Registered nurses' and nurse assistants' lived experience of troubled conscience in their work in elderly care--a phenomenological hermeneutic study.

摘要

BACKGROUND: In elderly care registered nurses (RNs) and nurse assistants (NAs) face ethical challenges which may trouble their conscience. OBJECTIVE: This study aimed to illuminate meanings of RNs' and NAs' lived experience of troubled conscience in their work in municipal residential elderly care. DESIGN: Interviews with six RNs and six NAs were interpreted separately using a phenomenological hermeneutic method. SETTINGS: Data was collected in 2005 among RNs and NAs working in special types of housings for the elderly in a municipality in Sweden. PARTICIPANTS: The RNs and NAs were selected for participation had previously participated in a questionnaire study and their ratings in the questionnaire study constituted the selection criteria for the interview study. RESULTS: The RNs' lived experience of troubled conscience was formulated in two themes. The first theme is 'being trapped in powerlessness' which includes three sub-themes: being restrained by others' omission, being trapped in ethically demanding situations and failing to live up to others' expectations. The second theme is 'being inadequate' which includes two sub-themes: lacking courage to maintain one's opinion and feeling incompetent. The NAs' lived experience of troubled conscience was formulated in the two themes. The first is 'being hindered by pre-determined conditions' which includes two sub-themes: suffering from lack of focus in one's work and being restrained by the organisation. The second theme is 'being inadequate' which includes two sub-themes: lacking the courage to object and being negligent. CONCLUSIONS: The RNs' lived experience of troubled conscience were feelings of being trapped in a state of powerlessness, caught in a struggle between responsibility and authority and a sense of inadequacy fuelled by feelings of incompetence, a lack of courage and a fear of revealing themselves and endangering residents' well-being. The NAs' lived experience of troubled conscience was feelings of being hindered by pre-determined conditions, facing a fragmented work situation hovering between norms and rules and convictions of their conscience. To not endangering the atmosphere in the work-team they are submissive to the norms of their co-workers. They felt inadequate as they should be model care providers. The findings were interpreted in the light of Fromm's authoritarian and humanistic conscience.