Workplace Distress and Ethical Dilemmas in Neuroscience Nursing

Marit Silén; Ping Fen Tang; Barbro Wadensten; Gerd Ahlström


J Neurosci Nurs. 2008;40(4):222-231. 

In This Article

Abstract and Introduction

This study concerns Swedish nurses' experiences of workplace stress and the occurrence of ethical dilemmas in a neurological setting. Qualitative interviews were conducted with 21 nurses. The interview results were subjected to qualitative latent content analysis and sorted into 4 content areas: workplace distress, ethical dilemmas, managing distress and ethical dilemmas, and quality of nursing. Common workplace stressors were high workload and lack of influence. These were perceived to have negative consequences for the quality of nursing. Ethical dilemmas mainly concerned decision making on initiation or withdrawal of treatment, which was experienced as a troublesome situation where conflicts could arise. The nurses managed the distress and ethical dilemmas by accepting and adjusting to the situation and seeking support from colleagues. They also endeavored to gain new strength in their private lives.

Neuroscience nurses, like other nurses, work in healthcare systems that undergo continual change. In Sweden, the changes in the healthcare system during the past 10 years have led to a greater demand for healthcare services, new discoveries in medicine, and greater demands by better-informed patients and families (Forsberg, 2001). All this contributes to ethical dilemmas and workplace stress, which have increased during recent decades and had a greater impact on nurses (McVicar, 2003). In a review by McVicar, six sources of workplace distress for nurses were identified: workload, relationship with other clinical staff, leadership and management issues, emotional demands of caring, shift working, and lack of reward. Nurses working in different areas of practice reported similar stress levels, but they ranked the stressors differently (McVicar). The workplace stressors are the same from one country to another, according to a cross-cultural study of workplace stressors. The highest-ranked stressors in the countries compared in the study were workload and dealing with death and dying (Lambert et al., 2004). Constant changes in the organizations where nurses work and in job designs also added to workplace stress (Clegg, 2001). Closely related to the concept of workplace stress is role stress, which is the result of unfulfilled role expectations. Factors contributing to role stress include lack of control over the work situation; shortage of resources; concern for the quality of nursing; and lack of cooperation among patients, families, and staff members (Chang, Hancock, Johnson, Daly, & Jackson, 2005).

Ethical dilemmas in nursing have been related to lack of resources such as staff and time, conflicts of interest involving professional hierarchies (Kälvemark, Höglund, Hansson, Westerholm, & Arnetz, 2004), difficulties with regard to preserving patients' integrity (Kälvemark et al.; van der Arend & Remmers-van den Hurk, 1999), and situations where patients are given, or are at risk of being given, unnecessary treatment (Raines, 2000). The research on workplace or role stress and ethical dilemmas has investigated different healthcare settings, but no study has been found that explicitly deals with the stress and dilemmas experienced by nurses working in a neurological setting. Neuroscience nurses care for patients with severe neurological conditions involving a complex mix of sensorimotor, cognitive, and emotional impairments (Banich, 2004; Hickey, 2003). These illnesses have a great impact on patients' lives and the lives of their families. This means that neuroscience nurses must be proficient in handling life-threatening situations, rehabilitation, and long-term palliative care. A limited number of studies examining Swedish nurses' experiences of workplace stress and ethical dilemmas have been carried out (Cronqvist, Lützén, & Nyström, 2006; Cronqvist, Theorell, Burns, & Lützén, 2001, 2004; Hertting, Nilsson, Theorell, & Larsson, 2004; Kälvemark et al.; Olofsson, Bengtsson, & Brink, 2003; Sporrong, Höglund, & Arnetz, 2006), but none of them has dealt with the experiences of nurses working with neurology patients. The aim of this study was therefore to describe Swedish nurses' experiences of workplace stress and the occurrence of ethical dilemmas in a neurological setting.


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