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.

Purpose Universities have increasingly been adopting intercultural virtual collaboration (IVC) to connect and develop the intercultural competence of students from different locations. However, the design and implementation of IVC have proved to be challenging, and thus there is a need for sharing positive experiences. This paper explores students’ overall impressions toward their participation in an IVC project involving a Spanish and Dutch university and discusses the on-going improvement process inherent to such practice. Design/methodology/approach This article presents (a) the results obtained from a content analysis of students’ feedback collected through a satisfaction survey, and (b) the observations of participating teachers on the challenges encountered during the implementation of the intercultural virtual collaborative project. Findings The analysis shows the potential of IVC to develop different aspects of students’ intercultural competence, especially intercultural teamwork, awareness and skills. Students appreciated the experience of working in intercultural teams, “the real-life application” of the project and the opportunity to gain cultural knowledge. At the institutional level, the biggest challenge related to aligning participating institutions’ courses, schedules, and grading systems. At the classroom level, it is argued that interaction between students should happen gradually. The discussion also approaches how partnerships between universities and companies could contribute to making training in intercultural virtual collaboration more authentic. Originality/value Given its impact on the development of students’ intercultural competence, the intercultural virtual collaborative project has been recognized as a best-practice in both universities, being officially incorporated into the curriculum of the participating institutions and replicated to other subject areas.

Background Maternal mental health during the peripartum period is critically important to the wellbeing of mothers and their infants. Numerous studies and clinical trials have focused on various aspects of interventions and treatments for perinatal mental health from the perspective of researchers and medical health professionals. However, less is known about women’s experiences of participating in perinatal mental health research, and the ethical issues that arise. Aim To systematically review the literature on the ethical issues that emerge from pregnant and/or postpartum women’s experiences of taking part in perinatal mental health-related research. Methods Systematic review of nine bibliographic databases, from inception to July 2021. Qualitative, quantitative and mixed method studies were included if they reported on ethical issues experienced by perinatal women. Research ethical issues encompassed any issue relating to women’s experiences of being offered study information, recruitment, consent, retention and respect for autonomy. Titles, abstracts and full text screening, appraisal of the methodological quality of included studies, and data extraction, were conducted independently by two reviewers. Ethical considerations Ethical approval was not required for this systematic review. Findings A total of 9830 unique citations was retrieved. Six studies met the inclusion criteria. Studies were clinically and methodologically heterogenous, and only one was purposively designed to explore women’s experiences. The key finding was the establishment of trust between the researcher and participant in all stages of the research process. Findings are presented according to recruitment and consent processes, participation and retention, and study follow-up and completion. Conclusion The establishment of trust between the researcher and perinatal women leads to a dynamic with research ethical implications relevant to all stages of perinatal mental health-related research. Further research on the research ethical issues experienced by perinatal women is required because of the limited literature.