Losing passion and injured self-image: An interpretive description study of troubled conscience among registered nurses caring for older people with delirium in hospital

Abstract:-

Background: Nurses caring for older people with delirium in hospitals often report stressful situations that trouble their conscience and threaten their wellbeing in the workplace. These situations are yet to be explored to gain a deeper understanding of troubled conscience when nurses are involved in care below expected professional standards or their personal values.

Aim: The purpose of this Interpretive Descriptive study was to explore the troubled conscience amongst nurses caring for older people with delirium in hospital. Method: The study was conducted at a regional health service with 250 acute in-patient hospital beds in Victoria, Australia. Using Thorne's (2016) approach to Interpretative Description (ID) allowed the results to be authentic and applicable to the nursing profession. To extend the understanding of the data, thematic networks were generated.

Findings: The global theme that illuminated troubled conscience was ‘losing passion and injured self-image.’ The nurses were losing passion and had their self-image compromised because they struggled to hold congruence between their ideal self and their actual self in their workplace. The organising themes were an inability to execute care to personal satisfaction, being incapacitated and constrained by the workplace environment, being involved in negligent care and misconduct, feeling powerless and hopeless and seeking fulfilment and contentment.

Conclusion: Re-conceiving the meaning of humane caring in nursing, empowering nurses’ voices, avoiding perceived negligent care and misconduct, as well as practising self-care through debriefing and physical exercise potentially reduces troubled conscience. This study is a step towards greater understanding of the phenomenon and interventions to support nurses’ passion, self-image, and integrity in their workplaces.