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Journal’s Extract Discussions of appeals to conscience by healthcare professionals typically focus on situations in which they object to providing a legal and professionally permitted service, such as abortion, sterilization, prescribing or dispensing emergency contraception, and organ retrieval pursuant to donation after cardiac death. “Negative claims of conscience” will designate such appeals to conscience. When healthcare professionals advance a negative claim of conscience, they do so to secure an exemption from ethical, professional, institutional, and/or legal obligations or requirements to provide a healthcare service.
Abstract The influence of conscience on nurses in terms of guilt has frequently been described but its impact on care has received less attention. The aim of this study was to describe nurses’ conceptions of the influence of conscience on the provision of inpatient care. The study employed a phenomenographic approach and analysis method. Fifteen nurses from three hospitals in western Sweden were interviewed. The results showed that these nurses considered conscience to be an important factor in the exercise of their profession, as revealed by the descriptive categories: conscience as a driving force; con- science as a restricting factor; and conscience as a source of sensitivity. They perceived that conscience played a role in nursing actions involving patients and next of kin, and was an asset that guided them in their efforts to provide high quality care.
Extract It is doubtful that moral distress can ever be eradicated from healthcare settings. As increasing evidence accumulates to support the damaging effects associated with this phenomenon over time, however, interventions to decrease moral distress and moral residue become more urgently -needed. The crescendo effect model focuses attention on moral distress and moral residue and the relationships between them. . . . Both providers and healthcare systems need to acknowledge the repetitive nature of morally distressing events, such as prolonged aggressive treatment at the EOL, that occur in clinical settings. The crescendo effect highlights the crushing blow to professional integrity that nurses, physicians, and other disciplines have to manage on a daily basis in settings where moral distress goes unrecognized and unaddressed. It is not appropriate to expect highly skilled, dedicated, and caring healthcare professionals to be repeatedly exposed to morally distressing situations when they have little power to change the system and little acknowledgment of these experiences as personally damaging or career compromising. As evidence for the crescendo effect and its consequences accumulates, healthcare professionals, insurers, patients, and healthcare systems must not assume that damaged moral integrity is an acceptable, natural consequence that must be borne by healthcare providers.