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Ericson-Lidman, E. & Strandberg, G. (2019). Care providers’ troubled conscience related to an implementation of a time management system in residential care for older people: a participatory action research study. Scandinavian Journal of Caring Sciences
Open this publication in new window or tab >>Care providers’ troubled conscience related to an implementation of a time management system in residential care for older people: a participatory action research study
2019 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Care providers in residential care for older people often refer to time shortage, a problem that may generate troubled conscience.

Aim: The aim of the study was to describe a PAR process to assist care providers in municipal residential care for older people to constructively deal with their troubled conscience related to an implemented time management system.

Method: This intervention study was carried out with 14 care providers and their manager in residential care for older people with the support of participatory action research (PAR). The recorded PAR sessions were transcribed and compiled with inspiration from content analysis.

Ethical considerations: The participants were given oral and written information and gave their written informed consent.

Findings: The PAR process was found to empower the participants to form their own structure of the practical professional planning, adapted to the residents needs and to their daily work. In this process, participants used their troubled conscience as a driving force and as an asset.

Conclusion: Instead of launching change without any deeper information, it is important to carefully prepare, involve and inform those who are going to execute the change. Meeting places should be arranged wherein care providers have the opportunity to share and reflect on challenging situations that can generate troubled conscience, especially when comprehensive changes in their work are going to be implemented.

Keywords
action research, qualitative approaches, care for older people.
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-164681 (URN)10.1111/scs.12779 (DOI)
Available from: 2019-10-28 Created: 2019-10-28 Last updated: 2019-11-04
Ericson-Lidman, E. (2019). Struggling between a sense of belonging and a sense of alienation: Residents' experiences of living in a residential care facility for older people in Sweden. Nordic journal of nursing research
Open this publication in new window or tab >>Struggling between a sense of belonging and a sense of alienation: Residents' experiences of living in a residential care facility for older people in Sweden
2019 (English)In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593Article in journal (Refereed) Epub ahead of print
Abstract [en]

Living in residential care facilities for older people is described in both positive and negative terms. To maintain care quality of a vulnerable group in a constantly changing care context, it is important to continually describe their experiences. This qualitative study aims to describe residents’ experiences of living in a residential care facility for older people in Sweden. Six residents were interviewed and the interviews were analyzed using qualitative content analysis. The analysis resulted in nine sub-categories, two categories and one overall theme. Living in a residential care facility for older people is revealed as ‘Struggling between a sense of belonging and a sense of alienation’. It is of great importance for care providers to explore and try to understand what individuals perceive as factors for feelings of belonging, thereby preventing alienation.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
alienation, content analysis, older people care, residential care facility, sense of belonging
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-158318 (URN)10.1177/2057158519825766 (DOI)
Available from: 2019-04-23 Created: 2019-04-23 Last updated: 2019-04-24
Mazaheri, M., Ericson-Lidman, E., Joakim, Ö. & Norberg, A. (2018). Meanings of troubled conscience and how to deal with it: expressions of Persian-speaking enrolled nurses in Sweden.. Scandinavian Journal of Caring Sciences, 32(1), 380-388
Open this publication in new window or tab >>Meanings of troubled conscience and how to deal with it: expressions of Persian-speaking enrolled nurses in Sweden.
2018 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 1, p. 380-388Article in journal (Refereed) Published
Abstract [en]

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.

Keywords
Persian-speaking, Sweden, dementia, enrolled nurse, immigrant, residential care, troubled conscience
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-138752 (URN)10.1111/scs.12472 (DOI)000426524200039 ()28799165 (PubMedID)
Available from: 2017-08-29 Created: 2017-08-29 Last updated: 2018-06-09Bibliographically approved
Ericson-Lidman, E. & Strandberg, G. (2018). Using a developed participatory action research process in practice to help care providers deal with troubled conscience in residential care of older people. Action Research, 16(2), 190-206
Open this publication in new window or tab >>Using a developed participatory action research process in practice to help care providers deal with troubled conscience in residential care of older people
2018 (English)In: Action Research, ISSN 1476-7503, E-ISSN 1741-2617, Vol. 16, no 2, p. 190-206Article in journal (Refereed) Published
Abstract [en]

Stress of conscience seriously influence the quality of care and the wellbeing of the care providers in care for older people. It is therefore of great importance to take measures to address, and relieve but preferably prevent stress related to troubled conscience. In our participatory action research studies, we have used troubled conscience as a driving force to relieve care providers’ burden and to increase quality of care. The aim with this paper is to present our experiences of using a further developed participatory action research process in practice to deal with care providers’ troubled conscience in residential care for older people. The contribution to participatory action research practice in our studies is a support to the participatory action research process through using a modified model of problem processing, an approach which we found fruitful. In the paper, we describe our experiences and discuss them in relation to relevant literature and theory. Our experiences are that in participatory action research it is crucial to build a trusting relationship and striving to create a fruitful dialogue between the researchers and the participants. In our studies, we found that participatory action research is an easy approach to adapt as a problem-solving process in clinical practice and in nursing research.

Place, publisher, year, edition, pages
London: Sage Publications, 2018
Keywords
Troubled conscience, participatory action research, care for older people
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-129337 (URN)10.1177/1476750316678916 (DOI)000435909700005 ()2-s2.0-85048890995 (Scopus ID)
Available from: 2016-12-22 Created: 2016-12-22 Last updated: 2018-09-21Bibliographically approved
Ericson-Lidman, E. & Åhlin, J. (2017). Assessments of stress of conscience, perceptions of conscience, burnout, and social support before and after implementation of a participatory action-research-based intervention. Clinical Nursing Research, 26(2), 205-223
Open this publication in new window or tab >>Assessments of stress of conscience, perceptions of conscience, burnout, and social support before and after implementation of a participatory action-research-based intervention
2017 (English)In: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 26, no 2, p. 205-223Article in journal (Refereed) Published
Abstract [en]

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.

Keywords
participatory action research (PAR), follow-up study, interventions
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-113454 (URN)10.1177/1054773815618607 (DOI)000398127300006 ()26671898 (PubMedID)
Available from: 2015-12-18 Created: 2015-12-18 Last updated: 2018-06-07Bibliographically approved
Åhlin, J., Strandberg, G., Norberg, A., Ternestedt, B.-M. & Ericson-Lidman, E. (2017). Care providers’ narrated experiences of working in private non-profit residential care for older people during downsizing and reorganisation, focusing on troubled conscience. Nordic journal of nursing research, 37(4), 177-185
Open this publication in new window or tab >>Care providers’ narrated experiences of working in private non-profit residential care for older people during downsizing and reorganisation, focusing on troubled conscience
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2017 (English)In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 37, no 4, p. 177-185Article in journal (Refereed) Published
Abstract [en]

Knowledge about care providers’ experiences of working in residential care of older people during times of downsizing and reorganisation is scarce, and it is not known whether/how their conscience is influenced by such changes. The aim was to describe care providers’ experiences of working in private residential care for older people during downsizing and reorganisation, focusing on troubled conscience. This study adopted a qualitative descriptive design based on interviews with seven care providers. A qualitative content analysis was used. The overall understanding was revealed as perceiving oneself as pinioned in between current circumstances to provide care and what one’s conscience conveyed. Care providers perceived: deteriorating working conditions as exhausting, downsizing and reorganisation as triggering one’s conscience when collaborating, troubled conscience when downsizing and reorganisation decrease the quality of care, and good management as crucial during downsizing and reorganisation. The results highlight that adequate communication strategies, well-functioning leadership and opportunities to know together and share what one’s conscience tells are aspects that need consideration.

Keywords
care providers, conscience, content analysis, downsizing, reorganisation, residential care of older people
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-129450 (URN)10.1177/2057158516678160 (DOI)
Available from: 2016-12-29 Created: 2016-12-29 Last updated: 2018-11-16Bibliographically approved
Mazaheri, M., Ericson-Lidman, E., Zargham-Boroujeni, A., Öhlén, J. & Norberg, A. (2017). Clear conscience grounded in relations: expressions of Persian-speaking nurses in Sweden. Nursing Ethics, 24(3), 349-361
Open this publication in new window or tab >>Clear conscience grounded in relations: expressions of Persian-speaking nurses in Sweden
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2017 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 24, no 3, p. 349-361Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Sage Publications, 2017
Keywords
Care provider, conscience, dementia, immigrant, Persian-speaking residential care
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-109970 (URN)10.1177/0969733015603442 (DOI)000401584200009 ()26385903 (PubMedID)
Available from: 2015-10-09 Created: 2015-10-09 Last updated: 2018-06-07Bibliographically approved
Juthberg, C. & Ericson-Lidman, E. (2016). Experiences of a PAR Intervention in Care for Older People. Clinical Nursing Research, 25(6), 646-664
Open this publication in new window or tab >>Experiences of a PAR Intervention in Care for Older People
2016 (English)In: Clinical Nursing Research, ISSN 1054-7738, E-ISSN 1552-3799, Vol. 25, no 6, p. 646-664Article in journal (Refereed) Published
Abstract [en]

Participatory action research (PAR) is an approach for dealing with problematic areas in practice. Follow-up studies in which participants describe their participation in PAR in detail are rare. This follow-up study aimed to describe care providers' (CPs) experiences of having participated in a PAR intervention designed to assist them to constructively deal with troubled conscience. Twenty-nine CPs who participated in a PAR intervention were interviewed 2 to 4 months post-intervention. Content analysis was used to analyze the data. The analysis revealed three main categories: the importance of having a communal and collaborative meeting place, perceived changes in daily life, and "It has been good, but it has not solved all of our problems." Using PAR to deal with troubled conscience might be an important organizational investment for the future that can help prevent ill health among CPs and maintain or improve the quality of care.

Place, publisher, year, edition, pages
Sage Publications, 2016
Keywords
participatory action research (PAR), troubled conscience, care for older people, follow-up study, content analysis
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-106828 (URN)10.1177/1054773815592372 (DOI)000387460100005 ()26122787 (PubMedID)
Note

First published online June 29, 2015.

Available from: 2015-08-10 Created: 2015-08-10 Last updated: 2018-06-07Bibliographically approved
Åhlin, J., Ericson-Lidman, E., Norberg, A. & Strandberg, G. (2015). A comparison of assessments and relationships of stress of conscience, perceptions of conscience, burnout and social support between healthcare personnel working at two different organizations for care of older people. Scandinavian Journal of Caring Sciences, 29(2), 277-287
Open this publication in new window or tab >>A comparison of assessments and relationships of stress of conscience, perceptions of conscience, burnout and social support between healthcare personnel working at two different organizations for care of older people
2015 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 2, p. 277-287Article in journal (Refereed) Published
Abstract [en]

AIM: The aim of this cross-sectional, descriptive study was to compare assessments and relationships of stress of conscience, perceptions of conscience, burnout and social support between healthcare personnel (HCP) working in two different organisations for care of older people.

METHODS: This cross-sectional, descriptive comparative study was performed among Registered Nurses and nurse assistants working in two different organisations (n(1)  = 98, n(2)  = 488) for residential care of older people. The organisations were chosen to be as different as possible, and data were collected using four different questionnaires. Hierarchical cluster analysis with multiscale bootstrap resampling was used to compare the associations between all items in the questionnaires. Descriptive statistics, 95% confidence intervals, chi-squared tests, Cohen's d, Cramer's V and the φ coefficient were all used to judge differences between the organisations.

RESULTS: The associations between stress of conscience, perceiving one's conscience as a burden, and burnout were similar in both organisations. Perceiving one's conscience as far too strict and having a troubled conscience from being unable to live up to one's standards were associated with stress of conscience and burnout in one organisation. Women had higher levels of stress of conscience and reported lower social support from co-workers compared with men.

CONCLUSIONS: This study shows that associations between perceptions of conscience, stress of conscience and burnout are common experiences that are similar among HCP despite great differences in the characteristics of organisations. It can be burdensome for HCP to be unable to realise their ambitions to provide good care, and sex/gender can be an important factor to consider in the development of measures against the negative effects of stress of conscience. More studies are needed about how HCP's ambition to provide good care and sex/gender are related to perceptions of conscience, stress of conscience and burnout.

Keywords
burnout, perceptions of conscience, residential care of older people, social support, stress of conscience
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-98475 (URN)10.1111/scs.12161 (DOI)000354260700009 ()25154457 (PubMedID)
Available from: 2015-01-22 Created: 2015-01-22 Last updated: 2018-06-07Bibliographically approved
Ericson-Lidman, E. & Strandberg, G. (2015). Learning to deal constructively with troubled conscience related to care providers' perceptions of deficient teamwork in residential care of older people: a participatory action research study. Scandinavian Journal of Caring Sciences, 29(2), 215-224
Open this publication in new window or tab >>Learning to deal constructively with troubled conscience related to care providers' perceptions of deficient teamwork in residential care of older people: a participatory action research study
2015 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, no 2, p. 215-224Article in journal (Refereed) Published
Abstract [en]

Conscience can be perceived as an asset that helps care providers to provide good care, but it can also be a burden that generates stress of conscience (stress related to a troubled conscience). Participatory action research (PAR) has been shown to be successful in supporting care providers in residential care of older people to learn to deal with their troubled conscience in challenging and demanding care situations. The aim of the study was to describe an intervention process to assist care providers in residential care of older people to constructively deal with their troubled conscience related to perceptions of deficient teamwork. The study design was grounded in PAR. Nine enrolled nurses (ENs), two nursing aids (NAs), one Registered Nurse (RN) and their manager participated in 12 PAR sessions. All sessions were tape-recorded, and a domain analysis of the transcriptions was performed. Findings show that a PAR-based intervention can support care providers to understand, handle and take measures against deficient teamwork. Using troubled conscience as a driving force can increase the opportunities to improve quality of care in residential care for older people. During the PAR process, participants raised their awareness of the need to view the team in a wider sense and that the manager and the Registered Nurse should also be members of the team to improve team outcome. To improve clinical practice, we suggest that teams in residential care of older people should be enabled to share and reflect on challenging situations that generate troubled conscience. However, as shown in this study, care providers might need support in order to facilitate and promote sharing and reflecting on what their conscience tells them.

Keywords
Participatory action research, residential care for older people, troubled conscience
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-90646 (URN)10.1111/scs.12152 (DOI)000354260700003 ()24867477 (PubMedID)
Available from: 2014-06-26 Created: 2014-06-26 Last updated: 2018-06-07Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-2126-7332

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