Nurses’ Experience of the Perception of Nursing Conscience: A Phenomenological Study

Introduction and Statement of the Problem

Nurses are considered the conscience of healthcare systems. They have a positive effect on public health and play a key role in improvement of healthcare systems. They are responsible for fulfilment of the methods that enhance access to safe, high-quality, and competent healthcare.¹ Respecting people’s rights and treating people with regard for their dignity is an inseparable part of healthcare systems.² In nursing, moral topics point to the values that govern the relationship of nurses and patients.³ To direct the relationship and moral acts, a sensitive conscience is needed; thus it is an important item for health-care providers.⁴ Conscience is the foundation of morality and influences private and professional life.⁵ Conscience originates from the living experience and is a part of our daily and professional life.⁶ An interview with nurses showed that when they are asked to narrate the moral challenges in patient care situations, they mostly refer to their conscience. The conscience precludes them from some acts and orders them to do some acts, and they need conscience for assessment of themselves and their acts.⁷ While talking about conscience in guiding specific acts, we should consider that conscience is different among different individuals, and thus the question is how conscience is perceived by healthcare providers. The perception of conscience is related to the qualities and acts of conscience and how the individuals think of the origin of conscience.⁸ Depending on the perception of conscience, some nurses opt out of their job, and some experience long-term moral distress, but some manage these moral stresses. It is necessary to know the viewpoints of nurses on the origin of conscience, the quality and acts of conscience.⁵ Studies show the relationship among perception of conscience, stress of conscience, and burnout in working environment.⁹–¹⁰ In a study on the relationship between burnout and the perception of conscience, it was shown that the way each individual perceives the conscience and deals with it affects which group the individual belongs to, the burnout or non-burnout group.¹¹ In a similar study, with respect to the items related to the ability to express what their conscience tells them, the non-burnout group obtained higher scores than the burnout group.¹² Dahlqvist et al. showed that the perception of conscience was significantly different among the Swedish healthcare staff, and by main component analysis, they found that conscience can be considered the authority and alarm signal that is the required sensitivity for nursing, a perceived asset and burden, and depends on the individual cultural background.⁵ In another study, it was shown that conscience plays a role in the nursing, which affects the patient and his/her relatives. It sometimes directs the acts of nurses toward good values and is thus perceived as a motivation in an attempt to provide high-quality care, and sometimes limits low-quality acts. In an attempt to provide high-quality care, it is necessary to be aware of the effect of conscience on nursing activities.² Thus, the current study was carried out to explain the experience of nurses about conscience.

The economic and social situation has changed and economic and social problems give rise to some problems such as unemployment, low salaries, and growing prices. The differences between different social groups are increasing too. All these problems have an influence on people’s health. Nurses and physicians who are working in primary healthcare are very close to families and their problems. It is difficult for healthcare professionals to act according to their conscience in some care situations, which is why they feel a stress of conscience. Reasons for the higher strain in their job include the times when staff did not have enough time to complete their tasks and worried that their jobs would be affected by organisational changes, overload, problems coping with expectations from the patients and the relatives (Lutzen et al. 2003), and others. According to the Altun (2002), nurses may...