Perceptions of Conscience in Relation To Stress of Conscience

Abstract

Every day situations arising in health care contain ethical issues influencing care providers' conscience. How and to what extent conscience is influenced may differ according to how conscience is perceived. This study aimed to explore the relationship between perceptions of conscience and stress of conscience among care providers working in municipal housing for elderly people. A total of 166 care providers were approached, of which 146 (50 registered nurses and 96 nurses' aides/enrolled nurses) completed a questionnaire containing the Perceptions of Conscience Questionnaire and the Stress of Conscience Questionnaire. A multivariate canonical correlation analysis was conducted. The first two functions emerging from the analysis themselves explained a noteworthy amount of the shared variance (25.6% and 17.8%). These two dimensions of the relationship were interpreted either as having to deaden one's conscience relating to external demands in order to be able to collaborate with coworkers, or as having to deaden one's conscience relating to internal demands in order to uphold one's identity as a `good' health care professional.

Keywords

care of elderly people care providers conscience stress

Get full access to this article

View all access options for this article.

References

Nordam A. , Torjuul K. , Sørlie V. Ethical challenges in the care of older people and risk of being burned out among male nurses. J Clin Nurs 2005; 14: 1248-56.

Rasmussen BH , Sandman PO , Norberg A. Stories of being a hospice nurse: a journey towards finding one's footing. Cancer Nurs 1997; 20: 330-41.

Jansson L. , Norberg A. Ethical reasoning among registered nurses experienced in dementia care. Scand J Caring Sci 1992; 6: 219-27.

Lindahl E. , Gilje F. , Norberg A. Striving for purity: shared understandings in retired Swedish care providers' narratives on nursing care around 1950. J Holistic Nurs 2004; 22: 333-50. 5 Jansson L. , Norberg A. , Sandman PO , Åström G. When the severely ill elderly patient refuses food. Ethical reasoning among nurses. Int J Nurs Stud 1995; 32: 68-78.

Sørlie V. , Jansson L. , Norberg A. The meaning of being in ethically difficult care situations in paediatric care as narrated by female registered nurses. Scand J Caring Sci 2003; 17: 285-92. 7 Sørlie V. , Kihlgren A. , Kihlgren M. Meeting ethical challenges in acute nursing care as narrated by registered nurses. Nurs Ethics 2005; 12: 133-42.

Heidegger M. Being and time. (Macquarrie J, Robinson E trans) Blackwell , 1962 (Sein und Zeit: German original 1927 ).

Nelms TP Living a caring presence in nursing: a Heideggerian hermeneutical analysis . J Adv Nurs 1996; 24: 368-74.

Hoose J. Conscience in world religions. Gracewing, 1999.

Løgstrup KE The ethical demand. (Jensen TI, Puckering G, Watkins E trans) University of Notre Dame Press, 1997 (Etiske fordring: Danish original 1956).

10.

Freud S. Civilization and its discontents. In: Strachey J ed. The standard edition of the complete psychological works of Sigmund Freud. Norton, 1989 : s. 5-112.

11.

Frankl VE Gud och det omedvetna: psykoterapi och religion. (The unconscious God: psychotherapy and theology.) (Wentz Edgardh M, Swedish trans.) Natur och Kultur, 1997 (Der unbewusste Gott : Psychotherapie and Religion: German original 1949).

12.

Fromm E. Man for himself: an inquiry into the psychology of ethics. Owl Books, 1990.

13.

Dahlqvist V. , Eriksson S. , Glasberg AL et al. Development of a questionnaire to identify perceptions of conscience (PCQ). Nurs Ethics 2007; 14: 181-93.

14.

Virt G. Conscience in conflict. In: Zecha G , Weingartner P eds. Conscience: an interdisciplinary view. Reidel, 1987: 165-91.

15.

Sørlie V. , Kihlgren AL , Kihlgren M. Meeting ethical challenges in acute care work as narrated by enrolled nurses . Nurs Ethics 2004; 11: 179-88.

16.

Häggstrom E. , Skovdahl K. , Fläckman B. , Kihlgren AL , Kihlgren M. To feel betrayed and to feel that you are betraying the older residents: caregivers' experiences at a newly opened nursing home. J Clin Nurs 2004; 13: 687-96.

17.

Kuremyr D. , Kihlgren M. , Norberg A. , Åström S. , Karlsson I. Emotional experiences, empathy and burnout among staff caring for demented patients at a collective living unit and a nursing home. J Adv Nurs 1994; 19: 670-79.

18.

Morgan DG , Semchuk KM , Stewart NJ , D'Arcy C. Job strain among staff of rural nursing homes. A comparison of nurses, aides, and activity workers. J Nurs Adm 2002; 32: 152-61. 21 McVicar A. Workplace stress in nursing: a literature review. J Adv Nurs 2003; 44: 633-42.

19.

Bowers BJ , Lauring C. , Jacobson N. How nurses manage time and work in long-term care. J Adv Nurs 2001; 33: 484-91.

20.

Duquette A. , Kerouac S. , Sandhu BK , Ducharme F. , Saulnier P. Psychosocial determinants of burnout in geriatric nursing. Int J Nurs Stud 1995; 32: 443-56.

21.

Weman K. , Kihlgren M. , Fagerberg I. Older people living in nursing homes or other community care facilities: registered nurses' views of their working situation and cooperation with family members . J Clin Nurs 2004; 13: 617-26.

22.

Dunn LA , Rout U. , Carson J. , Ritter SA Occupational stress amongst care staff working in nursing homes: an empirical investigation. J Clin Nurs 1994; 3: 177-83.

23.

Forsgärde M. , Westman B. , Jansson L. Professional carers' struggle to be confirmed. Narratives within the care of the elderly and disabled. Scand J Caring Sci 2002; 16: 12-18.

24.

Redfern S. , Hannan S. , Norman I. , Martin F. Work satisfaction, stress, quality of care and morale of older people in a nursing home. Health Soc Care Community 2002 ; 10: 512-17.

25.

Graneheim UH , Isaksson U. , Ljung IM , Jansson L. Balancing between contradictions: the meaning of interaction with people suffering from dementia and `behavioral disturbances' . Int J Aging Hum Dev 2005; 60: 145-57.

26.

Häggström E. Municipal care for older people: experiences narrated by caregivers and relatives [Dissertation]. Karolinska Institutet, 2005. Retrieved 4 January, 2007, from: http://diss.kib.ki.se/2005/91-7140-186-5/

27.

Lützén K. , Cronqvist A. , Magnusson A. , Andersson L. Moral stress: synthesis of a concept. Nurs Ethics 2003; 10: 312-22.

28.

Severinsson EI , Kamaker D. Clinical nursing supervision in the workplace - effects on moral stress and job satisfaction. J Nurs Manage 1999; 7: 81-90.

29.

Corley MC , Elswick RK , Gorman M. , Clor T. Development and evaluation of a moral distress scale. J Adv Nurs 2001; 33: 250-56.

30.

Jameton A. Dilemmas of moral distress: moral responsibility and nursing practice. AWHONNS Clinical Issues Perinat Women Health Nurs 1993; 4: 542-51.

31.

Wilkinson JM Moral distress in nursing practice: experience and effect. Nurs Forum 1988; 23(1): 16-29.

32.

Bischoff SJ , DeTienne KB , Quick B. Effects of ethics stress on employee burnout and fatigue: an empirical investigation . J Health Hum Service Adm 1999; 21: 512-32.

33.

Raines ML Ethical decision making in nurses. Relationships among moral reasoning, coping style, and ethics stress. JONAS Healthc Law Ethics Regul 2000; 2: 29-41.

34.

Glasberg A-L. , Eriksson S. , Dahlqvist V. et al. Development and initial validation of the Stress of Conscience Questionnaire. Nurs Ethics 2006; 13: 633-48.

35.

Erlen JA , Sereika SM Critical care nurses, ethical decision-making and stress. J Adv Nurs 1997; 26: 953-61.

36.

Kälvemark S. , Höglund AT , Hansson MG , Westerholm P. , Arnetz B. Living with conflicts: ethical dilemmas and moral distress in the health care system. Soc Sci Med 2004; 58: 1075-84.

37.

Lipp A. An enquiry into a combined approach for nursing ethics. Nurs Ethics 1998; 5: 122-38.

38.

von Post I. Perioperative nurses' encounter with value conflicts: a descriptive study. Scand J Caring Sci 1998 ; 12: 81-88.

39.

Westin L. , Danielson E. Nurses' experiences of caring encounters with older people living in Swedish nursing homes. Int J Older People Nurs 2006 ; 1: 3-10.

40.

Munro BH Statistical methods for health care research, fifth edition. Lippincott Williams & Wilkins, 2005.

41.

Tabachnick BG , Fidell LS Using multivariate statistics, fouth edition . Allyn and Bacon, 2001.

42.

Sherry A. , Henson RK Conducting and interpreting canonical correlation analysis in personality research: a user-friendly primer. J Pers Assess 2005; 84: 37-48.

43.

Kihlgren AL , Fagerberg I. , Skovdahl K. , Kihlgren M. Referrals from home care to emergency hospital care: basis for decisions. J Clin Nurs 2003 ; 12: 28-36.

44.

Smith KV , Godfrey NS Being a good nurse and doing the right thing: a qualitative study. Nurs Ethics 2002; 9: 301-12.

45.

Georges J-J. , Grypdonck M. Moral problems experienced by nurses when caring for terminally ill people: a literature review. Nurs Ethics 2002; 9: 155-78.

46.

Varcoe C. , Doane G. , Pauly B. et al. Ethical practice in nursing: working the in-betweens. J Adv Nurs 2004; 45: 316-25.

47.

Childress JF Appeals to conscience. Ethics 1979; 89: 315-35.

48.

Kelly B. Preserving moral integrity: a follow-up study with new graduate nurses. J Adv Nurs 1998; 28: 1134-45.

49.

Hartrick Doane GA Am I still ethical? The socially-mediated process of nurses' moral identity. Nurs Ethics 2002; 9: 623-35.

50.

Weil S. The need for roots: prelude to a declaration of duties towards mankind. (Wills AF trans) Routledge, 1997 (L'Enracinement: French original 1949).