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Participation has been of ongoing interest in the field of action research and the New Health Promotion movement, but it is not without tensions and problems. This article presents the challenge of containing the conflicting demands of personal empowerment, practical advancement and theory building in a community-based participatory action research project 'Aspiring to Healthy Living in The Netherlands'. A Participatory Action Research (PAR) methodology was chosen because of its contribution to empowerment of the community of older people, which was one of the project goals. Besides that, the project aimed at the development of an intervention program for encouraging healthy living amongst older people in The Netherlands and contributing to the knowledge base on healthy living, by analyzing narratives from the participants. However, when time pressure rose, the empowerment goal started to collide with academic and practical aims, and the dialogue within the project team became obstructed leading to a return to the traditional routine of applied research and the accompanying power relationships, with implications for the learning in and about the project. This article starts with a short review of the literature on community participation in health research and the challenges of learning participatory action research, followed by a description of the PAR project and the process of participation, using the ladder of Pretty as a tool to highlight different levels of participation in different project stages. By using the theory of organizational learning developed by Argyris and Schö n (Argyris, 1993; Argyris & Schö n, 1978), insights will be provided into the attempts of a relatively inexperienced team to create a participatory and dialogic research project, and the problems in keeping reflection and learning going within a context of external pressure.

The turn towards autonomy in healthcare raises moral questions about responsibilities for care. Promoting patient autonomy should be a collaborative endeavour and deliberation of patients, professional and informal caregivers together.

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Moral sensitivity is known to be the starting point for moral competence and even is a core concept in the curricula for bachelor’s-level nursing students in the Netherlands. While the development of moral sensitivity in nursing is commonly agreed to be important, there is no clear understanding of how to develop moral sensitivity through nursing education and what components of nursing education contribute to moral sensitivity. Studies on educational interventions could build knowledge about what works in developing moral sensitivity and how to achieve this outcome. Therefore, the aim of this study is to explore if and how educational interventions contribute to the development of moral sensitivity in nursing students. A scoping review was conducted. Four electronic databases were searched: CINAHL, PubMed, MEDLINE and SpringerLink. Articles that were not about formal or initial nursing education and that had no link to moral development or moral sensitivity were excluded. After the final selection on educational interventions, 10 articles out of the initial 964 resources were included in the review. Three different but related dimensions of moral sensitivity emerged from the literature: (1) raising moral awareness, (2) providing the ability to frame and name ethical issues and (3) improving moral reasoning ability. Half of the studies used quantitative measures to evaluate the educational intervention, in particular the Moral Sensitivity Questionnaire; the other half used diverse qualitative evaluation methods. None of the studies presented teaching methods that included all three dimensions of moral sensitivity. Moral awareness of self appears to be more loosely connected to the other two dimensions, which raises the question of whether it can be seen as a prerequisite for them. To encompass all dimensions of moral sensitivity, a mix of quantitative and qualitative measures seems most appropriate to study that topic.