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  • 1.
    Dahlqvist, Vera
    Umeå universitet, Institutionen för omvårdnad.
    Samvete i vården: att möta det moraliska ansvarets röster2008Doctoral 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.

  • 2. Dahlqvist, Vera
    et al.
    Eriksson, Sture
    Glasberg, Ann-Louise
    Lindahl, Elisabeth
    Lützén, Kim
    Strandberg, Gunilla
    Söderberg, Anna
    Sørlie, Venke
    Norberg, Astrid
    Ersta Sköndal University College, Department of palliative care research. Ersta Sköndal University College, Department of Health Care Sciences.
    Development of the perceptions of conscience questionnaire.2007In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 14, no 2, p. 181-93Article in journal (Refereed)
    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.

  • 3. Dahlqvist, Vera
    et al.
    Söderberg, Anna
    Norberg, Astrid
    Ersta Sköndal University College, Department of palliative care research. Ersta Sköndal University College, Department of Health Care Sciences.
    Dealing with stress: patterns of self-comfort among healthcare students.2008In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 28, no 4, p. 476-84Article in journal (Refereed)
    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.

  • 4. Dahlqvist, Vera
    et al.
    Söderberg, Anna
    Norberg, Astrid
    Ersta Sköndal University College, Department of palliative care research. Ersta Sköndal University College, Department of Health Care Sciences.
    Facing inadequacy and being good enough: psychiatric care providers' narratives about experiencing and coping with troubled conscience.2009In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 16, no 3, p. 242-7Article in journal (Refereed)
    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.

  • 5.
    Fischer Grönlund, Catarina E C
    et al.
    Umeå universitet.
    Söderberg, Anna
    Umeå universitet.
    Zingmark, Karin M
    Sandlund, Mikael
    Umeå universitet.
    Dahlqvist, Vera
    Ersta Sköndal University College, Department of Health Care Sciences.
    Ethically difficult situations in hemodialysis care - Nurses' narratives.2015In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 22, no 6Article in journal (Refereed)
    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.

  • 6. Glasberg, Ann-Louise
    et al.
    Eriksson, Sture
    Dahlqvist, Vera
    Lindahl, Elisabeth
    Strandberg, Gunilla
    Söderberg, Anna
    Sørlie, Venke
    Norberg, Astrid
    Ersta Sköndal University College, Department of palliative care research. Ersta Sköndal University College, Department of Health Care Sciences.
    Development and initial validation of the Stress of Conscience Questionnaire.2006In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, no 6, p. 633-48Article in journal (Refereed)
    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.

  • 7.
    Grönlund, Catarina Fischer
    et al.
    Umeå universitet.
    Dahlqvist, Vera
    Ersta Sköndal University College, Department of Health Care Sciences.
    Zingmark, Karin
    Luleå tekniska universitet.
    Sandlund, Mikael
    Umeå universitet.
    Söderberg, Anna
    Umeå universitet.
    Managing Ethical Difficulties in Healthcare: Communicating in Inter-professional Clinical Ethics Support Sessions.2016In: HEC Forum, ISSN 0956-2737, E-ISSN 1572-8498, Vol. 28, no 4, p. 321-338Article in journal (Refereed)
    Abstract [en]

    Several studies show that healthcare professionals need to communicate inter-professionally in order to manage ethical difficulties. A model of clinical ethics support (CES) inspired by Habermas' theory of discourse ethics has been developed by our research group. In this version of CES sessions healthcare professionals meet inter-professionally to communicate and reflect on ethical difficulties in a cooperative manner with the aim of reaching communicative agreement or reflective consensus. In order to understand the course of action during CES, the aim of this study was to describe the communication of value conflicts during a series of inter-professional CES sessions. Ten audio- and video-recorded CES sessions were conducted over eight months and were analyzed by using the video analysis tool Transana and qualitative content analysis. The results showed that during the CES sessions the professionals as a group moved through the following five phases: a value conflict expressed as feelings of frustration, sharing disempowerment and helplessness, the revelation of the value conflict, enhancing realistic expectations, seeing opportunities to change the situation instead of obstacles. In the course of CES, the professionals moved from an individual interpretation of the situation to a common, new understanding and then to a change in approach. An open and permissive communication climate meant that the professionals dared to expose themselves, share their feelings, face their own emotions, and eventually arrive at a mutual shared reality. The value conflict was not only revealed but also resolved.

  • 8.
    Lützén, Kim
    et al.
    Ersta Sköndal University College, Department of palliative care research.
    Dahlqvist, Vera
    Eriksson, Sture
    Norberg, Astrid
    Developing the concept of moral sensitivity in health care practice.2006In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, no 2, p. 187-96Article in journal (Refereed)
    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.

  • 9. Santamäki Fischer, Regina
    et al.
    Dahlqvist, Vera
    Ersta Sköndal University College, Department of Health Care Sciences.
    Tröst och trygghet2014In: Omvårdnadens grunder: perspektiv och förhållningssätt / [ed] Febe Friberg, Joakim Öhlén, Lund: Studentlitteratur AB, 2014, 2, p. 297-322Chapter in book (Other academic)
  • 10.
    Ångström-Brännström, Charlotte
    et al.
    Umeå universitet.
    Dahlqvist, Vera
    Ersta Sköndal University College, Department of Health Care Sciences.
    Norberg, Astrid
    Ersta Sköndal University College, Palliative Research Centre, PRC. Umeå universitet.
    Victor and the Dragon: A Young Child’s Experiences of Discomfort and Comfort, From Diagnosis Until Death2013In: Journal of Hospice and Palliative Nursing, ISSN 1522-2179, E-ISSN 1539-0705, Vol. 15, no 8, p. 464-470Article in journal (Refereed)
    Abstract [en]

    Children with progressive cancer often suffer during treatment and at the end of their life, and they need comfort. This study's aim was to describe a child's experiences of being cared for until death, with a focus on discomfort and comfort. Conversations, field notes, drawings, and interviews with the child and his mother and nurse were content analyzed. The themes enduring unbearable situations, expressing emotional suffering, and finding comfort were constructed. The children's parents and other family members are often a significant source of help for the children to endure discomfort and find comfort. Emotional suffering can be expressed in drawing and crying, but sometimes, a child is inconsolable and must endure discomfort. Comfort for a dying child is enhanced by having the family close, experiencing normal daily activities such as drawing and playing, and feeling at home in life despite approaching death.

  • 11.
    Ångström-Brännström, Charlotte
    et al.
    Umeå universitet.
    Dahlqvist, Vera
    Ersta Sköndal University College, Department of Health Care Sciences.
    Strandberg, Gunilla
    Umeå universitet.
    Norberg, Astrid
    Ersta Sköndal University College, Department of Health Care Sciences, Palliative Research Centre, PRC. Umeå universitet.
    Descriptions of Comfort in the Social Networks Surrounding a Dying Child2014In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 34, no 3, p. 4-8Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to describe how comforters of one dying child were comforted, described by the child's mother and nurse.

    Background: The death of a child is one of the greatest losses parents can sustain and a stressful experience for nurses. Those who provide comfort may also need comfort, yet little is known about how comforters are comforted.

    Method: The interviews with mother and nurse were analysed using content analysis. Persons and activities mentioned as comforting were outlined in a sociogram.

    Findings: The findings show that the mother received comfort from her child and family, the nurse, extended family and others close to the family. She found comfort in being involved in the care and sharing worries with the nurse and in self-comfort. She described that siblings found comfort in each other, in living everyday life, in music and in expressing their feelings in drawings. The nurse gained comfort from sharing hardships with colleagues and a relative and from making a difference to the child.

    Conclusion: The findings provide a picture of interacting comforting social networks surrounding one dying child.

  • 12. Ångström-Brännström, Charlotte
    et al.
    Norberg, Astrid
    Ersta Sköndal University College, Department of Health Care Sciences. Ersta Sköndal University College, Enheten för forskning i palliativ vård.
    Strandberg, Gunilla
    Söderberg, Anna
    Dahlqvist, Vera
    Parents' experiences of what comforts them when their child is suffering from cancer.2010In: Journal of Pediatric Oncology Nursing, ISSN 1043-4542, E-ISSN 1532-8457, Vol. 27, no 5, p. 266-75Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to describe parents' narratives concerning what they find comforting when they have a child suffering from cancer. Interviews were conducted with 9 parents--8 mothers and 1 father--of children aged 3 to 9 years who were admitted to a pediatric oncology ward and had undergone their first treatment. The findings showed that the parents derived comfort from being close to their child, perceiving the child's strength, feeling at home in the ward, being a family and being at home, and receiving support from their social network. Comfort experienced in communion with the child and others became important and helped the parents build a new normality perceived as being at home in life despite all their difficulties. Within the frame of communion, the parents seemed to experience moments of hope for their child's recovery and survival.

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