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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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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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Jodaki K, Esmaeili M, Cheraghi MA, Mazaheri M. Striving to Keep a Clear Conscience by Going Above and Beyond: The Experiences of Intensive Care Unit Nurses. Crit Care Nurs Q 2023; 46:192-202. [PMID: 36823746 DOI: 10.1097/cnq.0000000000000452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Working as a nurse in the critical care unit may involve ethical challenges including conflict of conscience. Literature provides very limited knowledge about intensive care unit (ICU) nurses' perception of conscience. Considering the influence of culture on the perception of conscience, it is important to study it in diverse contexts. This study aims were to explore the meaning of conscience and the impact of conscience on nurses' practice in the ICU. A qualitative research approach was used to answer the research question, and qualitative content analysis guided the study. A total of 17 interviews were conducted with ICU nurses. Data were collected through semistructured tools by using videoconferencing and face-to-face interviews. Data analysis resulted in the formation of 2 main categories and 7 subcategories. The main categories included understanding the conscience and unlimited efforts in caretaking as the path to a clear conscience. The category of understanding the conscience includes 3 subcategories of conscience as an intrinsic asset and internal observer, dynamicity of conscience, and conscience as the cornerstone of morality. Also, the category of unlimited efforts in caretaking as the path to a clear conscience consists of 4 subcategories including giving full attention to the patient, putting oneself in another's shoes, taking responsibility, and working beyond the job description. Conscience plays an essential role in providing the ethical care among ICU nurses. The ICU nurses felt that they need to go above and beyond to keep their conscience clear. Nurses expressed the importance of following the call of conscience at their workplace, which demanded unlimited efforts to achieve a clear conscience.
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Affiliation(s)
- Kurosh Jodaki
- School of Nursing & Midwifery, Iran University of Medical Sciences, Tehran, Iran (Dr Jodaki); Department of ICU, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran (Dr Esmaeili); Department of Nursing Management, School of Nursing and Midwifery, Tehran University of Medical Sciences and Health Sciences Phenomenology Association, Ministry of Health and Medical Education, Tehran, Iran (Dr Cheraghi); 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 (Dr Mazaheri)
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Juranić B, Včev A, Vuletić S, Rakošec Ž, Roguljić D, Mikšić Š, Jakab J, Vujanić J, Lovrić R. (Dis)Agreement with Dysthanasia, Religiosity and Spiritual Experience as Factors Related to Nurses' Workload during End-of-Life Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:955. [PMID: 36673711 PMCID: PMC9859098 DOI: 10.3390/ijerph20020955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/31/2022] [Accepted: 01/02/2023] [Indexed: 06/17/2023]
Abstract
This study intended to investigate whether the workload of nurses in the course of providing end-of-life care correlated with their religiousness, spiritual experience and level of agreement with dysthanasia procedures. The respondents included 279 nurses from four Croatian hospitals. A structured and validated instrument was applied. Almost 90% of respondents are religious, and almost 45% of them have daily spiritual experiences. Respondents, especially those with high levels of religiousness and spiritual experience, express a low level of agreement with dysthanasia (mean = 58.21; score = 25−125). Moreover, nurses self-rated (on a scale of 1−5) their workload as quite high, especially when performing contradictory tasks imposed on them by their superiors (mean = 3.05) and during direct contact with dying patients and their family members (mean = 2.56). This significantly highest level of workload was experienced by the youngest nurses (p = 0.01) and nurses with little work experience (p < 0.01). This study also indicated that nurses who agree with dysthanasia experienced a higher level of workload when providing end-of-life care (r = 0.178; p < 0.01), while more frequent spiritual experiences reduced the level of workload (r = −0.205; p < 0.01). A deeper understanding of nurses’ attitudes toward dysthanasia, as well as of their religiousness and spiritual experiences, may ensure the collection of data beneficial to the timely identification of potential risks caused by workload.
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Affiliation(s)
- Brankica Juranić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Nursing and Palliative Medicine, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Clinic for Internal Diseases, University Hospital Centre Osijek, 31000 Osijek, Croatia
| | - Aleksandar Včev
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Nursing and Palliative Medicine, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Clinic for Internal Diseases, University Hospital Centre Osijek, 31000 Osijek, Croatia
| | - Suzana Vuletić
- Catholic Faculty of Theology in Đakovo, Josip Juraj Strossmayer University of Osijek, 31400 Đakovo, Croatia
| | - Željko Rakošec
- The Ministry of the Interior of the Republic of Croatia, 10000 Zagreb, Croatia
| | - Domagoj Roguljić
- Department of Nursing and Palliative Medicine, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Štefica Mikšić
- Department of Nursing and Palliative Medicine, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Jelena Jakab
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Nursing and Palliative Medicine, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Jasenka Vujanić
- Department of Nursing and Palliative Medicine, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Robert Lovrić
- Department of Nursing and Palliative Medicine, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
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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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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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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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Backman A, Sjögren K, Lövheim H, Lindkvist M, Edvardsson D. The influence of nursing home managers' leadership on person-centred care and stress of conscience: A cross-sectional study. BMC Nurs 2021; 20:200. [PMID: 34654423 PMCID: PMC8518168 DOI: 10.1186/s12912-021-00718-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 09/29/2021] [Indexed: 12/04/2022] Open
Abstract
Background Leadership and stress are common concepts in nursing, and this study explores empirically the connection between leadership and stress of conscience in the context of aged care practice. Previous literature has shown that when staff are unable to carry out their ethical liabilities towards the residents, feelings of guilt may occur among staff, which may be an expression of stress of conscience. Although leadership has been described as crucial for staff’s work perceptions of stress as well as for person-centred practices, the influence of nursing home managers’ leadership on stress of conscience among staff and person-centred practices is still not fully explored. This study attempts to address that knowledge gap by exploring the relationship between leadership, person-centred care, and stress of conscience. Methods This study was based on a cross-sectional national survey of 2985 staff and their managers in 190 nursing homes throughout Sweden. Descriptive statistics and regression modelling were used to explore associations. Results Leadership was associated with a higher degree of person-centred care and less stress of conscience. A higher degree of person-centred care was also associated with less stress of conscience. The results also showed that leadership as well as person-centred care were individually associated with lower levels of stress of conscience when adjusting for potential confounders. Conclusion Nursing home managers’ leadership was significantly associated with less staff stress of conscience and more person-centred care. This indicates that a leadership most prominently characterised by coaching and giving feedback, relying on staff and handling conflicts constructively, experimenting with new ideas, and controlling work individually can contribute to less staff stress as well as higher degree of person-centred care provision.
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Affiliation(s)
- Annica Backman
- Department of Nursing, Umeå University, SE-901 87, Umeå, Sweden.
| | - Karin Sjögren
- Department of Nursing, Umeå University, SE-901 87, Umeå, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Marie Lindkvist
- Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - David Edvardsson
- Department of Nursing, Umeå University, SE-901 87, Umeå, Sweden.,School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
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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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Sjöberg A, Pettersson-Strömbäck A, Sahlén KG, Lindholm L, Norström F. The burden of high workload on the health-related quality of life among home care workers in Northern Sweden. Int Arch Occup Environ Health 2020; 93:747-764. [PMID: 32140826 PMCID: PMC7320931 DOI: 10.1007/s00420-020-01530-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 02/18/2020] [Indexed: 11/24/2022]
Abstract
Objective Previous studies have shown that high workload affects health negatively. However, studies are lacking among home care workers. The aim of this study is to examine the burden of perceived workload on health-related quality of life (HRQoL) among home care workers and to determine whether psychosocial factors modify such a relationship. Methods A cross-sectional study was conducted in which 1162 (58% response rate) home care workers participated. The psychosocial factors were measured by QPSnordic. HRQoL was measured by EuroQol 5 dimensions, from which responses were translated into quality-adjusted life year scores (QALY). Propensity scores were used with absolute risk differences (RD). Stratified analysis was used to test the buffer hypothesis of the demand–control–support model. Results Personnel with a high workload had a statistically significant 0.035 lower QALY than personnel with a normal workload. This difference was also statistically significant for the Visual Analogue Scale (RD 5.0) and the mobility (RD 0.033) and anxiety/depression scales (RD 0.20) dimensions of EQ-5D. For QALY, the effect of a high workload compared to a normal workload was higher, with low (RD 0.045, significant) compared with high (RD 0.015, non-significant) social support; while it was similar, and non-significant results, for low and high control. Conclusions Our study shows that lowered work burden would be beneficial for home care personnel. Furthermore, our results suggest that interventions aimed at increasing social support could reduce work-related illness.
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Affiliation(s)
- André Sjöberg
- Department of Epidemiology and Global Health, Umeå University, SE-901 87, Umeå, Sweden
| | | | - Klas-Göran Sahlén
- Department of Epidemiology and Global Health, Umeå University, SE-901 87, Umeå, Sweden
| | - Lars Lindholm
- Department of Epidemiology and Global Health, Umeå University, SE-901 87, Umeå, Sweden
| | - Fredrik Norström
- Department of Epidemiology and Global Health, Umeå University, SE-901 87, Umeå, Sweden.
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Kapu AN, Borg Card E, Jackson H, Kleinpell R, Kendall J, Lupear BK, LeBar K, Dietrich MS, Araya WA, Delle J, Payne K, Ford J, Dubree M. Assessing and addressing practitioner burnout: Results from an advanced practice registered nurse health and well-being study. J Am Assoc Nurse Pract 2019; 33:38-48. [PMID: 31702604 DOI: 10.1097/jxx.0000000000000324] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/08/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Numerous nursing and physician studies have reported the effects of workload, environment, and life circumstances contributing to burnout. Effects may include job dissatisfaction, poor quality of life, and associated negative patient outcomes. Although assessing clinician burnout to determine effective interventions has become a topic of great importance, there are minimal studies specific to advanced practice registered nurses (APRNs). PURPOSE This single-center study was conducted to assess the prevalence and impact of APRN burnout and to recommend targeted interventions toward improvement of overall health and well-being. METHODS A cross-sectional, mixed methods design was used. The voluntary, anonymous survey examined perceptions of wellness, inclusion, social support, personal coping mechanisms, and status of burnout. RESULTS The 78-question survey was sent to 1,014 APRNs (94%) and PAs (6%), with a 43.6% response rate (n = 433); 76.4% were nurse practitioners. Participants were identified as currently experiencing burnout, formerly burned out, or never having experienced burnout. Profiles were developed, and similarities and differences between each group were compared. Of 433 respondents, 40.4% (n = 175) reported having never experienced burnout, 33.3% (n = 144) reported they had formerly experienced burnout, and 26.3% (n = 114) reported they were currently experiencing burnout. IMPLICATIONS FOR PRACTICE The results of the study identified that some APRNs report experiencing burnout at different times in their careers. Recommendations by participants to mitigate burnout included self-care, organizational promotion of health and well-being, career development, and leadership support. This study is one of the first to report on burnout among APRNs and potential interventions to build resilience; however, additional research is warranted.
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Affiliation(s)
- April N Kapu
- Advanced Practice, Vanderbilt University Medical Center and Professor of Clinical Nursing, Vanderbilt University School of Nursing, Nashville, Tennessee
| | | | - Heather Jackson
- Outpatient Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ruth Kleinpell
- Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Jim Kendall
- Work/Life Connections-EAP, Vanderbilt University School of Nursing, Nashville, Tennessee
| | - Buffy Krauser Lupear
- Office of Advanced Practice, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kiersten LeBar
- Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mary S Dietrich
- Vanderbilt University Schools of Medicine and Nursing, Nashville, Tennessee
| | - Wendy A Araya
- Neonatal Intensive Care Practitioners, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Janelle Delle
- Trauma Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kate Payne
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jaquelyn Ford
- Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marilyn Dubree
- Vanderbilt University Medical Center, Nashville, Tennessee
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Jansen TL, Hem MH, Dambolt LJ, Hanssen I. Moral distress in acute psychiatric nursing: Multifaceted dilemmas and demands. Nurs Ethics 2019; 27:1315-1326. [DOI: 10.1177/0969733019877526] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background In this article, the sources and features of moral distress as experienced by acute psychiatric care nurses are explored. Research design A qualitative design with 16 individual in-depth interviews was chosen. Braun and Clarke’s six analytic phases were used. Ethical considerations Approval was obtained from the Norwegian Social Science Data Services. Participation was confidential and voluntary. Findings Based on findings, a somewhat wider definition of moral distress is introduced where nurses experiencing being morally constrained, facing moral dilemmas or moral doubt are included. Coercive administration of medicines, coercion that might be avoided and resistance to the use of coercion are all morally stressful situations. Insufficient resources, mentally poorer patients and quicker discharges lead to superficial treatment. Few staff on evening shifts/weekends make nurses worry when follow-up of the most ill patients, often suicidal, in need of seclusion or with heightened risk of violence, must be done by untrained personnel. Provision of good care when exposed to violence is morally challenging. Feelings of inadequacy, being squeezed between ideals and clinical reality, and failing the patients create moral distress. Moral distress causes bad conscience and feelings of guilt, frustration, anger, sadness, inadequacy, mental tiredness, emotional numbness and being fragmented. Others feel emotionally ‘flat’, cold and empty, and develop high blood pressure and problems sleeping. Even so, some nurses find that moral stress hones their ethical awareness. Conclusion Moral distress in acute psychiatric care may be caused by multiple reasons and cause a variety of reactions. Multifaceted ethical dilemmas, incompatible demands and proximity to patients’ suffering make nurses exposed to moral distress. Moral distress may lead to reduced quality care, which again may lead to bad conscience and cause moral distress. It is particularly problematic if moral distress results in nurses distancing and disconnecting themselves from the patients and their inner selves.
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15
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Lluch-Canut T, Sequeira C, Falcó-Pegueroles A, Pinho JA, Rodrigues-Ferreira A, Olmos JG, Roldan-Merino J. Ethical conflicts and their characteristics among critical care nurses. Nurs Ethics 2019; 27:537-553. [PMID: 31303110 DOI: 10.1177/0969733019857785] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Ethical conflict is a phenomenon that has been under study over the last three decades, especially the types moral dilemma and moral distress in the field of nursing care. However, ethical problems and their idiosyncrasies need to be further explored. AIM The objectives of this study were, first, to obtain a transcultural Portuguese-language adaptation and validation of the Ethical Conflict Nursing Questionnaire-Critical Care Version and, second, to analyse Portuguese critical care nurses' level of exposure to ethical conflict and its characteristics. METHODS A cross-cultural validation and descriptive, prospective and correlational study. The sample was made for 184 critical care nurses in 2016. ETHICAL CONSIDERATIONS The study was authorised by Bioethics Commission of the University of Barcelona, the Associaçâo de Apoio ao Serviço de Cuidados Intensivos do Centro Hospitalar do Porto and the Sociedade Portuguesa de Enfermagem de Saúde Mental. FINDINGS The Portuguese version of the Ethical Conflict Nursing Questionnaire-Critical Care Version was a valid and reliable instrument to measure exposure to conflict. Moral outrage was the most common type of conflict. The most problematic situations were the ineffectiveness of analgesic treatments, the administration of treatments considered futile and the mismanagement of resources.
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Affiliation(s)
- Michelle Cleary
- a School of Health Sciences , University of Tasmania , Sydney , New South Wales , Australia
| | - David Lees
- b School of Health Sciences, University of Tasmania , Launceston , Tasmania , Australia
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17
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Lamb C, Evans M, Babenko-Mould Y, Wong C, Kirkwood K. Nurses' use of conscientious objection and the implications for conscience. J Adv Nurs 2018; 75:594-602. [PMID: 30328136 DOI: 10.1111/jan.13869] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/21/2018] [Accepted: 09/20/2018] [Indexed: 11/29/2022]
Abstract
AIMS To explore the meaning of conscience for nurses in the context of conscientious objection (CO) in clinical practice. DESIGN Interpretive phenomenology was used to guide this study. DATA SOURCES Data were collected from 2016 - 2017 through one-on-one interviews from eight nurses in Ontario. Iterative analysis was conducted consistent with interpretive phenomenology and resulted in thematic findings. REVIEW METHODS Iterative, phased analysis using line-by-line and sentence highlighting identified key words and phrases. Cumulative summaries of narratives thematic analysis revealed how nurses made meaning of conscience in the context of making a CO. RESULTS Conscience issues and CO are current, critical issues for nurses. For Canadian nurses this need has been recently heightened by the national legalization of euthanasia, known as Medical Assistance in Dying in Canada. Ethics education, awareness, and respect for nurses' conscience are needed in Canada and across the profession to support nurses to address their issues of conscience in professional practice. CONCLUSION Ethical meaning emerges for nurses in their lived experiences of encountering serious ethical issues that they need to professionally address, by way of conscience-based COs. IMPACT This is the first study to explore what conscience means to nurses, as shared by nurses themselves and in the context of CO. Nurse participants expressed that support from leadership, regulatory bodies, and policy for nurses' conscience rights are indicated to address nurses' conscience issues in practice settings.
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18
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Oelhafen S, Cignacco E. Moral distress and moral competences in midwifery: A latent variable approach. J Health Psychol 2018; 25:2340-2351. [PMID: 30173571 DOI: 10.1177/1359105318794842] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Like other health professionals, midwives need moral competences in order to cope effectively with ethical issues and to prevent moral distress and negative consequences such as fatigue or impaired quality of care. In this study, we developed and conducted a survey with 280 midwives or midwifery students assessing the burden associated with ethical issues, moral competences, and negative consequences of moral distress. Results show that ethical issues associated with asymmetries of power and authority most often lead to the experience of distress. The results are critically discussed in the context of the conceptualization and operationalization of moral distress.
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Affiliation(s)
| | - Eva Cignacco
- Bern University of Applied Sciences, Switzerland
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Baur V, van Nistelrooij I, Vanlaere L. The sensible health care professional: a care ethical perspective on the role of caregivers in emotionally turbulent practices. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2017; 20:483-493. [PMID: 28432482 DOI: 10.1007/s11019-017-9770-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This article discusses the challenging context that health care professionals are confronted with, and the impact of this context on their emotional experiences. Care ethics considers emotions as a valuable source of knowledge for good care. Thinking with care ethical theory and looking through a care ethical lens at a practical case example, the authors discern reflective questions that (1) shed light on a care ethical approach toward the role of emotions in care practices, and (2) may be used by practitioners and facilitators for care ethical reflection on similar cases, in the particular and concrete context where issues around emotional experiences arise. The authors emphasize the importance of allowing emotions to exist, to acknowledge them and to not repress them, so that they can serve as a vehicle for ethical behavior in care practices. They stress the difference between acknowledging emotions and expressing them limitlessly. Formational practices and transformational research practices are being proposed to create moral space in care institutions and to support health care professionals to approach the emotionally turbulent practices they encounter in a way that contributes to good care for all those involved.
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Affiliation(s)
- Vivianne Baur
- Universiteit voor Humanistiek, Kromme Nieuwegracht 29, 3512 HD, Utrecht, The Netherlands.
| | - Inge van Nistelrooij
- Universiteit voor Humanistiek, Kromme Nieuwegracht 29, 3512 HD, Utrecht, The Netherlands
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Tuvesson H, Eklund M. Nursing Staff Stress and Individual Characteristics in Relation to the Ward Atmosphere in Psychiatric In-Patient Wards. Issues Ment Health Nurs 2017; 38:726-732. [PMID: 28574800 DOI: 10.1080/01612840.2017.1324929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study investigated the interplay between nursing staff stress, Mastery, Moral Sensitivity, individual characteristics and the ward atmosphere in psychiatric in-patient care. Data were collected through five questionnaires from 93 nursing staff. Multivariate analysis showed that Moral Strength, Moral Burden, Internal Demands, Perceived Stress and age were related to several factors of the ward atmosphere. We conclude that efforts to reduce stress levels and create a supporting ethical climate on psychiatric wards would be beneficial for both psychiatric nursing staff and their nursing practice.
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Affiliation(s)
- Hanna Tuvesson
- a Department of Health , Blekinge Institute of Technology , Karlskrona , Sweden
| | - Mona Eklund
- b Department of Health Sciences , Lund University , Lund , Sweden
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21
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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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Popa-Velea O, Diaconescu L, Mihăilescu A, Jidveian Popescu M, Macarie G. Burnout and Its Relationships with Alexithymia, Stress, and Social Support among Romanian Medical Students: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E560. [PMID: 28587094 PMCID: PMC5486246 DOI: 10.3390/ijerph14060560] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/24/2017] [Accepted: 05/22/2017] [Indexed: 01/22/2023]
Abstract
Medical school students often experience emotional difficulties when handling the challenges of their formation, occasionally leading to burnout. In this study, we measured the prevalence of burnout and its relationships with perceived stress, perceived social support, and alexithymia in medical students from the largest academic medical community in Romania. A cross-sectional survey was administered to a randomized sample of 299 preclinical medical students at the University of Medicine in Bucharest. Participants completed four standardized questionnaires. In addition to the assessment of burnout prevalence, stepwise backward regression was used to establish which variables had the highest correlation to burnout components. Further, t-tests were run to assess gender-related differences. Overall, burnout prevalence was 15.05%. Perceived stress was found to be the strongest predictor of emotional exhaustion and lack of accomplishment, while the strongest predictors of depersonalization were low perceived social support (in women) and alexithymia (in men). Women appear to be more vulnerable to two of the components of burnout (emotional exhaustion and low personal accomplishment) and associate higher perceived stress and alexithymia. These results suggest that interventions addressing academic burnout could benefit from being gender-specific, with focus on key elements, such as perceived stress and alexithymia.
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Affiliation(s)
- Ovidiu Popa-Velea
- Department of Medical Psychology, Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania.
| | - Liliana Diaconescu
- Department of Medical Psychology, Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania.
| | - Alexandra Mihăilescu
- Department of Medical Psychology, Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania.
| | - Mara Jidveian Popescu
- Department of Medical Psychology, Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania.
| | - George Macarie
- Department of Medical Psychology, Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania.
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Comparison of Nurses in Two Different Cultures: Who Experiences More Burnout. J Perianesth Nurs 2017; 32:238-244. [PMID: 28527553 DOI: 10.1016/j.jopan.2015.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 08/28/2015] [Accepted: 09/13/2015] [Indexed: 11/22/2022]
Abstract
PURPOSE Although burnout occurs in almost all occupational groups, it is mostly observed in professions requiring face-to-face relationships with people, especially among health care workers who deal constantly with problems and expectations of people. DESIGN The objective of this study was to determine the burnout levels of nurses working in surgical clinics in two countries. METHODS This descriptive study was conducted between June and September 2013. The study's population consisted of 179 nurses working in the surgical clinics of Ataturk University Research Hospital and Iran Urmiyili Shahidmotahari University Hospital. A questionnaire involving descriptive characteristics of nurses and the Maslach Burnout Inventory were used to collect the data. FINDINGS Nurses working in Turkey had higher mean scores of "emotional exhaustion" and "depersonalization," and a higher mean composite score. Nurses working in Iran had higher mean scores of the subscale "personal accomplishment." Although there was a statistically significant difference between both countries in terms of emotional exhaustion and personal accomplishment (P < .05), there was no statistically significant difference between them in terms of mean score of depersonalization and total mean composite score of the inventory (P > .05). CONCLUSIONS Nurses working in Turkey experienced more emotional exhaustion and less personal accomplishment compared with nurses working in Iran. In line with this result, improvements in their work environment and conditions are recommended to provide organizational support by fostering job satisfaction, preventing exhaustion by arranging shifts based on workload, and offering psychological counseling services to employees.
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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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Tahghighi M, Rees CS, Brown JA, Breen LJ, Hegney D. What is the impact of shift work on the psychological functioning and resilience of nurses? An integrative review. J Adv Nurs 2017; 73:2065-2083. [DOI: 10.1111/jan.13283] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Mozhdeh Tahghighi
- School of Psychology and Speech Pathology; Curtin University; Bentley Western Australia Australia
| | - Clare S. Rees
- School of Psychology and Speech Pathology; Curtin University; Bentley Western Australia Australia
| | - Janie A. Brown
- School of Nursing; Midwifery and Paramedicine; Curtin University; Bentley Western Australia Australia
| | - Lauren J. Breen
- School of Psychology and Speech Pathology; Curtin University; Bentley Western Australia Australia
| | - Desley Hegney
- School of Nursing; Midwifery and Paramedicine; Curtin University; Bentley Western Australia Australia
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26
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Ford NJ, Austin W. Conflicts of conscience in the neonatal intensive care unit: Perspectives of Alberta. Nurs Ethics 2017; 25:992-1003. [DOI: 10.1177/0969733016684547] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Limited knowledge of the experiences of conflicts of conscience found in nursing literature. Objectives: To explore the individual experiences of a conflict of conscience for neonatal nurses in Alberta. Research design: Interpretive description was selected to help situate the findings in a meaningful clinical context. Participants and research context: Five interviews with neonatal nurses working in Neonatal Intensive Care Units throughout Alberta. Ethical consideration: Ethics approval from the Health Research Ethics Board at the University of Alberta. Findings: Three common themes emerged from the interviews: the unforgettable conflict with pain and suffering, finding the nurse’s voice, and the unique proximity of nurses. Discussion and conclusion: The nurses described a conflict of conscience when the neonate in their care experienced undermanaged pain and unnecessary suffering. During these experiences, they felt guilty, sad, hopeless, and powerless when they were unable to follow their conscience. Informal ways to follow their conscience were employed before declaration of conscientious objection was considered. This study highlights the vital importance of respecting a conflict of conscience to maintain the moral integrity of neonatal nurses and exposes the complexities of conscientious objection.
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Burnout, compassion fatigue, compassion satisfaction, and secondary traumatic stress in trauma nurses. J Trauma Nurs 2016; 21:160-9. [PMID: 25023839 DOI: 10.1097/jtn.0000000000000055] [Citation(s) in RCA: 153] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The relationship of burnout (BO), compassion fatigue (CF), compassion satisfaction (CS), and secondary traumatic stress (STS) to personal/environmental characteristics, coping mechanisms, and exposure to traumatic events was explored in 128 trauma nurses. Of this sample, 35.9% had scores consistent with BO, 27.3% reported CF, 7% reported STS, and 78.9% had high CS scores. High BO and high CF scores predicted STS. Common characteristics correlating with BO, CF, and STS were negative coworker relationships, use of medicinals, and higher number of hours worked per shift. High CS correlated with greater strength of supports, higher participation in exercise, use of meditation, and positive coworker relationships. Caring for trauma patients may lead to BO, CF, and STS; identifying predictors of these can inform the development of interventions to mitigate or minimize BO, CF, and STS in trauma nurses.
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Ericson-Lidman E, Åhlin J. Assessments of Stress of Conscience, Perceptions of Conscience, Burnout, and Social Support Before and After Implementation of a Participatory Action-Research-Based Intervention. Clin Nurs Res 2016; 26:205-223. [DOI: 10.1177/1054773815618607] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Interventions aiming to constructively address stress of conscience are rare. The aim of the study was to compare assessments of stress of conscience, perceptions of conscience, burnout, and social support among health care personnel (HCP) working in municipal residential care of older adults, before and after participation in a participatory action research (PAR) intervention aiming to learn to constructively deal with troubled conscience. Questionnaire data were collected at baseline and at follow-up (1-year interval; n = 29). Descriptive statistics and nonparametric statistical tests were used to make comparisons between baseline and follow-up. HCP gave significantly higher scores to the question, “Are your work achievements appreciated by your immediate superior?” at follow-up compared with baseline. No significant differences in levels of stress of conscience and burnout at follow-up were found. The results suggested that a PAR intervention aiming to learn HCP to deal with their troubled conscience in difficult situations could be partially successful.
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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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Russell K. Perceptions of Burnout, Its Prevention, and Its Effect on Patient Care as Described by Oncology Nurses in the Hospital Setting. Oncol Nurs Forum 2016; 43:103-9. [DOI: 10.1188/16.onf.103-109] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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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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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: 28] [Impact Index Per Article: 2.8] [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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Fischer Grönlund CEC, Söderberg AIS, Zingmark KM, Sandlund SM, Dahlqvist V. Ethically difficult situations in hemodialysis care – Nurses' narratives. Nurs Ethics 2014; 22:711-22. [DOI: 10.1177/0969733014542677] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Providing nursing care for patients with end-stage renal disease entails dealing with existential issues which may sometimes lead not only to ethical problems but also conflicts within the team. A previous study shows that physicians felt irresolute, torn and unconfirmed when ethical dilemmas arose. Research question: This study, conducted in the same dialysis care unit, aimed to illuminate registered nurses’ experiences of being in ethically difficult situations that give rise to a troubled conscience. Research design: This study has a phenomenological hermeneutic approach. Participants: Narrative interviews were carried out with 10 registered nurses working in dialysis care. Ethical considerations: The study was approved by the Ethics Committee of the Faculty of Medicine, Umeå University. Results: One theme, ‘Calling for a deliberative dialogue’, and six sub-themes emerged: ‘Dealing with patients’ ambiguity’, ‘Responding to patients’ reluctance’, ‘Acting against patients’ will’, ‘Acting against one’s moral convictions’, ‘Lacking involvement with patients and relatives’ and ‘Being trapped in feelings of guilt’. Discussion: In ethically difficult situations, the registered nurses tried, but failed, to open up a dialogue with the physicians about ethical concerns and their uncertainty. They felt alone, uncertain and sometimes had to act against their conscience. Conclusion: In ethical dilemmas, personal and professional integrity is at stake. Mistrusting their own moral integrity may turn professionals from moral actors into victims of circumstances. To counteract such a risk, professionals and patients need to continuously deliberate on their feelings, views and experiences, in an atmosphere of togetherness and trust.
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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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Zhang H, Wang K, Liu Y, Chan DKS. Factors associated with stress of conscience among emergency medical technicians in China. Int J Nurs Pract 2013; 19 Suppl 3:89-96. [PMID: 24090302 DOI: 10.1111/ijn.12176] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Hong Zhang
- Nanjing University; Nanjing Jiangsu China
| | - Kang Wang
- Jinling Hospital; Nanjing Jiangsu China
| | - Yu Liu
- Nanjing University; Nanjing Jiangsu China
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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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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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Kulju K, Suhonen R, Leino-Kilpi H. Ethical problems and moral sensitivity in physiotherapy. Nurs Ethics 2013; 20:568-77. [DOI: 10.1177/0969733012468462] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study identified and described ethical problems encountered by physiotherapists in their practice and physiotherapists’ moral sensitivity in ethical situations. A questionnaire-based survey was constructed to identify ethical problems, and the Moral Sensitivity Questionnaire Revised version was used to measure moral sensitivity. Physiotherapists (n = 116) working in public health services responded to the questionnaire. Based on the results, most of the physiotherapists encounter ethical problems weekly. They concern mainly financial considerations, equality and justice, professionalism, unethical conduct of physiotherapists or other professions and patients’ self-determination. The dimension of moral strength was emphasised in physiotherapists’ self-evaluations of their moral sensitivity. As a conclusion, ethical problems do occur not only at individual level but also at organisational and society level. Physiotherapists seem to have moral strength for speaking on behalf of the patient. Scarce resources make them feel insufficient but much could still be done to provide quality care in co-operation with other health-care professionals.
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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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Epstein I, Carlin K. Ethical concerns in the student/preceptor relationship: a need for change. NURSE EDUCATION TODAY 2012; 32:897-902. [PMID: 22503294 DOI: 10.1016/j.nedt.2012.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 02/22/2012] [Accepted: 03/16/2012] [Indexed: 05/31/2023]
Abstract
Nursing schools are required to ensure that the clinical and academic milieu prepares nurses not only to recognize but also to act on various ethical issues. As a result of our years teaching nursing ethics to undergraduate nursing students we have come to believe there is a disconnect between classroom teaching and students' experiences in practice. How then can nurse educators help nursing students not only to see the ethical components of their work but also to take the necessary steps to solve ethical dilemmas and challenge unethical practice? One such strategy is the use of preceptorship. In this paper, we set out to learn about nursing students' ethical encounters in the clinical area, specifically those within the preceptor/student relationship. To this end we conducted an integrative review and are weaving in Gesler's (1992) concepts who argued that ethical issues play out in our physical and social environments. We identified nine articles that describe students' perceptions of ethical problems in their relationships with preceptors. However, it was rare for the authors of these articles to label these as 'ethical' issues. The integrative review revealed first, that students describe ethical issues in their narratives, and second, their most common response to these issues is silence. We continue to be concerned that nursing students' classroom learning of ethics is disconnected from their everyday nursing practice. Further research and education implications are discussed and explored in this paper.
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Affiliation(s)
- Iris Epstein
- George Brown College School of Nursing, 200 King St. East, Toronto, Ontario, Canada M5A 3W8.
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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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Abstract
Acute and critical care nurses routinely encounter ethical "quandaries" such as providing perceived futile care. Other everyday ethically important occurrences may go unrecognized, however, thus diminishing their importance to moral nursing practice. This column presents a framework that may assist in developing specific skills to recognize and engage in both critical and everyday ethical situations with confidence. James Rest's Four Component Model addresses the role of the moral practitioner from initial recognition that an ethical situation exists to implementation of a justifiable action. Patient/provider scenarios are used to illustrate components of Rest's model followed by an approach to distinguish ethical from nonethical situations. Practical strategies to enhance ethical skills such as development of nursing ethics groups and providing continuing ethics education also are presented.
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Affiliation(s)
- Catherine Robichaux
- Department of Health Restoration and Systems Care Management, University of Texas Health Science Center, TX 78229, USA.
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Falcó A. ¿Más conflictos éticos en tiempos de crisis económica? ENFERMERIA INTENSIVA 2012; 23:49-50. [DOI: 10.1016/j.enfi.2012.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 03/16/2012] [Indexed: 10/28/2022]
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Tuvesson H, Eklund M, Wann-Hansson C. Stress of Conscience among psychiatric nursing staff in relation to environmental and individual factors. Nurs Ethics 2012; 19:208-19. [DOI: 10.1177/0969733011419239] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present study aimed at investigating the relationship between environmental and individual factors and Stress of Conscience among nursing staff in psychiatric in-patient care. A questionnaire involving six different instruments measuring Stress of Conscience, the ward atmosphere, the psychosocial work environment, Perceived Stress, Moral Sensitivity, and Mastery was answered by 93 nursing staff at 12 psychiatric in-patient wards in Sweden. The findings showed that Sense of Moral Burden, Mastery, Control at Work and Angry and Aggressive Behavior were related to Stress of Conscience. We conclude that Mastery and Control at Work seemed to work as protective factors, while Sense of Moral Burden and perceptions of Angry and Aggressive Behavior made the nursing staff more vulnerable to Stress of Conscience. Future research should investigate whether measures to increase the level of perceived control and being part of decision making will decrease the level of Stress of Conscience among the staff.
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Åhlin J, Ericson-Lidman E, Norberg A, Strandberg G. Revalidation of the Perceptions of Conscience Questionnaire (PCQ) and the Stress of Conscience Questionnaire (SCQ). Nurs Ethics 2012; 19:220-32. [DOI: 10.1177/0969733011419241] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Perceptions of Conscience Questionnaire (PCQ) and the Stress of Conscience Questionnaire (SCQ) have previously been developed and validated within the ‘Stress of Conscience Study’. The aim was to revalidate these two questionnaires, including two additional, theoretically and empirically significant items, on a sample of healthcare personnel working in direct contact with patients. The sample consisted of 503 healthcare personnel. To test variation and distribution among the answers, descriptive statistics, item analysis and principal component analysis (PCA) were used to examine the underlying factor structure of the questionnaires. Support for adding the new item to the PCQ was found. No support was found for adding the new item to the SCQ. Both questionnaires can be regarded as valid for Swedish settings but can be improved by rephrasing some of the PCQ items and by adding items about private life to the SCQ.
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Little KG, Wilks SE. Psychometric evaluation of a proposed Alzheimer's aggression scale. Am J Alzheimers Dis Other Demen 2011; 26:373-80. [PMID: 21737406 PMCID: PMC10845433 DOI: 10.1177/1533317511414553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
The purpose of this study was to evaluate a popular measure of Alzheimer's disease (AD) memory and behavior problems and to determine whether its aggressive behavior items coalesced empirically as a subscale to form a psychometrically viable AD aggression measure for clinicians. Data from self-report questionnaires were examined from 419 informal AD caregivers in the southern United States. Principal axis factoring revealed a unidimensional solution with robust item loadings on the single factor. Three forms of reliability analysis indicated moderately strong internal consistency on this proposed measure. Evidence of convergent validity analysis was suggested via the measure's significant correlations to theoretically linked constructs. The proposed measure emerged as a reliable and valid tool for health care practitioners for the appraisal of problematic AD aggression behaviors from the caregiver perspective.
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Affiliation(s)
- Kristina G. Little
- LSU School of Social Work, Louisiana State University, Baton Rouge, LA, USA
| | - Scott E. Wilks
- LSU School of Social Work, Louisiana State University, Baton Rouge, LA, USA
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Abstract
The incidence of moral distress, compromised moral integrity, and leaving nursing is highest among nurses new to the profession. Understanding perceptions of moral integrity may assist in developing strategies to reduce distress and promote workforce retention. The purpose of this study was to determine how newly graduated baccalaureate prepared nurses perceive moral integrity and how prepared they feel to manage challenges to it. The design was qualitative descriptive using a confidential short answer online survey. Data were analyzed using conventional content analysis. Moral integrity was perceived as acting like, becoming, and being a certain kind of person who was honest, trustworthy, consistently doing and standing up for what is right, despite the consequences but also expected to set aside their values and beliefs and do what others ask, even if this would mean acting contrary to their conscience. The contradiction within this perception needs explanation.
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