Narratives of aggressive care

2013 ◽  
Vol 21 (4) ◽  
pp. 461-472 ◽  
Author(s):  
Elizabeth Peter ◽  
Shan Mohammed ◽  
Anne Simmonds

Background: While witnessing and providing aggressive care have been identified as predominant sources of moral distress, little is known about what nurses “know” to be the “right thing to do” in these situations. Research objectives: The purpose of this study was to explore what nurses’ moral knowledge is in situations of perceived overly aggressive medical care. Research design: A critical narrative approach was used. Participants: A total of 15 graduate nursing students from various practice areas participated. Findings: Four narrative types were identified, including “Wait and see: medical uncertainty,” “Deflected responsibilities to respond to dying, death, or futility,” “Divergent understandings, responsibilities, and temporalities,” and “Privileged medical understandings and responsibilities.” Discussion: The knowledge of differentially situated persons is acknowledged in dissimilar ways, the time required to determine that enough has been done is perceived differently, and how moral responsibilities are understood also varies. Conclusions: A better understanding of how social roles influence how time, knowledge, and responsibility are related to the provision of aggressive care is needed.

2016 ◽  
Vol 65 (5) ◽  
Author(s):  
Simone Conoci ◽  
Elena Cristofori ◽  
Caterina Galletti

Gli operatori sanitari, nell’esercizio professionale quotidiano, si avvalgono di un insieme di regole deontologiche che giustificano la moralità e irreprensibilità dell’atto assistenziale di cui sono garanti. Tuttavia l’iper-specializzazione del sapere e lo sviluppo di nuove tecnologie sottopongono costantemente i professionisti della salute all’impossibilità di conciliare sempre ciò che “è possibile fare” con ciò che “è doveroso” ed “eticamente lecito” fare per il paziente, condizione che potenzialmente genera nell’operatore distress morale. Gli infermieri che sperimentano Moral distress vivono una situazione di forte disagio, poiché riconoscono il comportamento da intraprendere più adeguato alla situazione clinica ma, per svariati motivi, non possono metterlo in pratica trovandosi quindi ad agire in modo contrario ai propri valori professionali. Le ricerche sul distress morale sono state condotte prevalentemente su infermieri. Nel presente studio sono state esaminate le situazioni che provocano conflitto morale nel vissuto degli studenti infermieri, in relazione a tutte quelle situazioni d’assistenza che si collocano al limite di una medicina etica e coscienziosa in termini di proporzionalità dei mezzi impiegati e di gravosità o beneficità dei trattamenti per il paziente. È stato svolto uno studio fenomenologico con interviste scritte semi-strutturate su un campione propositivo di studenti infermieri di una università romana. I testi delle interviste sono stati analizzati con il metodo Giorgi. I risultati hanno evidenziato che il Moral distress si manifesta nel vissuto esperienziale dello studente che è già in grado di delineare situazioni spiacevoli, cause, effetti e, in limitati casi, possibili strategie per rispondere al disagio vissuto nei setting clinici.During the professional practice of every day, caregivers use a set of ethical rules that warrant morality and irreproachability of welfare deed they are guarantors to. Nevertheless, hyperspecialization of knowledge and the development of new technologies, steadily submit professionals of wealth to inability to reconcile many times what “it is possible to do” to what “it is right to do” and “ethically correct” for patients, and that’s what potentially creates moral distress to the caregiver. Nurses who experience this moral distress, live a strong situation of discomfort, because they recognize the right behavior to have in a certain clinic situation but, due to several reasons, they can’t execute as they should, and they are incline to practice against their professional values. The most of surveys about moral distress are all conducted on nurses. This analysis inquires all situations that produce moral conflict in lived of nursing students, related to all those situations that lie on the border between an ethic and conscientious Medicine, about the proportionality in the use of means used and burdensomeness or beneficence of treatments for patients. It was carried out a phenomenological study by written semi-structured interviews on a purposeful sample of nursing students of a roman Campus. The texts of the interviews were analyzed with Giorgi’s method. The results showed that moral distress occurs in experiential lived of a student who is already able to outline unpleasant situations, causes, effects, and in few cases, possible strategies to respond to the distress experienced in clinical settings.


2014 ◽  
Vol 22 (7) ◽  
pp. 743-753 ◽  
Author(s):  
Elizabeth Peter ◽  
Shan Mohammed ◽  
Anne Simmonds

Background: Nurses who provide aggressive care often experience the ethical challenge of needing to preserve the hope of seriously ill patients and their families without providing false hope. Research objectives: The purpose of this inquiry was to explore nurses’ moral competence related to fostering hope in patients and their families within the context of aggressive technological care. A secondary purpose was to understand how this competence is shaped by the social–moral space of nurses’ work in order to capture how competencies may reflect an adaptation to a less than ideal work environment. Research design: A critical qualitative approach was used. Participants: Fifteen graduate nursing students from various practice areas participated. Ethical considerations: After receiving ethics approval from the university, signed informed consent was obtained from participants before they were interviewed. Findings: One overarching theme ‘Mediating the tension between providing false hope and destroying hope within biomedicine’ along with three subthemes, including ‘Reimagining hopeful possibilities’, ‘Exercising caution within the social–moral space of nursing’ and ‘Maintaining nurses’ own hope’, was identified, which represents specific aspects of this moral competency. Discussion: This competency represents a complex, nuanced and multi-layered set of skills in which nurses must be well attuned to the needs and emotions of their patients and families, have the foresight to imagine possible future hopes, be able to acknowledge death, have advanced interpersonal skills, maintain their own hope and ideally have the capacity to challenge those around them when the provision of aggressive care is a form of providing false hope. Conclusion: The articulation of moral competencies may support the development of nursing ethics curricula to prepare future nurses in a way that is sensitive to the characteristics of actual practice settings.


2021 ◽  
Vol 11 (2) ◽  
pp. 291-300
Author(s):  
Marie Kvamme Mæland ◽  
Britt Sætre Tingvatn ◽  
Linda Rykkje ◽  
Sigrunn Drageset

Background: Research indicates that newly graduated nurses are often unprepared for meeting challenging situations in clinical practice. This phenomenon is referred to as a “reality shock”. This gap in preparedness may lead to moral distress. The aim of this article is to provide knowledge of moral distress in clinical nursing practice. Methods: Bachelor and further education nursing students were invited to write a story about challenging situations from their own clinical practice, resulting in 36 stories. Analysis was based on hermeneutical reading inspired by a narrative method; therefore, six stories were selected to represent the findings. Results: A finding across the stories is that the students knew the right thing to do but ended up doing nothing. Four themes were related to moral distress: (a) undermining of professional judgement, (b) disagreement concerning treatment and care, (c) undignified care by supervisors, and (d) colliding values and priorities of care. Conclusion: Nursing education should emphasize to a greater extent ethical competency and training for the challenging situations students will encounter in clinical practice.


2019 ◽  
Vol 26 (7-8) ◽  
pp. 2325-2339 ◽  
Author(s):  
Simoní Saraiva Bordignon ◽  
Valéria Lerch Lunardi ◽  
Edison Luiz Devos Barlem ◽  
Graziele de Lima Dalmolin ◽  
Rosemary Silva da Silveira ◽  
...  

Background: Moral distress is considered to be the negative feelings that arise when one knows the morally correct response to a situation but cannot act because of institutional or hierarchal constraints. Objectives: To analyze moral distress and its relation with sociodemographic and academic variables in undergraduate students from different universities in Brazil. Method: Quantitative study with a cross-sectional design. Data were collected through the Moral Distress Scale for Nursing Students, with 499 nursing students from three universities in the extreme south of Brazil answering the scale. The data were analyzed in the statistical software SPSS version 22.0, through descriptive statistical analysis, association tests (t-test and analysis of variance), and linear regression models. Ethical considerations: Approval for the study was obtained from the Research Ethics Committee at Universidade Federal do Rio Grande. Findings: The mean intensity of moral distress in the constructs ranged from 1.60 to 2.55. As to the occurrence of situations leading to moral distress in the constructs, the frequencies ranged from 1.21 to 2.43. The intensity level of moral distress showed higher averages in the more advanced grades of the undergraduate nursing course, when compared to the early grades of this course (between 5 and 10 grade, average = 2.60–3.14, p = 0.000). Conclusion: The demographic and academic characteristics of the undergraduate nursing students who referred higher levels of moral distress were being enrolled in the final course semesters, were at a federal university, and had no prior degree as an auxiliary nurse/nursing technician.


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