title: Enhancing students' moral competence in practice: Challenges experienced by Malawian nurse teachers.
abstract: BACKGROUND
  Nurses and student nurses in Malawi often encounter challenges in taking a moral course of action. Several studies have demonstrated a need for increased awareness of ethical issues in the nursing education.
  
  
  OBJECTIVE
  To explore the challenges experienced by nurse teachers in Malawi in their efforts to enhance students' moral competence in clinical practice.
  
  
  METHODS
  A qualitative hermeneutic approach was employed to interpret the teachers' experiences.
  
  
  METHODS
  Individual interviews (N = 8) and a focus group interview with teachers (N = 9) from different nursing colleges were conducted.
  
  
  METHODS
  Ethical approval was granted and all participants signed their informed consent.
  
  
  RESULTS
  Two overall themes emerged: (1) authoritarian learning climate, with three subthemes: (a) fear of making critical comments about clinical practice, (b) fear of disclosing mistakes and lack of knowledge and (c) lack of a culture of critical discussion and reflection that promotes moral competence; and (2) discrepancy between expectations on learning outcome from nursing college and the learning opportunities in practice comprising three subthemes: (a) gap between the theory taught in class and learning opportunities in clinical practice, (b) lack of good role models and (c) lack of resources.
  
  
  CONCLUSIONS
  Our findings indicated that showing respect was a central objective when the students were assessed in practice. A number of previous studies have enlightened the need for critical reflection in nursing education. Few studies have linked this to challenges experienced by teachers for development of moral competence in practice. This is one of the first such studies done in an African setting.
  
  
  CONCLUSIONS
  There is a clear relationship between the two themes. A less authoritarian learning climate may enhance critical reflection and discussion between students, teachers and nurses. This can narrow the gap between the theory taught in college and what is demonstrated in clinical practice. Moral competence must be enhanced in order to ensure patients' rights and safety.
authors.affiliation: Buskerud and Vestfold University College, Norway eva.m.solum@hbv.no.
authors.forename: Eva Merethe
authors.initials: EM
authors.lastname: Solum
authors.affiliation: Daeyang Luke Mission Hospital, Malawi.
authors.forename: Veronica Mary
authors.initials: VM
authors.lastname: Maluwa
authors.affiliation: Diakonhjemmet University College, Norway.
authors.forename: Bodil
authors.initials: B
authors.lastname: Tveit
authors.affiliation: Buskerud and Vestfold University College, Norway.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Severinsson
mesh_terms: D004506:Education, Nursing / Q000191:economics / Q000941:ethics / Q000592:standards*; D004993:Ethics, Nursing; D005181:Faculty, Nursing / Q000941:ethics / Q000523:psychology*; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D066297:Hermeneutics; D006801:Humans; D008295:Malawi; D035863:Moral Development; D036301:Qualitative Research; D013338:Students, Nursing / Q000523:psychology*
keywords: Clinical practice; Malawi; critical reflection; moral competence; nurse teachers; student nurses