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Towards connectedness and trust : nurses’ enactment of their moral agency within an organizational context

University of British Columbia

This study generates an understanding of how nurses enact their moral agency within the culture of the organizational context in which they practice. Using a feminist ethnographic design, the investigator undertook approximately 180 hours of fieldwork on an acute medical unit in a community hospital, and approximately 38 hours of fieldwork on a second acute medical unit in a tertiary hospital. The investigator worked closely with six staff nurses during this time, and included formal research interviews with these six nurses to supplement her observations. She also included observation of and research interviews with five clinicians/nurse managers from the hospitals, and, in order to further extend her analysis, research interviews with three home care nurses from different communities. It was found that nurses enact their moral agency in a relational matrix with other members of the health care team, and that this matrix is strengthened by authentic presence and trust between all professionals/providers and patients and their families. The context of nurses' work was portrayed as fraught with everyday ethical problems that generated significant moral ambiguity and moral distress for nurses. There were significant personal costs associated with nurses' work, including fatigue, guilt, and personal risk. Moreover, the culture of the organizational context for nursing practice and patient care was portrayed as problematic. The communication between professionals/providers and patients and their families was fragmented, as was the communication between departments and agencies. Finally, a number of dominant sociopolitical ideologies seemed to be embedded in the organizational culture, including the disvaluing of nurses' work, the disvaluing of acute medicine as a nursing practice context, and the disvaluing of those in need—particularly elderly patients and patients with substance use problems. The investigator concludes by calling for more feminist ethnographic work so that the influence of problematic organizational cultures on the ethics of professional practice can be further addressed. She claims that trust should be fostered in health care teams by making the various members more authentically accessible to each other. Finally, she notes that the ethical mandate of professionals must encompass a broader notion of societal good if the dominant sociopolitical ideologies are to be challenged.

Thesis/Dissertation

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2009-04-03

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http://hdl.handle.net/2429/6797

Nursing

University of British Columbia

UBCV

DSpace