Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Moral stress: synthesis of a concept
Ersta Sköndal University College, Department of Health Care Sciences.
Ersta Sköndal University College, Department of Health Care Sciences. Karolinska institutet.
Ersta Sköndal University College, Department of Health Care Sciences. Karolinska institutet.
Ersta Sköndal University College, Department of Health Care Sciences.
2003 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 10, no 3, 312-322 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this article is to describe the synthesis of the concept of moral stress and to attempt to identify its preconditions. Qualitative data from two independent studies on professional issues in nursing were analysed from a hypothetical-deductive approach. The findings indicate that moral stress is independent of context-given specific preconditions: (1) nurses are morally sensitive to the patient's vulnerability; (2) nurses experience external factors preventing them from doing what is best for the patient; and (3) nurses feel that they have no control over the specific situation. The findings from this analysis are supported by recent research on stress in the workplace but differ that the imperatives directing work are moral in nature. Stress researchers have found that persons who experience that they have no control over their work situation and at the same time experience high demands may be prone to cardiovascular diseases. An important question raised by this study is whether moral stress should be recognized as a health risk in nursing. Further research is required in order to generate intervention models to prevent or deal with moral stress.

Place, publisher, year, edition, pages
2003. Vol. 10, no 3, 312-322 p.
National Category
Health Sciences
Identifiers
URN: urn:nbn:se:esh:diva-101DOI: 10.1191/0969733003ne608oaPubMedID: 12762464OAI: oai:DiVA.org:esh-101DiVA: diva2:319283
Available from: 2010-05-17 Created: 2010-05-10 Last updated: 2014-11-04Bibliographically approved
In thesis
1. The moral enterprise in intensive care nursing
Open this publication in new window or tab >>The moral enterprise in intensive care nursing
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aims of this thesis were to explore nurses' experiences of stress in the ICU (I), to analyze experiences of moral concerns in intensive care nursing from the perspective of relational ethics (II), to describe the synthesis of the concept of moral stress and to identify preconditions for moral stress (III) and to analyse and describe lived experiences of support in situations characterized by critical care situations and moral stress in intensive care (IV).The design was exploratory and descriptive. Material in studies I, II and IV consisted of interviews with intensive care nurses (10 head nurses and 26 staff nurses) employed in general, thoracic and neonatal intensive care units in five hospitals located in different parts of Sweden. The material in study III data from two studies of professional issues in nursing were used for the analysis: one concerned psychiatric nursing and the other was the previously referred study I.In study I qualitative content analysis and descriptive interpretation was used in the analysis. The main theme 'stress induced by dissonant imperatives' formulated in the analysis. Dissonant imperatives are composed of the four sub-themes: 1) controlled by the working situation - needing to be in control, 2) constrained by prioritisation - wanting to do more, 3) lacking authority to act - knowing that something should be done, and 4) professional distance - interpersonal involvement. In study II qualitative content analysis and descriptive interpretation were used in the analysis. A main theme was formulated, 'caring about-caring for: tensions between moral obligations and work responsibilities in intensive care nursing'. Five sub-themes were formulated 1) believing in a good death, 2) knowing the course of events, 3) feelings of distress, 4) reasoning about the physicians and 5) expressing moral awareness. In the study III a hypothetical-deductive method was used. The findings indicate that moral stress is independent of context-given specific pre-conditions: 1) nurses are morally sensitive to the patient's vulnerability, 2) nurses experience external factors preventing them from doing the best for the patient, and 3) nurses feel that they have no control over the situation. In the study IV an interpretive method was used. The first level of analysis of data identified contextual factors, such as type and purpose of support and working conditions. Thereafter five tentative interpretations were revealed: 1) receiving organised support is a matter of self-determination, 2) whether to participate or to be off duty is experienced mutually as exclusive, 3) dealing with moral stress is experienced as a private matter, 4) colleagues managing moral stress serve as models in stress support, and 5) not being able to deal with moral stress urges one to seek outside support. A comparison of these interpretations identified three major themes: availability, accessibility and receptivity of support. The main interpretation of data was: "lived experience of moral stress support involves an interconnectedness between structural and existential factors".A comprehensive understanding was formulated using the four studies (I, II, III and IV). Moral stress was found to be influential on the caring competence. Conflicts between different competences were found leading to a shift in focus away from the patients leading to a possible decrease in the caring competence. Moreover, the subtle resistance among nurses toward participation in organized moral stress support may obstruct the development of nurses' caring competence. Accordingly, imbalance, due to moral stress, between different competences hinders the development of collectively shared caring competence.

Place, publisher, year, edition, pages
Stockholm: Karolinska University Press, 2004. 69 p.
Keyword
caring competence, hermeneutics, intensive care nursing, moral stress, qualitative content analysis, stress support, ethics, nursing, intensive care units ethics, morals, nurses psychology, burnout, professional psychology, stress
National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-486 (URN)91-7349-942-0 (ISBN)
Public defence
2004-06-09, Hörsal 1, Karolinska Institutet, Alfred nobels allé, Huddinge, 13:00
Opponent
Supervisors
Available from: 2010-07-12 Created: 2010-07-12 Last updated: 2011-04-06Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Cronqvist, AgnetaMagnusson, AnnabellaAndersson, Lars
By organisation
Department of Health Care Sciences
In the same journal
Nursing Ethics
Health Sciences

Search outside of DiVA

GoogleGoogle Scholar

Altmetric score

Total: 100 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf