challenges they face in the clinical environment. (shrink)

Adherence to professional ethics in nursing is fundamental for high-quality ethical care. However, analysis of the use and impact of nurses’ codes of ethics as a part of professional ethics is limited. To fill this gap in knowledge, the aim of our review was to describe the use and impact of the Code of Ethics for Nurses with Interpretive Statements published by the American Nurses Association as an example of one of the earliest and most extensive codes of ethics for (...) nurses with their interpretative statements and constituting a strong basis for the International Council of Nurses’ Code of Ethics for Nurses. We based our review on previous literature using a scoping review method. We included both non-scientific and scientific publications to provide an analysis of codes of ethics which can be utilized in development and revision of other nurses’ codes of ethics. In the searches, we used CINAHL and PubMed databases limiting publications to texts with a connection to the Code of Ethics for Nurses published from January 2001 to November 2022 and written in English. Searches yielded 1739 references, from which 785 non-scientific and 71 scientific publications were included for analysis of the data. Although non-scientific and scientific publications addressed different number of categories, the results indicated that in the both groups the use and impact focused on professional ethics, nursing practice, and work environment and less on education, research, or social health issues. Nurses’ ethical standards were not addressed in non-scientific publications, and clinical issues and leadership were not in focus in scientific publications. To increase evidence-based knowledge of the impact of codes of ethics additional research is needed. Good scientific conduct was followed. (shrink)

This study analysed teaching of nurses’ codes of ethics in basic nursing education in Finland. A total of 183 educators and 214 students responded to a structured questionnaire. The data was analysed by SPSS. Teaching of nurses’ codes was rather extensive. The nurse-patient relationship was highlighted. Educators assessed their teaching statistically significantly more extensive than what students’ perceptions were. The use of teaching and evaluation methods was conventional, but differences between the groups concerning the use of these methods were statistically (...) significant. Students’ knowledge of and their ability to apply the codes was mediocre. Most educators and students assessed educators’ knowledge of the codes as adequate for teaching. These educators also taught the codes more extensively and these students perceived the teaching as more extensive. Otherwise educators’ and students’ socio-demographic variables had little association with the teaching. Research should focus on the organization and effectiveness of ethics education, and on educators’ competence. (shrink)

This article analyses and discusses dilemmas, ambivalences and problematic issues related to research ethics. This is done firstly by making a distinction between procedural research ethics and particularistic research ethics. Such a distinction reflects a theoretical construction and generalization. In practice, there can be a very close correlation between the two types. In the following, the distinction will therefore be used as a starting point for the presentation of a pragmatic-dualist research ethics. The approach is dualist because it draws on (...) the presence of two independent, contrasting understandings, which are essentially different yet equal aspects of good research ethics; it is pragmatic because this dualism is structural and institutional by nature, and designed with an eye to what can realistically and expediently be done in practice. Thus the intention of the article is to both analyze and discuss two different understandings of research ethics and simultaneously qualify a research ethics that draws on both of these understandings. Furthermore, the intention is to visualize a different understanding of research ethics which others can address and elaborate on or qualify. Even at this point, this research ethic can be included in a catalogue of understandings of ethical research practice an can be exploited in ethical research practice. (shrink)

This article analyses and discusses research-ethical dilemmas, ambivalences and problematic issues. This is done firstly by making a distinction between procedural research ethics and particularistic research ethics. Such a distinction refl ects a theoretical construction and generalization – in practice there can be a very close correlation between the two types. Hereafter, the distinction will therefore be used as a jumping-off point for the presentation of a pragmatic-dualist research ethics. Th e approach is dualist because it draws on the presence (...) of two independent, contrasting understandings, which are essentially diff erent yet equal aspects of good research ethics; and it is pragmatic because this dualism is first and foremost structural and institutional by nature, and designed with an eye to what can realistically and expediently be done in practice. Thus the intention of the article is to both analyze and discuss two different understandings of research ethics and simultaneouslyqualify a research ethics that draws on both these understandings. At the same time, the intention is to try to visualize a diff erent understanding of research ethics which others can address and elaborate on or qualify but even at this point can be included in an arsenal or catalogue of research-ethical understandings and approaches that can be exploited in research-ethical practice. (shrink)

Når man går i gang med et forskningsprojekt, vil der typisk være nogle forskningsetiske problemstillinger, man skal forholde sig til. Det kan fx være, at man skal have indhentet informeret samtykkeerklæringer fra de deltagere, der skal være med, eller man skal have indhentet forskningsetiske tilladelser og godkendelser fra uafhængige instanser. Det er altså overvejelser, som typisk dukker op ved begyndelsen af et forskningsprojekt. Der kan efterfølgende være en risiko for, at man forsømmer refleksioner over emergerende etiske problemstillinger, og at forskningsetik (...) således reduceres til, at man som forsker har underskrevet og overholdt nogle prædefinerede retningslinjer for god forskningspraksis. Sådanne retningslinjer er naturligvis særdeles vigtige. Men det er pointen i denne artikel, at de ikke kan stå alene. Forskningsetiske dilemmaer er et epistemologisk vilkår gennem hele forskningsprocessen, og de må således overvejes og genovervejes, forhandles og genforhandles gennem hele forskningsprocessen. Den form for forskningsetik, der følger bestemte på forhånd fastlagte retningslinjer, som typisk er formuleret i standardiserede, kontekstuafhængige principper for god etisk adfærd, benævnes i artiklen procedural forskningsetik, mens en forskningsetik, der foretager en konkret og kontekstafhængig vurdering af de specifikke etiske problemstillinger og dilemmaer, som de viser sig i praksis gennem hele forskningsprocessen, benævnes kasuistisk forskningsetik. Distinktionen mellem disse to typer forskningsetik er udtryk for en teoretisk konstruktion, og de skal ikke betragtes som modsatrettede alternativer, men derimod som supplerende sider ved god forskningsetisk praksis. I artiklen diskuteres forholdet mellem dem for ad den vej at fremhæve enhver forskers pågående og kontinuerlige ansvar gennem hele forskningsprocessen. Nøgleord: forskningsetik, procedural, kasuistisk, Leibniz English summary: Dic cur hic – a casuistic research ethic When embarking on a research project, researchers must customarily confront some ethical issues. To begin with, they may need informed consent from the participants, or research ethics permission and approval from an independent Research Ethics Committee. However, there is more involved than these legal requirements alone, for just complying with some pre-defined guidelines for good research practice is by no means enough. In fact, a number of ethical issues demanding thorough reflection may emerge during the research project. Far from being neglected, such questions deserve careful attention. Research ethical dilemmas are an epistemological condition throughout the whole research process, and must therefore be constantly considered and reviewed, negotiated and renegotiated. This article purports to categorize the ethical issues likely to arise during the course of an investigation into two main types, namely procedural and casuistic. The kind of research ethics following certain pre-established guidelines, which are typically expressed in standardized, context-independent principles of good ethical behavior, will be labeled as procedural research ethics, while the type of research ethics ensuing from the analysis and contextual assessment of the specific dilemmas arising in practice in the particular situation studied, will be named casuistic research ethics. A distinction between these two types of research ethics reflects a theoretical construct. Both types should not be regarded as opposing alternatives, but as complementary aspects of good ethical research practices. This article discusses the relationship between the two types in order to highlight the researcher’s ongoing and continuous responsibility throughout the research process. (shrink)

The way in which midwives relate to expectant parents during the process of childbirth greatly influences the parents’ childbirth experiences for a long time. We believe that examining and describing ways of relating in naturally occurring interactions during childbirth should be considered as an ethical responsibility. This has been highlighted in relation to parents’ experiences and in the light of the relational ethics of Løgstrup. Four couples’ and nine midwives’ ways of relating were documented by 27 hours of observation, including (...) 14.5 hours of video-recorded sessions. A qualitative content analysis was conducted. The midwives strongly influenced the different ways of relating and three aspects of professional competence were disclosed. The results can contribute to reflections about current praxis as an ethical demand for midwives. (shrink)

There is a growing interest in ethical competence-building within nursing and health care practising. This tendency is accompanied by a remarkable growth of ethical guidelines. Ethical demands have also been laid down in laws. Present-day practitioners and researchers in health care are thereby left in a virtual cross-fire of various legislations, codes, and recommendations, all intended to guide behaviour. The aim of this paper was to investigate the role of ethical guidelines in the process of ethical competence-building within health care (...) practice and medical research. A conceptual and critical philosophical analysis of some paragraphs of the Helsinki Declaration and of relevant literature was performed. Three major problems related to ethical guidelines were identified, namely, the interpretation problem (there is always a gap between the rule and the practice, which implies that ethical competence is needed for those who are to implement the guidelines); the multiplicity problem (the great number of codes, declarations, and laws might pull in different directions, which may confuse the health care providers who are to follow them); and the legalisation problem (ethics concerns may take on a legal form, where ethical reflection is replaced by a procedure of legal interpretations). Virtue ethics might be an alternative to a rule based approach. This position, however, can turn ethics into a tacit knowledge, leading to poorly reflected and inconsistent ethical decisions. Ethical competence must consist of both being (virtues) and doing (rules and principles), but also of knowing (critical reflection), and therefore a communicative based model is suggested. (shrink)

It is important to define and practice ethical rules and codes for professionalisation. Several national and international associations have determined midwifery ethical codes. In Turkey, ethical rules and codes that would facilitate midwifery becoming professionalised have not yet been determined. This study was planned to contribute to the professionalisation of midwifery by determining national ethical values and codes. A total of 1067 Turkish midwives completed the survey. The most prevalent values of Turkish midwives were care for mother–child health, responsibility and (...) professional adequacy. The preferred professional codes chosen by Turkish midwives were absence of conflicts of interest, respect for privacy, avoidance of deception, reporting of faulty practices, consideration of mothers and newborns as separate beings and prevention of harm. In conclusion, cultural values, beliefs and expectations of society cannot be underestimated, although the international professional values and codes of ethics contribute significantly to professionalisation of the midwifery profession. (shrink)

Although the need to theorize ethics within the complexities of nursing practice has been identified within the nursing literature, to date the link between ethics epistemology and specific nursing actions has received limited attention. In particular, little exploration has been carried out to examine how nurses ‘know’ what is ethical and the knowledge they draw upon to inform their nursing actions within the complexities of their everyday practice. This study describes a participatory inquiry project that focused on developing and articulating (...) an epistemology of ethics while in the midst of everyday nursing work. Epistemological and methodological insights are discussed in light of the challenges nurses face in contemporary healthcare contexts. (shrink)