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Registered nurses' and nurse assistants' lived experience of troubled conscience in their work in elderly care: a phenomenological hermeneutic study
Umeå University, Faculty of Medicine, Department of Nursing.
Umeå University, Faculty of Medicine, Department of Nursing.
2010 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 47, no 1, 20-29 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In elderly care registered nurses (RNs) and nurse assistants (NAs) face ethical challenges which may trouble their conscience.

OBJECTIVE: This study aimed to illuminate meanings of RNs' and NAs' lived experience of troubled conscience in their work in municipal residential elderly care.

DESIGN: Interviews with six RNs and six NAs were interpreted separately using a phenomenological hermeneutic method.

SETTINGS: Data was collected in 2005 among RNs and NAs working in special types of housings for the elderly in a municipality in Sweden.

PARTICIPANTS: The RNs and NAs were selected for participation had previously participated in a questionnaire study and their ratings in the questionnaire study constituted the selection criteria for the interview study.

RESULTS: The RNs' lived experience of troubled conscience was formulated in two themes. The first theme is 'being trapped in powerlessness' which includes three sub-themes: being restrained by others' omission, being trapped in ethically demanding situations and failing to live up to others' expectations. The second theme is 'being inadequate' which includes two sub-themes: lacking courage to maintain one's opinion and feeling incompetent. The NAs' lived experience of troubled conscience was formulated in the two themes. The first is 'being hindered by pre-determined conditions' which includes two sub-themes: suffering from lack of focus in one's work and being restrained by the organisation. The second theme is 'being inadequate' which includes two sub-themes: lacking the courage to object and being negligent.

CONCLUSIONS: The RNs' lived experience of troubled conscience were feelings of being trapped in a state of powerlessness, caught in a struggle between responsibility and authority and a sense of inadequacy fuelled by feelings of incompetence, a lack of courage and a fear of revealing themselves and endangering residents' well-being. The NAs' lived experience of troubled conscience was feelings of being hindered by pre-determined conditions, facing a fragmented work situation hovering between norms and rules and convictions of their conscience. To not endangering the atmosphere in the work-team they are submissive to the norms of their co-workers. They felt inadequate as they should be model care providers. The findings were interpreted in the light of Fromm's authoritarian and humanistic conscience.

Place, publisher, year, edition, pages
2010. Vol. 47, no 1, 20-29 p.
Keyword [en]
Conscience; Geriatric nursing; Nursing assistants; Phenomenological hermeneutics; Registered nurses; Work environment
National Category
Nursing
Identifiers
URN: urn:nbn:se:umu:diva-30199DOI: 10.1016/j.ijnurstu.2009.06.001ISI: 000273905500004PubMedID: 19573872OAI: oai:DiVA.org:umu-30199DiVA: diva2:280684
Available from: 2009-12-11 Created: 2009-12-11 Last updated: 2017-12-12Bibliographically 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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