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Samvete i vården: att möta det moraliska ansvarets röster
Umeå universitet, Institutionen för omvårdnad.
2008 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis is twofold: first, to develop and validate questionnaires that could be used for investigating relationships between perceptions of conscience, moral sensitivity and burnout and second, to describe patterns of self-comfort used to ease stress and illuminate meanings of living with a troubled conscience. The thesis comprises five studies and is based on both quantitative and qualitative data.

In study I, a questionnaire was constructed to assess perceptions of conscience; the Perceptions of Conscience Questionnaire (PCQ). This 15 item-questionnaire was distributed to 444 care providers. Statistical analyses of responses showed sufficient distribution and a stable six factor solution congruent with reviewed literature. The six factors were labelled: ‘the voice of authority’, ‘warning signal’, ‘demanding sensitivity’, ‘asset’, ‘burden’ and ‘depending on culture’. The findings suggest that the PCQ is a valid questionnaire. The aim of study II was further development of an existing questionnaire assessing care providers’ moral sensitivity, enabling its use in various care contexts. The revised nine-item questionnaire, the Moral Sensitivity Questionnaire Revised version (MSQ-R), was distributed to 278 care providers with various professional backgrounds. Statistical analyses of responses showed sufficient distribution and a three-factor solution congruent with reviewed literature. The three factors were labelled: ‘sense of moral burden’, ‘sense of moral strength,’ and ‘sense of moral responsibility.’ The findings suggest that MSQ-R is valid for use in various healthcare contexts. In study III, the PCQ, the MSQ-R and the Maslach Burnout Inventory (MBI) were distributed to a population of psychiatric care providers (n=101) to investigate relationships between perceptions of conscience and moral sensitivity and levels of burnout. The hierarchical cluster analysis shows two clusters with Pearson’s r >.50. Cluster A comprising items such as: being sensitive, interpreting and following the voice of conscience that warns us against hurting other or ourselves and developing as human beings was labelled ‘experiencing a sense of moral integrity’. Cluster B comprising items such as: feeling inadequate, doing more than one has strengths for, feeling always responsible, having difficulties to deal with wearing feelings, perceiving that conscience gives wrong signals and express social values, having to deaden one’ conscience, were all related to scores of the MBI subscales emotional exhaustion (EE) and depersonalisation (DP). Cluster B was labelled ‘experiencing a burdening accountability’. The results show that levels of ‘experiencing a burdening accountability’ are closely related to levels of being at risk of burnout.

The aim of study IV was to describe patterns of self-comforting measures used to ease stress. The written accounts of 168 care providers and healthcare students were analysed by means of qualitative content analysis. The findings disclose two dimensions: an ability to use early learned measures to take care of oneself (ingression) and an ability to feel intimately related to life, other human beings and universe or God (transcendence). The findings provide valuable knowledge about self-comfort as a coping strategy. The aim of study V was to illuminate meanings of living with a troubled conscience. Ten psychiatric care providers, respondents of study III with various perceptions of conscience were interviewed. The interviews were interpreted using a phenomenological - hermeneutical method. The findings show that one meaning of living with a troubled conscience is being confronted with inadequacy and struggling to view oneself as ‘good enough.’ The comprehensive understanding indicates that inadequacy, both one’s own and that of organization one represents, infuse feelings of shame rather than feelings of guilt. Shame concerns one’s identity and need of reconciliation.

Conclusions: The results reveal two ways of encountering a troubled conscience. One is being unable to interpret the ethical demand from a troubled conscience. This is indicated by connections between levels of moral burden and levels of burnout. The other way is being able to interpret the ethical demand and using one’s troubled conscience to develop practical wisdom. This means facing shame of feeling inadequate, reconciling images of the ideal self and self-contempt, and becoming realistic about what one can do. In this process comfort seems to be a mediator of reconciliation.

Place, publisher, year, edition, pages
Umeå: Omvårdnad , 2008.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1149
Keyword [en]
burnout, questionnaire, moral sensitivity, practical wisdom, conscience, stress of conscience, comfort, care provider
National Category
Nursing
Identifiers
URN: urn:nbn:se:esh:diva-4437ISBN: 978-91-7264-484-7 (print)OAI: oai:DiVA.org:esh-4437DiVA: diva2:795016
Public defence
2008-01-25, Aulan, Vårdvetarhuset, Umeå, 09:00 (English)
Opponent
Available from: 2015-03-13 Created: 2015-03-13 Last updated: 2015-03-13Bibliographically approved
List of papers
1. Development of the perceptions of conscience questionnaire.
Open this publication in new window or tab >>Development of the perceptions of conscience questionnaire.
Show others...
2007 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 14, no 2, 181-93 p.Article in journal (Refereed) Published
Abstract [en]

Health care often involves ethically difficult situations that may disquiet the conscience. The purpose of this study was to develop a questionnaire for identifying various perceptions of conscience within a framework based on the literature and on explorative interviews about perceptions of conscience (Perceptions of Conscience Questionnaire). The questionnaire was tested on a sample of 444 registered nurses, enrolled nurses, nurses' assistants and physicians. The data were analysed using principal component analysis to explore possible dimensions of perceptions of conscience. The results showed six dimensions, found also in theory and empirical health care studies. Conscience was perceived as authority, a warning signal, demanding sensitivity, an asset, a burden and depending on culture. We conclude that the Perceptions of Conscience Questionnaire is valid for assessing some perceptions of conscience relevant to health care providers.

National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-433 (URN)17425147 (PubMedID)
Available from: 2010-07-02 Created: 2010-07-02 Last updated: 2016-12-05Bibliographically approved
2. Developing the concept of moral sensitivity in health care practice.
Open this publication in new window or tab >>Developing the concept of moral sensitivity in health care practice.
2006 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, no 2, 187-96 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this Swedish study was to develop the concept of moral sensitivity in health care practice. This process began with an overview of relevant theories and perspectives on ethics with a focus on moral sensitivity and related concepts, in order to generate a theoretical framework. The second step was to construct a questionnaire based on this framework by generating a list of items from the theoretical framework. Nine items were finally selected as most appropriate and consistent with the research team's understanding of the concept of moral sensitivity. The items were worded as assumptions related to patient care. The questionnaire was distributed to two groups of health care personnel on two separate occasions and a total of 278 completed questionnaires were returned. A factor analysis identified three factors: sense of moral burden, moral strength and moral responsibility. These seem to be conceptually interrelated yet indicate that moral sensitivity may involve more dimensions than simply a cognitive capacity, particularly, feelings, sentiments, moral knowledge and skills.

Keyword
Adult, Attitude of Health Personnel, Awareness, Concept Formation, Ethics; Medical, Ethics; Nursing, Factor Analysis; Statistical, Health Knowledge; Attitudes; Practice, Health Personnel/education/ethics/psychology, Humans, Middle Aged, Models; Nursing, Models; Psychological, Moral Development, Nursing Methodology Research, Patient Advocacy/ethics/psychology, Philosophy; Medical, Philosophy; Nursing, Professional Competence/standards, Professional Role/psychology, Qualitative Research, Questionnaires, Self Efficacy, Social Responsibility, Sweden
National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-523 (URN)10.1191/0969733006ne837oa (DOI)16526152 (PubMedID)
Note

Ingår i avhandling: Dahlqvist, Vera. Samvete i vården: att möta det moraliska ansvarets röster. 2008.

Available from: 2010-07-16 Created: 2010-07-16 Last updated: 2016-12-05Bibliographically approved
3. Dealing with stress: patterns of self-comfort among healthcare students.
Open this publication in new window or tab >>Dealing with stress: patterns of self-comfort among healthcare students.
2008 (English)In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 28, no 4, 476-84 p.Article in journal (Refereed) Published
Abstract [en]

Stress among healthcare students is a growing problem. As self-comfort is assumed to be a way of coping with stressful emotions, the aim of this study was to describe the patterns of self-comforting actions that healthcare students usually use in distress. One hundred and sixty-eight healthcare students volunteered to write down accounts of what they do when they comfort themselves. Their accounts were analysed using qualitative content analysis. The findings reveal two themes: Ingressing and Transcending. Ingressing comprises the sub-themes Unloading, Distracting, Nurturing oneself, Withdrawing and Reassuring. Transcending comprises the sub-themes Opening up and Finding new perspectives. These findings are in line with some stress-reducing strategies described in the literature on stress management. Winnicott's theory about the phenomenon of transition is used to interpret the findings. In the light of Winnicott's theory, self-comforting measures can be comprehended as the ability to transfer early childhood experiences of being nurtured and comforted into well-adapted strategies to effect relaxation and gain strength.

National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-409 (URN)10.1016/j.nedt.2007.07.010 (DOI)17868956 (PubMedID)
Available from: 2010-06-30 Created: 2010-06-30 Last updated: 2016-12-05Bibliographically approved
4. Facing inadequacy and being good enough: psychiatric care providers' narratives about experiencing and coping with troubled conscience.
Open this publication in new window or tab >>Facing inadequacy and being good enough: psychiatric care providers' narratives about experiencing and coping with troubled conscience.
2009 (English)In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 16, no 3, 242-7 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study is to illuminate the meaning of encounters with a troubled conscience among psychiatric therapists. Psychiatric care involves ethical dilemmas which may affect conscience. Conscience relates to keeping or losing a sense of personal integrity when making judgments about one's actions. Ten psychiatric therapists were interviewed in June 2006. The interviews were tape-recorded, transcribed verbatim and interpreted using a phenomenological-hermeneutic method. Two themes 'Facing inadequacy' and 'Struggling to view oneself as being 'good enough'' are presented. In the therapists interviewed, awareness of their use of power, a sense of powerlessness and a sense of blame gave rise to feelings of betrayals and shameful inadequacy. By sharing their inadequacy with co-workers, they managed to endure the sense of their inadequacy which otherwise would have threatened to paralyse them. Finding consolation in sharing wearing feelings, becoming realistic and attesting their worthiness, they reached reconciliation and found confirmation of being good enough. The findings are interpreted in light of Lögstrup's ethics of trust, according to which conscience alerts us to silent but radical ethical demand and the risk of self-deception.

National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-744 (URN)10.1111/j.1365-2850.2008.01343.x (DOI)19291152 (PubMedID)
Available from: 2010-10-29 Created: 2010-10-29 Last updated: 2016-12-05Bibliographically approved

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