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Tarabeih M, Na’amnih W. Non-Maleficence toward Young Kidney Donors: A Call for Stronger Ethical Standards and Associated Factors in Multidisciplinary Nephrology Teams. NURSING REPORTS 2024; 14:1998-2013. [PMID: 39189279 PMCID: PMC11348254 DOI: 10.3390/nursrep14030149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 08/08/2024] [Accepted: 08/12/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND The rising frequency of live kidney donations is accompanied by growing ethical concerns as to donor autonomy, the comprehensiveness of disclosure, and donors' understanding of long-term consequences. AIM To explore donors' satisfaction with the ethical competence of multi-professional nephrology teams regarding disclosure of donation consequences to live kidney donors. METHODS A cross-sectional study was performed among Israeli live kidney donors who had donated a kidney in two hospitals that belonged to the Ministry of Health's Transplantation Center one year after the donation, from December 2018 to December 2020. Data collection was conducted online and through face-to-face interviews with the donors in their native language (Hebrew or Arabic). RESULTS Overall, 91 live kidney donors aged 18-49 years were enrolled. Of those, 65.9% were males, and 54.9% were academic donors. Among the live kidney donors, 59.3% reported that the motivation behind the donation was a first-degree family member vs. 35.2% altruistic and 5.5% commercial. Only 13.2% reported that the provided disclosure adequately explained the possible consequences of living with a single kidney. Approximately 20% of the participants reported that the disclosure included information regarding their risk of developing ESRD, hypertension, and proteinuria. The donors reported a low mean of the index score that indicates a low follow-up by the physician after the donation (mean = 1.16, SD = 0.37). The mean GFR level was significantly lower in the post-donation period one year following a kidney donation (117.8 mL/min/1.73 m2) compared with the pre-donation period (84.0 mL/min/1.73 m2), p < 0.001. CONCLUSION Our findings display that donors' satisfaction with the ethical competence of multi-professional nephrology teams regarding the disclosure of donation consequences to live kidney donors is low. This study indicates that donors are at an increased risk of worsening kidney functions (creatinine and GFR), and BMI. Our findings underscore the imperative to advise donors that their condition may worsen over time and can result in complications; thus, they should be monitored during short and long-term follow-up periods. This study was not registered.
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Affiliation(s)
- Mahdi Tarabeih
- School of Nursing Sciences, The Academic College of Tel-Aviv-Yaffa, Tel Aviv 64044, Israel;
| | - Wasef Na’amnih
- School of Nursing Sciences, The Academic College of Tel-Aviv-Yaffa, Tel Aviv 64044, Israel;
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
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Kalantari S, Modanloo M, Ebadi A, Khoddam H. Concept analysis of conscience-based nursing care: a hybrid approach of Schwartz-Barcott and Kim's hybrid model. BMC Med Ethics 2024; 25:70. [PMID: 38890687 PMCID: PMC11184846 DOI: 10.1186/s12910-024-01070-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 06/06/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND The nursing profession considers conscience as the foundation and cornerstone of clinical practice, which significantly influences professional decision-making and elevates the level of patient care. However, a precise definition of conscience in the nursing field is lacking, making it challenging to measure. To address this issue, this study employed the hybrid approach of Schwartz Barcott and Kim to analyze the concept of conscience-based nursing care. METHODS This approach involves a three-phase process; theoretical, fieldwork, and analytical. A systematic literature review was conducted using electronic databases during the first phase to find relevant papers. The content of 42 articles that met the inclusion criteria was extracted to determine the attributes, antecedents, and consequences of consciousness care using thematic analysis. Based on the working definition as a product of this phase, the plan of doing the fieldwork phase was designed. During this phase, data were collected through interviews with nurses all of whom were responsible for patient care in hospitals. In this phase, 5 participants were chosen for in-depth interviewing by purposeful sampling. Data were analyzed using directed content analysis. The findings of the theoretical and fieldwork phases were integrated and the final definition was derived. RESULTS The integration of the theoretical and fieldwork phases resulted in identifying four key characteristics of conscience-based nursing care. Firstly, it involves providing professional care with a conscientious approach. Secondly, ethics is at the core of conscience-based care. Thirdly, external spirituality plays a significant role in shaping one's conscience in this context. Finally, conscience-based nursing care is both endogenous and exogenous, with professional commitment being the central focus of care. CONCLUSION Conscience-based nursing care is an essential component of ethical care, which elevates clinical practice to professional care. It requires the integration of individual and social values, influenced by personal beliefs and cultural backgrounds, and supported by professional competence, resources, and a conducive organizational atmosphere in the healthcare field. This approach leads to the provision of responsive care, moral integrity, and individual excellence, ultimately culminating in the development of professionalism in nursing.
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Affiliation(s)
- Soheyla Kalantari
- Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mahnaz Modanloo
- Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Abbas Ebadi
- Research Center for Life & Health Sciences & Biotechnology of the Police, Direction of Health, Rescue & Treatment , Police Headquarter, Tehran, Iran
| | - Homeira Khoddam
- Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Iran.
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Gulec HY, Aslan H. The effect of conscience perception on job satisfaction and care behaviours in nurses. Arch Psychiatr Nurs 2024; 50:49-59. [PMID: 38789233 DOI: 10.1016/j.apnu.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 10/28/2023] [Accepted: 03/08/2024] [Indexed: 05/26/2024]
Abstract
Conscience is a force capable of making judgments about one's own moral values during individual behaviour. Conscience in nursing is a concept that is perceived as authority and an inner voice, and it positively affects nursing care. Today, according to many research results, conscience is an indicator of professionalism that affects our personal and professional lives. This research was carried out to determine the effect of nurses' perceptions of conscience on job satisfaction and care behaviours. A cross-sectional study was performed in a training and research hospital. The sample size of 338 nurses was determined by power analysis, and the participants were selected using a simple random sampling method. The data were collected between June and November 2020. A "Personal Information Form", the "Conscience Perception Scale (CPS)", the "Nurse Job Satisfaction Scale (NJSS)" and the "Caring Behaviours Scale-30 (CBS-30)" were used to collect the data. The nurses obtained a score of 63.36 ± 12.13 on the CPS, indicating a high level of conscience perception; a total of 3.41 ± 0.69 points on the NJSS, revealing a high level of job satisfaction; and a total of 150.42 ± 21.22 points on the CBS-30, implying that care perceptions were found to be high. It was determined that the nurses' perceptions of conscience had an effect on their job satisfaction and care behaviours (R = 0.398, Adjusted R2 = 0.158, p = 0.000). The nurses who participated in the study had a high perception of conscience, which positively affected their job satisfaction and care behaviours.
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Affiliation(s)
- Haci Yusuf Gulec
- Department of Fundamentals of Nursing, Yusuf Şerefoğlu Faculty of Health Sciences, Kilis 7 Aralık University, Kilis, Turkey.
| | - Hakime Aslan
- Department of Fundamentals of Nursing, Faculty of Nursing, Inonu University, Malatya 44280, Turkey.
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Gelaw A, Parker S, Johnson A, Nguyen H, Jolly A, Forner V, Deng C, Collie A. Determinants of psychological injury among health and social care workers in community settings: A systematic review. Work 2024; 78:3-27. [PMID: 38578915 DOI: 10.3233/wor-230426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Health and Social Care (HSC) workers face psychological health risks in the workplace. While many studies have described psychological injuries in HSC workers, few have examined the determinants. Previous research has primarily focused on hospitals, lacking systematic reviews of community-based settings. OBJECTIVE To systematically identify and appraise current evidence on the determinants of psychological injuries among HSC workers in community settings. METHODS Searches were conducted in three bibliographic databases, supplemented by citation searches. Included studies focused on community-based HSC workers, reporting statistical associations between psychological injury and personal, health, occupational, or organizational factors. Quantitative studies published in English between January 1, 2000 and August 15, 2023 were included. Quality appraisal was undertaken using the JBI critical appraisal checklist. RESULTS Sixty-six studies were included. Study quality was highly variable, and all studies were cross-sectional. Twenty-three studies linked psychological injury with occupational factors (e.g. low job control, high job demands and low job satisfaction). Thirteen studies observed an association between work environment and psychological injury, and a further eleven between workplace social support and psychological injury. Fewer studies have examined the relationship between psychological injury and personal/individual factors. CONCLUSION Occupational and organisational factors are significantly associated with psychological health among HSA workers, in community settings. These aspects of job design, work environment and workplace relationships are modifiable, suggesting an opportunity for work design interventions to improve workers' psychological health and reduce the prevalence of psychological injury in this sector.
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Affiliation(s)
- Asmare Gelaw
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Sharon Parker
- Future of Work Institute, Curtin University, Perth, WA, Australia
| | - Anya Johnson
- The University of Sydney Business School, The University of Sydney, Sydney, NSW, Australia
| | - Helena Nguyen
- The University of Sydney Business School, The University of Sydney, Sydney, NSW, Australia
| | - Anu Jolly
- Future of Work Institute, Curtin University, Perth, WA, Australia
| | - Vivien Forner
- The University of Sydney Business School, The University of Sydney, Sydney, NSW, Australia
| | - Connie Deng
- The University of Sydney Business School, The University of Sydney, Sydney, NSW, Australia
| | - Alex Collie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Munkeby H, Bratberg G. Registered nurses' exposure to high stress of conscience in long-term care. Nurs Ethics 2023; 30:1011-1024. [PMID: 37163482 PMCID: PMC10710004 DOI: 10.1177/09697330231167542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND In long-term care, registered nurses and other care providers often experience tensions between ideals and realities in the delivery of services, which can result in stress of conscience. Burnout, low quality of care and a tendency to leave the profession are perceived as consequences. OBJECTIVES This study aimed to identify the socio-demographic and work-related factors associated with a high level of stress of conscience, particularly between nursing occupations. RESEARCH DESIGN A cross-sectional survey was conducted among care providers who worked in Norwegian nursing homes and home care services in the spring of 2021. The sample consisted of 950 registered nurses and 1143 other care providers. Data were collected online using the Stress of Conscience Questionnaire (SCQ). ETHICAL CONSIDERATIONS Participation was voluntary and based on consent. The study was approved by the Norwegian Center for Research Data. RESULTS Registered nurses were nearly twice as likely to report high levels of stress of conscience compared to other care providers in long-term care. In addition, being a female, living alone, caring for their own children, working in an institution (versus home based), working >75% time, working shifts, not having scheduled meetings for ethical reflection and working in municipalities with a higher population density were factors associated with a high level of SCQ score. DISCUSSION Knowledge of factors that increase the risk of high SCQ scores in registered nurses provides opportunities for prevention. Managers in long-term care should pay more attention to how work is distributed between the occupational groups and should facilitate real opportunities for ethical reflection. CONCLUSIONS The results of this study show that registered nurses have particular exposure to high levels of stress of conscience compared to other care providers in long-term care. Particular attention should be paid to registered nurses working in nursing homes.
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Affiliation(s)
- Hilde Munkeby
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Grete Bratberg
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
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Nazari S, Norberg A, Strandberg G, Åhlin J, Ericson-Lidman E, Mazaheri M. Perceptions and stress of conscience in relation to burnout among nursing staff in older people care settings: a cross sectional study. BMC Nurs 2023; 22:379. [PMID: 37833719 PMCID: PMC10571441 DOI: 10.1186/s12912-023-01529-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Considering cultural influences, it is important to study the perceptions and stress of conscience in different contexts. This study aimed to investigate the association between perceptions of conscience, stress of conscience, and burnout among nursing staff working in older people care settings in Tehran. METHODS This was a descriptive, cross-sectional study. A total of 161 participants completed the Perceptions of Conscience Questionnaire, Stress of Conscience Questionnaire, and Oldenburg Burnout Inventory, 2019. All nursing staff working at the 20 contacted nursing homes agreed to participate in the study. The descriptive and inferential analysis was conducted through SPSS, using T-tests and one-way between-groups analysis of variance, Chi-square and t-tests, Cohen's d (d), Eta-squared (η2), and Phi coefficient (φ), Partial least squares regression (PLSR), jackknife approximate t-tests of the regression coefficients, and jackknife 95% confidence intervals of the regression coefficients. RESULTS The nursing staff perceived their conscience mainly as an authority, asset, and warning signal. Impact of workload on family life was the most common source of stress for the nursing staff. Dealing with incompatible demands, the impact of workload on family life, witnessing insulated patients, inability to meet one's standards in providing care, and perception of conscience as a burden were strongly associated with the burnout. CONCLUSIONS Perceiving conscience as a warning signal or authority may serve as a buffer against burnout among nursing staff. This study highlights the need for further exploration of perceptions of conscience in different cultural and social backgrounds.
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Affiliation(s)
- Shima Nazari
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Johan Åhlin
- Department of Nursing, Umeå University, Umeå, Sweden
| | | | - Monir Mazaheri
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
- Department of Neurobiology Care Sciences and Society, Karolinska Institute, Huddinge, Sweden
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Munkeby H, Bratberg G, Devik SA. Meanings of troubled conscience in nursing homes: nurses' lived experience. Nurs Ethics 2023; 30:20-31. [PMID: 36036774 PMCID: PMC9902975 DOI: 10.1177/09697330221117261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Troubled conscience among nurses and other healthcare workers represents a significant contributor to healthcare worker moral distress, burnout and attrition. While research in this area has examined critical care in hospitals, less knowledge has been obtained from long-term care contexts such as nursing homes, despite widely recognised challenges with regard to vulnerable patients, increasing workload and maintaining workforce sustainability among nurses. OBJECTIVE The aim of this study was to illuminate and interpret the meaning of the lived experience of troubled conscience among registered nurses (RNs) working in nursing homes. RESEARCH DESIGN This qualitative research employed narrative interviews with eight nurses to obtain essential meanings of their lived experiences of troubled conscience. The interview texts were analysed using a phenomenological hermeneutic approach. ETHICAL CONSIDERATIONS Participation was voluntary, informed and was conducted with written consent. The Norwegian Centre for Research Data approved the data processing of personal data. FINDINGS The analysis uncovered two themes: (1) troubled conscience means abandoning ideals, with the subthemes: failing dependent patients; being disloyal to colleagues; being inadequate in the performance of work tasks and (2) troubled conscience means facing realities, with the subthemes: accepting being part of the system; responding to barriers. DISCUSSION Troubled conscience meant experiencing continuous and simmering tension between one's ideals and realities and feeling a drive to preserve accountability and one's moral integrity. Endangered ideals were often under cross-pressure and included humanistic values, professional values, working life values and the values of the organisation. CONCLUSION Nurses' troubled conscience refers to a struggle, but also a force that plays out at various levels and arenas in long-term care. Openness and dialogue about how professional values and the welfare state's intentions can be realised within the given framework are important for individual nurses' occupational health as well as the quality of care provided to patients.
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Affiliation(s)
- Hilde Munkeby
- Hilde Munkeby, Faculty of Nursing and Health Sciences, Nord University, Høgskolevegen 27, Levanger 7600, Norway.
| | | | - Siri A Devik
- 158927Centre of Care Research, Steinkjer, Mid-Norway; Faculty of Nursing and Health Sciences, Nord University, Namsos, Norway
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Oner Yalcin S, Yildirim G, Kadioglu FG, Sertdemir Y. Stress of conscience and burnout among nurses in Turkey. Perspect Psychiatr Care 2022; 58:1882-1890. [PMID: 34914116 DOI: 10.1111/ppc.13002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 12/01/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To investigate the validity and reliability of the Turkish version of the Stress of Conscience Questionnaire (SCQ) and to determine its relationship to burnout among Turkish nurses. DESIGN AND METHODS The sample of this study with a cross-sectional design comprised 375 nurses. The data were collected using the Maslach Burnout Inventory (MBI) and SCQ. FINDINGS The mean score of the nurses obtained from the overall SCQ was 85.36 ± 39.3 (min: 0; max: 225). The highest scored item by the nurses was related to "lack of energy to devote themselves to their families." There was a significant positive correlation between the Emotional Exhaustion-MBI scores and SCQ scores (r = 0.414, p < 0.001). PRACTICE IMPLICATIONS The Turkish version of SCQ is a valid and reliable tool among Turkish nurses and is associated with emotional exhaustion.
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Affiliation(s)
- Sibel Oner Yalcin
- Department of Medical Ethics and History, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Gulay Yildirim
- Department of Medical Ethics and History, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Funda G Kadioglu
- Department of Medical Ethics and History, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Yasar Sertdemir
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Cukurova University, Adana, Turkey
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Jokwiro Y, Wilson E, Bish M. Losing passion and injured self-image: An interpretive description study of troubled conscience among registered nurses caring for older people with delirium in hospital. Collegian 2022. [DOI: 10.1016/j.colegn.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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The Association of Life Events Outside the Workplace and Burnout: A Cross-Sectional Study on Nursing Assistants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159342. [PMID: 35954702 PMCID: PMC9368059 DOI: 10.3390/ijerph19159342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 01/27/2023]
Abstract
Background: Burnout, by definition, is related to adverse chronic workplace stressors. Life events outside the workplace have been associated with an increased risk of psychiatric morbidity. However, it is unknown whether life events outside the workplace increase the severity of burnout. Purpose: The aim of the study was to investigate the association between burnout and life events outside the workplace in nursing assistants. Methods: In an observational, cross-sectional, single-site study of 521 nursing assistants at a university hospital, we assessed burnout with the Maslach Burnout Inventory-Human Services Survey, and life events with the Social Readjustment Rating Scale. We constructed equations of multiple linear regression analyses that included each burnout subscale as the dependent variable and a domain of life events as the independent variable. Results were adjusted for potential confounders, including gender, no religion or faith, years of work, and depression. Results: An increase in the number of life events in the domain of personal changes or difficulties (e.g., personal injury or illness, sexual difficulties, change in recreation, church activities, social activities, sleeping habits, eating habits and revision of personal habits) was associated with increased severity of emotional exhaustion. An increase in the number of life events in the domain of changes in familial situation and in the domains of death of relatives or friends were associated with increased severity of depersonalization. Those associations were independent of work-related life events and other potential confounders. Conclusions: Life events outside the workplace may increase the levels of burnout in nursing assistants.
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Jodaki K, Esmaeili M, Cheraghi MA, Mazaheri M. Intensive care unit nurses' conflict of conscience: Walking the Razor's edge. Nurs Health Sci 2022; 24:265-273. [PMID: 35061324 DOI: 10.1111/nhs.12921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/28/2022]
Abstract
The study aimed to explore the conditions that accompany conflict of conscience experienced by nurses in intensive care units. A qualitative approach guided the study, which was undertaken between April 2020 and April 2021. A total of 15 registered nurses working in intensive care units were recruited through purposive sampling. Individual semistructured interviews were conducted. The data were analyzed using a qualitative content analysis. The analysis revealed two themes: "conflict of conscience in relation to the structure" and "conflict of conscience based on context." Conflict of conscience in relation to the structure consisted of two categories: conflict of interest and conflict of conscience and law. Conflict of conscience based on context consisted of two categories: care dilemmas and arbitrary behaviors with end-stage patients. A variety of factors were accompanied by a conflict of conscience for nurses in intensive care units. Given that conflict of conscience has negative consequences for the health and quality of nursing care, health care managers need to tailor strategies to reduce the negative consequences considering the findings of the study.
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Affiliation(s)
- Kurosh Jodaki
- PhD Candidate of Nursing, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Esmaeili
- Associate Professor, Nursing and Midwifery care research center, School of Nursing and Midwifery, Tehran University of Medical Sciences; Health Sciences Phenomenology Association, Ministry of Health and Medical Education, Tehran, Iran
| | - Mohammad Ali Cheraghi
- Associate Professor, Nursing and Midwifery care research center, School of Nursing and Midwifery, Tehran University of Medical Sciences; Health Sciences Phenomenology Association, Ministry of Health and Medical Education, Tehran, Iran
| | - Monir Mazaheri
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Department of Health Sciences, The Swedish Red Cross University College, Huddinge, Sweden
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Jodaki K, Esmaeili M, Cheraghi MA, Pashaeypoor S, Sadat Hoseini AS. Clarifying the concept of conscience in nurses' ethical performance in Iran: a concept analysis study. J Med Ethics Hist Med 2022; 14:14. [PMID: 35035801 PMCID: PMC8696592 DOI: 10.18502/jmehm.v14i14.7669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 08/15/2021] [Indexed: 11/24/2022] Open
Abstract
Although conscience, as an ethical concept, has emerged widely in the field of nursing, its functional meaning and its effects on nurses' performance are not clear. Therefore, the present study aimed to analyze the concept of conscience in the context of Iranian nurses’ ethical performance. This study used a hybrid model including theoretical, fieldwork, and final analytic stages. In the theoretical phase, English and Persian articles published up to 2020 and indexed by scientific databases were analyzed. In the fieldwork phase, semi-structured in-depth interviews were conducted on nurse participants. The last two stages were jointly considered to draw the study’s conclusions. In the theoretical phase, conscience was considered as a context-dependent concept, an inner voice, and a criterion for distinguishing right from wrong. The fieldwork phase’ results were categorized into three themes: “perception of conscience”, “commands of conscience”, and “obedience to conscience. The final definition was reached by merging the theoretical and field stages. This article aimed at investigating the relevance of conscience to ethical practice in the nursing field. Findings show that conscience is an inner feeling or voice that plays a vital role in providing ethical care by nurses.
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Affiliation(s)
- Kurosh Jodaki
- PhD Candidate of Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Esmaeili
- Assistant Professor, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Cheraghi
- Professor, Department of Critical Care and Nursing Management, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran; Health Sciences Phenomenology Association, Ministry of Health and Medical Education, Tehran, Iran
| | - Shahzad Pashaeypoor
- Assistant Professor, Department of Community Health and Geriatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Sadat Sadat Hoseini
- Associated Professors, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Jokwiro Y, Wilson E, Bish M. The extent and nature of stress of conscience among healthcare workers: A scoping review. Appl Nurs Res 2022; 63:151554. [PMID: 35034704 DOI: 10.1016/j.apnr.2021.151554] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/15/2021] [Accepted: 12/16/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Healthcare workers experience morally stressful situations during delivery of care which may trouble their conscience. Literature emerging in the context of global pandemics suggest increased frequency of morally stressful situations in healthcare and a link with negative outcomes such as attrition and burnout. Little is known about the emerging concept of stress of conscience which could provide a meaningful way to highlight and address these morally stressful situations in healthcare. AIM The aim of this scoping review was to provide an overview of the literature on, (i) the extent, (ii) the factors associated, and (iii) the interventions to prevent or mitigate stress of conscience among healthcare workers. DESIGN The study was guided by the framework provided by Arksey and O'Malley in 2005 and the PRISMA Guidelines. Relevant healthcare databases were searched in November 2020 to identify relevant studies. RESULTS The search identified 24 studies for inclusion in the analysis, 19 of these were from Nordic countries, particularly Sweden. Across those studies, stress of conscience was prevalent among healthcare workers and the levels varied with demographic factors, individual personalities, perceptions of belonging and the workplace culture and environment. Stress of conscience was associated with negative outcomes such as burnout, moral burden, workplace stress, and low quality of care. Although there were few quality interventions studies, facilitating healthcare workers to provide person-centred care appears to be a promising intervention. CONCLUSIONS The concept of stress of conscience provides a contemporary framework to assess, highlight and discuss the degree of the negative impact of perceived violations of professional and personal values in healthcare. However, the limited studies suggest that exploring stress of conscience, including trials of potential interventions, particularly beyond Nordic countries is essential to fill the gaps in the literature.
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Affiliation(s)
- Yangama Jokwiro
- Department of Rural Nursing & Midwifery, La Trobe Rural Health School, Australia.
| | - Elena Wilson
- Rural Dept of Community Health, La Trobe Rural Health School, Australia
| | - Melanie Bish
- Department of Rural Nursing & Midwifery, La Trobe Rural Health School, Australia
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Abstract
The ability of nurses to act as moral agents in accordance with their conscience is both an essential human freedom and an important part of professional ethics. Recent developments in Canada related to Medical Assistance in Dying have revealed new and important challenges related to conscientious objection - challenges that may require rethinking of how nurses do professional ethics. Notably, the inclusion of a personalist bioethical approach is needed to introduce and explicate what conscience is for nurses to be able to apply it to nursing practice. In this article, we explore the importance of conscience and conscientious objection as ethical concepts to support nurses in addressing issues of conscience amid ethically challenging situations. We discuss how a personalist basis for conscience can support nurses to inclusively engage with one another across diverse moral perspectives.
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Gadsby J, McKeown M. Mental health nursing and conscientious objection to forced pharmaceutical intervention. Nurs Philos 2021; 22. [PMID: 34463024 DOI: 10.1111/nup.12369] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/03/2021] [Accepted: 08/10/2021] [Indexed: 11/26/2022]
Abstract
This paper attempts a critical discussion of the possibilities for mental health nurses to claim a particular right of conscientious objection to their involvement in enforced pharmaceutical interventions. We nest this within a more general critique of perceived shortcomings of psychiatric services, and injustices therein. Our intention is to consider the philosophical and practical complexities of making demands for this conscientious objection before arriving at a speculative appraisal of the potential this may hold for broader aspirations for a transformed or alternative mental health care system, more grounded in consent than coercion. We consider a range of ethical and practical dimensions of how to realize this right to conscientious objection. We also rely upon an abolition democracy lens to move beyond individual ethical frameworks to consider a broader politics for framing these arguments.
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Affiliation(s)
- Jonathan Gadsby
- School of Nursing and Midwifery, Birmingham City University, Birmingham, UK
| | - Mick McKeown
- School of Nursing, University of Central Lancashire, Preston, UK
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16
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Factors associated with stress of conscience in caring for older people with delirium in a hospital setting: An exploratory cross-sectional study. Collegian 2021. [DOI: 10.1016/j.colegn.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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17
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Åhlin J, Ericson-Lidman E, Strandberg G. Assessments of stress of conscience, burnout and social support amongst care providers in home care and residential care for older people. Scand J Caring Sci 2021; 36:131-141. [PMID: 33734472 DOI: 10.1111/scs.12970] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/18/2020] [Accepted: 01/31/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Studies points to that levels of stress of conscience and burnout among staff in healthcare contexts may seriously affect their health. AIM To compare assessments and associations of stress of conscience, perceptions of conscience, social support and burnout amongst care providers working in home care respectively residential care for older people. METHODS This cross-sectional descriptive comparative study was performed among all care providers working in home care (n = 227) and residential care of older people (n = 354) in a municipality in northern Sweden. Data was collected using four different questionnaires. Analysis were performed using partial least square regression, descriptive statistics, statistical tests and effect size measures. RESULTS Care providers in residential care of older people assessed higher levels of stress of conscience compared to those working in home care. Exhaustion was an important predictor for belonging to the group of care providers working in residential care of older people. The most important predictor for belonging to the group of care providers working in home care were social support from one's immediate superior and co-workers. Women assessed significantly higher levels of stress of conscience and exhaustion compared to men. CONCLUSION Further research seems needed to investigate what the high levels of stress of conscience is caused by. A combined intervention consisting of work-directed measures against burnout and measures aiming at reducing stress of conscience is suggested.
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Affiliation(s)
- Johan Åhlin
- Department of Nursing, Umeå University, Skellefteå, Sweden
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Jokwiro Y, Pascoe E, Edvardsson K, Rahman MA, McDonald E, Lood Q, Edvardsson D. Stress of Conscience Questionnaire (SCQ): exploring dimensionality and psychometric properties at a tertiary hospital in Australia. BMC Psychol 2020; 8:109. [PMID: 33081845 PMCID: PMC7576718 DOI: 10.1186/s40359-020-00477-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 10/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study explored the psychometric properties and dimensionality of the Stress of Conscience Questionnaire (SCQ) in a sample of health professionals from a tertiary-level Australian hospital. The SCQ, a measure of stress of conscience, is a recently developed nine-item instrument for assessing frequently encountered stressful situations in health care, and the degree to which they trouble the conscience of health professionals. This is relevant because stress of conscience has been associated with negative experiences such as job strain and/or burnout. The validity of SCQ has not been explored beyond Scandinavian contexts. METHODS A cross-sectional study of 253 health professionals was undertaken in 2015. The analysis involved estimates of reliability, variability and dimensionality. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to explore dimensionality and theoretical model fit respectively. RESULTS Cronbach's alpha of 0.84 showed internal consistency reliability. All individual items of the SCQ (N = 9) met the cut-off criteria for item-total correlations (> 0.3) indicating acceptable homogeneity. Adequate variability was confirmed for most of the items, with some items indicating floor or ceiling effects. EFA retained a single latent factor with adequate factor loadings for a unidimensional structure. When the two-factor model was compared to the one-factor model, the latter achieved better goodness of fit supporting a one-factor model for the SCQ. CONCLUSION The SCQ, as a unidimensional measure of stress of conscience, achieved adequate reliability and variability in this study. Due to unidimensionality of the tool, summation of a total score can be a meaningful way forward to summarise and communicate results from future studies, enabling international comparisons. However, further exploration of the questionnaire in other cultures and clinical settings is recommended to explore the stability of the latent one-factor structure.
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Affiliation(s)
- Yangama Jokwiro
- College of Science, Health and Engineering, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia. .,School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia.
| | - Elizabeth Pascoe
- College of Science, Health and Engineering, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Kristina Edvardsson
- College of Science, Health and Engineering, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Muhammad Aziz Rahman
- School of Nursing and Healthcare Professions, Federation University, Berwick Campus, Melbourne, Australia
| | - Ewan McDonald
- College of Science, Health and Engineering, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Qarin Lood
- College of Science, Health and Engineering, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.,Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Sahlgrenska Academy, Centre for Ageing and Health - AgeCap, University of Gothenburg, Box 455, 40530, Gothenburg, Sweden
| | - David Edvardsson
- College of Science, Health and Engineering, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.,Department of Nursing, The Medical Faculty, Umea University, Umeå, Sweden
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Kunkle R, Chaperon C, Hanna KM. Formal Caregiver Burden in Nursing Homes: A Concept Analysis. J Gerontol Nurs 2020; 46:19-24. [DOI: 10.3928/00989134-20200706-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/01/2020] [Indexed: 11/20/2022]
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20
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Govasli L, Solvoll BA. Nurses' experiences of busyness in their daily work. Nurs Inq 2020; 27:e12350. [PMID: 32133740 DOI: 10.1111/nin.12350] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 11/30/2022]
Abstract
The purpose of this study is to explore and illuminate the phenomenon of busyness as experienced by nurses. The daily work of nursing practice is often characterized by a hectic pace in the execution of tasks. Previous research shows that busyness can potentially lead to a reduction in the quality of nursing. Little has been explored about nurses' own experiences of busyness. This study has a qualitative design. The method chosen is a phenomenological hermeneutical exploration of personal experiences. Results reveal that busyness is experienced as a disparity between perceived necessary tasks and time available to accomplish them. Busyness has an outer dimension of events and a dimension of internal processes. Busyness is experienced as acceptable to some extent, but feels strongly uncomfortable if important tasks remain undone. The intolerable busyness raises negative emotions, steals energy and weakens health. Coping with busyness seems to be a personal and individual struggle, even though health service enterprises are a collective matter.
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Affiliation(s)
- Laila Govasli
- Department Physical Medicine and Rehabilitation (FMR), The Hospital at Helgeland, Mo I Rana, Norway
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21
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Sastrawan S, Newton JM, Malik G. Nurses' integrity and coping strategies: An integrative review. J Clin Nurs 2018; 28:733-744. [PMID: 30358004 DOI: 10.1111/jocn.14702] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 10/13/2018] [Accepted: 10/16/2018] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Integrity is one of the core values in nursing that needs to be maintained by nurses in practice. However, the complexity in the nursing milieu can pose threats to integrity. An understanding of the common threats and coping strategies might assist nurses in preserving integrity in everyday practice. AIMS AND OBJECTIVES To review and synthesis the concept of integrity in nursing and identify common threats and coping strategies. METHODS Whittemore and Knafl's integrative review method was implemented. A search was performed in Scopus, Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Proquest Health and Medical electronic databases published in English between 2000-2017. Two reviewers independently assessed eligibility for inclusion. Methodological appropriateness for the included studies was assessed using the critical appraisal skills programme. The constant comparative method of grounded theory was used to analyse and synthesise data from seven peer-reviewed articles. RESULTS Two major conceptions of integrity were identified. These included the sense of wholeness with regard to personal-professional concerns and ethical-moral conducts. Five entities, self, patients, teamwork and work culture, the nature of work, and organisation, were identified as interweaving elements that may induce threats to integrity. When integrity is threatened, nurses use two key strategies to survive: adjusting and compensating. An emergent framework to facilitate understanding of nurses' threats to integrity is discussed. CONCLUSIONS A threat to nurses' integrity takes form when there is an unmitigated gap between a nurse's expectation and reality. While the expectation comes from within the nurse, the reality materialises out of the complex interplays that occur in the healthcare workforce. Maintaining integrity demands a continual strive to balance personal expectations, professional concerns and nursing realities.
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Affiliation(s)
| | - Jennifer Margaret Newton
- Nursing and Midwifery, Monash University, Clayton, Victoria, Australia.,School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Gulzar Malik
- Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
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22
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Awosoga O, Pijl EM, Hagen B, Hall B, Sajobi T, Spenceley S. Development and validation of the Moral Distress in Dementia Care Survey instrument. J Adv Nurs 2018; 74:2685-2700. [PMID: 30019353 DOI: 10.1111/jan.13803] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/25/2018] [Accepted: 07/02/2018] [Indexed: 11/28/2022]
Abstract
AIMS To report on the development and validation of the Moral Distress in Dementia Care Survey instrument. BACKGROUND Despite growing awareness of moral distress among nurses, little is known about the moral distress experiences of nursing staff in dementia care settings. To address this gap, our research team developed a tool for measuring the frequency, severity and effects of moral distress in nursing staff working in dementia care. DESIGN The research team employed an exploratory sequential mixed method design to generate items for the moral distress questionnaire. Data were collected between January 2013 - June 2014. In this paper, we report on the development and validation of the Moral Distress in Dementia Care Survey instrument. METHODS The Moral Distress in Dementia Care Survey instrument was piloted with a portion of the target population prior to a broader implementation. Appropriate statistical analyses and psychometric testing were completed. RESULTS The team collected 389 completed surveys from registered nurses, licensed practical nurses and healthcare aides, representing a 43.6% response rate across 23 sites. The Moral Distress in Dementia Care Survey emerged as a reliable and valid instrument to measure the frequency, severity and effects of moral distress for nursing staff in dementia care settings. The relative value of the Moral Distress in Dementia Care Survey as a measurement instrument was superseded by its clinical relevance for dementia care staff. CONCLUSION The Moral Distress in Dementia Care Survey is a potentially useful tool for estimating the frequency, severity and effects of moral distress in nursing staff working in dementia care settings and for the evaluation of measures taken to mitigate moral distress.
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Affiliation(s)
- Olu Awosoga
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada
| | - Em M Pijl
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada
| | - Brad Hagen
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada
| | - Barry Hall
- Faculty of Social Work, University of Calgary, Lethbridge, AB, Canada
| | - Tolulope Sajobi
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Shannon Spenceley
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada
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Martín-Del-Río B, Solanes-Puchol Á, Martínez-Zaragoza F, Benavides-Gil G. Stress in nurses: The 100 top-cited papers published in nursing journals. J Adv Nurs 2018. [PMID: 29516543 DOI: 10.1111/jan.13566] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To identify and analyse the 100 most cited papers on stress in nurses published in nursing journals. BACKGROUND The number of citations an article receives is an index of its impact on the scientific community. An analysis of the most cited articles on stress in nursing would allow us to identify the most important articles and to obtain information about this area of knowledge. DESIGN A retrospective bibliometric analysis. DATA SOURCES In 2016, 111 journals belonging to the "nursing" category were identified in the Science and Social Science Citation Index. A search was performed of the Science Core Collection Website for articles on stress published in these journals. REVIEW METHODS The topic, type of article, publishing journal, countries and institutions of origin and year of publication were extracted from the articles. The impact factor, immediacy index, journal country and publisher and h index were collected from the Institute for Scientific Information. The citation density, citation tendency and Bradford's law were calculated. RESULTS They identified articles were mostly empirical quantitative studies with a transversal design, published from 1975 - 2011 in 23 journals. They were signed by 233 authors, most of whom are English-speaking from the USA and UK. The core distribution of the publications comprises a single journal, the Journal of Advanced Nursing. CONCLUSION The study of stress in nursing has shown increased visibility and recognition each decade. The most recent articles have the highest number of citations, are the highest in rank and have the higher citation densities.
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Alkrisat M. Predict Moral Distress Using Workplace Stress, Stress of Conscience Mediated by Coping Using Roy Adaptation Model: A Path Analysis. J Nurs Meas 2017; 24:477-492. [PMID: 28714452 DOI: 10.1891/1061-3749.24.3.477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Moral distress can be predisposed when nurses are exposed to ambiguous moral situations. PURPOSE Is to test a conceptual model based on Roy adaptation model (RAM) to examine the relationship among workplace stress, conscience stress, and moral distress mediated by coping. DESIGN A correlational, cross sectional. RESULTS Data were collected from 199 licensed nurses. The findings indicated that workplace stress was related negatively to coping processes (β = -.12) and that stress of conscience was predictive of greater use of coping process (β = -.21). CONCLUSION The results indicated that the model suggested based on RAM is saturated and is the perfect fit. However, the alternative models indicated that workplace stress moderately predicted moral distress.
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25
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Mazaheri M, Ericson-Lidman E, Joakim Ö, Norberg A. Meanings of troubled conscience and how to deal with it: expressions of Persian-speaking enrolled nurses in Sweden. Scand J Caring Sci 2017; 32:380-388. [PMID: 28799165 DOI: 10.1111/scs.12472] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 03/29/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION A feature of the healthcare system in Sweden, particularly in the care of older people, is its cultural diversity in terms of having considerable numbers of both caregivers and care recipients with an immigrant background. Considering the influence of culture in ethical decision-making processes, the idea of conscience and the adverse effects of a troubled conscience, it is important to study the concepts of conscience and troubled conscience in culturally diverse populations. There is no published study regarding troubled conscience among immigrant populations that includes enrolled nurses. AIM To illuminate the meanings of troubled conscience and how to deal with it among enrolled nurses with Iranian backgrounds working in Swedish residential care for Persian-speaking people with dementia who have emigrated from Iran. METHOD The study was conducted with a phenomenological hermeneutic design. Ten enrolled nurses with an Iranian background, with at least one year's experience of taking care of older people with dementia, were interviewed. The study was reviewed by the Regional Ethical Review Board for ethical vetting of research involving humans. Appropriate measures were taken to ensure confidentiality and voluntary participation. RESULTS The meanings of having a troubled conscience for the participants comprise not being a good person, including being an uncaring person, not acting according to one's values and living in a state of unease. Dealing with a troubled conscience involves trying to compensate for the harm one has caused and trying to prevent similar situations by being a responsible caregiver. CONCLUSIONS The enrolled nurses understood themselves as caring people and not only caregivers. They knew that they should hear their conscience and respond to it by trying to be a caring person and acting according to their values. The findings should be interpreted in the given specific context.
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Affiliation(s)
- Monir Mazaheri
- Department of Nursing and Care, The Swedish Red Cross University College, Stockholm, Sweden.,Tehran University of Medical Sciences, Tehran, Iran
| | | | - Öhlén Joakim
- Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,University of Gothenburg Centre for Person-Centred Care, Gothenburg, Sweden
| | - Astrid Norberg
- Department of Nursing, Umeå University, Umeå, Sweden.,Ersta Sköndal Bräcke University College, Stockholm, Sweden
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26
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Lamb C, Evans M, Babenko-Mould Y, Wong CA, Kirkwood KW. Conscience, conscientious objection, and nursing: A concept analysis. Nurs Ethics 2017; 26:37-49. [PMID: 28399688 DOI: 10.1177/0969733017700236] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Ethical nursing practice is increasingly challenging, and strategies for addressing ethical dilemmas are needed to support nurses' ethical care provision. Conscientious objection is one such strategy for addressing nurses' personal, ethical conflicts, at times associated with conscience. Exploring both conscience and conscientious objection provides understanding regarding their implications for ethical nursing practice, research, and education. RESEARCH AIM: To analyze the concepts of conscience and conscientious objection in the context of nurses. DESIGN: Concept analysis using the method by Walker and Avant. RESEARCH CONTEXT: Data were retrieved from Philosopher's Index, PubMed, and CINAHL with no date restrictions. ETHICAL CONSIDERATION: This analysis was carried out per established, scientific guidelines. FINDINGS: Ethical concepts are integral to nursing ethics, yet little is known about conscientious objection in relation to conscience for nurses. Of note, both concepts are well established in ethics literature, addressed in various nursing codes of ethics and regulatory bodies, but the meaning they hold for nurses and the impact they have on nursing education and practice remain unclear. DISCUSSION AND CONCLUSION: This article discusses the relevance of conscience and conscientious objection to ethical nursing practice and proposes a model case to show how they can be appreciated in the context of nurses. Conscientious objection is an option for ethical transparency for nurses but is situated in contentious discussions over its use and has yet to be fully understood for nursing practice. Conscience is an element in need of more exploration in the context of conscientious objection. Further research is warranted to understand how nurses respond to conscience concerns in morally, pluralistic nursing contexts.
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27
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Chamberlain SA, Gruneir A, Hoben M, Squires JE, Cummings GG, Estabrooks CA. Influence of organizational context on nursing home staff burnout: A cross-sectional survey of care aides in Western Canada. Int J Nurs Stud 2017; 71:60-69. [PMID: 28334686 DOI: 10.1016/j.ijnurstu.2017.02.024] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 02/10/2017] [Accepted: 02/28/2017] [Indexed: 10/24/2022]
Abstract
PURPOSE Our study examined care aide characteristics, organizational context, and frequency of dementia-related resident responsive behaviours associated with burnout. Burnout is the experience of emotional exhaustion, cynicism, and professional inefficacy. Care aide burnout has implications for turnover, staff health, and quality of care. DESIGN AND METHODS We used surveys collected from 1194 care aides from 30 urban nursing homes in three Western Canadian provinces. We used a mixed-effects regression analysis to assess care aide characteristics, dementia-related responsive behaviours, unit and facility characteristics, and organizational context predictors of care aide burnout. We measured burnout using the Maslach Burnout Inventory, Short Form. RESULTS We found that care aides were at high risk for emotional exhaustion and cynicism, but report high professional efficacy. Statistically significant predictors of emotional exhaustion included English as a second language, medium facility size, organizational slack-staff, organizational slack-space, health (mental and physical) and dementia-related responsive behaviours. Statistically significant predictors of cynicism were care aide age, English as a second language, unit culture, evaluation (feedback of data), formal interactions, health (mental and physical) and dementia-related responsive behaviours. Statistically significant predictors of professional efficacy were unit culture and structural resources. Greater care aide job satisfaction was significantly associated with increased professional efficacy. IMPLICATIONS This study suggests that individual care aide and organization features are both predictive of care aide burnout. Unlike care aide or structural characteristics of the facility elements of the organizational context are potentially modifiable, and therefore amenable to intervention.
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Affiliation(s)
| | - Andrea Gruneir
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | - Janet E Squires
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
| | - Greta G Cummings
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
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Abstract
Participatory action research (PAR) is an approach for dealing with problematic areas in practice. Follow-up studies in which participants describe their participation in PAR in detail are rare. This follow-up study aimed to describe care providers' (CPs) experiences of having participated in a PAR intervention designed to assist them to constructively deal with troubled conscience. Twenty-nine CPs who participated in a PAR intervention were interviewed 2 to 4 months post-intervention. Content analysis was used to analyze the data. The analysis revealed three main categories: the importance of having a communal and collaborative meeting place, perceived changes in daily life, and "It has been good, but it has not solved all of our problems." Using PAR to deal with troubled conscience might be an important organizational investment for the future that can help prevent ill health among CPs and maintain or improve the quality of care.
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García-Cano A, Paterna C, Martínez C. Influence of gender self-schema and type of service-oriented NGOs on volunteering activity / Influencia del autoesquema de género y del tipo de servicios de las ONG en las actividades de voluntariado. INTERNATIONAL JOURNAL OF SOCIAL PSYCHOLOGY 2016. [DOI: 10.1080/02134748.2016.1190129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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30
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Sarvimäki A, Stenbock-Hult B, Sundell E, Oesch-Börman C. The vulnerability of family caregivers in relation to vulnerability as understood by nurses. Scand J Caring Sci 2016; 31:112-119. [PMID: 27126224 DOI: 10.1111/scs.12325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 12/02/2015] [Indexed: 11/30/2022]
Abstract
In Finland, the care of older persons is shifting from institutional care to family care. Research shows that family caregivers experience their situation much in the same way as professional nurses. The nurses' experiences have been studied in terms of vulnerability, and the same perspective could deepen our understanding of family caregivers' experiences. The aim of this study was to gain knowledge of the vulnerability of older caregivers taking care of an ageing family member. The research questions were as follows: How do family caregivers experience vulnerability? How do their experiences relate to vulnerability as understood by nurses? The study was done as a secondary analysis of focus group interviews on the experiences and daily life of older family caregivers. Four caregivers had taken part in monthly interviews during a period of 10 months. The interviews were analysed by deductive and inductive content analysis. The results showed that the caregivers saw caregiving as part of being human. They experienced a variety of feelings and moral agony and were harmed physically, mentally and socially. They showed courage, protected themselves and recognised that being a caregiver also was a source of maturing and developing. These results corresponded with the nurses' understanding of vulnerability. Shame, the experience of duty as a burden, worry and loneliness were themes that were found only among the family caregivers. The use of a matrix may have restricted the analysis, but using it in an unconstrained way allowed for new themes to be created. The results indicate a common humanness and vulnerability in professional and family caregiving. They also show that family caregivers need more support both from society and professionals.
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Affiliation(s)
| | | | - Eija Sundell
- Arcada University of Applied Sciences, Helsinki, Finland
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31
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Rosendahl SP, Söderman M, Mazaheri M. Immigrants with dementia in Swedish residential care: an exploratory study of the experiences of their family members and Nursing staff. BMC Geriatr 2016; 16:18. [PMID: 26772758 PMCID: PMC4715319 DOI: 10.1186/s12877-016-0200-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Worldwide, there is a growing population of older people who develop dementia in a country other than that of their origin. When their dementia has reached an advanced stage, residential care is most often needed. People with dementia in Sweden are often cared for in group homes. For immigrants, this may mean a linguistically challenging care environment for both healthcare staff and the patients' family members. The aim of this study was to explore and describe the experiences of family members and professional caregivers regarding the care provided to immigrants with dementia in group homes in Sweden. METHODS An exploratory, descriptive study with a qualitative approach was chosen. In-depth semi-structured interviews were conducted with nine professional caregivers and five family members of people with dementia with Finnish, Estonian, Hungarian and Ingrian backgrounds; all were chosen purposefully. All people with dementia had lost their Swedish language skills as their second language. The data was analysed using qualitative content analysis. RESULTS Three main categories and seven subcategories were identified. The first main category: A new living situation comprised the subcategories: adjusting to new living arrangements and expectations regarding activities and traditional food at the group home, the second main category: Challenges in communication with the subcategories: limited communication between the immigrant with dementia and the Swedish-speaking nursing staff and the consequences of linguistic misunderstandings and nuanced communication in a common language and the third main category: The role of the family member at the group home with the subcategories: a link to the healthy life story of the family member with dementia and an expert and interpreter for the nursing staff. CONCLUSIONS The family member played a crucial role in the lives of immigrants with dementia living in a group home by facilitating communication between the nursing staff and the PWD and also by making it possible for PWD to access the cultural activities they wanted and which professional caregivers were either not able to recognise as needed or could not deliver.
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Affiliation(s)
- Sirpa Pietilä Rosendahl
- Mälardalen University, School of Health, Care and Social Welfare, Division of Caring Sciences, Eskilstuna, Sweden.
| | - Mirkka Söderman
- Mälardalen University, School of Health, Care and Social Welfare, Division of Caring Sciences, Eskilstuna, Sweden.
| | - Monir Mazaheri
- Mälardalen University, School of Health, Care and Social Welfare, Division of Caring Sciences, Eskilstuna, Sweden. .,Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
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Gorbanzadeh B, Rahmani A, Mogadassian S, Behshid M, Azadi A, Taghavy S. Levels of Conscience and Related Factors among Iranian Oncology Nurses. Asian Pac J Cancer Prev 2016; 16:8211-4. [PMID: 26745062 DOI: 10.7314/apjcp.2015.16.18.8211] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Having a conscience is one of the main pre-requisite of providing nursing care. The knowledge regarding levels of conscience among nurses in eastern countries is limited. So, the purpose of this study was to examine the level of conscience and its related factors among Iranian oncology nurses. MATERIALS AND METHODS This descriptive-correlational study was conducted in 3 hospitals in Tabriz, Iran. Overall, 68 nurses were selected using a non-probability sampling method. The perceptions of conscience questionnaire was used to identify the levels of conscience among nurses. The data were analyzed using SPSS version 13.0. RESULTS The mean nurses' level of conscience scores was 72.7. In the authority and asset sub-scales nurses acquired higher scores. The mean of nurses' scores in burden and depending on culture sub-scales were the least. Also, there were no statistical relationship between some demographic characteristics of participants and their total score on the perceptions of conscience questionnaire. CONCLUSIONS According to study findings Iranian nurses had high levels of conscience. However, understanding all the factors that affect nurses' perception of conscience requires further studies.
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Affiliation(s)
- Behrang Gorbanzadeh
- Medical-Surgical Department, Nursing and Midwifery Faculty, Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran E-mail :
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Mazaheri M, Ericson-Lidman E, Zargham-Boroujeni A, Öhlén J, Norberg A. Clear conscience grounded in relations: Expressions of Persian-speaking nurses in Sweden. Nurs Ethics 2015; 24:349-361. [DOI: 10.1177/0969733015603442] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Conscience is an important concept in ethics, having various meanings in different cultures. Because a growing number of healthcare professionals are of immigrant background, particularly within the care of older people, demanding multiple ethical positions, it is important to explore the meaning of conscience among care providers within different cultural contexts. Research objective: The study aimed to illuminate the meaning of conscience by enrolled nurses with an Iranian background working in residential care for Persian-speaking people with dementia. Research design: A phenomenological hermeneutical method guided the study. Participants and research context: A total of 10 enrolled nurses with Iranian background, aged 33–46 years, participated in the study. All worked full time in residential care settings for Persian-speaking people with dementia in a large city, in Sweden. Ethical considerations: The study was approved by the Regional Ethical Review Board for ethical vetting of research involving humans. Participants were given verbal and written study information and assured that their participation was voluntary and confidential. Findings: Three themes were constructed including perception of conscience, clear conscience grounded in relations and striving to keep a clear conscience. The conscience was perceived as an inner guide grounded in feelings, which is dynamic and subject to changes throughout life. Having a clear conscience meant being able to form a bond with others, to respect them and to get their confirmation that one does well. To have a clear conscience demanded listening to the voice of the conscience. The enrolled nurses strived to keep their conscience clear by being generous in helping others, accomplishing daily tasks well and behaving nicely in the hope of being treated the same way one day. Conclusion: Cultural frameworks and the context of practice needed to be considered in interpreting the meaning of conscience and clear conscience.
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Affiliation(s)
- Monir Mazaheri
- Mälardalen University, Sweden; Tehran University of Medical Sciences, Iran
| | | | | | - Joakim Öhlén
- Ersta Sköndal University College, Sweden; University of Gothenburg, Sweden
| | - Astrid Norberg
- Umeå University, Sweden; Ersta Sköndal University College, Sweden
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Nilsson A, Rasmussen BH, Edvardsson D. A threat to our integrity - Meanings of providing nursing care for older patients with cognitive impairment in acute care settings. Scand J Caring Sci 2015; 30:48-56. [DOI: 10.1111/scs.12220] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 01/17/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - David Edvardsson
- Department of Nursing; Umeå University; Umeå Sweden
- School of Nursing and Midwifery; La Trobe University; Melbourne Vic. Australia
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Sjögren K, Lindkvist M, Sandman PO, Zingmark K, Edvardsson D. To what extent is the work environment of staff related to person-centred care? A cross-sectional study of residential aged care. J Clin Nurs 2014; 24:1310-9. [PMID: 25420415 DOI: 10.1111/jocn.12734] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2014] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To explore the relationship between staff characteristics, perceived work environment and person-centred care in residential aged care units. BACKGROUND Person-centred care is often described as the model of choice in residential aged care and in the care of persons with dementia. Few empirical studies have reported on the relationship between how staff experience different aspects of their work and person-centred care. DESIGN The study had a cross-sectional quantitative design. METHODS Staff in 151 residential aged care units in Sweden (n = 1169) completed surveys which included questions about staff characteristics, valid and reliable measures of person-centred care, satisfaction with work and care, job strain, stress of conscience and psychosocial unit climate. Statistical analyses of correlations, group differences and multiple linear regression analysis estimated with generalised estimating equation were conducted. RESULTS Higher levels of staff satisfaction, lower levels of job strain, lower levels of stress of conscience, higher levels of a supportive psychosocial unit climate and a higher proportion of staff with continuing education in dementia care were associated with higher levels of person-centred care. Job strain and a supportive psychosocial climate, explained most of the variation in person-centred care. CONCLUSIONS This study shows that the work environment as perceived by staff is associated with the extent to which staff perceive the care as being person-centred in residential aged care. These empirical findings support the theoretical postulation that the work environment is an important aspect of person-centred care. RELEVANCE TO CLINICAL PRACTICE Promoting a positive and supportive psychosocial climate and a work environment where staff experience balance between demands and control in their work, to enable person-centred care practice, seems to be important implications for managers and leaders in residential aged care.
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Affiliation(s)
- Karin Sjögren
- Department of Nursing, Umeå University, Umeå, Sweden
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Falcó-Pegueroles A, Lluch-Canut T, Roldan-Merino J, Goberna-Tricas J, Guàrdia-Olmos J. Ethical conflict in critical care nursing: Correlation between exposure and types. Nurs Ethics 2014; 22:594-607. [PMID: 25335920 DOI: 10.1177/0969733014549883] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Ethical conflicts in nursing have generally been studied in terms of temporal frequency and the degree of conflict. This study presents a new perspective for examining ethical conflict in terms of the degree of exposure to conflict and its typology. OBJECTIVES The aim was to examine the level of exposure to ethical conflict for professional nurses in critical care units and to analyze the relation between this level and the types of ethical conflict and moral states. RESEARCH DESIGN This was a descriptive correlational study. Central and dispersion, normality tests, and analysis of variance were carried out. PARTICIPANTS AND RESEARCH CONTEXT A total of 203 nurses were from two third-level teaching hospitals in Spain. Both centers are part of the University of Barcelona Health Network. Participants filled out the Ethical Conflict in Nursing Questionnaire-Critical Care Version. ETHICAL CONSIDERATIONS This investigation received the approval of the ethical committees for clinical investigation of the two participating hospitals. Participants were informed of the authorship and aims of the study. FINDINGS The index of exposure to ethical conflict was [Formula: see text]. The situations involving analgesic treatment and end-of-life care were shown to be frequent sources of conflict. The types of ethical conflict and moral states generally arranged themselves from lesser to greater levels of index of exposure to ethical conflict. DISCUSSION The moderate level of exposure to ethical conflict was consistent with other international studies. However, the situations related with family are infrequent, and this presents differences with previous research. The results suggest that there is a logical relationship between types of conflict and levels of exposure to ethical conflict. CONCLUSION The types of ethical conflict and moral states were related with the levels of exposure to ethical conflict. The new perspective was shown to be useful for analyzing the phenomenon of ethical conflict in the nurse.
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Åhlin J, Ericson-Lidman E, Norberg A, Strandberg G. A comparison of assessments and relationships of stress of conscience, perceptions of conscience, burnout and social support between healthcare personnel working at two different organizations for care of older people. Scand J Caring Sci 2014; 29:277-87. [DOI: 10.1111/scs.12161] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 06/10/2014] [Indexed: 01/10/2023]
Affiliation(s)
- Johan Åhlin
- Department of Nursing; Umeå University; Umeå Sweden
| | | | - Astrid Norberg
- Department of Nursing; Umeå University; Umeå Sweden
- Ersta Sköndal University College; Stockholm Sweden
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Skytt B, Hagerman H, Strömberg A, Engström M. First-line managers' descriptions and reflections regarding their staff's access to empowering structures. J Nurs Manag 2014; 23:1003-10. [PMID: 25059511 DOI: 10.1111/jonm.12246] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2014] [Indexed: 11/30/2022]
Abstract
AIM To elucidate first-line managers' descriptions and reflections regarding their staff's access to empowering structures using Kanter's theory of structural empowerment. BACKGROUND Good structural conditions within workplaces are essential to employees' wellbeing, and their ability to access empowerment structures is largely dependent on the management. METHOD Twenty-eight first-line managers in elderly care were interviewed. Deductive qualitative content analysis was used to analyse data. RESULTS Managers perceived that staff had varying degrees of access to the empowering structures described in Kanter's theory - and that they possessed formal power in their roles as contact persons and representatives. The descriptions mostly started from the managers' own actions, although some started from the needs of staff members. CONCLUSION All managers described their staff's access to the empowering structures in Kanter's theory as important, yet it seemed as though this was not always reflected on and discussed as a strategic issue. IMPLICATIONS FOR NURSING MANAGEMENT Managers could make use of performance and appraisal dialogues to keep up to date on staff's access to empowering structures. Recurrent discussions in the management group based on such current information could promote staff's access to power through empowering structures and make job definitions a strategic issue in the organisation.
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Affiliation(s)
- Bernice Skytt
- Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Heidi Hagerman
- Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Annika Strömberg
- Faculty of Health and Occupational Studies, Department of Social Work and Psychology, University of Gävle, Gävle, Sweden
| | - Maria Engström
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Graneheim UH, Slotte A, Säfsten HM, Lindgren BM. Contradictions between ideals and reality: Swedish registered nurses' experiences of dialogues with inpatients in psychiatric care. Issues Ment Health Nurs 2014; 35:395-402. [PMID: 24766174 DOI: 10.3109/01612840.2013.876133] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study explored ten registered nurses' experiences of dialogues with inpatients in psychiatric care. Data were collected through four focus group discussions, and two individual interviews. The nurses described contradictions between their nursing ideals about dialogues and the reality faced in psychiatric inpatient care, resulting in an unsatisfactory work situation and feelings of insufficiency. We conclude that in order to improve quality of care and increase well-being for both patients and health care workers, nursing interventions, such as dialogues and meaningful activities, need to be offered to patients. A management that is visible and present on-site should encourage and facilitate health care workers' participation in clinical supervision.
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Hanna T, Mona E. Psychosocial work environment, stress factors and individual characteristics among nursing staff in psychiatric in-patient care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:1161-75. [PMID: 24448633 PMCID: PMC3924497 DOI: 10.3390/ijerph110101161] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 01/13/2014] [Accepted: 01/13/2014] [Indexed: 12/05/2022]
Abstract
The psychosocial work environment is an important factor in psychiatric in-patient care, and knowing more of its correlates might open up new paths for future workplace interventions. Thus, the aims of the present study were to investigate perceptions of the psychosocial work environment among nursing staff in psychiatric in-patient care and how individual characteristics--Mastery, Moral Sensitivity, Perceived Stress, and Stress of Conscience--are related to different aspects of the psychosocial work environment. A total of 93 nursing staff members filled out five questionnaires: the QPSNordic 34+, Perceived Stress Scale, Stress of Conscience Questionnaire, Moral Sensitivity Questionnaire, and Mastery scale. Multivariate analysis showed that Perceived Stress was important for Organisational Climate perceptions. The Stress of Conscience subscale Internal Demands and Experience in current units were indicators of Role Clarity. The other Stress of Conscience subscale, External Demands and Restrictions, was related to Control at Work. Two types of stress, Perceived Stress and Stress of Conscience, were particularly important for the nursing staff's perception of the psychosocial work environment. Efforts to prevent stress may also contribute to improvements in the psychosocial work environment.
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Affiliation(s)
- Tuvesson Hanna
- School of Health Science, Blekinge Institute of Technology, SE-37971 Karlskrona, Sweden.
| | - Eklund Mona
- School of Health Science, Blekinge Institute of Technology, SE-37971 Karlskrona, Sweden.
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Orrung Wallin A, Jakobsson U, Edberg AK. Job strain and stress of conscience among nurse assistants working in residential care. J Nurs Manag 2013; 23:368-79. [PMID: 23924400 DOI: 10.1111/jonm.12145] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2013] [Indexed: 11/28/2022]
Abstract
AIM The aim was to investigate job strain and stress of conscience among nurse assistants working in residential care and to explore associations with personal and work-related aspects and health complaints. BACKGROUND It is important to investigate job strain and stress of conscience, both for the well-being of the nurse assistants themselves and for the impact on the quality of care they provide. METHOD Questionnaires measuring job strain, stress of conscience, personal and work-related aspects and health complaints were completed by NAs (n = 225). Comparisons of high and low levels of job strain and stress of conscience and multiple linear regression analyses were performed. RESULT Organisational and environmental support and low education levels were associated with low levels of job strain and stress of conscience. Personalised care provision and leadership were related to stress of conscience and the caring climate was related to job strain. CONCLUSION There is a need for support from the managers and a supportive organisation for reducing nurse assistants work-related stress, which in turn can create a positive caring climate where the nurse assistants are able to provide high quality care. IMPLICATIONS FOR NURSING MANAGEMENT The managers' role is essential when designing supportive measures and implementing a value-system that can facilitate personalised care provision.
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Affiliation(s)
- Anneli Orrung Wallin
- Department of Health Sciences, Lund University, Lund, Sweden; The Swedish Institute for Health Sciences (Vårdalinstitutet), Lund University, Lund, Sweden
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Åhlin J, Ericson-Lidman E, Norberg A, Strandberg G. Care providers' experiences of guidelines in daily work at a municipal residential care facility for older people. Scand J Caring Sci 2013; 28:355-63. [PMID: 23865824 DOI: 10.1111/scs.12065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 07/02/2013] [Indexed: 11/29/2022]
Abstract
AIM To describe care providers' narrated experiences of guidelines in daily work at a municipal residential care facility for older people. BACKGROUND Guidelines are used as a way of promoting high-quality health care. Most research concerning guidelines has focused on physician behaviour and to improve one specific aspect of care. Care providers working within municipal residential care of older people have described that working with multiple guidelines sometimes exposed them to contradictory demands and trouble their conscience. DESIGN A qualitative descriptive design was adopted. METHODS Interviews with eight care providers were carried out between February and March 2012 and analysed by qualitative content analysis. RESULTS Care providers described experiences that guidelines are coming from above and are controlling and not sufficiently anchored at their workplace. Furthermore, they described guidelines as stealing time from residents, colliding with each other, lacking practical use and complicating care, and challenging care providers' judgment. The overall understanding is that care providers describe experiences of struggling to do their best, prioritising between arcane guidelines while keeping the residents' needs in the foreground. CONCLUSION In order to prevent fragmented use, guidelines have to be coordinated and adapted to the reality of daily practice before implementation. It seems essential to provide opportunities for discussions between care providers, registered nurses and management about how to make guidelines work within their daily practice. Sufficient support, knowledge and involvement are likely key issues that can help care providers to constructively work according to guidelines and thus, by extension, improve the quality of care.
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Affiliation(s)
- Johan Åhlin
- Department of Nursing, Umeå University, Umeå, Sweden
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Abstract
Safeguarding patients is a professional responsibility. Perioperative staff must take account of their sphere of practice and influence and must report when either care or the environment falls short and patients are at risk of harm, or of a poor quality experience. This will require speaking up and making representation to colleagues and managers. This article explores the distinctions between whistleblowing and speaking up and explores the associated challenges.
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Falcó-Pegueroles A, Lluch-Canut T, Guàrdia-Olmos J. Development process and initial validation of the Ethical Conflict in Nursing Questionnaire-Critical Care Version. BMC Med Ethics 2013; 14:22. [PMID: 23725477 PMCID: PMC3711987 DOI: 10.1186/1472-6939-14-22] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 05/20/2013] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Ethical conflicts are arising as a result of the growing complexity of clinical care, coupled with technological advances. Most studies that have developed instruments for measuring ethical conflict base their measures on the variables 'frequency' and 'degree of conflict'. In our view, however, these variables are insufficient for explaining the root of ethical conflicts. Consequently, the present study formulates a conceptual model that also includes the variable 'exposure to conflict', as well as considering six 'types of ethical conflict'. An instrument was then designed to measure the ethical conflicts experienced by nurses who work with critical care patients. The paper describes the development process and validation of this instrument, the Ethical Conflict in Nursing Questionnaire Critical Care Version (ECNQ-CCV). METHODS The sample comprised 205 nursing professionals from the critical care units of two hospitals in Barcelona (Spain). The ECNQ-CCV presents 19 nursing scenarios with the potential to produce ethical conflict in the critical care setting. Exposure to ethical conflict was assessed by means of the Index of Exposure to Ethical Conflict (IEEC), a specific index developed to provide a reference value for each respondent by combining the intensity and frequency of occurrence of each scenario featured in the ECNQ-CCV. Following content validity, construct validity was assessed by means of Exploratory Factor Analysis (EFA), while Cronbach's alpha was used to evaluate the instrument's reliability. All analyses were performed using the statistical software PASW v19. RESULTS Cronbach's alpha for the ECNQ-CCV as a whole was 0.882, which is higher than the values reported for certain other related instruments. The EFA suggested a unidimensional structure, with one component accounting for 33.41% of the explained variance. CONCLUSIONS The ECNQ-CCV is shown to a valid and reliable instrument for use in critical care units. Its structure is such that the four variables on which our model of ethical conflict is based may be studied separately or in combination. The critical care nurses in this sample present moderate levels of exposure to ethical conflict. This study represents the first evaluation of the ECNQ-CCV.
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Affiliation(s)
- Anna Falcó-Pegueroles
- Department of Fundamental Care and Medical-Surgical Nursing, Campus of Health Science of Bellvitge, Nursing School, University of Barcelona, Central Pavilion, 3r floor, L’08907, Hospitalet de Llobregat, Barcelona, Spain
| | - Teresa Lluch-Canut
- Department of Public Health, Mental Health and Midwife Nursing, Health Science Campus of Bellvitge, Nursing School, University of Barcelona, Barcelona, Spain
| | - Joan Guàrdia-Olmos
- Methodology of Behavioural Sciences, Faculty of Psychology, Research Institute on Brain, Cognition and Behaviour (IR3C), University of Barcelona, Barcelona, Spain
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Åhlin J, Ericson-Lidman E, Eriksson S, Norberg A, Strandberg G. Longitudinal relationships between stress of conscience and concepts of importance. Nurs Ethics 2013; 20:927-42. [PMID: 23702896 DOI: 10.1177/0969733013484487] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this observational longitudinal cohort study was to describe relationships over time between degrees of stress of conscience, perceptions of conscience, burnout scores and assessments of person-centred climate and social support among healthcare personnel working in municipal care of older people. This study was performed among registered nurses and nurse assistants (n = 488). Data were collected on two occasions. Results show that perceiving one's conscience as a burden, having feelings of emotional exhaustion and depersonalization and noticing disturbing conflicts between co-workers were positively associated with stress of conscience. No significant changes were observed during the year under study, but degrees of stress of conscience and burnout scores were higher than in previous studies, suggesting that downsizing and increased workloads can negatively affect healthcare personnel. Following and expressing one's conscience in one's work, and perceiving social support from superiors are of importance in buffering the effects of stress of conscience.
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Söderlund M, Norberg A, Hansebo G. Validation method training: nurses' experiences and ratings of work climate. Int J Older People Nurs 2013; 9:79-89. [PMID: 23601158 DOI: 10.1111/opn.12027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 02/03/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Training nursing staff in communication skills can impact on the quality of care for residents with dementia and contributes to nurses' job satisfaction. Changing attitudes and practices takes time and energy and can affect the entire nursing staff, not just the nurses directly involved in a training programme. Therefore, it seems important to study nurses' experiences of a training programme and any influence of the programme on work climate among the entire nursing staff. AIMS AND OBJECTIVES To explore nurses' experiences of a 1-year validation method training programme conducted in a nursing home for residents with dementia and to describe ratings of work climate before and after the programme. DESIGN A mixed-methods approach. METHODS Twelve nurses participated in the training and were interviewed afterwards. These individual interviews were tape-recorded and transcribed, then analysed using qualitative content analysis. The Creative Climate Questionnaire was administered before (n = 53) and after (n = 56) the programme to the entire nursing staff in the participating nursing home wards and analysed with descriptive statistics. RESULTS Analysis of the interviews resulted in four categories: being under extra strain, sharing experiences, improving confidence in care situations and feeling uncertain about continuing the validation method. The results of the questionnaire on work climate showed higher mean values in the assessment after the programme had ended. CONCLUSION The training strengthened the participating nurses in caring for residents with dementia, but posed an extra strain on them. These nurses also described an extra strain on the entire nursing staff that was not reflected in the results from the questionnaire. The work climate at the nursing home wards might have made it easier to conduct this extensive training programme. IMPLICATIONS FOR PRACTICE Training in the validation method could develop nurses' communication skills and improve their handling of complex care situations.
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Affiliation(s)
- Mona Söderlund
- Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Ericson-Lidman E, Strandberg G. Dealing with troubled conscience in municipal care of older people. Nurs Ethics 2013; 20:300-11. [DOI: 10.1177/0969733012462054] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Troubled conscience may jeopardize the health of healthcare personnel and, hence, the quality of care provided. Learning more about how personnel deal with their troubled conscience therefore seems important. The aim of this study was to describe personnel’s experiences of how they deal with troubled conscience generated in their daily work in municipal care of older people. Interviews were conducted with 20 care providers and analysed with a thematic content analysis. The findings show that in order to deal with troubled conscience, personnel dialogued with themselves and with others. They took measures in a direction they perceived to be correct, and they expressed a need for distancing and re-energizing. It is of importance to share situations that generate troubled conscience in order to find ways to deal with them. Reconsidering one’s ways of dealing with troubled conscience may give care providers an opportunity to reach consensus within themselves.
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Genuis SJ, Lipp C. Ethical diversity and the role of conscience in clinical medicine. INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2013; 2013:587541. [PMID: 24455248 PMCID: PMC3876678 DOI: 10.1155/2013/587541] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 10/09/2013] [Indexed: 05/09/2023]
Abstract
In a climate of plurality about the concept of what is "good," one of the most daunting challenges facing contemporary medicine is the provision of medical care within the mosaic of ethical diversity. Juxtaposed with escalating scientific knowledge and clinical prowess has been the concomitant erosion of unity of thought in medical ethics. With innumerable technologies now available in the armamentarium of healthcare, combined with escalating realities of financial constraints, cultural differences, moral divergence, and ideological divides among stakeholders, medical professionals and their patients are increasingly faced with ethical quandaries when making medical decisions. Amidst the plurality of values, ethical collision arises when the values of individual health professionals are dissonant with the expressed requests of patients, the common practice amongst colleagues, or the directives from regulatory and political authorities. In addition, concern is increasing among some medical practitioners due to mounting attempts by certain groups to curtail freedom of independent conscience-by preventing medical professionals from doing what to them is apparently good, or by compelling practitioners to do what they, in conscience, deem to be evil. This paper and the case study presented will explore issues related to freedom of conscience and consider practical approaches to ethical collision in clinical medicine.
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Affiliation(s)
- Stephen J. Genuis
- University of Alberta, 2935-66 Street, Edmonton, AB, Canada T6K 4C1
- *Stephen J. Genuis:
| | - Chris Lipp
- University of British Columbia, 2329 W Mall, Vancouver, BC, Canada V6T 1Z4
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From I, Nordström G, Wilde-Larsson B, Johansson I. Caregivers in older peoples' care: perception of quality of care, working conditions, competence and personal health. Scand J Caring Sci 2012; 27:704-14. [DOI: 10.1111/j.1471-6712.2012.01083.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 08/06/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Ingrid From
- School of Health and Social Studies; Dalarna University; Falun; Sweden
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Beck I, Törnquist A, Edberg AK. Nurse assistants’ experience of an intervention focused on a palliative care approach for older people in residential care. Int J Older People Nurs 2012; 9:140-50. [DOI: 10.1111/j.1748-3743.2012.00343.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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