Moral Stress Research Articles

The impact of perceived leadership quality, moral stress and participation on turnover intentions in ECEC sector

The aim of this study was to investigate how perceived leadership quality, moral stress and participation are related to turnover intentions in early childhood education and care (ECEC). The theoretical framework was based on mentalizing leadership, participation, and moral stress. The data were collected via a survey (N = 332). The results showed that the ECEC staff were on average quite content with the quality of leadership and participation. Their turnover intentions and moral stress were moderate on average. However, the staff groups differed statistically significantly, with the ECEC nurses scoring lower on leadership satisfaction and participation, and higher on moral stress and turnover intentions than the teachers and leaders. This suggests that we need to develop a way of recognizing stressors at earlier stages, as well as handling them in time before they grow too large. For this, a functioning leadership that promotes reflection and participation is crucial.

"We just take care after each other": Relational health strategies of nurses and nursing aides working in residential long-term care as a mechanism of in- and exclusion in care teams.

The health of care workers in residential long-term care (LTC) is under pressure. Scholars emphasize the importance of gender-sensitive and intersectional approaches to occupational health. To unravel how the health of nurses and nursing aides is shaped by gender, class, age, sexuality and race. A qualitative participatory study. A participatory research team, consisting of academic scholars and nursing aides, conducted semi-structures interviews (N = 20) and one natural group discussion (N = 8 participants) to validate our findings. Thematic data-analysis was guided by gender and intersectionality theory. Empirical findings suggest that gendered norms limit possibilities for self-care for female nurses and nursing aides. Feeling uncared for by society and LTC organizations, paid care workers describe how they take care of each other. These relational health strategies require a feeling of sameness, limiting space for diversity and disability within care teams. Care workers seen as 'cultural other', or those who experienced (chronic) health issues, financial struggles or informal caregiving, risked being excluded from relational care within care teams, which negatively impacted their health. Care workers' relational health strategies are a gendered and care ethical response to the lack of societal and political care for LTC, but can become mechanisms of exclusion within care teams. This can be understood as a sign of exhaustion, shaped by adverse working conditions and leading to moral stress. The lack of societal appreciation needs to be addressed by occupational health physicians and LTC organizations, to counter mechanisms of exclusion among paid care workers.

Mental health and humanitarian crisis: Moral stress in trauma therapy.

This articleoffers a narrative analysis of the contributing factors of moral distress (MD) and moral injury (MI) among mental health clinicians working amidst humanitarian crises. It discusses the impact of moral stress on therapeutic relationships in mental health trauma. The articleoriginated from the author's experience developing a peer-to-peer support program at a nongovernmental organization (NGO) and conducting peer-to-peer support for mental health clinicians and healthcare providers in Ukraine and Turkey. A significant amount of literature has documented the detrimental effects of MD and MI on mental health, job sustainability, and resilience of healthcare providers and first responders. The negative effects of MD and MI are particularly relevant in trauma counseling, where clinicians must draw upon the use of self to develop therapeutic relationships with their clients. This process demands a high level of moral reasoning and self-awareness, which can be severely tested under the morally challenging conditions of a humanitarian crisis. There is an imperative need to deepen our understanding and to swiftly address the factors that precipitate MD and MI in mental health clinicians working in crisis zones. By doing so, we aim to bolster their resilience and the enduring nature of their commitment to help and save others. This, in turn, will not only contribute to saving more lives but also enable those who are affected by trauma to flourish in the aftermath of their experiences.

Slaughterhouse workers, bullfighters, and cockfighters in Ecuador: paradoxical moral and affective action on non-human animals

ABSTRACT The process of killing non-human animals demands certain psychosocial, affective, and moral processes. In the case of so-called ‘death-saturated environments’, psychic numbing and systematic desensitisation related to violent attitudes and behaviours against non-human animals acquire contradictory dimensions. To understand these processes in depth, this article proposes a theoretical perspective based on the social psychology of human-animal relations. Empirically, the study examines the experiences, attitudes, and worldviews of men in Ecuador whose jobs involve inflicting pain and death on animals and focuses on the ways in which these subjects deal with ‘moral stress’ and ‘the caring-killing paradox’. It examines how slaughterhouse workers, bullfighters, and cockfighters establish ambivalent relationships with the animals, characterised by a certain paradoxical moral and affective action. Eleven in-depth interviews, lasting one to three hours, were conducted for this purpose, and are analysed through the qualitative data analysis software Atlas.ti, using thematic analysis as a qualitative research technique.

"Some missions can be quite emotionally painful." Paramedic´s experience exercising coercion during assignments-A qualitative study.

More than 70% of respondents in a previous survey among paramedics reported use of coercion or physical force towards patients. Coercion outside hospital is not permitted, and neither routines nor equipment intended for physical restraint is available in the Norwegian ambulance services. Paramedics carry out assignments involving use of force and coercion on unclear legal grounds, with no training in techniques or proper equipment. Attitudes and experiences of healthcare workers regarding incidents involving coercion in mental health care services are frequently reported in the research literature, yet little is known about paramedics' experiences, and which factors contribute to their moral stress. In the period June-August 2021, almost 400 employees in the ambulance services in a county in the eastern part of Norway were invited to answer a digital questionnaire. One question had an open text field with the question "Can you say something about how you experience transporting patients where force has to be used to secure the patient during transport?". The answers were analyzed using Graneheim and Lundman's content analysis. We received eighty-five completed responses (response rate 21%). Force was used by 62 paramedics. Twenty-three left the text field open. The answers showed many unique responses. Content analysis resulted in two overarching themes; 1) lack of routines, equipment, and training regarding use of coercion and force in the ambulance service, and 2) paramedics were confronted with ethical dilemmas, alone and without support from legislation or management. The paramedics experienced discomfort related to the exercise of force and coercion during ambulance assignments due to the experience of unclear legislation, lack of training, routines, and equipment in addition to frequent ethical dilemmas and the concern about lack of support from the employer. A clearer legal basis, adapted equipment in the ambulance and regular training, will contribute to greater security in the performance of the work, which will provide safer and more caring treatment for the patients and less moral stress for the staff. With established routines, the employer will be implicitly obliged, and paramedics will be safer in the performance of their work. Ethical reflection must be offered and put into a system.

Moral distress and psychological status among healthcare workers in a newly established paediatric intensive care unit.

Healthcare workers in intensive care units often experience moral distress, depression, and stress-related symptoms. These conditions can lower staff retention and influence the quality of patient care. This study aimed to evaluate the prevalence of moral distress and psychological status among healthcare workers in a newly established paediatric intensive care unit (PICU) in Hong Kong. A cross-sectional questionnaire survey was conducted in the PICU of the Hong Kong Children's Hospital; healthcare workers (doctors, nurses and allied health professionals) were invited to participate. The Revised Moral Distress Scale (MDS-R) Paediatric Version and Depression Anxiety and Stress Scale-21 items were used to assess moral distress and psychological status, respectively. Demographic characteristics were examined in relation to moral distress, depression, anxiety, and stress scores to identify risk factors for poor psychological outcomes. Correlations of moral distress with depression, anxiety, and stress were examined. Forty-six healthcare workers completed the survey. The overall median MDS-R moral distress score was 71. Nurses had a significantly higher median moral distress score, compared with doctors and allied health professionals (102 vs 47 vs 20). Nurses also had the highest median anxiety and stress scores (11 and 20, respectively). Moral distress scores were correlated with depression (r=0.445; P=0.002) and anxiety scores (r=0.417; P<0.05). Healthcare workers intending to quit their jobs had significantly higher moral distress scores (P<0.05). Among PICU healthcare workers, nurses had the highest level of moral distress. Moral distress was associated with greater depression, anxiety, and intention to quit. Healthcare workers need support and a sustainable working environment to cope with moral distress.

“Being prevented from providing good care: a conceptual analysis of moral stress among health care workers during the COVID-19 pandemic”

BackgroundHealth care workers (HCWs) are susceptible to moral stress and distress when they are faced with morally challenging situations where it is difficult to act in line with their moral standards. In times of crisis, such as disasters and pandemics, morally challenging situations are more frequent, due to the increased imbalance between patient needs and resources. However, the concepts of moral stress and distress vary and there is unclarity regarding the definitions used in the literature. This study aims to map and analyze the descriptions used by HCWs regarding morally challenging situations (moral stress) and refine a definition through conceptual analysis.MethodsQualitative data were collected in a survey of 16,044 Swedish HCWs who attended a COVID-19 online course in autumn 2020. In total, 643 free-text answers with descriptions of moral stress were analyzed through content analysis.ResultsThree themes emerged from the content analysis (1) “Seeing, but being prevented to act; feeling insufficient/inadequate and constrained in the profession,” (2) “Someone or something hindered me; organizational structures as an obstacle,” and (3) “The pandemic hindered us; pandemic-related obstacles.” The three themes correspond to the main theme, “Being prevented from providing good care.”DiscussionThe main theme describes moral stress as various obstacles to providing good care to patients in need and acting upon empathic ability within the professional role. The themes are discussed in relation to established definitions of moral stress and are assessed through conceptual analysis. A definition of moral stress was refined, based on one of the established definitions.ConclusionsOn the basis of the study results and conceptual analysis, it is argued that the presented definition fulfils certain conditions of adequacy. It is essential to frame the concept of moral stress, which has been defined in different ways in different disciplines, in order to know what we are talking about and move forward in developing prevention measures for the negative outcomes of this phenomenon.

The Impact of COVID-19 Visitor Restrictions on Clinical Cancer Nurses

To explore the impact of visitor restrictions on clinical cancer nurses, their roles and duties, and the coping strategies used to address the impact. Semistructured qualitative interviews were conducted through purposive sampling with nurses working in a clinical role within cancer services at the study site for at least 1 year. Interviews were recorded and transcribed. Textual data transcribed from interviews were analyzed for themes using NVivo version 12 software, following Braun and Clarke's six phases of thematic analysis. Visitor restrictions implemented due to COVID-19 had a significant impact on clinical cancer nurses. The study found evidence of moral injury and conflict-within the role of the nurse, the implementation of organizational policies, and nurses' professional identity and personal beliefs. Despite this adversity, nurses remained committed to their clinical practice. Changes to nurses' roles and the practice environment have potentially significant impact on well-being and retention. To ensure that nurses can continue to provide high-quality nursing care in challenging environments, organizations must minimize this impact. Consistent communication and support activities, including recognizing and responding appropriately to situations, may be used in the reduction of potential moral injury and stress.

Canadian respiratory therapists who considered leaving their clinical position experienced elevated moral distress and adverse psychological and functional outcomes during the COVID-19 pandemic.

Respiratory therapists (RTs) faced morally distressing situations throughout the COVID-19 pandemic, including working with limited resources and facilitating video calls for families of dying patients. Moral distress is associated with a host of adverse psychological and functional outcomes (e.g. depression, anxiety, symptoms of posttraumatic stress disorder [PTSD] and functional impairment) and consideration of position departure. The purpose of this study was to understand the impact of moral distress and its associated psychological and functional outcomes on consideration to leave a clinical position among Canadian RTs during the COVID-19 pandemic. Canadian RTs (N = 213) completed an online survey between February and June 2021. Basic demographic information (e.g. age, sex, gender) and psychometrically validated measures of moral distress, depression, anxiety, stress, PTSD, dissociation, functional impairment, resilience and adverse childhood experiences were collected. One in four RTs reported considering leaving their position. RTs considering leaving reported elevated levels of moral distress and adverse psychological and functional outcomes compared to RTs not considering leaving. Over half (54.5%) of those considering leaving scored above the cut-off for potential diagnosis of PTSD. Previous consideration to leave a position and having left a position in the past each significantly increased the odds of currently considering leaving, along with system-related moral distress and symptoms of PTSD, but the contribution of these latter factors was small. Canadian RTs considering leaving their position reported elevated levels of distress and adverse psychological and functional outcomes, yet these individual-level factors appear unlikely to be the primary factors underlying RTs' consideration to leave, because their effects were small. Further research is required to identify broader, organizational factors that may contribute to consideration of position departure among Canadian RTs.

The impact of the coronavirus pandemic on the mental health of critical care workers

The coronavirus pandemic has focused attention on the importance of critical care and highlighted the shortage of critical care specialists. Due to increasing workloads and high mortality rates, healthcare professionals were exposed to higher levels of physical and psychological stress during the pandemic than before. Our study investigated the effects of the coronavirus outbreak on the emotional, mental and moral stress of intensive care professionals. Our workgroup performed paper-based surveys among caregivers in the Department of Anaesthesiology and Intensive Therapy at Semmelweis University. The first survey was conducted at the start of the pandemic in 2020, the second survey was conducted after the third wave in 2021. We applied validated questionnaires (Professional Quality of Life, Demoralization Scale, Perceived Stress Scale, Impact of Event Scale, and Posttraumatic Growth Inventory), collected demographic data and information on lifestyle, recreation, dietary habits, and accepting psychological support. The number and demographic characteristics of the participants in the two studies are different, reflecting the changes in the workforce during the pandemic. Our results revealed no differences between the working and socio-demographic groups before the outbreak, however, one year later, nurses scored significantly higher on all negative psychological scales compared to other groups. Only a minority of the respondents had sought psychological support (9.5-12.7%), although more than a third of respondents reported the need for psychological support. Employees in new work positions showed significantly increased posttraumatic growth (2.91 ± 0.82 vs. 2.20 ± 1.06, p = 0.016). These findings demonstrate that nurses are the most strained workgroup during an uncertain and stressful period. The available mental support alone is not enough to help caregivers. Further steps are needed to improve the mental health of critical care workers. Orv Hetil. 2023; 164(42): 1646-1655.

Determining nursing students' moral distress levels

This descriptive cross-sectional study was conducted to determine the level of moral distress among nursing students. The study was conducted between April 17 and April 20, 2023, with the participation of 150 students studying in the nursing department of the Faculty of Health Sciences of a university who agreed to participate in the study. Data were collected using a questionnaire designed by the researchers based on the literature and the Moral Distress Scale for Nursing Students. The arithmetic mean, standard deviation, median, and frequency (in percent), t-test, ANOVA test, and Pearson correlation analysis were used to analyze the data. This study found that the intensity and frequency of moral stress among nursing students were not high. In line with the findings, it is recommended that ethics education be provided to nursing students, teaching them how to deal with unethical behavior they encounter in the clinical setting, and raising the awareness of nursing educators to support students' development.&#x0D; Keywords: Distress; moral distress; morality student; nurses; nursing.

How Military Chaplains Strengthen the Moral Resilience of Soldiers and Veterans: Results From a Case Studies Project in the Netherlands

AbstractIn spiritual care research, studies on military chaplaincy are underrepresented, and most available studies center on moral injury. This article contributes to the existing literature on spiritual care in the military by presenting a study of 13 case descriptions of spiritual care provision by military chaplains from the Netherlands. These were analyzed using the framework method, a qualitative method of systematically searching for patterns in data sets, in order to answer the question: How do military chaplains contribute to the moral resilience of soldiers and veterans experiencing moral stress? The analytical framework was constructed on the basis of Doehring’s (Pastoral Psychology, 64(5), 635–649, 2015) conceptual understanding of moral resilience as the outcome of processes of spiritual integration of moral stress in caregiving relationships. This study shows that soldiers experience moral stress when core values associated with ‘being a soldier’ conflict with expectations or actions of soldiers themselves or of others, with the way the military organization functions, or with the spiritual notion of ‘being a good, loving and loveworthy human being’. In their responses to moral stress, chaplains contribute to moral resilience by engaging in co-creating spiritual orienting frameworks which accommodate a sense of goodness of self and others and allow for nuanced, biographically rooted moral views. Soldiers experience conversations and brief encounters with chaplains as relational ‘moments of goodness’, which may also contribute to moral resilience.

Financial support of military personnel is one of the most important elements of their financial situation and motivation in the service

Taking into account the fact that there is a war going on in Ukraine today in connection with armed Russian aggression, rethinking the specifics of social protection of military personnel, who perform special work aimed at protecting the Motherland, is of particular importance. The purpose of the article is to investigate the financial support of military personnel as one of the most important elements of their financial situation and motivation in the service. Because today, in view of the long general mobilization and the increase in the number of those who are forced to simultaneously protect the independence of the state and take care of the well-being of their families, the financial support of military personnel is the subject of public discussions.It is noted that the financial support of military personnel should correspond to modern realities, ensure stability, its dimensions should reflect the level of physical and moral stress, take into account risks and create appropriate material conditions for the life of military personnel and their family members. It was concluded that a decent financial support of military personnel is impossible without fundamental normative and legal support, which not only contains the relevant social rights, but also provides social guarantees for their implementation. Therefore, supporting the positions of other scientists, it is proposed to develop a legislative act, which would enshrine the basic principles of monetary support for military personnel, in particular, to develop a draft law on monetary support for military personnel, which will contribute to the universalization and consolidation of norms on the remuneration of military personnel at the legislative level, and therefore - will constitute a an additional important guarantee of ensuring the right of the specified employees to remuneration.

Possible versus desired diets: food legislation as additional stress for low-income mothers

ABSTRACT Deciding what, where, when and how much to feed a child occupies much of a mother’s time, energy, and financial resources. This study aids our understanding of the effects of legislation promoting healthier eating on mothers from low socioeconomic groups and on their families. We interview mothers and nutrition experts in Santiago, Chile – the site of the most recent and comprehensive effort to change a population’s food habits via legislation. We introduce the notions of ‘desired diets’ – ideal diets promoted by health experts and public policy discourses that moralise food consumption and promote consumer responsibilisation for health-related issues; and ‘possible diets’ – diets that mothers can adapt to and habituate in the household, considering their life realities. We argue that the notions of possible and desired diets often find themselves at odds, leading to mothers facing moral scrutiny, anxiety, and stress, which affects their sense of self, shaping notions of ‘good mothering’.

The moral deliberation pathway in veterinary practice: a qualitative study.

Veterinarians may face various ethical decisions and potential moral conflicts in clinical practice. The ethical decision-making process often leads to a satisfying resolution. However, when such a process is accompanied by a perceived inability to act according to a person's values, it can lead to psychological distress that characterises moral distress. Theoretical models in professions such as nursing attempt to explain the evolution of moral conflict into moral distress. In veterinary professionals, a model has been proposed to explain this pathway (the moral deliberation pathway). However, empirical data are still lacking on whether veterinary clinicians experience a moral deliberation pathway as hypothesised. Using thematic analysis, this qualitative study investigates veterinary clinicians' experiences with moral distress and aims to explain the moral deliberation pathway in these veterinarians. The results suggest that veterinarians' experiences with moral distress follow a deliberation process that can be explained by the proposed moral deliberation pathway. Experiencing a moral conflict leads to moral stress, then either to moral distress or resolution into moral comfort. Self-selection of participants and possible recollection bias may have biased the findings. The empirical data provided by this study can inform future research and intervention strategies to identify, measure and manage moral distress in the veterinary context.

Cash support for employees of the National Police of Ukraine as an important legal guarantee of their activities

The paper examines the financial support of the National Police of Ukraine as an important legal guarantee of their activities in today's conditions, identifies existing problems and suggests ways to solve them. It is noted that the guarantees of the protection of the right of the police officer to monetary support are a special manifestation of the guarantees of the protection of the employee's right to remuneration. Studying the normative legal acts, it was noted that the legislation in the field of providing monetary support to the employees of the National Police of Ukraine is constantly developing and improving, although many issues still remain unresolved, especially in today's conditions. Attention was drawn to the fact that reforms in law enforcement agencies should, first of all, be coordinated and integrated with departmental plans and programs, since the task of reforming is to ensure that there is a correspondence between tasks and functions, structure and people and resource provision. One of the important issues that needs to be solved immediately is the decent remuneration of Ukrainian police officers, because the safety of citizens and the level of crime detection directly depend on their motivation. And therefore, their salary must correspond to modern risks and realities, ensure stability, and only the law can guarantee this. Since a decent financial provision of police officers is impossible without fundamental normative and legal provision, which not only contains relevant social rights, but also provides social guarantees for their implementation. It was concluded that the amount of financial support should reflect the level of physical and moral stress for the police officer, take into account the risks that the official activity carries and create appropriate material conditions for the life of police officers and their family members. In this regard, it is proposed that the main components of monetary support (position salary, salary for a special rank, bonus for years of service) should make up at least 70 % of monetary support, additional types of monetary support intended to stimulate official activity – 30 %, which should be fixed at the legislative level.

Reducing Moral Stress in Veterinary Teams? Evaluating the Use of Ethical Discussion Groups in Charity Veterinary Hospitals.

This study examines experiences of veterinary moral stress in charity veterinary practice and qualitatively evaluates the role of ethical discussion in reducing veterinary moral stress. Results are drawn from a thematic data analysis of 9 focus groups and 15 individual interviews with veterinary team members from 3 UK charity veterinary hospitals. Moral stress is described as an everyday experience by participants and is caused by uncertainty about their ability to fulfill their ethical obligations. Moral stress is shown to be cumulative and can interact with other forms of stress. Distinct practical and relational barriers to ethical action are identified and proposed as contributors to moral stress, and different team members experience different barriers within their roles. The potential impact of moral stress on team members' quality of life and mental health is highlighted. Results show that regular facilitated ethical group discussions may reduce moral stress in the hospital setting, particularly through familiarization with others' roles and ethical perspectives and through supporting one another's ethical decision-making. The article concludes that moral stress is an important and poorly understood problem in veterinary practice and that further development of regular facilitated ethical group discussion may be of considerable benefit to team members.

Critical care nurses' role in the decision-making process of withdrawal of life-sustaining treatment: A qualitative systematic review.

To synthesise the qualitative evidence regarding the role of critical care nurses in the decision-making process of withdrawing life-sustaining treatment in critically ill adults. Qualitative systematic review. This qualitative systematic review employed the guidelines of Bettany-Saltikov and McSherry. The review was reported according to the ENTREQ checklist. Pairs of authors independently assessed eligibility, appraised methodological quality and extracted data. Data were synthesised using thematic synthesis. CINAHL, MEDLINE and EMBASE were searched for studies published between January 2001 and November 2021. Twenty-three studies were included. Three analytical themes were synthesised: performing ethical decision-making to safeguard patients' needs rights, and wishes; tailoring a supporting role to guide the family's decision-making process; and taking on the role of the middleman by performing coordination. The role of the critical care nurses in the decision-making process in withdrawal of life-sustaining treatment requires experience and the development of the clinical perspective of critical care nurses. Enhanced knowledge of the decision-making process of withdrawing life-sustaining treatment can prepare critical care nurses to be more equipped to master this role and enhance their ability to handle the emotional and moral stress associated with this part of the critical care unit. The literature reveals the complex and challenging role of critical care nurses during the decision-making process of withdrawing life-sustaining treatment. Critical care nurses perform ethical decision-making to safeguard patients' concerns, guide the family's decision-making process and take on the role of the middleman. The findings have implications for critical nurses working in critical care units in hospitals and for educators and students in training in critical care nursing. No patient or public contribution was included.

Beautifully broken: Implementing a peer support program to help healthcare providers heal

Introduction: This evidence-based project aimed to determine the feasibility of implementing a peer support program to minimize trauma in healthcare professionals (HCP)s following unanticipated adverse events. Based on the forYOU Program designed by Sue Scott at the University of Missouri Health System, this program trained peers to offer real-time caring and support to other clinicians coping with such events. Most healthcare professionals are involved in at least one adverse event in their careers. Albert Wu, MD (2000) coined the term second victim to capture the essence of the trauma experienced by healthcare professionals when an unanticipated event negatively impacts a patient. When left unchecked, this trauma can result in moral distress, stress disorders, and burnout as the clinician ruminates over the event. Providing emotional support has improved second victims' emotional well-being and recovery. Therefore, healthcare leaders are encouraged to develop comprehensive programs to provide easy access to peer and social support when they experience an adverse event.Methods: Designed for implementation in the Women's Service Department of a 350-bed southwestern hospital, this project employed a pre-/post-evaluation of subjective outcomes using an online survey for nurses. A core group of trainers attended a two-day peer support train-the-trainer event hosted by the forYOU Program at the University of Missouri Health Care System. This group trained 26 peer supporters representing the four departments in Women's Services and both shifts. Baseline data was collected (n = 44) to assess the frequency and impact of unanticipated adverse events, the perceived support, and the type of support received. Following the four-month implementation in the Summer/Fall of 2020, post-data was obtained, including a program awareness assessment (n = 17).Results: Pre- and post-implementation of the Peer Support Program, nurses in Women's Services reported adverse events impacting their emotional well-being. Post-program, more nurses reported receiving support (86% post-program versus 43% pre-program). Before employment, 79% of nurses who received support received peer support, versus 86% receiving peer support post-implementation. The implementation occurred during the COVID pandemic, which may have resulted in a decreased post-assessment sample size. However, the peer supporters reported hesitancy in completing encounter forms feeling that providing support was “too personal”. The participants said that they found the peer support program worthwhile.Conclusions: Nurses on the implementation units indicated receiving more support after the peer support program was implemented and felt the program was beneficial. Since unanticipated events are inevitable in health care, the steering committee recommended sustaining and spreading the program to all the nursing departments. More data is needed to determine the full impact of the program.

Delaktighet i forskningsprocessen

Participation in the research process - PAR in a contemporary context.&#x0D; Expectations and demands on coproduction in research have increased. Therefore, there is a need for knowledge on how these coproducing processes where researchers and practitioners work side by side during the research process can be carried out. In this article, methodological questions related to coproduction and collaboration between researchers and practitioners in the field ofsocial work are raised and discussed. The article draws on an on going research project where participatory action research (PAR) is the leading guideline. PAR in a contemporary context is understood as a democratization process, where values such as participation, mutual learning, empowerment, improvement and development of practice are given as much attention as the actual research findings. The research project discussed takes its starting point in Swedish eldercare, investigating situations of moral stress and moral agency. The project is carried out in close cooperation with three municipalities and institutions where future staff for eldercare are trained (social workers and auxiliary nurses). In the article the relations between researchers and practitioners are discussed. Strategies on how to establish cooperation applying a synergistic approach are highlighted. Furthermore, strategies for dissemination or research results are discussed. The article suggests PAR as a specific social work signature methodology, as PAR acknowledges the need for relational work as well as an action-oriented research agenda, well in line with the core values and understanding of social work as a professional practice and academic discipline. In the article, applying PAR in a contemporary context, is understood as a key component when striving for socially robust knowledge; that is, knowledge that is considered relevant and reliable in the eyes of all actors involved, in this case staff in municipal eldercare, as well as in academia.