Nursing is a profession which deals with many aspects of people's lives. Nurses are often faced with ethical problems and experience many conflicts between their professional oath. The influence of conscience on nurses has frequently been described but its impact on their practice has received less attention. During their daily practice, they need to quickly decide on one of the several competing options. Conscience i directs individuals towards non-maleficence and veracity and helps people understand their duties for coping with life as a valuable component of nursing practice which demands sensitivity, respect for human rights, and attentive and dignified care delivery. How to increase work conscience in nursing?
I would like to think that people working as nurses try to do the best that they can in their patients' interest and for those who are also responsible for others who they are working with, that they, as you described, Prof Nader Aghakhani, try their best to care similarly and justly for those under their supervision.
I think the selection of the right people both for nurse training and when interviewing for specific job roles also comes into this.
I seem to remember the name comes from the Victorian children's book, Charles Kingsley’s The Water Babies, where there was a character called 'Mrs Do-As-You-Would-Be-Done-By'. I think that's what people working as nurses could bear in mind.
But I'm looking back to 2012, when I was last in practice. Maybe after a very tiring day when things had not always gone right, this golden past would not have been so golden. But I hope that my conscience would still have guided me.
From an ethics perspective I have found feminist ethics the best framework to understand when Dr Aghakhani is referring to. How moral decisions are made in real time and real space along with taking the context into consideration. Urban-walker (Moral Understandings) and de Beauvoir (The Second Sex) can be useful paradigms.
Moral conscience in nursing may only be increased by the 'owner' who happens to be the the nurse, by answering the question on what may be perceived as being right or wrong for the patient. Thus apart from 'making' nurses through education, there is a necessity for nurses to be 'born', since moral conscience is innate.
Yes, I agree with Godfrey Mbaabu Limungi. Not all nurses are 'born' nurses, but I always wanted to go into nursing and a lot of people who I have worked with were similar.
Can nurses be 'made' as well as born?
I think - as now the role is increasingly technical and requires a degree course in the UK now - that the learning side has become much more necessary.
When those who are hoping to be accepted onto the degree course for nursing, presumably they would be expected to gain the A level results set by the university, but in they will also be interviewed for their appropriateness for the training. This is where interviewer, hopefully, would be able to ascertain the moral conscience of the applicants.
Moral conscience is innate. A nurse must be humanitarians , kind and dedicated. A good nursing education helps her/ him along the way, as like as a railroad that move high speed train in a right direction. As a teacher, we can strengthen our student's sense of conscience. But at the beginning, the person himself must be inherently kind and trained in an environment or family that respects humanity.
I am a nurse 21 years . Can it be increased? I doubt you are ethical and empathetic or not. People without it pretend to be the right posture and are mechanical, they do well in principle and see no need to change their behavior. Empathy in nursing is the key, it influences our attitude towards the patient, gives job satisfaction when its help brings results. There is no holism without empathy.
Can you learn empathy?
Can I lose her?
Education is crucial, it is able to guide and show how important conscience is in this work. On their way, the student should meet instructors who will punish the code of nursing ethics as an instrument that will help to do the right thing. At work
older nurses should set a good example for their younger colleagues, however, there are situations, for example, in Polish hospitals, when ideals and enthusiasm collide with the passive resistance of professionally burned out people who do not want changes. Most often the new person will adjust to avoid making conflicts. Not having people with high morale in the environment, such a graduate, despite good grounds, may silence the conscience and consider empathy as an unnecessary burden.
Regards, a very interesting topic worth analyzing.
Franke Ewa
A really interesting and good response. You ought to start a discussion about empathy and see what others think?
I looked up empathy; not that I didn't know what it meant but the links also discussed whether it could be learnt:
https://www.inc.com/justin-bariso/there-are-actually-3-types-of-empathy-heres-how-they-differ-and-how-you-can-develop-them-all.html
Yes, I think it is very important to have empathy when you are nursing, but I agree that not everyone does have it. When I worked as a newly qualified registered nurse in a hospital for older people, thinking back, there were older nurses comparable to each type that you mention. I tried to be a positive example to the even younger, pupil nurses who came for placements with us. When I left there, I spent the rest of my working life either in research (not many years) or seeing people on a one-to-one basis for bladder / bowel problems (or teaching about this). I would like to feel that when they saw me, they found me empathetic; they seemed relaxed and sometimes talked at length.
But this would make an interesting discussion on ResearchGate or the subject of an article for publication.
Mary C R Wilson
You are right about a topic worth researching.
The article you found perfectly fit my assumptions, it perfectly defined the essence of empathy..
Moral conscience starts right frm childhood.Parents,peer group and especially school teachers play an important role in developing moral values.Nursing must be considered as a nobel profession along with teaching and doctors.It would create a sense of responsibility in people who wants to join this profession.It will definately improve the moral consiousness.
Teachers should direct the interests of kind and conscientious students from childhood to jobs that deal with human beings.
There has been done a lot of research into the practice of nursing. Very thorough research has been done for decades by Isobel Menzies-Lyth from the Tavistock Institute. She highlights that the ways the work of nursing is organised deeply effects their capacity for being able to exercise their professional capacity, responsibility for their patients, their feelings of agency, and ultimately their energy levels, motivation which ofcourse influence their capacity for empathy.
Nurses do not nurse in a vacuum, their working environment and the way they are treated is of great influence on their work. Therefore it is not right to look only at the individuals and to consider empathy chiefly as a personal characteristic. If someone is interested in boosting empathy, nursing and nurses should be studied as part of a system and the nursing system should be studied. How are they valued or devalued by doctors and patients? How are their working conditions and working hours? How is work-life balance? How are their stress levels? How are they paid? How much freedom do they have in planning and organising their own work? All of this is of influence to their mental state and their wellbeing, and ultimately on how they treat their patients.
Isobel Menzies-Lyth’s publications can be found by googling. If necessary I can send a starting list. Hope this is helpful.
La moral es un tema que necesariamente se debe analizar de conformidad con la moral social a la cual pertenecen las enfermeras, considerando que no se puede desligar. De seguro este material le servirá: https://www.scielo.br/pdf/rlae/v21n1/es_v21n1a02.pdf
Although I used the word empathy, what I wanted to say was about moral conscience. Moral conscience is what a person has as part of their inner norms and values. What others, e.g. hospital management and doctors want to see is behaviour that is congruent with the moral norms and values of the organisation. You look at behaviour and actions, not thoughts.
Lilian Hupkens Yes, I agree. Strengthening the conscience of a nurse as a single person will not affect the patient's well-being in the ward, where care is grouped and hierarchical. The key here is the radiation of the characteristics of, for example, a ward nurse to the rest of the team. The young nurse after school is full of ideals, moral values are at the highest level, her progress or regression is influenced by the work environment and her personal life.
To add to Franke’s reaction, how a nurse develops or is able to use her talents is influenced by the whole system around her/him and not just the head-nurse. How much is budgeted for nursing? To what extent are they encouraged to get more schooling and training and is there money for it? How is nursing seen in the hospital environment? As independently and strong professionals or as the doctor,s handmaiden who is told what to do?
analyzed nursing graduates, where the first months of work immediately after school are closely related to the environment of their colleagues. Of course, this is not the only factor influencing the moral attitude, but it is dominant at this stage.
In Poland, the ward nurse is like the queen mother in the hive.
They are also a problem
Growing demands on nurses are not reflected in finances and social prestige. The nurse is the subject of criticism faster than the doctor, which causes flustration and discouragement.
Conscience is involved in nursing care plans and makes nurses to be careful
in providing care to prevent causing harm to their clients. Therefore, for providing high-quality care, it is essential to pay attention the effect of conscience on nursing activities. Nursing interacts with human beings, and any profession that is like nursing should be considered in this regard. Of course, in order to be conscientious, the work environment must be encouraging and favorable. .
Nader Aghakhani,
It would be interesting if you describe what you mean by “conscience”.
When you write about “nursing plans” I would expect a nurse to have quite a bit of theoretical knowledge about the medical diagnosis, the prognosis, the treatment plan, about the science of nursing, cure or care dilemma, the ambition of the patient and so forth. Where the conscience comes into this, more than for any other professional, I cannot really understand.
I may be completely wrong and understand this not too well, but I get the feeling that somehow a characteristic like “conscience” is tied up in nurses generally being women and that certain standards are demanded of women, in order to be feminine or remain a ”good woman”, characteristics like being a good care taker or they must not get too big for their boots.
This emphasis on “conscience” or “moral conscience” makes taking care very personal and completely disregards the social environment of the hospital as a working place, or society as a whole. If nurses are stressed out by a too heavy workload or because being a woman means you may not speak out at meetings or in the presence of men or higher ranking doctors, then their conscience is squashed and they cannot follow their conscience at all. They are then trained in the opposite, to bury their conscience and instead be obedient. Then when things go wrong it is not the hierarchy or the working environment but it can be blamed on personal deficiencies, like lack of “conscience”.
The nurses should undergo the educational program to improve their Knowledge on Work Conscience that keeps the nurses in ethical track.
Nader you mention "professional oath" in my 40 year of nursing in the NHS I have never taken an oath. We have professional guidelines developed over many years by the MNC
Moral conscience is individual.in Nursing education teach to nurses for moral values and ethics.it depends how much practice and adopt it.
I think by changing attitude. The nurse has knowledge and practice, but he needs to change his attitude towards moral matters, especially he deals with a person who needs (unable) nursing care.
By making good approaches a basis for studying nursing subjects, as nursing knowledge and practice, through the behavior of the professor, the appropriate environment for work that maintains these trends, and a deterrent law for the morally deficient.
Yes, I agree with Zeki Sabah Musihb's reply (not so much the last one, which is good, but the one above this). The moral attitude is important but so is the knowledge necessary for the role that the nurse is occupying. The right person in the right job also helps to nurture and develop the right attitude.
"The right person in the right job" was, is and will be the most important problem in health care professions!
“… demands sensitivity, respect for human rights, …”
Presentation on “The Science of Rights” at the Thermodynamics 2.0 conference:
https://www.youtube.com/watch?v=ZvD4DHMq1Y4
With an excellent training in Bioethics and always following the Principle of Beneficence; never forgetting the UNIQUE AND UNREPEATABLE character of each human being and his BIOPSYCHOSOCIAL CONDITION; always exercising a VOCATIONAL AND PATIENT-CENTERED praxis, following the decalogue and advice of Florence Nightingale and that of Saint John of God-Patron of Nursing for Christians and Founder of the Hospitaller Order of Saint John of God or "Juaninos" - when he said: "Take care of each sick person as if they were your mother."
CONGRATULATIONS TO ALL NURSING PROFESSIONALS ON NURSING DAY (precisely in honor of F. Nightingale)
Conscience has been characterized as a warning signal and as increasing sensitivity to patients’ needs.
It's important for nurses to understand the importance of conscience in the provision of care and its congruence with professional codes and guidelines.
It contributed to making them aware of human weakness. When striving for high quality care, it is important to be aware of the implicit influence that conscience has on nursing activities and may can be a useful factor in providing high-quality care to patients and families.
Research indicates that conscience within the nursing context can be viewed as: “nursing as an act of duty; nursing as an act of courage; and nursing as an act of high quality care” https://www.tandfonline.com/doi/full/10.1080/01612840.2019.1548852
Check https://www.revhipertension.com/rlh_3_2018/13_conscience_understanding.pdf
One of the difficulties for nurses I think is we are given much responsibility but very little if any autonomy. This doesn't bode well for using one's conscience to decide on a course of action. It is a very interesting and important issue and one that was never mentioned during my nurse training, albeit that was quite a few years ago.
Continuing education programs and curricular revisions are recommended to strengthen their religious beliefs.
Conscience in nursing is an ethical idea inherent to nursing that has been shown to favorably affect nursing practice, driving forward ethical nursing care.
Conscience problems can also develop when nurses’ ethical perspectives conflict with professional norms of practice.
Nurses can turn to these philosophically rooted guidelines to solve such conflict of conscience by declaring a conscientious objection, as guided by ethics education and codes of ethics across the world.
An internationally recognized option for nurses to object to care that conflicts with their personal beliefs is conscientious objection, which is a much disputed notion, but it is unclear in the research what influence conscientious objection has on practicing nurses.
Therefore, more understanding is required to appreciate the meaning conscience and conscientious objection hold for nursing practice in order to develop further knowledge for nursing ethics.
La enfermera es el brazo derecho del medico en cualquier sitio donde trabajes. Desde la Atencion Primaria de Salud, es necesario que la enfermera este formada en los principios de la no maleficiencia y la conciencia del humanismo como primer renglon. es necesario una formacion solida de este personal de la salud y de forma importante en los cuidados paliativos
Prof Dr Lazara Esther Fernández Mendoza
I was keen to read your response, so got a translation; I hope it is true to what you wrote:
The nurse on the doctor's right arm wherever you work. From the Primary Health Care, it is necessary that the nurse is trained in the principles of non-maleficence and the awareness of humanism as the first line. a solid training of these health personnel is necessary and in an important way in palliative care."
Yes, I agree. We should all put the patient's best interests foremost.
Conscience is an ethical concept fundamental to nursing and found to positively influence nursing practice, driving forward ethical nursing care. Appreciating conscience and conscientious objection as ethical components for nursing care is an opportunity to advance nursing ethics through research, education, and practice.
Unfortunately, research available indicates that front-line nurses and nursing teachers, theoreticians, managers and leaders do not always understand what conscientious objection is, exposing a gap between the routine guidelines and how they are taken up by practicing nurses, which can pose a problem at a professional level on how to enact conscientious objections in practice.
How do I increase my moral conscience in nursing?
https://www.quora.com/How-do-I-increase-my-moral-conscience-in-nursing
Conscience is inborn voice, internal inclination, spectator, and guide; the concept of conscience includes three viewpoints or aspects: “perception”, “command”, and “obedience” of conscience. Identifying such viewpoints can improve the status, importance, and application of this idea in the nursing field. In any case, idea analysis is an ongoing process, and with expanding information and experience, should be extended and developed in the future.
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