Strengthening the ethical competence of future nurses and midwives: An inter-professional action-learning project on experiential training methods

Healthcare is a very demanding working environment that is characterized by societal and organizational changes, technological development, growing diversity among care recipients and patients, and scarcity of resources. Nurses and midwives are at constant risk to develop moral distress. Moreover, a constant exposure to moral distress ultimately leads to moral stress, which has negative outcomes such burn-outs, extended sick leave, and nurses and midwives even leaving their profession. It is evident that to avoid moral distress and stress, and their negative outcomes, nurses and midwives' ethical competence need to be strengthened. Nurses and midwifes need to have an increased awareness of the ethical complexity of the settings in which they work and have the ethical competence to deal with this complexity before entering the working field. Although the World Health Organization, in 2016, identified “ethical and legal principles and professionalism” as one of the core competences, good practices to improve ethical competence integrated in educational curricula of Nursing and Midwifery Programs are still lacking. Hence, there is an urgent need to develop innovative learning methods to establish ethical competence.

The overall objective of the ETHCOM project was to strengthen ethical competence of future nurses and midwives by means of experiential inter-professional learning methods, which can be implemented in nursing and midwifery educational curricula and programs. The long-term goal was to make nursing and care profession as also their work environment more ethically robust. This overall objective was translated into different sub-objectives: 1) Harmonising the nursing and midwifery educational curricula and programs to the ethical needs experienced in the professional nursing working fields. 2) Developing and implementing experiential inter-professional training methods to enhance the ethical competence of nursing and midwifery students, educational and clinical professionals, particularly teachers and tutors. 3) Safeguarding the impact of the co-created experiential training methods by ensuring the inclusion of all the stakeholder groups. 4) Enhancing proactive ethical conflict solving competences of healthcare professionals working in inter-disciplinary healthcare teams with diverse approaches, views, and beliefs. 5) Facilitating interdisciplinary ethical problem-solving skills related to ethical dilemmas.

Concrete outputs are: ETHCOM TOOLKIT - Practical Compass and 13 Experiential Learning Methods to improve Ethical Competence in Nursing and Midwifery. Each tool provides an instruction manual for teachers and tutors with guidance for teachers and tutors describing the objectives, expectations, risks and pitfalls of the learning materials. Consequently, a range of different experiential learning materials - 13 tools - with practical instructions and videos were developed ETHCOM NETWORK which systematically broadened to a wider network of partners by means of a digital platform and a yearly ETHCOM course, organized by one of the partners. By means of this network, methods, good practices, and experiences are publicly available and shared. ETHCOM LIBRARY an accommodative and structured way of sharing knowledge on experiential learning methods in ethics. All articles and books are selected by the ETHCOM consortium. ETHCOM MANIFEST: Ethical baselines for Nursing and Midwifery. There are guidelines in order to be able to make choices for curricula with comments from Ethicists.