Abstract
Background: Many studies of moral distress have explored nurses’ experience of caring for patients. Acting ethically in accordance with professional nursing practice and in concert with professional values is the core of nursing. Moral distress involves situations in which moral values are challenged (Ferrell, 2006). Moral distress can be related to the nurse's locus of control, his or her ability to protect the patient's wellbeing, close and constant physical presence at the bedside, and other situational variables (Schlutter et al, 2008). Purpose: The aim of this study was to explore nurses’ experiences working on a chronic ventilator dependent unit with a predominance of elderly Orthodox Jewish patients at the end of life. Little is known about how cultural complexity creates differences between nurses’ and family’s expectations for patient care at the end of life. Methods: A qualitative study of 27 nurses (71% participation rate) using semi-structured focus groups. Our research team conducted analysis of excerpts from focus groups. Early interviews led to the expansion of the original question to include exploring nurses’ moral distress. Using descriptive, axial coding, the team independently reviewed and coded excerpts from consecutive focus groups, revising the coding scheme and categories based on emerging findings into higher-level themes that describe the experiences described by the participants. Results: Content analysis revealed three levels of themes: universal themes (workload, lack of appreciation), themes common to other studies of nurses in end-of-life care (aggressive medical treatment, providing unrealistic hope to patients and families), and unique interconnected themes (significance of teamwork cultural mismatch, nurses’ expectations of their role not being completely met). The main finding was an incongruence of perspectives, described as depth-of-field dissimilarity. Using the photographic term as a metaphor whereby the focus and depth of perspective depends on the person doing the looking. We will provide exemplar quotations to illustrate each of higher-order themes and sub-themes. Conclusion: Nurses want to practice in an environment where they feel professional satisfaction and pride in their work. Providing care that conflicts with one’s conscience and ethical values on a frequent basis is unhealthy and contributes to moral distress. Implications of this study are to use the metaphor of depth-of-field dissimilarity to develop educational strategies, clinical interventions, and research to address moral distress and cultural complexity.Nurses need to accept the values of their patients and families, reconciling personal values that may be different and learn to navigate their own web of emotions and build resilience through recognition, support and education. Moral uncertainties and ethical dilemmas are inherent in the practice of nursing. As nurse leaders we need to support our colleagues to develop skills which enhance wellbeing, work together to create organizational strategies to mitigate moral distress, and help nurses grow through their experiences of moral distress.
Notes
Item accepted for presentation at the 2017 International Nursing Research Conference, but not presented at the event.
Sigma Membership
Epsilon Kappa
Type
Poster
Format Type
Text-based Document
Study Design/Type
N/A
Research Approach
Qualitative Research
Keywords:
Cultural Complexity, Organizational and Workforce Issues, Palliative and End of Life Care
Recommended Citation
Bressler, Toby; Smith, Elizabeth; and Hanna, Debra R., "Depth-of-field dissimilarity: Making sense of moral distress within cultural complexity" (2017). INRC (Congress). 174.
https://www.sigmarepository.org/inrc/2017/posters_2017/174
Conference Name
28th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Dublin, Ireland
Conference Year
2017
Rights Holder
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Acquisition
Proxy-submission
Depth-of-field dissimilarity: Making sense of moral distress within cultural complexity
Dublin, Ireland
Background: Many studies of moral distress have explored nurses’ experience of caring for patients. Acting ethically in accordance with professional nursing practice and in concert with professional values is the core of nursing. Moral distress involves situations in which moral values are challenged (Ferrell, 2006). Moral distress can be related to the nurse's locus of control, his or her ability to protect the patient's wellbeing, close and constant physical presence at the bedside, and other situational variables (Schlutter et al, 2008). Purpose: The aim of this study was to explore nurses’ experiences working on a chronic ventilator dependent unit with a predominance of elderly Orthodox Jewish patients at the end of life. Little is known about how cultural complexity creates differences between nurses’ and family’s expectations for patient care at the end of life. Methods: A qualitative study of 27 nurses (71% participation rate) using semi-structured focus groups. Our research team conducted analysis of excerpts from focus groups. Early interviews led to the expansion of the original question to include exploring nurses’ moral distress. Using descriptive, axial coding, the team independently reviewed and coded excerpts from consecutive focus groups, revising the coding scheme and categories based on emerging findings into higher-level themes that describe the experiences described by the participants. Results: Content analysis revealed three levels of themes: universal themes (workload, lack of appreciation), themes common to other studies of nurses in end-of-life care (aggressive medical treatment, providing unrealistic hope to patients and families), and unique interconnected themes (significance of teamwork cultural mismatch, nurses’ expectations of their role not being completely met). The main finding was an incongruence of perspectives, described as depth-of-field dissimilarity. Using the photographic term as a metaphor whereby the focus and depth of perspective depends on the person doing the looking. We will provide exemplar quotations to illustrate each of higher-order themes and sub-themes. Conclusion: Nurses want to practice in an environment where they feel professional satisfaction and pride in their work. Providing care that conflicts with one’s conscience and ethical values on a frequent basis is unhealthy and contributes to moral distress. Implications of this study are to use the metaphor of depth-of-field dissimilarity to develop educational strategies, clinical interventions, and research to address moral distress and cultural complexity.Nurses need to accept the values of their patients and families, reconciling personal values that may be different and learn to navigate their own web of emotions and build resilience through recognition, support and education. Moral uncertainties and ethical dilemmas are inherent in the practice of nursing. As nurse leaders we need to support our colleagues to develop skills which enhance wellbeing, work together to create organizational strategies to mitigate moral distress, and help nurses grow through their experiences of moral distress.