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


The participants were drawn from two departments at a university hospital in Sweden. The physician in charge gave permission for the study to be performed. The project leader (the fourth author) informed the nurse manager of each department about the study and the procedure of data collection. All 21 nurses working the day shift received a letter with information about the study. The nurse manager informed them about the study orally and asked whether the nurses would be willing to participate in the study. In the written and oral information that preceded the data collection, it was clearly stated that participation was voluntary and confidentiality was assured. Participation in this study was based on informed consent and conducted in accordance with the Swedish act concerning the ethical review of research involving humans (Swedish Code of Statutes, 2003), the ethical principles for medical research involving human subjects (World Medical Association, 2004), and the ethical rules and guidelines established by the Swedish Council for Research in the Humanities and Social Sciences (2007). Completion of the interview was viewed as consent. Participation or refusal to participate was not linked to the individual nurses' jobs or performance reviews. Of the 21 nurses who were asked to participate, only one did not want to because of a lack of time for an interview. One nurse who mainly worked night shifts but had many years' experience of working day shifts was then invited to participate and was included in the study. Ultimately, 21 nurses participated in the study. Descriptive data on the study group are shown in Table 1.

The interviews were performed over a 3-week period. They were carried out as conversations based on an interview guide that included some general questions as well as individualized follow-up questions. The interview guide consisted of the following general questions:

  • What upsets you at work?

  • When do you feel displeasure at work?

  • What situations at work make you sad after a working day?

  • Do you experience ethical issues/dilemmas in your work? If yes, can you give an example of a situation where one of these issues/dilemmas appeared?

  • If yes on the latter question, how did you try to cope with this situation?

  • How do you perceive the quality of nursing on your unit?

  • Do you experience a discrepancy between the actual quality of nursing on your unit and the desirable quality?

  • If yes on the latter question, how do you try to cope with this discrepancy?

  • What in the working environment is an obstacle to resolving ethical issues/dilemmas at your work?

Follow-up questions were asked, their scope and number depending on how precisely and fully the person had answered the general questions. The interviews lasted 45-80 minutes and were audiorecorded. They were transcribed verbatim by an experienced secretary.

The interviews were subjected to qualitative latent content analysis, whereby the underlying meaning of the text was interpreted (Downe-Wamboldt, 1992; Graneheim & Lundman, 2004). The analysis had an inductive approach. At first, the interviews were listened to and read through several times to obtain a sense of the whole. Then each interview was divided into meaning units, for example, sentences or paragraphs that related to the same central meaning (Graneheim & Lundman, 2004). In the next step, the meaning units were condensed so that the essential content was clear. The condensed meaning units were abstracted and labeled with codes, and from these codes, subthemes and preliminary themes were generated. The meaning units, codes, subthemes, and preliminary themes were sorted using the framework of content areas (Graneheim & Lundman), which had been developed on the basis of the interview questions. Thereafter, the interpretation of the underlying meaning or latent content of the codes, subthemes, and preliminary themes led to the formulation of themes within each content area. The analysis was discussed at several meetings with the researchers (the first author and CJ) who did the original analysis. The trustworthiness of the results was further guaranteed by critical scrutiny of the analyses by the two other authors experienced in qualitative research (the third and fourth authors). This resulted in a few refinements of codes, subthemes, and themes.


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