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  • 1.
    Ahlin, Johan
    et al.
    Umeå University.
    Ericson-Lidman, Eva
    Umeå University.
    Norberg, Astrid
    Ersta Sköndal högskola, Palliativt forskningscentrum, PFC. Umeå University.
    Strandberg, Gunilla
    Umeå University.
    Revalidation of the Perceptions of Conscience Questionnaire (PCQ) and the Stress of Conscience Questionnaire (SCQ)2012Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 19, nr 2, s. 220-232Artikel i tidskrift (Refereegranskat)
  • 2. Breitholtz, Agneta
    et al.
    Snellman, Ingrid
    Fagerberg, Ingegerd
    Ersta Sköndal högskola, Institutionen för vårdvetenskap.
    Carers' ambivalence in conflict situations with older persons2013Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 20, nr 2, s. 226-237Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to illuminate the meaning of professional carers’ experiences in caring situations when a conflict of interest arises with the older person receiving care. The findings reveal the complexity of the carers’ ambivalence when facing a conflict of interest, weighing up between the older persons’ right to self-determination and external demands. The carers are alone in their ambivalence, and the conclusion is that they need help and support to be more present in the encounter. The implication for this study is to focus on care as a person-centered practice and to focus on people as interdependent on support carers to maintain older people’s right to self-determination in the relationship.

  • 3. Christine, Gustafsson
    et al.
    Asp, Margareta
    Fagerberg, Ingegerd
    Mälardalens högskola.
    Municipal night nurses' experience of the meaning of caring2009Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 16, nr 5, s. 599-612Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to elucidate municipal night registered nurses’ (RNs) experiences of the meaning of caring in nursing. The research context involved all night duty RNs working in municipal care of older people in a medium-sized municipality located in central Sweden. The meaning of caring in nursing was experienced as: caring for by advocacy, superior responsibility in caring, and consultative nursing service. The municipal night RNs’ experience of caring is interpreted as meanings in paradoxes: ‘being close at distance’, the condition of ‘being responsible with insignificant control’, and ‘being interdependently independent’. The RNs’ experience of the meaning of caring involves focusing on the care recipient by advocating their perspectives. The meaning of caring in this context is an endeavour to grasp an overall caring responsibility by responding to vocational and personal demands regarding the issue of being a RN, in guaranteeing ethical, qualitative and competent care for older people.

  • 4. Cronqvist, Agneta
    et al.
    Theorell, Töres
    Burns, Tom
    Lützén, Kim
    Caring about--caring for: moral obligations and work responsibilities in intensive care nursing.2004Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 11, nr 1, s. 63-76Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to analyse experiences of moral concerns in intensive care nursing. The theoretical perspective of the study is based on relational ethics, also referred to as ethics of care. The participants were 36 intensive care nurses from 10 general, neonatal and thoracic intensive care units. The structural characteristics of the units were similar: a high working pace, advanced technology, budget restrictions, recent reorganization, and shortage of experienced nurses. The data consisted of the participants' examples of ethical situations they had experienced in their intensive care unit. A qualitative content analysis identified five themes: believing in a good death; knowing the course of events; feelings of distress; reasoning about physicians' 'doings' and tensions in expressing moral awareness. A main theme was formulated as caring about--caring for: moral obligations and work responsibilities. Moral obligations and work responsibilities are assumed to be complementary dimensions in nursing, yet they were found not to be in balance for intensive care nurses. In conclusion there is a need to support nurses in difficult intensive care situations, for example, by mentoring, as a step towards developing moral action knowledge in the context of intensive care nursing.

  • 5. Dahlqvist, Vera
    et al.
    Eriksson, Sture
    Glasberg, Ann-Louise
    Lindahl, Elisabeth
    Lützén, Kim
    Strandberg, Gunilla
    Söderberg, Anna
    Sørlie, Venke
    Norberg, Astrid
    Ersta Sköndal högskola, Enheten för forskning om vård i livets slutskede. Ersta Sköndal högskola, Institutionen för vårdvetenskap.
    Development of the perceptions of conscience questionnaire.2007Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 14, nr 2, s. 181-93Artikel i tidskrift (Refereegranskat)
    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.

  • 6.
    Dwyer, Lise-Lotte
    et al.
    Ersta Sköndal högskola, Enheten för forskning om vård i livets slutskede. Ersta Sköndal högskola, Institutionen för vårdvetenskap. Örebro universitet.
    Nordenfelt, Lennart
    Linköpings universitet.
    Ternestedt, Britt-Marie
    Ersta Sköndal högskola, Enheten för forskning om vård i livets slutskede.
    Three nursing home residents speak about meaning at the end of life2008Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 15, nr 1, s. 97-109Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This article provides a deeper understanding of how meaning can be created in everyday life at a nursing home. It is based on a primary study concerning dignity involving 12 older people living in two nursing homes in Sweden. A secondary analysis was carried out on data obtained from three of the primary participants interviewed over a period of time (18-24 months), with a total of 12 interviews carried out using an inductive hermeneutic approach. The study reveals that sources of meaning were created by having a sense of: physical capability, cognitive capability, being needed, and belonging. Meaning was created through inner dialogue, communication and relationships with others. A second finding is that the experience of meaning can sometimes be hard to realize.

  • 7.
    Elmberger, Eva
    et al.
    Ersta Sköndal högskola, Institutionen för vårdvetenskap.
    Bolund, Christina
    Lützén, Kim
    Experience of Dealing with Moral Responsibility as a Mother with Cancer2005Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 12, nr 3, s. 253-262Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study explored how women with a diagnosis of cancer (lymphoma) deal with moral concerns related to their responsibility as parents. Ten women with cancer and who had children living at home were interviewed. The interviews were analysed according to the constant comparative method used in grounded theory. In order to provide a focus for the analysis, the ethics of care and the concept of mothering were used as sensitizing concepts. The core concept 'experience of dealing with moral responsibility of being a parent with cancer by redefining oneself as a mother' was identified. The processes involved were: interrupted mothering; facing the life-threatening illness and children's reactions; striving to be a good mother; attempting to deal with moral responsibility; and coming to terms with being a mother.

  • 8.
    Fischer Grönlund, Catarina E C
    et al.
    Umeå universitet.
    Söderberg, Anna
    Umeå universitet.
    Zingmark, Karin M
    Sandlund, Mikael
    Umeå universitet.
    Dahlqvist, Vera
    Ersta Sköndal högskola, Institutionen för vårdvetenskap.
    Ethically difficult situations in hemodialysis care - Nurses' narratives.2015Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 22, nr 6Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Providing nursing care for patients with end-stage renal disease entails dealing with existential issues which may sometimes lead not only to ethical problems but also conflicts within the team. A previous study shows that physicians felt irresolute, torn and unconfirmed when ethical dilemmas arose.

    RESEARCH QUESTION: This study, conducted in the same dialysis care unit, aimed to illuminate registered nurses' experiences of being in ethically difficult situations that give rise to a troubled conscience.

    RESEARCH DESIGN: This study has a phenomenological hermeneutic approach.

    PARTICIPANTS: Narrative interviews were carried out with 10 registered nurses working in dialysis care.

    ETHICAL CONSIDERATIONS: The study was approved by the Ethics Committee of the Faculty of Medicine, Umeå University.

    RESULTS: One theme, 'Calling for a deliberative dialogue', and six sub-themes emerged: 'Dealing with patients' ambiguity', 'Responding to patients' reluctance', 'Acting against patients' will', 'Acting against one's moral convictions', 'Lacking involvement with patients and relatives' and 'Being trapped in feelings of guilt'.

    DISCUSSION: In ethically difficult situations, the registered nurses tried, but failed, to open up a dialogue with the physicians about ethical concerns and their uncertainty. They felt alone, uncertain and sometimes had to act against their conscience.

    CONCLUSION: In ethical dilemmas, personal and professional integrity is at stake. Mistrusting their own moral integrity may turn professionals from moral actors into victims of circumstances. To counteract such a risk, professionals and patients need to continuously deliberate on their feelings, views and experiences, in an atmosphere of togetherness and trust.

  • 9.
    Franklin, Lise-Lotte
    et al.
    Örebro universitet.
    Ternestedt, Britt-Marie
    Ersta Sköndal högskola, Institutionen för vårdvetenskap. Ersta Sköndal högskola, Enheten för forskning i palliativ vård.
    Nordenfelt, Lennart
    Linköpings universitet.
    Views on dignity of elderly nursing home residents2006Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, nr 2, s. 130-46Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Discussion about a dignified death has almost exclusively been applied to palliative care and people dying of cancer. As populations are getting older in the western world and living with chronic illnesses affecting their everyday lives, it is relevant to broaden the definition of palliative care to include other groups of people. The aim of the study was to explore the views on dignity at the end of life of 12 elderly people living in two nursing homes in Sweden. A hermeneutic approach was used to interpret the material, which was gathered during semi-structured interviews. A total of 39 interviews were transcribed. The analysis revealed three themes: (1) the unrecognizable body; (2) fragility and dependency; and (3) inner strength and a sense of coherence.

  • 10. Glasberg, Ann-Louise
    et al.
    Eriksson, Sture
    Dahlqvist, Vera
    Lindahl, Elisabeth
    Strandberg, Gunilla
    Söderberg, Anna
    Sørlie, Venke
    Norberg, Astrid
    Ersta Sköndal högskola, Enheten för forskning om vård i livets slutskede. Ersta Sköndal högskola, Institutionen för vårdvetenskap.
    Development and initial validation of the Stress of Conscience Questionnaire.2006Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, nr 6, s. 633-48Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Stress in health care is affected by moral factors. When people are prevented from doing 'good' they may feel that they have not done what they ought to or that they have erred, thus giving rise to a troubled conscience. Empirical studies show that health care personnel sometimes refer to conscience when talking about being in ethically difficult everyday care situations. This study aimed to construct and validate the Stress of Conscience Questionnaire (SCQ), a nine-item instrument for assessing stressful situations and the degree to which they trouble the conscience. The items were based on situations previously documented as causing negative stress for health care workers. Content and face validity were established by expert panels and pilot studies that selected relevant items and modified or excluded ambiguous ones. A convenience sample of 444 health care personnel indicated that the SCQ had acceptable validity and internal consistency (Cronbach's alpha exceeded 0.83 for the overall scale). Explorative factor analysis identified and labelled two factors: 'internal demands' and 'external demands and restrictions'. The findings suggest that the SCQ is a concise and practical instrument for use in various health care contexts.

  • 11.
    Grönlund, Catarina Fischer
    et al.
    Umeå universitet.
    Söderberg, Anna
    Umeå universitet.
    Dahlqvist, Vera
    Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap.
    Andersson, Lars
    Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap.
    Isaksson, Ulf
    Umeå universitet.
    Development, validity and reliability testing the Swedish Ethical Climate Questionnaire.2019Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, artikel-id 969733018819122Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:: An ethical climate has been described as a working climate embracing shared perceptions about morally correct behaviour concerning ethical issues. Various ethical climate questionnaires have been developed and validated for different contexts, but no questionnaire has been found concerning the ethical climate from an inter-professional perspective in a healthcare context. The Swedish Ethical Climate Questionnaire, based on Habermas' four requirements for a democratic dialogue, attempts to assess and measure the ethical climate at various inter-professional workplaces. This study aimed to present the construction of and to test the psychometric properties of the Swedish Ethical Climate Questionnaire.

    METHOD:: An expert group of six researchers, skilled in ethics, evaluated the content validity. The questionnaire was tested among 355 healthcare workers at three hospitals in Sweden. A parallel analysis (PA), an exploratory factor analysis and confirmatory factor analysis were performed.

    ETHICAL CONSIDERATIONS:: The participants included in the psychometric analysis were informed about the study, asked to participate in person and informed that they could withdraw at any time without giving any reason. They were also assured of confidentiality in the reporting of the results.

    FINDINGS:: The parallel analysis (PA) recommended one factor as a solution. The initial exploratory factor analysis with a four-factor solution showed low concordance with a four-factor model. Cronbach's alpha varied from 0.75 to 0.82; however, since two factors only consisted of one item, alpha could not be reported. Cronbach's alpha for the entire scale showed good homogeneity (α = 0.86). A confirmatory factory analysis was carried out based on the four requirements and showed a goodness-of-fit after deleting two items. After deletion of these items, Cronbach's alpha was 0.82.

    DISCUSSION:: Based on the exploratory factor analysis, we suggest that the scale should be treated as a one-factor model. The result indicates that the instrument is unidimensional and assesses ethical climate as a whole.

    CONCLUSION:: After testing the Swedish Ethical Climate Questionnaire, we found support for the validity and reliability of the instrument. We found the 10-item version of Swedish Ethical Climate Questionnaire satisfactory. However, we found no support for measuring different dimensions and, therefore, this instrument should be seen as assessing ethical climate as of whole.

  • 12.
    Gustafsson, Gabriella
    et al.
    Umeå universitet.
    Eriksson, Sture
    Umeå universitet.
    Strandberg, Gunilla
    Umeå universitet.
    Norberg, Astrid
    Ersta Sköndal högskola, Palliativt forskningscentrum, PFC. Umeå universitet.
    Burnout and perceptions of conscience among health care personnel: a pilot study2010Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 17, nr 1, s. 23-38Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Although organizational and situational factors have been found to predict burnout, not everyone employed at the same workplace develops it, suggesting that becoming burnt out is a complex, multifaceted phenomenon. The aim of this study was to elucidate perceptions of conscience, stress of conscience, moral sensitivity, social support and resilience among two groups of health care personnel from the same workplaces, one group on sick leave owing to medically assessed burnout (n = 20) and one group who showed no indications of burnout (n = 20). The results showed that higher levels of stress of conscience, a perception of conscience as a burden, having to deaden one's conscience in order to keep working in health care and perceiving a lack of support characterized the burnout group. Lower levels of stress of conscience, looking on life with forbearance, a perception of conscience as an asset and perceiving support from organizations and those around them (social support) characterized the non-burnout group.

  • 13. Heijkenskjöld, Katarina Bredenhof
    et al.
    Ekstedt, Mirjam
    Lindwall, Lillemor
    The patient's dignity from the nurse's perspective.2010Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 17, nr 3, s. 313-24Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to understand how nurses experience patients' dignity in Swedish medical wards. A hermeneutic approach and Flanagan's critical incident technique were used for data collection. Twelve nurses took part in the study. The data were analysed using hermeneutic text interpretation. The findings show that the nurses who wanted to preserve patients' dignity by seeing them as fellow beings protected the patients by stopping other nurses from performing unethical acts. They regard patients as fellow human beings, friends, and unique persons with their own history, and have the courage to see when patients' dignity is violated, although this is something they do not wish to see because it makes them feel bad. Nurses do not have the right to deny patients their dignity or value as human beings. The new understanding arrived at by the hermeneutic interpretation is that care in professional nursing must be focused on taking responsibility for and protecting patients' dignity.

  • 14.
    Hellström, Ingrid
    et al.
    Linköpings universitet.
    Nolan, Mike
    University of Sheffield, Sheffield, UK.
    Nordenfelt, Lennart
    Ersta Sköndal högskola, Enheten för forskning i palliativ vård.
    Lundh, Ulla
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier ; Linköpings universitet, Hälsouniversitetet.
    Ethical and methodological issues in interviewing persons with dementia2007Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 14, nr 5, s. 608-619Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    People with dementia have previously not been active participantsin research, with ethical difficulties often being cited asthe reason for this. A wider inclusion of people with dementiain research raises several ethical and methodological challenges.This article adds to the emerging debate by reflecting on theethical and methodological issues raised during an interviewstudy involving people with dementia and their spouses. Thestudy sought to explore the impact of living with dementia.We argue that there is support for the inclusion of people withdementia in research and that the benefits of participationusually far outweigh the risks, particularly when a `safe context'has been created. The role of gatekeepers as potentially responsiblefor excluding people with dementia needs further consideration,with particular reference to the appropriateness of viewingconsent as a primarily cognitive, universalistic and exclusionaryevent as opposed to a more particularistic, inclusive and contextrelevant process.

  • 15.
    Holmberg, Bodil
    et al.
    Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap.
    Hellström, Ingrid
    Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap. Linköpings universitet.
    Österlind, Jane
    Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap.
    End-of-life care in a nursing home: Assistant nurses' perspectives.2018Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, artikel-id 969733018779199Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Worldwide, older persons lack access to palliative care. In Sweden, many older persons die in nursing homes where care is provided foremost by assistant nurses. Due to a lack of beds, admission is seldom granted until the older persons have complex care needs and are already in a palliative phase when they move in.

    OBJECTIVE: To describe assistant nurses' perspectives of providing care to older persons at the end of life in a nursing home.

    RESEARCH DESIGN: Data were collected in semi-structured individual interviews and analyzed with inductive qualitative content analysis. Participants and research context: Seven assistant nurses from a nursing home in Sweden were randomly selected. Ethical consideration: The research was approved by the local ethics committee.

    RESULTS: Three main categories emerged; "Death a natural part of life"; "The older person's well-being"; and "Care in the moment of death"; and seven sub-categories. The assistant nurses described themselves as knowing the older persons well enough to provide good end-of-life care. This was achieved by making small-talk while providing daily care. Relying on experience-based knowledge, they strove to provide end-of-life care built upon respect and engagement with the ambition to strengthen older persons' dignity, for example, by lowering the tempo of care at the end of life, in spite of organizational restrictions.

    DISCUSSION: The assistant nurses offered attentive end-of-life care, focusing upon bodily care. The existential needs of the older persons were not foregrounded.

    CONCLUSION: To develop their work, and to promote an ethical foundation for such care, assistant nurses might need support and education to be able to offer a care more in line with the aims of palliative care. Furthermore, the organization of care needs to promote, not impede, the realization of this development.

  • 16. Högberg, Torbjörn
    et al.
    Magnusson, Annabella
    Karolinska institutet.
    Lützén, Kim
    Ersta Sköndal högskola, Institutionen för vårdvetenskap.
    To be a nurse or a neighbour?: A moral concern for psychiatric nurses living next door to individuals with a mental illness2005Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 12, nr 5, s. 468-478Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Several studies reveal that positive attitudes towards individuals with a mental illness are correlated with knowledge about mental illness. The aim of this study was to explore and describe psychiatric nurses' experiences of living next to people with mental health problems. In addition, it sought to identify and describe how they handle situations arising in a neighbourhood where people with a mental illness live. Two men and seven women participated in the study. The constant comparative method of grounded theory was used for data collection and analysis. The process of 'behaving as a nurse or not' was identified as a core category. Four subcategories were identified: 'receiving involuntary information', 'to take action or not', 'behaving as a mediator in the neighbourhood' and 'the freedom of choice'. The findings show that psychiatric nurses with professional knowledge about mental illness have moral concerns about their role as nurses during their leisure time. In conclusion, it is not obvious that psychiatric nurses want to live in the same neighbourhood as persons with a mental illness. However, this study shows that their knowledge about mental illness creates for them a moral dilemma consisting of a conflict between whether to care for these mentally ill persons or to preserve their own leisure time.

  • 17. Juthberg, Christina
    et al.
    Eriksson, Sture
    Norberg, Astrid
    Ersta Sköndal högskola, Enheten för forskning om vård i livets slutskede. Ersta Sköndal högskola, Institutionen för vårdvetenskap.
    Sundin, Karin
    Perceptions of conscience in relation to stress of conscience.2007Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 14, nr 3, s. 329-43Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    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.

  • 18. Lindahl, Elisabeth
    et al.
    Gilje, Fredricka
    Norberg, Astrid
    Ersta Sköndal högskola, Palliativt forskningscentrum, PFC.
    Söderberg, Anna
    Nurses' ethical reflections on caring for people with malodorous exuding ulcers.2010Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 17, nr 6, s. 777-790Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to illuminate nurses' reflections on obstacles to and possibilities for providing care as desired by people with malodorous exuding ulcers. Six nurses who took part in a previous study were interviewed. The participants were shown an illustration with findings from a study that elucidated the meaning of living with malodorous exuding ulcers. They were asked to reflect on the obstacles to and possibilities of providing the care desired by the patients. Twelve audio-recorded transcribed interviews were analysed using qualitative content analysis. Our interpretations of participants' reflections on the obstacles and possibilities while caring for such patients revealed one theme: striving to 'do good' and 'be good'. The obstacles were formulated as subthemes: experiencing clinical competence constraints, experiencing organizational constraints, experiencing ineffective communication, fearing failure, and experiencing powerlessness. The possibilities were formulated by the subthemes: spreading knowledge about ulcer treatments, considering wholeness, and creating clear channels of communication. A multiprofessional team could overcome the identified obstacles and provide structure, competencies, commitment and support to 'do good' for patients and 'be good' nurses.

  • 19.
    Lützén, Kim
    et al.
    Ersta Sköndal högskola, Institutionen för vårdvetenskap.
    Cronqvist, Agneta
    Ersta Sköndal högskola, Institutionen för vårdvetenskap. Karolinska institutet.
    Magnusson, Annabella
    Ersta Sköndal högskola, Institutionen för vårdvetenskap. Karolinska institutet.
    Andersson, Lars
    Ersta Sköndal högskola, Institutionen för vårdvetenskap.
    Moral stress: synthesis of a concept2003Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 10, nr 3, s. 312-322Artikel i tidskrift (Refereegranskat)
    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.

  • 20.
    Lützén, Kim
    et al.
    Ersta Sköndal högskola, Enheten för forskning om vård i livets slutskede.
    Dahlqvist, Vera
    Eriksson, Sture
    Norberg, Astrid
    Developing the concept of moral sensitivity in health care practice.2006Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, nr 2, s. 187-96Artikel i tidskrift (Refereegranskat)
    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.

  • 21.
    Mazaheri, Monir
    et al.
    Mälardalens högskola, Iran.
    Ericson-Lidman, Eva
    Umeå universitet.
    Zargham-Boroujeni, Ali
    Iran.
    Öhlén, Joakim
    Ersta Sköndal högskola, Institutionen för vårdvetenskap, Palliativt forskningscentrum, PFC. Göteborgs universitet.
    Norberg, Astrid
    Ersta Sköndal högskola, Institutionen för vårdvetenskap, Palliativt forskningscentrum, PFC. Umeå universitet.
    Clear conscience grounded in relations: Expressions of Persian-speaking nurses in Sweden.2017Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 24, nr 3, s. 349-361Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Conscience is an important concept in ethics, having various meanings in different cultures. Because a growing number of healthcare professionals are of immigrant background, particularly within the care of older people, demanding multiple ethical positions, it is important to explore the meaning of conscience among care providers within different cultural contexts.

    RESEARCH OBJECTIVE: The study aimed to illuminate the meaning of conscience by enrolled nurses with an Iranian background working in residential care for Persian-speaking people with dementia.

    RESEARCH DESIGN: A phenomenological hermeneutical method guided the study. Participants and research context: A total of 10 enrolled nurses with Iranian background, aged 33-46 years, participated in the study. All worked full time in residential care settings for Persian-speaking people with dementia in a large city, in Sweden. Ethical considerations: The study was approved by the Regional Ethical Review Board for ethical vetting of research involving humans. Participants were given verbal and written study information and assured that their participation was voluntary and confidential.

    FINDINGS: Three themes were constructed including perception of conscience, clear conscience grounded in relations and striving to keep a clear conscience. The conscience was perceived as an inner guide grounded in feelings, which is dynamic and subject to changes throughout life. Having a clear conscience meant being able to form a bond with others, to respect them and to get their confirmation that one does well. To have a clear conscience demanded listening to the voice of the conscience. The enrolled nurses strived to keep their conscience clear by being generous in helping others, accomplishing daily tasks well and behaving nicely in the hope of being treated the same way one day.

    CONCLUSION: Cultural frameworks and the context of practice needed to be considered in interpreting the meaning of conscience and clear conscience.

  • 22. Norberg, Astrid
    Performing research with people who are not capable of giving their informed consent to research is sometimes justified.2004Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 11, nr 3, s. 225-226Artikel i tidskrift (Övrigt vetenskapligt)
  • 23.
    Norberg, Astrid
    Ersta Sköndal högskola, Enheten för forskning om vård i livets slutskede. Ersta Sköndal högskola, Institutionen för vårdvetenskap.
    The meaning of evidence-based nursing.2006Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, nr 5, s. 453-4Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The article discusses the meaning of evidence-based nursing. Evidence-based medicine is an explicit and conscientious use of current best medical approach in the care of individual patients. In clarifying this issue, several considerations are needed to be underlined. These are clinical experience, local context, and patient's preference. The need to reflect and research about ethics relative to evidence-based nursing is mentioned.

  • 24.
    Norbergh, Karl-Gustaf
    et al.
    Mittuniversitetet.
    Helin, Yvonne
    Department of Social Services, Sundsvall.
    Dahl, Annika
    Mittuniversitetet.
    Hellzén, Ove
    Mittuniversitetet.
    Asplund, Kenneth
    Mittuniversitetet.
    Nurses' attitudes towards people with dementia: the semantic differential technique2006Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, nr 3, s. 264-274Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    One important aspect of the nurse-patient relationship is the nurses' attitudes towards their patients. Nurses' attitudes towards people with dementia have been studied from a wide range of approaches, but few of them have focused on the structure in nurses' attitudes. This study aimed to identify a structure in licensed practical nurses' attitudes towards people with dementia. Twenty-one group dwelling units for people with dementia at eleven nursing homes participated in the study. In all, 1,577 assessments of 178 patients were sent out to 181 respondents and 1,237 answers were returned. The semantic differential technique was used. The scale has 57 bipolar pairs of adjectives, which estimate an unknown number of dimensions of nurses' attitudes towards an identified patient. The assessments were analysed using entropy-based measures of association combined with structural plots. The analysis revealed four dimensions. These four dimensions related to licensed practical nurses' opinion of the patients; from an ethical and aesthetic dimension; their ability to understand; their ability to experience; their ability for social interaction. The study indicates that, on the positive to negative attitude continuum, attitudes fall at the positive to neutral end of the continuum. This is an important finding due to the personhood perspective. From this perspective, it is reasonable to assume that with a more positive attitude to people with dementia, the prerequisites for person-centred care will improve.

  • 25. Oresland, Stina
    et al.
    Määttä, Sylvia
    Norberg, Astrid
    Ersta Sköndal högskola, Enheten för forskning om vård i livets slutskede. Ersta Sköndal högskola, Institutionen för vårdvetenskap.
    Jörgensen, Marianne Winther
    Lützén, Kim
    Nurses as guests or professionals in home health care.2008Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 15, nr 3, s. 371-83Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to explore and interpret the diverse subject of positions, or roles, that nurses construct when caring for patients in their own home. Ten interviews were analysed and interpreted using discourse analysis. The findings show that these nurses working in home care constructed two positions: ;guest' and ;professional'. They had to make a choice between these positions because it was impossible to be both at the same time. An ethics of care and an ethics of justice were present in these positions, both of which create diverse ethical appeals, that is, implicit demands to perform according to a guest or to a professional norm.

  • 26. Oresland, Stina
    et al.
    Määttä, Sylvia
    Norberg, Astrid
    Ersta Sköndal högskola, Enheten för forskning om vård i livets slutskede. Ersta Sköndal högskola, Institutionen för vårdvetenskap.
    Lützén, Kim
    Patients as 'safeguard' and nurses as 'substitute' in home health care.2009Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 16, nr 2, s. 219-30Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    One aim of this study was to explore the role, or subject position, patients take in the care they receive from nurses in their own home. Another was to examine the subject position that patients say the nurses take when giving care to them in their own home. Ten interviews were analysed and interpreted according to a discourse analytical method. The findings show that patients constructed their subject position as 'safeguard', and the nurses' subject position as 'substitute' for themselves. These subject positions provided the opportunities, and the obstacles, for the patients' possibilities to receive care in their home. The subject positions described have ethical repercussions and illuminate that the patients put great demands on tailored care.

  • 27.
    Rejnö, Åsa
    et al.
    Skaraborgs sjukhus, Skövde.
    Silfverberg, Gunilla
    Ersta Sköndal högskola, Institutionen för vårdvetenskap. Skaraborgs sjukhus, Skövde.
    Ternestedt, Britt-Marie
    Ersta Sköndal högskola, Institutionen för vårdvetenskap, Palliativt forskningscentrum, PFC.
    Reasoning about truth-telling in end-of-life care of patients with acute stroke.2017Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 24, nr 1, s. 100-110Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Ethical problems are a universal phenomenon but rarely researched concerning patients dying from acute stroke. These patients often have a reduced consciousness from stroke onset and thereby lack ability to convey their needs and could be described as 'incompetent' decision makers regarding their own care.

    OBJECTIVE: The aim of the study was to deepen the understanding of stroke team members' reasoning about truth-telling in end-of-life care due to acute stroke.

    RESEARCH DESIGN: Qualitative study based on individual interviews utilizing combined deductive and inductive content analysis.

    PARTICIPANTS AND RESEARCH CONTEXT: A total of 15 stroke team members working in stroke units of two associated county hospitals in western Sweden participated.

    ETHICAL CONSIDERATIONS: The study was approved by the Regional Ethics Review Board, Gothenburg, Sweden.

    FINDINGS: The main findings were the team members' dynamic movement between the categories 'Truth above all' and 'Hide truth to protect'. Honesty was highly valued and considered as a reason for always telling the truth, with the argument of truth as common morality. However, the carers also argued for hiding the truth for different reasons such as not adding extra burden in the sorrow, awaiting a timely moment and not being a messenger of bad news. Withholding truth could both be seen as a way of protecting themselves from difficult conversations and to protect others.

    DISCUSSION: The results indicate that there are various barriers for truthfulness. Interpreted from a virtue of ethics perspective, withholding of truth might also be seen as an expression of sound judgement to put the patient's best interest first.

    CONCLUSION: The carers may need support in the form of supervision to be given space to reflect on their experience and thereby promote ethically justified care. Here, the multi-professional team can be of great value and contribute through inter-professional sharing of knowledge.

  • 28. Sjöstedt, E
    et al.
    Dahlstrand, Anita
    Severinsson, E
    Lützén, K
    The first nurse-patient encounter in a psychiatric setting: discovering a moral commitment in nursing.2001Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 8, nr 4, s. 313-27Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to deepen nurses' understanding of the importance of carefully managing the first nurse-patient encounter in a psychiatric setting according to each patient's suffering and future hopes. The study was carried out using an action research approach. The action planned was the implementation of a conceptual model reflecting Eriksson's caring theory. Data were collected by interviews with nurses and observational notes kept in a research diary. The data analysis followed the procedure of qualitative content analysis. A generalization of the entire learning process shows the first nurse-patient encounter to be a moral commitment in nursing. A theoretical framework of nursing assessment conveying knowledge about the patient as unique and being a whole person can support the nurse in encouraging the patient to enter into a relationship. This insight stimulated the nurses in this study to reflect on the moral responsibility of continuing the relationship and initiating an ongoing nursing process. Awareness of this responsibility made them reflect more on the possibility of nurses taking autonomous actions in order not to abandon the patient and to avoid feeling guilty.

  • 29.
    Talseth, Anne-Grethe
    et al.
    Tromsø College, Norway.
    Gilje, Fredricka
    Montana State University, Billings, MT, USA.
    Norberg, Astrid
    Umeå universitet.
    Struggling to Become Ready for Consolation: experiences of suicidal patients2003Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 10, nr 6, s. 614-623Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Although there has been a vast amount of research about suicide, very few studies focus on the inner world of the suicidal patient. A secondary analysis of two exemplar narrative interviews with Norwegian patients reveals a glimpse of the inner world of suicidal patients’ longing for consolation. The results of a phenomenological hermeneutic study inspired by Ricoeur’s philosophy reveal five themes and one main theme. The themes are: ‘longing for closeness’, ‘desiring connectedness’, ‘struggling to open up inner dialogue’, ‘breaking into outer dialogue’, and ‘liberating inner and outer dialogue’. The main theme is ‘struggling to become ready for consolation’. These results describe a process of becoming ready for consolation, which, when interpreted in the light of the model of consolation by Norberg et al., reveals that the end of the process of becoming ready for consolation is consolation itself as praxis.

  • 30.
    Åhlin, Johan
    et al.
    Umeå universitet.
    Ericson-Lidman, Eva
    Umeå universitet.
    Eriksson, Sture
    Umeå universitet.
    Norberg, Astrid
    Umeå universitet.
    Strandberg, Gunilla
    Umeå universitet.
    Longitudinal relationships between stress of conscience and concepts of importance2013Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 20, nr 8, s. 927-942Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this observational longitudinal cohort study was to describe relationships over time between degrees of stress of conscience, perceptions of conscience, burnout scores and assessments of person-centred climate and social support among healthcare personnel working in municipal care of older people. This study was performed among registered nurses and nurse assistants (n = 488). Data were collected on two occasions. Results show that perceiving one's conscience as a burden, having feelings of emotional exhaustion and depersonalization and noticing disturbing conflicts between co-workers were positively associated with stress of conscience. No significant changes were observed during the year under study, but degrees of stress of conscience and burnout scores were higher than in previous studies, suggesting that downsizing and increased workloads can negatively affect healthcare personnel. Following and expressing one's conscience in one's work, and perceiving social support from superiors are of importance in buffering the effects of stress of conscience.

  • 31.
    Öresland, Stina
    et al.
    Umeå universitet.
    Määttä, Sylvia
    Göteborgs universitet.
    Norberg, Astrid
    Ersta Sköndal högskola, Palliativt forskningscentrum, PFC. Umeå universitet.
    Lützén, Kim
    Karolinska institutet.
    Home-based nursing: an endless journey.2011Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 18, nr 3, s. 408-417Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to explore metaphors for discovering values and norms held by nurses in home-based nursing care. Ten interviews were analysed and interpreted in accordance with a metaphor analytical method. In the analysis, metaphoric linguistic expressions and two entailments emerged, grounded in the conceptual metaphor 'home-based nursing care is an endless journey', which were created in a cross-domain mapping between the two conceptual domains of home-based nursing care and travel. The metaphor exposed home-based nursing care as being in constant motion, thereby requiring nurses to adjust to circumstances that demand ethical maturity. The study focuses on the importance of developing further theories supporting nurses' expressions of their experiences of everyday ethical issues.

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