The extent and nature of stress of conscience among healthcare workers: A scoping review

Jokwiro, Yangama; Wilson, Elena; Bish, Melanie

doi:10.1016/j.apnr.2021.151554

Cited by 13 publications

(37 citation statements)

References 38 publications

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“… 15 Troubled conscience is a growing and multifaceted field of research that focuses on its contributing factors and conditions, the relationship between troubled conscience and perception of conscience, its psychological and emotional consequences and the interventions that can be used to reduce stress related to conscience. 10 …”

Section: Introductionmentioning

confidence: 99%

Meanings of troubled conscience in nursing homes: nurses’ lived experience

2022

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Background: Troubled conscience among nurses and other healthcare workers represents a significant contributor to healthcare worker moral distress, burnout and attrition. While research in this area has examined critical care in hospitals, less knowledge has been obtained from long-term care contexts such as nursing homes, despite widely recognised challenges with regard to vulnerable patients, increasing workload and maintaining workforce sustainability among nurses. Objective: The aim of this study was to illuminate and interpret the meaning of the lived experience of troubled conscience among registered nurses (RNs) working in nursing homes. Research design: This qualitative research employed narrative interviews with eight nurses to obtain essential meanings of their lived experiences of troubled conscience. The interview texts were analysed using a phenomenological hermeneutic approach. Ethical considerations: Participation was voluntary, informed and was conducted with written consent. The Norwegian Centre for Research Data approved the data processing of personal data. Findings: The analysis uncovered two themes: (1) troubled conscience means abandoning ideals, with the subthemes: failing dependent patients; being disloyal to colleagues; being inadequate in the performance of work tasks and (2) troubled conscience means facing realities, with the subthemes: accepting being part of the system; responding to barriers. Discussion: Troubled conscience meant experiencing continuous and simmering tension between one’s ideals and realities and feeling a drive to preserve accountability and one’s moral integrity. Endangered ideals were often under cross-pressure and included humanistic values, professional values, working life values and the values of the organisation. Conclusion: Nurses’ troubled conscience refers to a struggle, but also a force that plays out at various levels and arenas in long-term care. Openness and dialogue about how professional values and the welfare state’s intentions can be realised within the given framework are important for individual nurses’ occupational health as well as the quality of care provided to patients.

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Section: Introductionmentioning

confidence: 99%

Meanings of troubled conscience in nursing homes: nurses’ lived experience

2022

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“…Of interest, Jokwiro et al [ 29 ] conducted a scoping review on the extent and nature of stress of conscience among healthcare workers. All 24 of the studies in the scoping review were conducted prior to COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

“…It is clear that nurses are suffering from stress of conscience during the pandemic partially due to: lack of resources; exhaustion from delivering complex care to COVID-19 infected patients; lack of preparation; poor leadership; repeated episodes of moral distress; and anxiety over the possibility of infection spread to themselves or their families [ 29 – 31 ]. Nurses have reported working because of a “sense of duty” [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Stress of conscience of COVID-19 among perianaesthesia nurses having worked in a COVID-ICU during the coronavirus pandemic: an international perspective

et al. 2022

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Background Several studies have reported that working in a COVID-ICU impacted nurses’ mental well-being. Yet little is known about how perianaesthesia nurses who have been working in a COVID-ICU perceived their stress of conscience. The aim of this study was to: (1) describe and compare stress related to troubled conscience among perianaesthesia nurses in three countries who have been working in a COVID-ICU during the pandemic, (2) compare their levels of troubled conscience between working in a COVID-ICU and their usual workplace, and (3) compare nurses that usually work in an ICU department with nurses who usually work outside of the ICU. Methods A descriptive, international cross‐sectional online survey including the Stress of Conscience Questionnaire (SCQ) was distributed between organizational member countries of the International Collaboration of PeriAnaesthesia Nurses. Results A total of 246 nurses from three countries participated. Significant differences were found in stress of conscience when working in the Covid-ICU between Sweden 31.8 (8.6), Denmark 23.1 (8.6), and Netherlands 16.4 (6.5) p < 0.001. Significant differences were also found between nurses working in a COVID-ICU in contrast with their usual workplace: 23.1(5.6) versus 17.7(5.3), p < 0.001. The most stressful aspect of conscience reported was that work in the COVID-ICU was so demanding, nurses did not have sufficient energy to be involved with their family as much as they desired. No statistical differences were found between nurses that usually work in an ICU department with nurses who usually work outside of the ICU. Conclusion The COVID-19 pandemic has negatively impacted stress of conscience among nurses working in the COVID-ICU. Swedish nurses were found to be more significantly impacted. This could be related to low numbers of existing ICU beds and ICU nurses prior to the pandemic necessitating a longer time required for working in a COVID-ICU. Stress of conscience also increased when working in the Covid-ICU compared to working in the usual workplace, and the most stressing aspect reported was that COVID-ICU work was so demanding that nurses did not have the energy to devote themselves to their family as they would have liked.

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“…The effects of moral distress on nurses include burnout ( Austin et al, 2017 ; Scanlan & Still, 2019 ), intent to leave the profession ( Jameton, 2013 ; Scanlan & Still, 2019 ; Wan et al, 2020 ), lower work satisfaction ( Poikkeus et al, 2020 ) and dissatisfaction with their organization's ethical climate ( Epstein et al, 2019 ). The negative effects of moral distress are apparent in all health care disciplines ( Houston et al, 2013 ) and negatively impact the quality of patient care ( Goethals et al, 2010 ; Jokwiro et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Developing and Testing Digital Ethical Reflection in Long-Term Care: Nurses’ Experiences

et al. 2023

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Introduction Nurses working in municipal long-term care face ethical challenges that can lead to moral distress and discomfort for the nurse and affect the quality of patient care. Tools and methods that contribute to increased ethical awareness and support for nurses dealing with moral issues are lacking. Technological innovations may be suitable for ethics work, but little research has been conducted on how such solutions could be designed or their potential benefit. Therefore, this study contributes knowledge about the development and testing of a digital tool for ethics support among nurses. Objective To investigate how digital ethical reflection can support ethics work among nurses working in long-term care. Methods A digital ethical reflection tool was designed and tested in nursing homes and home nursing care in collaboration with two Norwegian municipalities. The study used sequential explanatory mixed-methods design. Over a 6-week period, at the end of each shift, nurses digitally reported the ethical challenges they had experienced. Their responses and experiences were described using descriptive statistics. Additionally, focus group interviews were conducted and analyzed using reflexive thematic analysis (TA). Results During the study period, 17 nurses reported a total of 223 registrations, with 24.8% stating that they had been in an ethically difficult situation. The digital reporting was perceived as practically applicable and helped to increase nurses’ awareness of morally charged situations. The value of the registrations was found to depend on manager participation and the application of the obtained information. The participating nurses become aware that they lacked an arena for meaningful dialogue with and recognition from their manager. Conclusions Information obtained through digital reflection can form the basis for ethical reflections at the departmental level. Digital reflection has the potential to become a tool for managers in their support for employees facing ethical challenges when providing long-term care.

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The extent and nature of stress of conscience among healthcare workers: A scoping review

Cited by 13 publications

References 38 publications

Meanings of troubled conscience in nursing homes: nurses’ lived experience

Meanings of troubled conscience in nursing homes: nurses’ lived experience

Stress of conscience of COVID-19 among perianaesthesia nurses having worked in a COVID-ICU during the coronavirus pandemic: an international perspective

Developing and Testing Digital Ethical Reflection in Long-Term Care: Nurses’ Experiences

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