Ericson-Lidman Eva, Strandberg Gunilla
Department of Nursing, Umeå University, Umeå, Sweden.
Scand J Caring Sci. 2015 Jun;29(2):215-24. doi: 10.1111/scs.12152. Epub 2014 May 28.
Conscience can be perceived as an asset that helps care providers to provide good care, but it can also be a burden that generates stress of conscience (stress related to a troubled conscience). Participatory action research (PAR) has been shown to be successful in supporting care providers in residential care of older people to learn to deal with their troubled conscience in challenging and demanding care situations. The aim of the study was to describe an intervention process to assist care providers in residential care of older people to constructively deal with their troubled conscience related to perceptions of deficient teamwork. The study design was grounded in PAR. Nine enrolled nurses (ENs), two nursing aids (NAs), one Registered Nurse (RN) and their manager participated in 12 PAR sessions. All sessions were tape-recorded, and a domain analysis of the transcriptions was performed. Findings show that a PAR-based intervention can support care providers to understand, handle and take measures against deficient teamwork. Using troubled conscience as a driving force can increase the opportunities to improve quality of care in residential care for older people. During the PAR process, participants raised their awareness of the need to view the team in a wider sense and that the manager and the Registered Nurse should also be members of the team to improve team outcome. To improve clinical practice, we suggest that teams in residential care of older people should be enabled to share and reflect on challenging situations that generate troubled conscience. However, as shown in this study, care providers might need support in order to facilitate and promote sharing and reflecting on what their conscience tells them.
良知可以被视为一种有助于护理人员提供优质护理的资产，但它也可能成为一种负担，产生良心压力（与良心困扰相关的压力）。参与式行动研究（PAR）已被证明在支持老年护理机构的护理人员学会在具有挑战性和高要求的护理情境中应对良心困扰方面是成功的。本研究的目的是描述一个干预过程，以协助老年护理机构的护理人员建设性地应对与团队协作不足认知相关的良心困扰。该研究设计基于参与式行动研究。九名注册护士（ENs）、两名护理助理（NAs）、一名注册护士（RN）及其经理参加了12次参与式行动研究会议。所有会议均进行了录音，并对转录内容进行了领域分析。研究结果表明，基于参与式行动研究的干预可以支持护理人员理解、处理并针对团队协作不足采取措施。将良心困扰作为驱动力可以增加改善老年护理机构护理质量的机会。在参与式行动研究过程中，参与者提高了他们对从更广泛意义上看待团队的必要性的认识，以及经理和注册护士也应成为团队成员以改善团队成果的认识。为了改善临床实践，我们建议老年护理机构的团队应能够分享和反思产生良心困扰的具有挑战性的情况。然而，正如本研究所示，护理人员可能需要支持，以便促进和推动分享以及反思他们的良心所告诉他们的内容。
