| 1. |
- Amsberg, Susanne
(författare)
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Health Promotion in Diabetes Care : Studies on Adult Type 1 Diabetes Patients
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: A landmark report has shown that improving glycaemic control among type 1 diabetes patients markedly reduces diabetes-related complications. In clinical practice, however, many patients have problems in adhering to the treatment, and thus remain in poor glycaemic control. Research suggests a more behaviour-oriented approach to diabetes, but there is a lack of evidence on the efficacy of interventions, especially for those adult type 1 diabetes patients who are in poor glycaemic control. Diabetes-related distress has been associated with poor adherence to treatment and poor glycaemic control. There is a need for validated measures in this area, to identify patients who experience diabetes-related distress. Additionally, injection technique is crucial for the management of diabetes, and lipohypertrophy is a common side effect which deserves further attention.Objectives: The overall aim of this thesis was to evaluate a behavioural medicine intervention among poorly controlled adult type 1 diabetes patients, and to gain a deeper knowledge in an area of diabetes self-management.Methods: Quantitative design was used for the studies, and the clinical settings comprised two diabetes care units in Stockholm, Sweden. Study I: The Swedish version of the Problem Areas in Diabetes (Swe-PAID-20) scale was evaluated regarding its psychometric properties by type 1 diabetes patients, as well as by an expert panel of diabetes specialist nurses. Study II: A behavioural medicine intervention based on Cognitive Behaviour Therapy (CBT) was evaluated in a randomised controlled trial among poorly controlled adult type 1 diabetes patients. Study III: Using the same sample as in study II, descriptive statistics were produced, and predictive and comparative analyses performed, in order to find predictors of or associations with improvements in glycaemic control as a response to the intervention. Study IV: In a randomised crossover trial insulin absorption in lipohypertrophic injection sites was investigated in type 1 diabetes patients.Results and conclusions: Study I: A three-factor solution of the scale was found, comprising sub-dimensions of diabetes-related emotional problems, treatment-related problems and support-related problems. Cronbach’s alpha for the total score was 0.94 and varied between 0.61 and 0.94 in the three subscales. The findings also supported the convergent and content validity. The Swe-PAID-20 seems to be a reliable and valid outcome for measuring diabetes-related distress in type 1 diabetes patients. Study II: Significant differences were observed with respect to HbA1c, well-being, diabetes-related distress, frequency of blood glucose testing, fear of hypoglycaemia, perceived stress, and depression, all of which improved more in the intervention group compared with the control group. The CBT based behavioural medicine intervention appears to be a promising approach to diabetes self-management. Study III: The participation rate in the study was 41% and attrition was 24%. Of those patients who actually participated in the intervention, 13% withdrew. From the regression models no predictors or associations were found with regard to improvement in HbA1c. The programme proved to be feasible in terms of design and methods. However, no clear pattern was found regarding predictors of or associations with improved metabolic control. Study IV: Impairment of insulin absorption from lipohypertrophic injection sites was also found with analogue insulins. It is suggested that patients should be advised to refrain from injecting insulin aspart into lipohypertrophic subcutaneous tissue.
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| 2. |
- Andersen, Rebecka
(författare)
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I kvinnornas värld : Omsorg och tvång på uppfostringsanstalten Viebäckhemmen 1905–1947
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- At the beginning of the 20th century, a range of new laws concerning children and- youths in Sweden were enacted. An effect of the laws was that 15 to 18-year-oldboys and girls facing prosecution could get their sentences transformed into time spent at a reformatory. However, while the state established public reformatories for boys, girls were sent to Viebäckhemmen, a reformatory that was run by a religious organization; the Swedish Deaconess Institute. Given that the state organized different solutions for boys and girls during this period, the aim of this thesis is in part to analyze how gender impacted social policy. Theories on the private and public are used as a theoretical framework, as well as theories on how gender impacts the social contract and how the social contract impacts gendernotions. By incorporating the history of early social work in the field of civil society research, as well as adding a gender perspective, the thesis discusses how and why the logics within civil society were considered more suitable for the upbringing and re-education of girls. The study draws from a wide range of sources. Government documents and correspondence between the state and the organization provide a timeline for the reformatory, while other archival materials such as internal documents, court records, journals, and letters provide an insight into the daily life at Viebäckhemmen. The first part of the thesis focuses on the relationship and negotiations between state and organization, while the second part focuses on the women that populated the institution, where the concept of“caring power” is used to describe the relationship between girls and deaconesses.
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| 3. |
- Backman, Ellen, MSc, 1981-
(författare)
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Ordinary mealtimes under extraordinary circumstances : Routines and rituals of nutrition, feeding and eating in children with a gastrostomy and their families
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis is to explore routines and rituals related to feeding, eating, and mealtimes in families that have a child with a gastrostomy tube (G-tube), from the perspectives of healthcare professionals, the children, and their parents. The thesis is based on four empirical studies. Study I is a longitudinal, quantitative study with the aim to describe children with developmental or acquired disorders receiving a G-tube, and to compare characteristics, contacts with healthcare professionals, and longitudinal eating outcomes. Findings from Study I demonstrated that children with developmental disorders needed G-tube feeding for longer than children with acquired disorders. Children with developmental disorders were also younger at G-tube placement, and had more multidisciplinary healthcare. These findings led to the subsequent studies focused specifically on children with developmental disorders. Study II applies mixed methods and explores everyday life, health care, and intervention goals during the first year following G-tube placement through the documentation in medical records. In Studies III and IV, the experiences of family mealtimes for children with a G-tube and their parents are collected through individual interviews that are analysed qualitatively. Triangulation of methods, participants, researchers, and data across the four studies is applied to search for confirmation between findings, as well as to identify areas of discrepancy. Ecocultural theory, the WHO framework ICF, and the concept of participation form the conceptual framework of the thesis. Taken together, findings from the studies describe how the main experiences of feeding, eating, and mealtime relate to specific impairments of the child, the collective value attached to family mealtimes, and the parental responsibility to harmonise competing interests and conflicts among family members and/or healthcare professionals. This thesis extends previous research by focusing on the ecocultural context of the child in combination with a dimensional understanding of health. The findings shed light on measures taken by the families themselves to adjust to and handle their daily lives, as well as spell out areas where more support is needed. Furthermore, this thesis suggests that an expanded focus on children’s participation in everyday mealtimes, and in the healthcare follow-up of G-tube feeding, is important in enhancing intervention outcomes.
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| 4. |
- Bos (Sparén), Elisabeth, 1958-
(författare)
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A good learning environment for nursing students in primary health care
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Clinical learning is a key part for developing nursingursing education. Previous studies concentrated on hospitals as placement sites. Research results reported in this dissertation identify factors that encourage good learning environments in primary health care (PHC) placements.Aims and methods: The overall aim of the present research was to identify factors that promote good clinical learning environments in PHC settings. Clinical learning environment was investigated from students 'and supervisors' perspectives and their perceptions of the clinical part of nursing education in PHC settings. The present research implemented three quantitative studies (I, II, III) and one qualitative study (IV). In study I investigated district nurses’ (DNs’) student supervision experiences in PHC units before and after implementation of a new supervision model; 98 of 133 DNs (74%) responded to a questionnaire before and 84 (65%) respondes after implementation. In study II validated the Clinical Learning Environment, Supervision, and Nurse Teacher (CLES+T) scale. In study III investigated students’ motivation, total satisfaction, and experience of professional role models associated with dimensions in clinical learning environments. In studies II and III collected data from undergraduate nursing students (n=356) using the CLES+T scale. In study IV interviewed six focus groups with 24 supervisors (DNs); these data provided understanding of student supervision in PHC units.Results: Study I revealed significant need for a new supervision model in PHC units. Supervisors had difficulties staying updated on changes in nursing curricula and experienced insufficient support from universities. They felt that they had to set aside time from their regular duties and get permission from unit managers to supervise students. The supervisors felt confident in the supervisory role, but few had formal educational and academic credentials. After the new supervision model implementation, several supervisors were more satisfied with the supervision organization. The model implementation resulted in improvements within PHC units. Study II confirmed good internal reliability in the CLES+T scale and demonstrated that the five-factor model within the scale is the best-fit model. Supervisory relationship was the most important factor and it strongly correlated with these factors: (i) pedagogical atmosphere and (ii) premises of nursing. Supervisory relationship was moderately correlated with the role of the nurse teacher, and leadership style correlated with PHC units. Study III revealed a statistically significant association between (i) students’ motivation, total satisfaction, and experiences of professional role models and (ii) five dimensions of clinical learning environments. The satisfaction factor had a statistically significant association (effect size was high) with the dimensions; this clearly indicated that students experienced satisfaction. Supervisory relationship and pedagogical atmosphere particularly influenced students’ satisfaction and motivation. Study IV revealed three themes related to supervisors’ experiences during student supervision in PHC units: abandonment, ambivalence, and sharing the holistic approach. Supervisors felt abandoned by their managers, colleagues, and nurse teachers rom universities. They were proud to be DNs and willing to share experiences with students – yet torn between being students’ supervisors and patients’ nurses.Conclusion: This dissertation reports six main factors for good learning environments in PHC units. Supervisors must be prepared and engaged, and students must be motivated. A close, reflective supervisory relationship is one of the most important factors for learning in PHC units. Successful supervision requires clear structure and organization. Adequate support and resources from PHC units are needed for supervisors. Collaboration and liaison between universities and PHC units are needed to link theoretical and practical parts of nurse education. PHC-unit circumstances contribute to holistic nursing care, which is an important factor for student learning. Furthermore, the CLES+T scale was shown to be a reliable tool to use for evaluating PHC settings as clinical learning environment.
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| 5. |
- Bullington, Jennifer, 1957-
(författare)
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The Mysterious Life of the Body : A New look at Psychosomatics
- 1999
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this study is to critically examine traditional psychosomatic theories, paying special attention to certain philosophical issues such as the mind-body problem and efficacious mechanisms of interaction between meaning, understood as psychosocial factors, and that which is traditionally called "body" (the material, objectified body). Afterwards, an alternative psychosomatic theory is worked out, drawing inspiration from the phenomenology of Maurice Merleau-Ponty. The first part of the dissertation examines the following schools of thought (orientations) concerning psychosomatic theory: 1) psychodynamic theory, 2) psychosomatic medicine, 3) stress theory as well as neuroimmunology and neuroendocrinology, and 4) the work of the psychobiologist Herbert Weiner. The phenomenological alternative worked out in part II of the dissertation breaks up dualistic and materialistic-reductionistic thinking by starting with the "lived body" rather than the objective body studied by natural science. The question then becomes, how is the mind-body unity lived, and what categories of understanding open up when the person-world field becomes the focus for psychosomatic theory.
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| 6. |
- Börjeson, Martin, 1959-
(författare)
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"Vi vet inte vilka metoder vi ska använda" : om relationen mellan kunskap, praktik och politik när det gäller det sociala arbetet med hemlöshetsfrågor
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation examines the relationship between knowledge, practice and policy within a specific area of social work, namely, social intervention to ameliorate the problem of homelessness. In the thesis, the ambition shown in recent years to lay the ground for an evidence-based practice in social work is discussed as an expression of late modern attempts to deal with the contradictory character of scientific knowledge.The work is composed of four separate studies along with an introduction. The first study considers the present state of knowledge concerning those groups readily described as “the most vulnerable” in that they often have a diffi¬cult complex of problems. The social conditions of these groups can only be examined to a limited extent with the help of traditional methods, however, so that our knowledge of their situation is poor. The group of the homeless seems largely to have remained unchanged during the most recent decade; but results of various studies suggest that the vul¬nerability of the group has increased, which is to say that even if the group has not increased in size, their social situa¬tion has definitely become worse.In the second study, a more in-depth discussion is advanced of methods and definitions concerning the charting of groups with a weak position in the housing market. Starting from a review of the various research methods presently in use, a model is sketched for future investigations that might more adequately provide the evidence-based information for making informed decisions.The third and fourth studies deal above all with the effectiveness of social interventions being made to come to grips with homelessness; how these strategies have evolved and the role of knowledge in them. The goal of the third study has therefore been to describe how knowledge and social work practice have developed respectively, and above all, to shed some light on their relationship. A review of social work journals dated 1965-2000 shows that only a very few of the relatively small number of articles dealing with homelessness could in any way directly form a basis for the planning and implementation of social interventions. In Stockholm Municipality, also during this period, several special programs were instigated to boost the development of knowledge in the field; but the connections between this accu¬mulation of knowledge and any implementation in actual social interventions remains unclear.The fourth study uses interview material to describe the social work being carried out to combat homelessness in four Swedish local government districts and to discuss any differences between them, where a clear difference did emerge between the larger and the smaller districts. The larger local governments had created special organisations for work with homelessness issues, which had even brought with it the allocation of special resources for the build-up of knowledge; but not even here is it possible to state that any cumulative build-up of knowledge has taken place. An in-depth case study of the discussion carried out in Stockholm Municipality concerning a proposal to create a special knowledge centre suggests that these questions are also deeply influenced by the local political context in which it would be used.In the introductory section of the dissertation, the aim is to relate the four studies to a broader discussion. The vari¬ous strategies being developed for increasing the evidence basis for social work with the homeless are discussed, taking a point of departure in Ulrich Beck’s contention that in spite of contrary intentions, more knowledge tends to involve the risk of added uncertainty. Also treated in this context is how an earlier dominant tradition of knowledge – inspired by social medicine – has come to diminish in importance, while another – more directed towards the results and effects of social interventions – has grown.
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| 7. |
- Carlander (Goliath), Ida, 1968-
(författare)
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Me-ness and we-ness in a modified everyday life close to death at home
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overarching aim of this thesis was to describe how family members experienced everyday life with life-threatening illness close to death, with focus on self-image and identity. The thesis comprises four papers, each with a specific aim to illuminate various aspects of the phenomenon under study. The study population consisted of 29 participants; ten family caregivers and five families, including five patients with life threatening illness and their family members. Data were based on retrospective single interviews (paper I), prospective individual, couple and group interviews with the families over six to eighteen month (papers II-III). Interpretive description approach (papers I, II, IV), narrative method (paper III) and secondary analysis (paper IV) were used to analyze data. The findings show how living close to death influences everyday life at home, at several levels (papers I-IV). From the perspective of the dying person, narrations of daily situations was described by four themes related to identity and everyday life; inside and outside of me, searching for togetherness, my place in space and my death and my time. The changing body, pain, fatigue, decreased physical capacity and changed appearance, appeared to influence the dying person’s need for altered knowledge and community, and as a result the patterns of interaction within the families changed. The strive for knowledge and community took place at home, an arena for identity work and the conscious search for meaning, knowledge and community; it was limited by time and inevitable death (paper III). For the family member, life close to death can mean sharing life with a changing person in a changing relationship (paper II). It may mean that everyday life needs to be modified in order for it to work (papers I-IV). New patterns of dependence and an asymmetrical relationship affect all involved (papers III-IV). Daily life close to death is about finding the space to promote the individual self-image, me-ness, at the same time as finding new ways of being a family; we-ness (paper II). Regardless of being the ill person or not, the family members we interviewed had to face impending death, which challenged earlier ways of living together (papers I-IV). From the perspective of the relatives, the everyday life of caring for the dying family member was characterized by challenged ideals, stretched limits and interdependency (paper I). Situations that challenged the caregivers’ self-image were connected to intimacy, decreasing personal space and experiences such as “forbidden thoughts”. The findings suggest that the bodily changes were of importance for the self-image, and that the former approach to the own body was important in the process of experiencing the body. The person living close to death was in transition to something new; being dead in the near future. One way of handling the struggles of everyday life was to seek togetherness, strive to find other persons with similar experiences while sharing thoughts and feelings. Togetherness was sought within the family, in the health care system and on the internet; a sense of togetherness was also sought with those who had already died. The other family members were also in transition as the future meant living on without the ill family member and changing their status to for example being a widow or being motherless. Identity work close to death denotes creating an access ramp into something new; a transition into the unknown. From a clinical perspective, this study emphasizes the significance of creating a climate that allows caregivers to express thoughts and feelings.
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| 8. |
- Christiansson, Elisabeth
(författare)
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Kyrklig och social reform : motiveringar till diakoni 1845-1965
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The main purpose of this dissertation is to see how proponents of diaconia justified the establishment of three Swedish diaconal institutions: Diaconissanstalten 1851 (The Institution for Deaconesses, Stockholm, now Ersta diakonissällskap/Ersta Association for Diaconal Work), Stockholms Stadsmission 1853 (The Stockholm City Mission) and Svenska Diakonanstalten 1898 (The Swedish institution for Deacons, first in Gävle, from 1905 in Stockholm, now Stiftelsen Stora Sköndal/The Stora Sköndal Foundation). Included is also a study of how diaconal work was justified in Sweden in the post-war period, a time when religious neutrality within health care and education was high on the political agenda. An additional purpose is to discuss how these justifications are related to the modern discourse of social work. The primary source material consists of journals that voiced the opinions of the aforementioned diaconal institutions, Parliamentary records and newspaper articles. This material is culled for justificatory arguments. The set of justifications found in each setting is discussed from three angles: theology, ideology and gender roles. The dissertation shows that justifications for diaconal institutions have varied over time, but that all the initiatives have reformism in common. Diaconal institutions are vindicated as projects for social and ecclesial improvement and not merely as instruments for the material or spiritual well-being of individuals. This reformist stance contrasts with how responsibility for one's neighbour was justified in pre-industrial Sweden: as a duty performed within a static society. Reformism in diaconia is in this dissertation looked upon as an early example of modernisation. The justifications of diaconal work found in the source material are the following. In the 1850s diaconal work was justified theologically as a means of revival and evangelism. The ideological stance of its proponents was social conservative. Female diaconia was propagated because women were regarded as particularly apt for nursing and caring. Around the year 1900 diaconal work was mainly a question of reinforcing the Church of Sweden as the spiritual and moral foundation of Swedish society. Ideologically, diaconia (both male and female) was still social conservative. The justification of male diaconia was that supposedly male characteristics could be made useful in a lay ministry at the service of the Church of Sweden. In post-war Sweden the basis for justifications shifted to social liberalism and a theology of stewardship.
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| 9. |
- Cronqvist, Agneta, 1953-
(författare)
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The moral enterprise in intensive care nursing
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aims of this thesis were to explore nurses' experiences of stress in the ICU (I), to analyze experiences of moral concerns in intensive care nursing from the perspective of relational ethics (II), to describe the synthesis of the concept of moral stress and to identify preconditions for moral stress (III) and to analyse and describe lived experiences of support in situations characterized by critical care situations and moral stress in intensive care (IV).The design was exploratory and descriptive. Material in studies I, II and IV consisted of interviews with intensive care nurses (10 head nurses and 26 staff nurses) employed in general, thoracic and neonatal intensive care units in five hospitals located in different parts of Sweden. The material in study III data from two studies of professional issues in nursing were used for the analysis: one concerned psychiatric nursing and the other was the previously referred study I.In study I qualitative content analysis and descriptive interpretation was used in the analysis. The main theme 'stress induced by dissonant imperatives' formulated in the analysis. Dissonant imperatives are composed of the four sub-themes: 1) controlled by the working situation - needing to be in control, 2) constrained by prioritisation - wanting to do more, 3) lacking authority to act - knowing that something should be done, and 4) professional distance - interpersonal involvement. In study II qualitative content analysis and descriptive interpretation were used in the analysis. A main theme was formulated, 'caring about-caring for: tensions between moral obligations and work responsibilities in intensive care nursing'. Five sub-themes were formulated 1) believing in a good death, 2) knowing the course of events, 3) feelings of distress, 4) reasoning about the physicians and 5) expressing moral awareness. In the study III a hypothetical-deductive method was used. The findings indicate that moral stress is independent of context-given specific pre-conditions: 1) nurses are morally sensitive to the patient's vulnerability, 2) nurses experience external factors preventing them from doing the best for the patient, and 3) nurses feel that they have no control over the situation. In the study IV an interpretive method was used. The first level of analysis of data identified contextual factors, such as type and purpose of support and working conditions. Thereafter five tentative interpretations were revealed: 1) receiving organised support is a matter of self-determination, 2) whether to participate or to be off duty is experienced mutually as exclusive, 3) dealing with moral stress is experienced as a private matter, 4) colleagues managing moral stress serve as models in stress support, and 5) not being able to deal with moral stress urges one to seek outside support. A comparison of these interpretations identified three major themes: availability, accessibility and receptivity of support. The main interpretation of data was: "lived experience of moral stress support involves an interconnectedness between structural and existential factors".A comprehensive understanding was formulated using the four studies (I, II, III and IV). Moral stress was found to be influential on the caring competence. Conflicts between different competences were found leading to a shift in focus away from the patients leading to a possible decrease in the caring competence. Moreover, the subtle resistance among nurses toward participation in organized moral stress support may obstruct the development of nurses' caring competence. Accordingly, imbalance, due to moral stress, between different competences hinders the development of collectively shared caring competence.
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| 10. |
- Dahlqvist, Vera, 1954-
(författare)
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Samvete i vården : att möta det moraliska ansvarets röster
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis is twofold: first, to develop and validate questionnaires that could be used for investigating relationships between perceptions of conscience, moral sensitivity and burnout and second, to describe patterns of self-comfort used to ease stress and illuminate meanings of living with a troubled conscience. The thesis comprises five studies and is based on both quantitative and qualitative data.In study I, a questionnaire was constructed to assess perceptions of conscience; the Perceptions of Conscience Questionnaire (PCQ). This 15 item-questionnaire was distributed to 444 care providers. Statistical analyses of responses showed sufficient distribution and a stable six factor solution congruent with reviewed literature. The six factors were labelled: ‘the voice of authority’, ‘warning signal’, ‘demanding sensitivity’, ‘asset’, ‘burden’ and ‘depending on culture’. The findings suggest that the PCQ is a valid questionnaire. The aim of study II was further development of an existing questionnaire assessing care providers’ moral sensitivity, enabling its use in various care contexts. The revised nine-item questionnaire, the Moral Sensitivity Questionnaire Revised version (MSQ-R), was distributed to 278 care providers with various professional backgrounds. Statistical analyses of responses showed sufficient distribution and a three-factor solution congruent with reviewed literature. The three factors were labelled: ‘sense of moral burden’, ‘sense of moral strength,’ and ‘sense of moral responsibility.’ The findings suggest that MSQ-R is valid for use in various healthcare contexts. In study III, the PCQ, the MSQ-R and the Maslach Burnout Inventory (MBI) were distributed to a population of psychiatric care providers (n=101) to investigate relationships between perceptions of conscience and moral sensitivity and levels of burnout. The hierarchical cluster analysis shows two clusters with Pearson’s r >.50. Cluster A comprising items such as: being sensitive, interpreting and following the voice of conscience that warns us against hurting other or ourselves and developing as human beings was labelled ‘experiencing a sense of moral integrity’. Cluster B comprising items such as: feeling inadequate, doing more than one has strengths for, feeling always responsible, having difficulties to deal with wearing feelings, perceiving that conscience gives wrong signals and express social values, having to deaden one’ conscience, were all related to scores of the MBI subscales emotional exhaustion (EE) and depersonalisation (DP). Cluster B was labelled ‘experiencing a burdening accountability’. The results show that levels of ‘experiencing a burdening accountability’ are closely related to levels of being at risk of burnout.The aim of study IV was to describe patterns of self-comforting measures used to ease stress. The written accounts of 168 care providers and healthcare students were analysed by means of qualitative content analysis. The findings disclose two dimensions: an ability to use early learned measures to take care of oneself (ingression) and an ability to feel intimately related to life, other human beings and universe or God (transcendence). The findings provide valuable knowledge about self-comfort as a coping strategy. The aim of study V was to illuminate meanings of living with a troubled conscience. Ten psychiatric care providers, respondents of study III with various perceptions of conscience were interviewed. The interviews were interpreted using a phenomenological - hermeneutical method. The findings show that one meaning of living with a troubled conscience is being confronted with inadequacy and struggling to view oneself as ‘good enough.’ The comprehensive understanding indicates that inadequacy, both one’s own and that of organization one represents, infuse feelings of shame rather than feelings of guilt. Shame concerns one’s identity and need of reconciliation.Conclusions: The results reveal two ways of encountering a troubled conscience. One is being unable to interpret the ethical demand from a troubled conscience. This is indicated by connections between levels of moral burden and levels of burnout. The other way is being able to interpret the ethical demand and using one’s troubled conscience to develop practical wisdom. This means facing shame of feeling inadequate, reconciling images of the ideal self and self-contempt, and becoming realistic about what one can do. In this process comfort seems to be a mediator of reconciliation.
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