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Perceptions of conscience, stress of conscience and burnout among registered nurses and nurse assistants in municipal residential care of older people
Umeå University, Faculty of Medicine, Department of Nursing.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
Umeå University, Faculty of Medicine, Department of Nursing.ORCID iD: 0000-0001-5994-4012
Umeå University, Faculty of Medicine, Department of Nursing.
2010 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 66, no 8, 1708-18 p.Article in journal (Refereed) Published
Abstract [en]

Aim. This paper is a report of a study of patterns of perceptions of conscience, stress of conscience and burnout in relation to occupational belonging among Registered Nurses and nursing assistants in municipal residential care of older people.Background. Stress and burnout among healthcare personnel and experiences of ethical difficulties are associated with troubled conscience. In elder care the experience of a troubled conscience seems to be connected to occupational role, but little is known about how Registered Nurses and nursing assistants perceive their conscience, stress of conscience and burnout.Method. Results of previous analyses of data collected in 2003, where 50 Registered Nurses and 96 nursing assistants completed the Perceptions of Conscience Questionnaire, Stress of Conscience Questionnaire and Maslach Burnout Inventory, led to a request for further analysis. In this study Partial Least Square Regression was used to detect statistical predictive patterns.Result. Perceptions of conscience and stress of conscience explained 41·9% of the variance in occupational belonging. A statistical predictive pattern for Registered Nurses was stress of conscience in relation to falling short of expectations and demands and to perception of conscience as demanding sensitivity. A statistical predictive pattern for nursing assistants was perceptions that conscience is an authority and an asset in their work. Burnout did not contribute to the explained variance in occupational belonging.Conclusion. Both occupational groups viewed conscience as an asset and not a burden. Registered Nurses seemed to exhibit sensitivity to expectations and demands and nursing assistants used their conscience as a source of guidance in their work. Structured group supervision with personnel from different occupations is needed so that staff can gain better understanding about their own occupational situation as well as the situation of other occupational groups.

Place, publisher, year, edition, pages
2010. Vol. 66, no 8, 1708-18 p.
Keyword [en]
burnout, conscience, gerontological nursing, nursing assistants, older people, Registered Nurses, residential care, stress
National Category
Geriatrics Nursing
Identifiers
URN: urn:nbn:se:umu:diva-3463DOI: 10.1111/j.1365-2648.2010.05288.xISI: 000279447100006PubMedID: 20557396OAI: oai:DiVA.org:umu-3463DiVA: diva2:142170
Available from: 2008-09-19 Created: 2008-09-19 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Samvetsstress hos vårdpersonal i den kommunala äldreomsorgens särskilda boenden
Open this publication in new window or tab >>Samvetsstress hos vårdpersonal i den kommunala äldreomsorgens särskilda boenden
2008 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis is to describe perception of conscience, stress of conscience (stress related to troubled conscience) and burnout, to explore their relationships and to illuminate meanings of the lived experience of troubled conscience in one’s work among registered nurses (RNs) and nurse assistants (NAs) in municipal residential care for the elderly. The thesis comprises four studies; studies I-III are based on questionnaire data from 50 RNs and 96 NAs and study IV is based on interview data from 6 RNs and 6 NAs selected from the participants in the questionnaire study. Questionnaire data was analysed with multivariate statistics (I-III). Narrative interviews were interpreted with a phenomenological hermeneutic method (IV).

Study I showed two relationships explaining a noteworthy amount of the shared variance by themselves (25.6% and 17.8%). One relationship was shown between having to deaden one’s conscience in order to keep working in healthcare and stress of conscience related to external demands which was interpreted as having to deaden one’s conscience in order to be able to collaborate with co-workers. The other relationship was shown between having to deaden one’s conscience in order to keep working in healthcare and stress of conscience related to internal demands which was interpreted as having to deaden one’s conscience in order to be able to feel like a good healthcare professional.

Study II showed a relationship between stress of conscience and burnout (43.6% explained variance) indicating that experiences of shortcomings and of being exposed to contradictory demands are strongly related to burnout. The relationship between perceptions of conscience and burnout (33.9% explained variance) indicated that having to deaden one’s conscience in order to keep working in healthcare is strongly related to burnout.

Study III showed that both RNs and NAs perceived conscience mainly as an asset and a guide and not as a burden in their work. Lack of time and high demands of work influencing home life were the situations related to the highest stress of conscience for both RNs and NAs. The predictive pattern for RNs was interpreted as RNs showing sensitivity to expectations and demands and NAs using their conscience as a guide in their work.

Study IV showed that meanings of the RNs’ lived experience of troubled conscience in their work are of being trapped in feelings of powerlessness and a sense of being inadequate. They feel they are failing to live up to expectations from residents and their families, colleagues and themselves because of feelings of powerlessness, cowardice and incompetence. Meanings of NAs’ lived experience of troubled conscience in their work are a sense of being hindered in providing the level of care they would like to provide because of pre-determined conditions and by feelings of being inadequate. They are betraying the residents and themselves by accepting perceived inadequate working conditions and through their own perceived sense of cowardice and negligence.

The conclusion of these studies is that stress of conscience is related to burnout among RNs and NAs in municipal residential care for the elderly. Experiences of inadequacy, powerlessness and feelings of being hindered are shown in situations where they have troubled conscience. When the norms of others and/or the pre-determined conditions do not correspond to their own values and norms it may result in the feeling that they cannot perceive themselves as good healthcare professionals.

Place, publisher, year, edition, pages
Umeå: Omvårdnad, 2008. 80 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1203
Keyword
burnout, conscience, elderly care, nurse assistants, registered nurses, stress of conscience
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-1840 (URN)978-91-7264-629-2 (ISBN)
Public defence
2008-10-03, Aulan, Vårdvetarhuset, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2008-09-19 Created: 2008-09-19 Last updated: 2011-03-30Bibliographically approved

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