Midwives, like other health professionals, are confronted with ethical issues on a daily basis and acting ethically is a core competence within professional conduct. In midwifery in particular, the complexity of ethical problems is increasing e.g., due to new medical options in diagnostics and reproductive medicine, the increasing diversity of life styles or the high number of preterm births. The main purpose of the current project was to develop effective interventions to increase midwives' ethical competence in educational and practical settings. To reach this goal, we conducted 43 individual semi-structured and 6 focus group interviews with midwives, lecturers and midwifery students to explore their views on ethics education and the support needed in practice to develop ethical competence. Based on the analysis of these interviews, a set of 15 interventions was designed and piloted in educational and clinical settings. The piloted interventions were then evaluated with an online questionnaire. Results from the interviews, the online questionnaire as well as the lessons learnt from piloting the interventions and the current literature on ethics education were integrated in a spiral curricular model for increasing

INTRODUCTION Midwives have a remarkable influence on various outcomes in healthcare, of which the activities related to the management during the childbirth are emphasised the most. Midwives like all healthcare workers encounter many different stressors in clinical practice, including time pressure, excessive workload, different roles, and emotional issues. The profession of the midwife requires much knowledge, competence, good attitude and self-confidence in order to cope with many different complicated situations and dilemmas. This study has been conducted under the project: 'Increasing midwives' ethical competence: a European educational and practice development project (INEC)'. METHODS This is a qualitative case study. The current case study involved 7 midwives of the Women's Clinic, East-Tallinn Central Hospital, Estonia; the midwives expressed their willingness and agreed to take part in the activities of the peer group supervisors. The aim of the case study was to find how peer group supervision as a method helps midwives to solve complicated cases and dilemmas, helping them to maintain self-confidence and therefore to manage stress at work more effectively. RESULTS All the participating midwives shared the opinion that peer group supervision helps midwives to cope with complicated situations and dilemmas more effectively, it empowers professional skills and self-confidence, and so contributes to more effective stress management at work. Also, the midwives expressed hope that this topic would be useful for the professional midwives and to other employees working in the field of healthcare, that encounter complicated cases in their daily work, and so will form an active team of peer group supervision. CONCLUSIONS Peer group supervision is an efficient method that helps midwives solve complicated cases in the Women's Clinic, East-Tallinn Central Hospital, Estonia.

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