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Abstract
In elderly care registered nurses (RNs) and nurse assistants (NAs) face ethical challenges
which may trouble their conscience.
This study aimed to illuminate meanings of RNs' and NAs' lived experience of troubled
conscience in their work in municipal residential elderly care.
Interviews with six RNs and six NAs were interpreted separately using a phenomenological
hermeneutic method.
Data was collected in 2005 among RNs and NAs working in special types of housings
for the elderly in a municipality in Sweden.
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.
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.
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.