Change search
Link to record
Permanent link

Direct link
BETA
Silén, Marit
Publications (8 of 8) Show all publications
Silén, M. (2011). Encountering ethical problems and moral distress as a nurse: Experiences, contributing factors and handling. (Doctoral dissertation). School of Health Sciences, Jönköping University
Open this publication in new window or tab >>Encountering ethical problems and moral distress as a nurse: Experiences, contributing factors and handling
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to explore and describe what nurses find ethically problematic and morally distressing in their work, the factors contributing to the arising of ethically problematic situations and the actions reported taken in order to handle them, thus creating an ethical climate.

Descriptive as well as correlational and exploratory designs were employed in the four papers on which this thesis is based. A total of 283 nurses from 21 acute care wards at four Swedish hospitals participated. Interviews were analyzed using qualitative content analysis and the critical incident technique, and questionnaires were analyzed using descriptive and non-parametric statistics.

The nurses described ethical problems and moral distress related to decision making about life-sustaining treatment, but also when they experienced difficulties in preserving a patient’s integrity and when they could not give care that was necessary and safe. Inadequate communication between healthcare staff, the physicians’ ways of handling potentially ethically problematic situations and patients’ poor state of health, which hindered their participation in decisions concerning them, were some of the factors that could contribute to the rise of an ethically problematic situation. Among the actions described as being used to handle ethical problems and moral distress, some were explicitly stated to promote a positive ethical climate, i.e. a perceived positive handling of ethical issues. These were supporting each other in the working group, using policies and routines as help, giving care based on the needs of patients and their next of kin and daring to speak out, thus contributing to setting a standard for behavior. Having the need for explanations and information satisfied and working as a team also promoted a positive ethical climate.

In conclusion, the professional role of being a nurse seems to be of importance not only when it comes to what situations are experienced as ethically problematic and morally distressing, but also concerning what factors may contribute to the rise of them. Perceiving a positive ethical climate may mediate these experiences.

Place, publisher, year, edition, pages
School of Health Sciences, Jönköping University, 2011. p. 67
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 20
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-16429 (URN)978-91-85835-19-5 (ISBN)
Public defence
2011-11-11, Forum Humanum, Hälsohögskolan, Jönkping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2011-10-21 Created: 2011-10-20 Last updated: 2014-05-20Bibliographically approved
Silén, M., Svantesson, M., Kjellström, S., Sidenvall, B. & Christensson, L. (2011). Moral distress and ethical climate in a Swedish nursing context:perceptions and instrument usability. Journal of Clinical Nursing, 20(23-24), 3483-3493
Open this publication in new window or tab >>Moral distress and ethical climate in a Swedish nursing context:perceptions and instrument usability
Show others...
2011 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 23-24, p. 3483-3493Article in journal (Refereed) Published
Abstract [en]

Aim. The aim was fivefold: to describe Swedish nurses' perceptions of moral distress and determine whether there were differences in perceptions depending on demographic characteristics and to describe the usability of the Moral Distress Scale in a Swedish context. Further, the aim was to describe Swedish nurses' perceptions of ethical climate and the relationship between moral distress and ethical climate.

Background. Moral distress has been studied for more than two decades and the Moral Distress Scale is the most widely used instrument for measuring it. Moral distress has mainly been studied in relation to nurses' characteristics, but increasing attention has been paid to contextual aspects, such as ethical climate, that could be associated with moral distress.

Design. Descriptive, with a quantitative approach.

Methods. The study used two questionnaires: the Moral Distress Scale and the Hospital Ethical Climate Survey. The study was carried out at two hospitals in Sweden and included 249 nurses.

Results. Both level and frequency of moral distress were low, however level of moral distress was high in situations when the patient was not given safe and proper care. Generally, the frequency of moral distress was lower than the level. Of the situations on the Moral Distress Scale, 13 of the 32 were considered irrelevant by 10-50% of the participants. The more positive the ethical climate was perceived to be, the less frequentely morally distressing situations were reported.

Conclusions. Since a positive ethical climate was associated with less frequent occurencies of moral distress, it should be investigated what contributes to a positive ethical climate. To be used in a Swedish context, the Moral Distress Scale needs further revision.

Relevance to clinical practice. Open dialouges at wards are encouraged regarding what practices contribute to a positive ethical climate.

Keywords
ethical climate, moral distress, nurses, questionnaires, Sweden
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-16264 (URN)10.1111/j.1365-2702.2011.03753.x (DOI)
Available from: 2011-10-10 Created: 2011-10-10 Last updated: 2017-12-08Bibliographically approved
Silén, M., Tang, P. F. & Ahlström, G. (2009). Swedish and Chinese nurses' conceptions of ethical problems: a comparative study. Journal of Clinical Nursing, 18(10), 1470-1479
Open this publication in new window or tab >>Swedish and Chinese nurses' conceptions of ethical problems: a comparative study
2009 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, no 10, p. 1470-1479Article in journal (Refereed) Published
Abstract [en]

The aim was to investigate Swedish and Chinese nurses' conceptions of ethical problems and workplace stress and ascertain whether there are differences between the nurses in the two countries and between types of clinics. A comparative and quantitative research design was used. The study was carried out at one hospital in China and two hospitals in Sweden. One hundred and thirty-six Chinese nurses and 137 Swedish nurses participated by completing a questionnaire. There was a statistical difference between nurses working in the different countries regarding commonest stated ethical problem. The Swedish nurses indicated a greater number of ethical problems than the Chinese nurses. The latter felt irritated, dissatisfied or sad at work or after work more often than the Swedish nurses. Forty-one per cent of the nurses in both countries thought there was a modest or rather big difference between the current and the desired quality of nursing. The findings were partially the same in the two countries and this underlines the importance of looking at ethical problems from an organisational perspective.

Keywords
China, cross-national, ethics, nurses, nursing, Sweden
Identifiers
urn:nbn:se:hj:diva-6820 (URN)10.1111/j.1365-2702.2008.02422.x (DOI)
Available from: 2008-11-14 Created: 2008-11-14 Last updated: 2017-12-14Bibliographically approved
Wadensten, B., Wenneberg, S., Silén, M., Tang, P. F. & Ahlström, G. (2008). A cross-cultural comparison of nurses' ethical concerns. Nursing Ethics, 15(6), 745-760
Open this publication in new window or tab >>A cross-cultural comparison of nurses' ethical concerns
Show others...
2008 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 15, no 6, p. 745-760Article in journal (Refereed) Published
Abstract [en]

 

The aim of this study was to compare Swedish and Chinese nurses' experiences of ethical dilemmas and workplace distress in order to deepen understanding of the challenges neuroscience nurses encounter in different cultures. Qualitative interviews from two previously performed empirical studies in Sweden and China were the basis of this comparative study. Four common content areas were identified in both studies: ethical dilemmas, workplace distress, quality of nursing and managing distress. The themes formulated within each content area were compared and synthesized into novel constellations by means of aggregated concept analysis. Despite wide differences in the two health care systems, the nurse participants had similar experiences with regard to work stress and a demanding work situation. They were struggling with similar ethical dilemmas, which concerned seriously ill patients and the possibilities of providing good care. This indicates the importance of providing nurses with the tools to influence their own work situation and thereby reducing their work-related stress.

 

Keywords
cross-cultural comparison, ethical dilemmas, nursing ethics, quality of nursing, workplace distress
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-6874 (URN)10.1177/0969733008095385 (DOI)
Available from: 2008-12-04 Created: 2008-12-04 Last updated: 2017-12-14Bibliographically approved
Silén, M. (2008). Etiska problem och arbetsrelaterad stress hos svenska och kinesiska sjuksköterskor. In: Forskningskonferens Halmstad 6-7 november 2008: Konferens med fokus på forskning inom omvårdnad/vård, folkhälsovetenskap, handikapp, socialt arbete och idrottspsykologi.
Open this publication in new window or tab >>Etiska problem och arbetsrelaterad stress hos svenska och kinesiska sjuksköterskor
2008 (Swedish)In: Forskningskonferens Halmstad 6-7 november 2008: Konferens med fokus på forskning inom omvårdnad/vård, folkhälsovetenskap, handikapp, socialt arbete och idrottspsykologi, 2008Conference paper, Published paper (Other academic)
Keywords
Svenska sjuksköterskor, kinesiska sjuksköterskor, arbetsrelaterad stress, etiska problem, kvantitativa analysmetoder
Identifiers
urn:nbn:se:hj:diva-6790 (URN)
Available from: 2008-11-11 Created: 2008-11-11 Last updated: 2009-02-26Bibliographically approved
Silén, M., Svantesson, M. & Ahlström, G. (2008). Nurses' conceptions of decision making concerning life-sustaining treatment. Nursing Ethics, 15(2), 160-173
Open this publication in new window or tab >>Nurses' conceptions of decision making concerning life-sustaining treatment
2008 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 15, no 2, p. 160-173Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to describe nurses' conceptions of decision making with regard to life-sustaining treatment for dialysis patients. Semistructured interviews were conducted with 13 nurses caring for such patients at three hospitals. The interview material was subjected to qualitative content analysis. The nurses saw decision making as being characterized by uncertainty and by lack of communication and collaboration among all concerned. They described different ways of handling decision making, as well as insufficiency of physician-nurse collaboration, lack of confidence in physicians, hindrances to patient participation, and ambivalence about the role of patients' next of kin. Future research should test models for facilitating communication and decision making so that decisions will emerge from collaboration of all concerned. Nurses' role in decision making also needs to be discussed.

Keywords
Adaptation; Psychological, Adult, Attitude of Health Personnel, Communication Barriers, Conflict (Psychology), Cooperative Behavior, Decision Making/ethics, Family/psychology, Humans, Life Support Care/ethics/*psychology, Nursing, Nurse's Role/psychology, Nursing Methodology Research, Nursing Staff; Hospital/ethics/*psychology, Patient Advocacy, Ethics, Patient Participation, Physician-Nurse Relations, Power (Psychology), Qualitative Research, Sweden, Uncertainty
National Category
Nursing Nursing
Identifiers
urn:nbn:se:hj:diva-5679 (URN)18272607 (PubMedID)
Available from: 2008-06-10 Created: 2008-06-10 Last updated: 2017-12-12Bibliographically approved
Silén, M., Tang, P. F., Wadensten, B. & Ahlström, G. (2008). Workplace Distress and Ethical Dilemmas in Neuroscience Nursing. Journal of Neuroscience Nursing, 40(4), 222-231
Open this publication in new window or tab >>Workplace Distress and Ethical Dilemmas in Neuroscience Nursing
2008 (English)In: Journal of Neuroscience Nursing, ISSN 0888-0395, Vol. 40, no 4, p. 222-231Article in journal (Refereed) Published
Abstract [en]

This study concerns Swedish nurses' experiences of workplace stress and the occurrence of ethical dilemmas in a neurological setting. Qualitative interviews were conducted with 21 nurses. The interview results were subjected to qualitative latent content analysis and sorted into 4 content areas: workplace distress, ethical dilemmas, managing distress and ethical dilemmas, and quality of nursing. Common workplace stressors were high workload and lack of influence. These were perceived to have negative consequences for the quality of nursing. Ethical dilemmas mainly concerned decision making on initiation or withdrawal of treatment, which was experienced as a troublesome situation where conflicts could arise. The nurses managed the distress and ethical dilemmas by accepting and adjusting to the situation and seeking support from colleagues. They also endeavored to gain new strength in their private lives.

Keywords
Swedish nurses, workplace stress, ethical dilemma, coping, quality of nursing, content analysis
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-6789 (URN)
Available from: 2008-12-04 Created: 2008-11-11 Last updated: 2011-10-21Bibliographically approved
Silén, M., Tang, P. F., Wadensten, B. & Ahlström, G. (2007). Workplace distress and ethical dilemmas among swedish neuroscience nurses.. In: The 7th Conference on Advances in Health Care Science Research.
Open this publication in new window or tab >>Workplace distress and ethical dilemmas among swedish neuroscience nurses.
2007 (English)In: The 7th Conference on Advances in Health Care Science Research, 2007Conference paper, Published paper (Refereed)
Keywords
workplace distress, ethical dilemmas, swedish nurses
National Category
Nursing Nursing
Identifiers
urn:nbn:se:hj:diva-3856 (URN)
Available from: 2007-10-24 Created: 2007-10-24 Last updated: 2010-07-30Bibliographically approved
Organisations

Search in DiVA

Show all publications