OBJECTIVES Improving nurses' competence in resolving clinical ethical issues must start with ethics education in training and clinical practice. However, many students complain that they cannot apply classroom learning to actual clinical scenarios. This study explored ethical issues and dilemmas, and their impact experienced by student nurses in clinical practice. METHODS Focus groups were conducted with 44 first-year student nurses from a 2-year college course in northern Taiwan. Interviews were tape-recorded and verbatim transcripts were analysed using content analysis. RESULTS Students expressed and discussed their views in eight focus groups. Analysis of interviews revealed five themes: frustration at inability to help some patients; oppression caused by lower status; lack of honesty and ethical courage; powerlessness, and self-encouragement in adversity. CONCLUSIONS Taiwanese nurse ethics training was only recently introduced and the curriculum has not addressed the clinical reality in Taiwan. This reality includes limitations arising from the medical hierarchy and the socio-cultural role of families in medical decision making, which may inhibit ethical judgements and decision making. In clinical dilemmas, the most common problems faced by Taiwanese nursing students involved not knowing how to handle some situations, inability to abide by principles, and a lack of appropriate role models. Hence, we suggest that nursing ethics education should: (i) integrate scenarios involving ethical dilemmas into daily routines; (ii) give students opportunities to discuss their feelings about their experiences; (iii) allow teachers and students to talk about scenarios with ethical implications, and (iv) provide students with opportunities to reflect on clinical scenarios in order to clarify their values and learn how to respect the value of life.

The purpose of this qualitative research was to explore and develop the process of self-empowerment for primary caregivers responsible for caring for elderly with dementia. Nine primary caregivers who lived in northern Taiwan were interviewed through a theoretical sampling procedure. In-depth, face-to-face interviews were tape-recorded and transcribed verbatim. The grounded theory method was applied for analyzing data. The six main components that emerged in this model: "filial piety", "feeling of out of control", "inner awareness", "care ability", "emotion reconstruction", and "life management". This model starts from "filial piety" and "feeling of out of control," then evokes caregivers' "inner awareness". The inner awareness powerfully influences caregivers' "care ability", "emotion reconstruction" and "life management," which account for the three inner mechanism parts in their caregiving experience. Each part comprises three stages that are influenced by "inner awareness". The lower stage of each part supports the next higher stage. The same stages in all parts parallel one another, and influence each other by providing support or creating barriers. On the other side, competition between support and barriers from the outside environment determines the completion of this self-empowerment process. Results of this research extend the knowledge in understanding the psychological processes related to caring for elderly with dementia. The findings also provide readers a positive viewpoint on the caring experiences of primary caregivers of elderly with dementia.