Depth-of-Field Dissimilarity: Making Sense of Moral Distress Within Cultural Complexity

2.50
Hdl Handle:
http://hdl.handle.net/10755/621502
Category:
Full-text
Format:
Text-based Document
Type:
Poster
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Depth-of-Field Dissimilarity: Making Sense of Moral Distress Within Cultural Complexity
Author(s):
Bressler, Toby; Smith, Elizabeth; Hanna, Debra R.
Lead Author STTI Affiliation:
Epsilon Kappa
Author Details:
Toby Bressler, PhD, RN, OCN, Professional Experience: Toby serves as the Vice President for Oncology Nursing at the Mount Sinai Health System. Toby has published and lectures locally and nationally. In addition to her scholarship in nursing education and leadership, her interests in oncology, developing policies related to family-centered care, promotion of palliative care and pediatric palliative care. A member of the education committee for the American Nurses Association, advisory board member for schools of nursing, clinical advisor and mentor for graduate nursing students, and an abstract reviewer for Sigma Theta Tau-Virginia Henderson Library. Nursing is Toby’s second career after a decade in early childhood education. A Fellow of the NY Academy of Medicine and is serving as a Jonas Policy Scholar with the American Academy of Nursing. Author Summary: Toby is the Vice President of Oncology Nursing for the Mount Sinai Health System in New York City, where she leads oncology nursing, and the professional development of nurses and nursing practice through research, education and scholarship. Chair of American Nurses Association education committee, Fellow in the NY Academy of Medicine, and an American Academy of Nursing Jonas Policy Scholar. She has received awards for exemplary leadership, academic excellence, community service.
Abstract:

Background:

Many studies of moral distress have explored nurses’ experience of caring for patients. Acting ethically in accordance with professional nursing practice and in concert with professional values is the core of nursing. Moral distress involves situations in which moral values are challenged (Ferrell, 2006). Moral distress can be related to the nurse's locus of control, his or her ability to protect the patient's wellbeing, close and constant physical presence at the bedside, and other situational variables (Schlutter et al, 2008).

Purpose:

The aim of this study was to explore nurses’ experiences working on a chronic ventilator dependent unit with a predominance of elderly Orthodox Jewish patients at the end of life. Little is known about how cultural complexity creates differences between nurses’ and family’s expectations for patient care at the end of life.

Methods:

A qualitative study of 27 nurses (71% participation rate) using semi-structured focus groups.. Our research team conducted analysis of excerpts from focus groups. Early interviews led to the expansion of the original question to include exploring nurses’ moral distress. Using descriptive, axial coding, the team independently reviewed and coded excerpts from consecutive focus groups, revising the coding scheme and categories based on emerging findings into higher-level themes that describe the experiences described by the participants.

Results:

Content analysis revealed three levels of themes: universal themes (workload, lack of appreciation), themes common to other studies of nurses in end-of-life care (aggressive medical treatment, providing unrealistic hope to patients and families), and unique interconnected themes (significance of teamwork cultural mismatch, nurses’ expectations of their role not being completely met). The main finding was an incongruence of perspectives, described as depth-of-field dissimilarity. Using the photographic term as a metaphor whereby the focus and depth of perspective depends on the person doing the looking. We will provide exemplar quotations to illustrate each of higher-order themes and sub-themes.

Conclusion:

Nurses want to practice in an environment where they feel professional satisfaction and pride in their work. Providing care that conflicts with one’s conscience and ethical values on a frequent basis is unhealthy and contributes to moral distress. Implications of this study are to use the metaphor of depth-of-field dissimilarity to develop educational strategies, clinical interventions, and research to address moral distress and cultural complexity. Nurses need to accept the values of their patients and families, reconciling personal values that may be different and learn to navigate their own web of emotions and build resilience through recognition, support and education. Moral uncertainties and ethical dilemmas are inherent in the practice of nursing. As nurse leaders we need to support our colleagues to develop skills which enhance wellbeing, work together to create organizational strategies to mitigate moral distress, and help nurses grow through their experiences of moral distress.

Keywords:
Cultural Complexity; Organizational and Workforce Issues; palliative and end of life care
Repository Posting Date:
16-Jun-2017
Date of Publication:
16-Jun-2017
Other Identifiers:
INRC17PST71
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship
Note:
Item accepted for presentation at the 2017 International Nursing Research Conference, but not presented at the event.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePosteren
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleDepth-of-Field Dissimilarity: Making Sense of Moral Distress Within Cultural Complexityen_US
dc.contributor.authorBressler, Tobyen
dc.contributor.authorSmith, Elizabethen
dc.contributor.authorHanna, Debra R.en
dc.contributor.departmentEpsilon Kappaen
dc.author.detailsToby Bressler, PhD, RN, OCN, Professional Experience: Toby serves as the Vice President for Oncology Nursing at the Mount Sinai Health System. Toby has published and lectures locally and nationally. In addition to her scholarship in nursing education and leadership, her interests in oncology, developing policies related to family-centered care, promotion of palliative care and pediatric palliative care. A member of the education committee for the American Nurses Association, advisory board member for schools of nursing, clinical advisor and mentor for graduate nursing students, and an abstract reviewer for Sigma Theta Tau-Virginia Henderson Library. Nursing is Toby’s second career after a decade in early childhood education. A Fellow of the NY Academy of Medicine and is serving as a Jonas Policy Scholar with the American Academy of Nursing. Author Summary: Toby is the Vice President of Oncology Nursing for the Mount Sinai Health System in New York City, where she leads oncology nursing, and the professional development of nurses and nursing practice through research, education and scholarship. Chair of American Nurses Association education committee, Fellow in the NY Academy of Medicine, and an American Academy of Nursing Jonas Policy Scholar. She has received awards for exemplary leadership, academic excellence, community service.en
dc.identifier.urihttp://hdl.handle.net/10755/621502-
dc.description.abstract<p><strong>Background:</strong></p> <p>Many studies of moral distress have explored nurses’ experience of caring for patients. Acting ethically in accordance with professional nursing practice and in concert with professional values is the core of nursing. Moral distress involves situations in which moral values are challenged (Ferrell, 2006). Moral distress can be related to the nurse's locus of control, his or her ability to protect the patient's wellbeing, close and constant physical presence at the bedside, and other situational variables (Schlutter et al, 2008).</p> <p><strong><strong>Purpose</strong>:</strong></p> <p>The aim of this study was to explore nurses’ experiences working on a chronic ventilator dependent unit with a predominance of elderly Orthodox Jewish patients at the end of life. Little is known about how cultural complexity creates differences between nurses’ and family’s expectations for patient care at the end of life.</p> <p><strong>Methods:</strong></p> <p><strong></strong>A qualitative study of 27 nurses (71% participation rate) using semi-structured focus groups.. Our research team conducted analysis of excerpts from focus groups. Early interviews led to the expansion of the original question to include exploring nurses’ moral distress. Using descriptive, axial coding, the team independently reviewed and coded excerpts from consecutive focus groups, revising the coding scheme and categories based on emerging findings into higher-level themes that describe the experiences described by the participants.</p> <p><strong>Results:</strong></p> <p>Content analysis revealed three levels of themes: universal themes (workload, lack of appreciation), themes common to other studies of nurses in end-of-life care (aggressive medical treatment, providing unrealistic hope to patients and families), and unique interconnected themes (significance of teamwork cultural mismatch, nurses’ expectations of their role not being completely met). The main finding was an incongruence of perspectives, described as depth-of-field dissimilarity. Using the photographic term as a metaphor whereby the focus and depth of perspective depends on the person doing the looking. We will provide exemplar quotations to illustrate each of higher-order themes and sub-themes.</p> <p><strong><strong>Conclusion</strong>:</strong></p> <p>Nurses want to practice in an environment where they feel professional satisfaction and pride in their work. Providing care that conflicts with one’s conscience and ethical values on a frequent basis is unhealthy and contributes to moral distress.<strong> </strong>Implications of this study are to use the metaphor of depth-of-field dissimilarity to develop educational strategies, clinical interventions, and research to address moral distress and cultural complexity.<strong> </strong>Nurses need to accept the values of their patients and families, reconciling personal values that may be different and learn to navigate their own web of emotions and build resilience through recognition, support and education. Moral uncertainties and ethical dilemmas are inherent in the practice of nursing. As nurse leaders we need to support our colleagues to develop skills which enhance wellbeing, work together to create organizational strategies to mitigate moral distress, and help nurses grow through their experiences of moral distress.</p>en
dc.subjectCultural Complexityen
dc.subjectOrganizational and Workforce Issuesen
dc.subjectpalliative and end of life careen
dc.date.available2017-06-16T14:21:37Z-
dc.date.issued2017-06-16-
dc.date.accessioned2017-06-16T14:21:37Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
dc.description.noteItem accepted for presentation at the 2017 International Nursing Research Conference, but not presented at the event.-
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