Ethical dilemmas faced by healthcare teachers during the COVID-19 pandemic.

BACKGROUND: Previous studies have shown that the rapid transition to emergency remote teaching due to the COVID-19 pandemic was challenging for healthcare teachers in many ways. This sudden change made them face ethical dilemmas that challenged their values and ethical competence. RESEARCH AIM: This study aimed to explore and gain a deeper understanding of the ethical dilemmas healthcare teachers faced during the COVID-19 pandemic. RESEARCH DESIGN: This was an inductive qualitative study using a hermeneutic approach. Semi-structured interviews were conducted and analysed thematically. PARTICIPANTS AND RESEARCH CONTEXT: Healthcare teachers (n = 20) from eight universities and universities of applied sciences in the Nordic and Baltic countries participated. ETHICAL CONSIDERATIONS: This study was based on the research ethics of the Norwegian National Research Ethics Committee for Medicine and Health Sciences and approved by the Norwegian Agency for Shared Services in Education and Research. FINDINGS: Healthcare teachers faced several ethical dilemmas due to restrictions during the COVID-19 pandemic. The analysis revealed three main themes: How should I deal with students' ill-being, and what can I as a teacher do?; What can I demand from myself and my students, what is good teaching?; How do I manage the heavy workload and everyone's needs, and who gets my time? CONCLUSIONS: This study highlights the importance of healthcare teachers' continuous need for pedagogic and didactic education, especially considering new technology and ethical issues. During the pandemic, the ethical consequences of remote teaching became evident. Ethical values and ethical dilemmas should be addressed in healthcare education programmes at different levels, especially in teacher education programmes. In the coming years, remote teaching will grow. Therefore, we need more research on this issue from an ethical perspective on its possible consequences for students and healthcare teachers.

Understanding and formation-A process of becoming a nurse.

Nursing is a complicated and multifaceted profession that sets high demands in preparing nursing students for the profession. In today's education, the emphasis is often on knowledge and skills, that is, epistemology. In caring science another approach is sought, an approach based on human sciences in which knowledge will serve a more profound understanding, that is, the ontology. Consequently, the question of what this 'understanding' in clinical education is and how it is promoted in clinical nursing education becomes important to clarify. Therefore, the aim here is to explicate the phenomenon of understanding in clinical education as experienced by third-year undergraduate nursing students ready for graduation. This study, with a hermeneutic approach, is based on a secondary analysis of focus group interviews with undergraduate nursing students. The analytical expansion of the original material suggests three interrelated themes that illuminate the phenomenon of understanding in clinical education. These findings are deepened and enriched through philosophical abstraction. In the process of understanding, episteme, techne and phronesis can be viewed as inherent parts of the structure of thought in nursing. The perspective advanced in this study adds new aspects to the phenomenon of understanding and its meaning and significance in the dynamic process of formation and becoming in clinical education. The focus in clinical nursing education should be on learning reflective, critical thinking and the ways of being a nurse, rather than drilling students on particular skills. In the rapidly changing world of the 21st century, an understanding-based education is needed as a more meaningful and authentic approach. Therefore, an ontological turn in nursing education, through which the main focus shifts from a traditional epistemology to an epistemology in the service of ontology, is suggested. Further studies are needed in the development and implementation of an understanding-based, interpretative education in nursing.

Appropriation and application of caring science theory: Experiences of master education alumni in three Nordic countries.

BACKGROUND: A theoretical foundation in caring science is invaluable for nursing care because it enriches practice by providing explanations, clarity and direction. However, after graduation, students experience the frustration of not being able to sufficiently intertwine caring science theories in practice. Consequently, the integration of caring science theories in nursing education and practice is considered an essential focus area to reduce this theory-practice gap. AIM: This study aims to elucidate master alumni's experiences of appropriation and application of caring science after completing a master's education. METHODS: The data were collected by semi-structured interviews with 21 alumni from Finland, Sweden and Norway who had recently completed a master's degree with caring science as the major subject. A thematic analysis was used. FINDINGS: The analysis resulted in two main themes, both with three subthemes. Educator's bearing and a learning community are important for students' appropriation of caring science theories. Learning through reflection and the response of others evoke new paths of thought, and practice-related teaching promotes the intertwining and application of caring science theory in practice. The appropriated theory has significance to alumni by providing a guiding basis that strengthens alumni's professional bearing and way of being. The caring science theory guides alumni in providing nursing care with an increased ethical awareness and questioning approach that enables good patient care. Their professional identity and confidence in caring are also strengthened. CONCLUSION: Educators' bearing is of outermost importance for appropriation and application of caring science theory. It has a key function in facilitating students' understanding and intertwining of caring science theory and practice. Appropriated caring science theory provides authority and courage to practice nursing care. The appropriated theory promotes alumni's ethical awareness, confidence and a sense of pride in the profession.

Nurses' experiences of continuity of care for patients with heart failure: A thematic analysis.

AIMS AND OBJECTIVES: This study aimed to describe nurses' experiences of continuity of care for patients with heart failure. BACKGROUND: Heart failure is a life-influencing condition that causes varying care needs over time with risks of fragmentation. Nurses play an important role in caring for patients with heart failure. However, nurses' experiences of continuity of care seem to be less explored in this context. DESIGN: A qualitative study with a descriptive design. METHODS: Four focus groups were chosen to collect the data, and the analysis was made by using a method for thematic analysis. A purposeful sampling of nurses (n = 14) with experiences from hospital-connected heart failure clinics, primary healthcare centres and municipal home healthcare settings was recruited. The COREQ checklist was used in this study. RESULTS: The nurses' experiences of continuity of care for patients with heart failure were described in four themes: access and flexibility, responsibility and transparency, trustful and caring relationships and communication and collaboration. CONCLUSIONS: The results indicate that nurses have an excellent position to act as the "hub" in caring for patients with heart failure, but they need to have the possibility of networking and establishing trusting relationships with their colleagues. From the nurses' point of view, mutual trust between the nurse, the patient and the patient's next of kin is crucial for promoting and maintaining continuity of care in patients with heart failure. RELEVANCE TO CLINICAL PRACTICE: To promote continuity of care for patients with heart failure, nurses expressed the necessity of establishing trusting relationships in a continuity-promoting organisation with seamless coordination. Nurses can be the "hub" supporting a person-centred care approach based on the patients' needs. There seems to be a need for better collaboration with common guidelines across and within primary healthcare centres, hospital-connected heart failure clinics and municipal home healthcare settings.

"Being in good hands": next of kin's perceptions of continuity of care in patients with heart failure.

BACKGROUND: Heart failure (HF) is a chronic condition with a variety of diverse symptoms. Patients with HF are usually elderly with multimorbidity, which are both multifaceted and challenging. Being a next of kin to patients with HF is described as a complex task consisting of managing care and treatment, monitoring illness and being an emotional support, while also being able to navigate the healthcare system especially in long-term contact. However, few studies have investigated next of kin's perceptions of continuity of care in connection with HF. The present study aimed to describe continuity of care as perceived by the next of kin who care for patients with HF. METHODS: This study used a qualitative descriptive design. Semi-structured interviews were conducted with the next of kin (n = 15) of patients with HF to obtain their perceptions of continuity of care. A phenomenographic analysis method was used to capture the participants' perceptions of the phenomenon. RESULTS: The analysis reveals that the next of kin perceive that support from healthcare professionals was strongly associated with experiences of continuity of care. Four categories reveal the next of kin's perceptions of continuity of care: Want to be involved without being in charge; A desire to be in control without acting as the driving force in the care situation; A need for sustainability without being overlooked; and Focusing on making life meaningful while being preoccupied with caregiving activities. CONCLUSIONS: Next of kin perceive continuity of care, when they have access to care and treatment and when caregivers collaborate, regardless of healthcare is given by primary care, municipalities or specialist clinics. A sense of "being in good hands" sums up the need for continuous support, shared decision-making and seamless transitions between caregivers. It seems important that healthcare organisations safeguard effective and collaborative models. Moreover, professionals need to plan and perform healthcare in collaboration with patients and next of kin.

Understanding and becoming - the heart of the matter in nurse education.

The aim of this study was to deepen the understanding of student nurses' processes of understanding and becoming nurses. The study is phenomenological-hermeneutic in design, comprising data from three focus group interviews in two Scandinavian countries. The process of student nurses' understanding and becoming a nurse emerged as a hermeneutical movement. A caring student-preceptor relationship and a growth-promoting preception in a supportive and inclusive environment provide the frame within which the movement happens. The movement towards understanding and becoming is initiated as students, based on their level of knowledge, are given responsibility. In order to fulfil the responsibility imposed on them, students take their entire repertoire of knowledge into consideration. By tying these threads together, they found the basis for conscious action, and care is provided according to what the current situation requires. The experiences obtained are reflected on and integrated with earlier knowledge, which leads to enhanced understanding. Students form a new base to stand on. They show increased readiness for still more responsibility and action. This movement towards deeper understanding and becoming affects the students also ethically and deepens their ethical awareness. When one loop of understanding and becoming is closed the process continues by passing into a new loop. This movement could be described as a hermeneutical spiral consisting of interconnected loops taking the students further and deeper in their process of understanding and becoming a nurse. The student-preceptor relationship and the ethos permeating it are decisive for students' learning both epistemologically and ontologically. Responsibility is the catalyst in students' understanding and becoming both intellectually and ethically. Understanding and becoming are ongoing processes of appropriation, thus altering students both professionally and personally. Understanding and becoming can be perceived as the hearth of the matter in nurse education.

A Nordic model for learning compassionate care in clinical education.

BACKGROUND: Preceptorship is one model of supporting student nurses' learning and development during their clinical education. However, little is known about what there is in preceptorship that promotes or hinders learning. Earlier studies found that there were ethical dimensions to students' encounters with preceptors. AIM: The overall purpose of this Nordic follow-up study was to develop a model for learning compassionate care among student nurses during their clinical education - first, to deeper understand the learning of student nurses, and second, to investigate the phenomenon of preceptorship from the preceptors´ point of view. METHOD: This study used a mixed methods design. Undergraduate student nurses (n = 139) from three universities in Finland and Sweden were shadowed for a period of three years. Quantitative data were collected through a questionnaire and were analysed using statistical methods. To better understand the learning acquired by the student nurses, focus group interviews (n = 70) were conducted. The phenomenological-hermeneutical approach was adopted. To capture the preceptors' point of view, narrative interviews were held with them (n = 88) in western Finland and northern Sweden. A hermeneutical approach was used when analysing the data. FINDINGS: According to both student nurses and preceptors, a caring student-preceptor relationship, imbued with commitment, reverence and responsibility, is fundamental and serves as the basis for students' learning and development more than pedagogical methods used. Three main themes emerged: a caring student-preceptor relationship; a caring manner of being-the conduct; and a caring culture-the tone of the learning space. CONCLUSIONS: This study shows the importance of preceptorship on student nurses in their quest of becoming compassionate and caring nurses. Therefore, based on earlier findings and the findings in this study, there is a need to facilitate and support the students' transformation, that is, the process of becoming, from student to a professional nurse.

Becoming a caring nurse--a Nordic study on students' learning and development in clinical education.

The aim of this study was to elucidate the meaning and deepen the understanding of student learning and development in becoming a nurse. Data were collected from focus group interviews with students from three different universities and analysed using a phenomenological-hermeneutical method. The comprehensive understanding of student learning and development in becoming a nurse resulted in two constituents: the prerequisites for learning and development, and itineraries for learning and development. The prerequisites consisted of a caring relationship as the foundation for learning and development, and will and motivation for learning and development. The itineraries for learning and development involved pushing boundaries through challenges and support, and of a synthesis of theory and praxis through reflection. Caring relationships can be seen as the foundation for student learning and development and as a prerequisite for becoming a nurse. Learning is not merely a skills-acquisition procedure but a transforming experience for students, who feel that their whole existence has been altered. It is time to move beyond examining student learning and development merely from an epistemological perspective and start focussing on the ontological aspect of learning, on the processes of transformation and becoming a nurse.