Molinaro Monica L, Polzer Jessica, Rudman Debbie Laliberte, Savundranayagam Marie
Health and Rehabilitation Sciences Graduate Program, The University of Western Ontario, 1151 Richmond Street, London, ON N6G 2V4, Canada; Department of Family Medicine, McMaster University, David Braley Health Sciences Centre 100 Main Street West, Hamilton, ON L8P 1H6, Canada.
Department of Gender, Sexuality & Women's Studies, The University of Western Ontario, 1151 Richmond Street London, ON N6A 5B8, Canada; School of Health Studies, The University of Western Ontario, 1151 Huron Drive, London, ON N6A 2K5, Canada.
Soc Sci Med. 2023 Mar;320:115677. doi: 10.1016/j.socscimed.2023.115677. Epub 2023 Jan 14.
As a term used in nursing and other health professions to describe when one is prevented by institutional constraints from pursuing the right course of action, moral distress has gained traction to examine the effects of restructuring on health and social care providers. Using a critical narrative methodology, this paper presents the counter-stories of nine pediatric oncology nurses in Ontario, Canada, whose stories illustrate the embeddedness of their caregiving and moral distress within institutional contexts that leave them stretched thin amongst multiple caregiving and administrative demands, and that limit their capacities to be the nurses they want to be. Informed by feminist philosophical theorizations of moral distress, we elucidate how the nurses' counter-stories: (i) re-locate the sources of their moral distress within institutional constraints that fracture their moral identities and moral relationships, and (ii) dis-locate dominant narratives of technological cure by ascribing value and meaning to the relational care through which they sustain moral responsibilities with patients and their families. By making visible the relational care that they find meaningful and that brings them in proximity to patients and families, these counter-stories assist nurses in restoring their damaged moral identities. This study demonstrates the power of identifying and mobilizing counter-stories in tracing and critically examining the conditions that structure nurses' experiences of moral distress. The findings add theoretical and empirical depth to contemporary understandings of moral distress and complement ongoing public discussion of burnout among nurses and other health care workers during the COVID-19 pandemic. These counter-narratives may act as resources for resistance among nurses, help to reduce the distance between management and health care workers, and catalyze changes in policy and practice so that nurses, and the full scope of their caregiving, are valued.
作为护理及其他健康专业领域中使用的一个术语，用以描述当一个人因制度性限制而无法采取正确行动时的情况，道德困扰已越来越受到关注，用以审视医疗体系重组对医护人员的影响。本文采用批判性叙事方法，呈现了加拿大安大略省九名儿科肿瘤护士的反叙事故事，这些故事表明，她们的护理工作和道德困扰深植于制度环境之中，使得她们在多重护理和行政要求下疲于应对，限制了她们成为理想中护士的能力。基于女性主义对道德困扰的哲学理论阐释，我们阐明了护士的反叙事故事如何：（i）将她们道德困扰的根源重新定位在那些破坏她们道德身份和道德关系的制度性限制之中；（ii）通过赋予她们与患者及其家属维持道德责任的关系性护理以价值和意义，从而打破关于技术治疗的主导叙事。通过展现她们认为有意义且能拉近与患者和家属距离的关系性护理，这些反叙事故事有助于护士修复受损的道德身份。本研究展示了识别和运用反叙事故事在追溯和批判性审视构建护士道德困扰体验的条件方面的力量。这些发现为当代对道德困扰的理解增添了理论和实证深度，并补充了在新冠疫情期间护士及其他医护人员职业倦怠问题的持续公开讨论。这些反叙事故事可能成为护士进行抗争的资源，有助于缩小管理层与医护人员之间的距离，并促使政策和实践发生改变，从而使护士及其全方位的护理工作得到重视。
