Moral resilience through harmonised connectedness in intensive care nursing: A grounded theory study

Abstract

To examine intensive care nurses' main concerns in respect of ethical practice, and to investigate how nurses continue to practise in an ethical way despite challenges in order to offer a conceptualisation of moral resilience. RESEARCH METHODOLOGY / DESIGNThis qualitative study followed Glaser and Strauss' version of grounded theory. The study was reviewed, and approved, by research ethics committees in Switzerland and in England. MAIN OUTCOME MEASURESData consisted of field notes and in-depth interviews with 16 nurses working in intensive care in Switzerland and memos developed during the analysis. Data analysis followed the constant comparative method. This study took place between 2014 and 2017. FINDINGSThis study identified new understanding in how intensive care nurses manage their concerns and challenges regarding moral practice. The main category for moral resilience is harmonising connectedness, which represents intensive care nurses' main concern with regard to their moral life, and at the same time, represents the pattern of behaviour in their social interactions and what they yearn for. CONCLUSIONSThis study offers new insight into intensive care nurses' moral practice, moral resilience and strategies nurses use to achieve moral wellbeing.

Influence of spirituality on moral distress and resilience in critical care staff: A scoping review

“…The data collection from the 13 included studies occurred from summer 2017 ( Alazmani-Noodeh et al, 2021 ) to March 2021 ( Borges et al, 2021 ). With 6 studies, most used a qualitative design ( Callis et al, 2021 , Helmers et al, 2020 , Nasrabadi et al, 2021 , Sala Defilippis et al, 2020 , Silverman et al, 2021 , Smiechowski et al, 2021 ), 2 other studies used a mixed-methods approach ( Alazmani-Noodeh et al, 2021 , LoGiudice and Bartos, 2021 ). The remaining studies are 4 quantitative studies ( Borges et al, 2021 , Davis and Batcheller, 2020 , Rushton et al, 2021 , Wang et al, 2021 ) and 1 case study ( Tracey et al, 2021 ).…”

“…MEPRA found no significant changes in moral distress. Sala Defilippis et al (2020) Switzer-land August 2015 to March 2016 Qualitative Cross-sectional ICU nurses n = 16 In-depth interviews Peoplés perception of meaning in life and the need for peace with the environment and themselves Spirituality can increase moral distress. Spirituality increased resilience.…”

“…So I kind of help families through that. And I think that they do feel that.” Sala Defilippis et al (2020) “ Nurses are always in contact with themselves through self-awareness, which keeps them attentive to their feelings and physical reactions in certain situations .” Silverman et al (2021) “ The continuous effort to demonstrate compassion for families experiencing spiritual distress was viewed as the main wellspring from which personal resilience was generated .” Smiechowski et al (2021) “ Reflection on previously successful and unsuccessful family encounters fostered self-growth and ongoing improvement in one’s ability to care for those experiencing spiritual distress .” (c) counselling Silverman et al (2021) „ We do have a weekly Zoom call with all the team members where we kind of like vent out concerns, frustrations, ideas, all sort of things, together, that’s been kind of helpful. “ “ So, I emailed my managers and asked to bring a crisis counselor into the ( … ) team to offer some support because I know this isn’t sustainable and I know there are some colleagues of mine that are, they are definitely struggling .“ Smiechowski et al (2021) „ The ability to share openly about personal feelings and emotions with fellow colleagues, and to debrief around difficult patient cases, was a meaningful coping strategy used by many participants.…”

“…The chaplain is the person on the interdisciplinary team who is best suited to be able to have this emotional and spiritual discussion .” (d) reward from God Alazmani-Noodeh et al (2021) “ When I think about the usefulness of these cares, I tell myself that even if the patient does not survive, I will receive my rewards from god. ” Nasrabadi et al (2021) “ Thinking and recalling of the most powerful nature helps me to tolerate these situations and continue to be a nurse.” (3) spiritual resources support Callis et al (2021) “ I think it’s that self-reflection moment when you’re sharing with the chaplain or the father .” Sala Defilippis et al (2020) “ But these resources were often not accessed due to logistical issues or concerns with breaches of confidentiality with resulting stigma .” Smiechowski et al (2021) “ Social workers and spiritual care providers were viewed as a resource in this regard, both for each other, as well as for other colleagues on the ICU team .” (4) influence of spirituality on resilience Sala Defilippis et al (2020) “ Awareness and self-awareness have a role in moral resilience. Awareness and self-awareness find their expression in the continuous process of evaluating what is going on in their daily practice.…”

Comparisons of Adaptations in Grounded Theory and Phenomenology: Selecting the Specific Qualitative Research Methodology

“…The output contributed to healthcare professionals working on expanding patients' life space, achieving healthcare goals, and boosting professional integrity. An example of Glaser and Strauss's GT is the study by Sala-Defilippis et al (2020). They employed post-positivist GT to conceptualize a theoretical model of harmonized connectedness in intensive care nursing.…”