Registered nurses’ and nurse assistants’ lived experience of troubled conscience in their work in elderly care—A phenomenological hermeneutic study

Abstract

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.