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Nursing Ethics, Vol. 13, No. 6, 633-648 (2006)
DOI: 10.1177/0969733006069698

Development and Initial Validation of the Stress of Conscience Questionnaire

Ann-Louise Glasberg

Umeå University, Umeå, Sweden

Sture Eriksson

Umeå University, Umeå, Sweden

Vera Dahlqvist

Umeå University, Umeå, Sweden

Elisabeth Lindahl

Umeå University, Umeå, Sweden

Gunilla Strandberg

Umeå University, Umeå, Sweden

Anna Söderberg

Umeå University, Umeå, Sweden

Venke Sørlie

University of Oslo, Oslo, Norway

Astrid Norberg

Umeå University, Umeå, Sweden

Stress in health care is affected by moral factors. When people are prevented from doing ‘good’ they may feel that they have not done what they ought to or that they have erred, thus giving rise to a troubled conscience. Empirical studies show that health care personnel sometimes refer to conscience when talking about being in ethically difficult everyday care situations. This study aimed to construct and validate the Stress of Conscience Questionnaire (SCQ), a nine-item instrument for assessing stressful situations and the degree to which they trouble the conscience. The items were based on situations previously documented as causing negative stress for health care workers. Content and face validity were established by expert panels and pilot studies that selected relevant items and modified or excluded ambiguous ones. A convenience sample of 444 health care personnel indicated that the SCQ had acceptable validity and internal consistency (Cronbach’s alpha exceeded 0.83 for the overall scale). Explorative factor analysis identified and labelled two factors: ‘internal demands’ and ‘external demands and restrictions’. The findings suggest that the SCQ is a concise and practical instrument for use in various health care contexts.

Key Words: conscience • health care personnel • questionnaire validation • stressors

References

  • Söderberg A, Gilje F, Norberg A. Transforming desolation into consolation: the meaning of being in situations of ethical difficulty in intensive care . Nurs Ethics 1999; 6: 357-373 .[Abstract/Free Full Text]
  • Åström G, Norberg A, Jansson L, Hallberg I. Nurses’ narratives about difficult care situations. Interpretation by means of Løgstrup’s ethics . Psychooncology 1994; 3: 27-34 .
  • Sørlie V, Jansson L, Norberg A. The meaning of being in ethically difficult care situations in paediatric care as narrated by female registered nurses . Scand J Caring Sci 2003;17: 285-292 .[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Strandberg G, Jansson L. Meaning of dependency on care as narrated by nurses . Scand J Caring Sci 2003; 17: 84-91 .[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Gore EJ, Harvey OJ. A factor analysis of a scale of shame and guilt: dimensions of conscience questionnaire . Pers Individ Diff 1995; 19: 769-771 .
  • Kelly B. Preserving moral integrity: a follow-up study with new graduate nurses . J Adv Nurs 1998; 28: 1134-1145 .[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Adams KE. Ethical issues in gynecology: adolescent confidentiality, provider conscience and abortion, and patient choice of provider gender . Curr Womens Health Rep 2002; 2: 423-428 .[Medline] [Order article via Infotrieve]
  • Beauchamp TL, Childress JF. Principles of biomedical ethics, third edition. Oxford University Press , 1989.
  • Allport GW. Becoming: basic considerations for a psychology of personality. Yale University Press , 1955.
  • Virt G. Conscience in conflict. In: Zecha G, Weingartner P eds. Conscience: an interdisciplinary view. Reidel , 1987: 165-191.
  • Jonsen AR, Toulmin S. The abuse of casuistry. University of California Press , 1988.
  • Aldén M. Samvete och samvetsfrihet. (Conscience and freedom of conscience.) [Thesis] Lund University, 2001 (in Swedish).
  • Miceli M, Castelfranchi C. How to silence one’s conscience: cognitive defences against the feeling of guilt . J Theory Soc Behav 1998; 28: 287-318 .[CrossRef]
  • Pask EJ. Guilt and nursing practice: implications for nurse education and the climate of care . Nurs Ethics 1994; 1: 80-85 .[Abstract/Free Full Text]
  • Holly CM. The ethical quandaries of acute care nursing practice . J Prof Nurs 1993; 9: 110-115 .[CrossRef][Medline] [Order article via Infotrieve]
  • Price DM, Murphy PA. Staff burnout in the perspective of grief theory . Death Educ 1984; 8: 47-58 .[ISI][Medline] [Order article via Infotrieve]
  • Norberg A, Norberg B, Bexell G. Ethical problems in feeding patients with advanced dementia . Br Med J 1980; 281: 847-848 .[ISI][Medline] [Order article via Infotrieve]
  • Kukla R. The ontology and temporality of conscience . Continental Philos Rev 2002; 35: 1-34 .
  • Langston D. Conscience and other virtues. Penn State University Press , 2001.
  • Barresi J. From ‘the thought is the thinker’ to ‘the voice is the speaker’. William James and the dialogical self . Theory and Psychology 2002; 12: 237-250 .
  • Rose SR. Towards the development of an internalized conscience: theoretical perspectives on socialization . J Human Behav Soc Environ 1999; 2(3): 15-28 .
  • Ricoeur P. Oneself as another. University of Chicago Press , 1992.
  • Björklund F. Defense mechanisms and morality: a link between isolation and moralization . Scand J Psychol 2000; 41: 55-61 .[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Corley MC, Elswick RK, Gorman M, Clor T. Development and evaluation of a moral distress scale . J Adv Nurs 2001; 33: 250-256 .[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Cooper C, Dewe P. Stress: a brief history. Blackwell , 2004.
  • Gray-Toft P, Andersson JG. Stress among hospital nursing staff: its causes and effects . Soc Sci Med [A] 1981; 15: 639-647 .[Medline] [Order article via Infotrieve]
  • Agius RM, Blenkin H, Deary IJ, Zealley HE, Wood RA. Survey of perceived stress and work demands of consultant doctors . Occup Environ Med 1996; 53: 217-224 .[Abstract]
  • Cushway D, Tyler PA, Nolan P. Development of a stress scale for mental health professionals . Br J Clin Psychol 1996; 35: 279-295 .[Medline] [Order article via Infotrieve]
  • French SE, Lenton R, Walters V, Eyles J. An empirical evaluation of an expanded nursing stress scale . J Nurs Measure 2000; 8: 161-178 .
  • Lazarus RS, Folkman S. Stress, appraisal, and coping. Springer Publishing , 1984.
  • McVicar A. Workplace stress in nursing: a literature review . J Adv Nurs 2003; 44: 633-642 .[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Lambert VA, Lambert CE. Literature review of role stress/strain on nurses: an international perspective . Nurs Health Sci 2001; 3: 161-172 .[CrossRef][Medline] [Order article via Infotrieve]
  • Burnard P, Edwards D, Fothergill A, Hannigan B, Coyle D. Community mental health nurses in Wales: self-reported stressors and coping strategies . J Psychiatr Ment Health Nurs 2000; 7: 523-528 .[CrossRef][Medline] [Order article via Infotrieve]
  • Cronqvist A, Theorell T, Burns T, Lützén K. Dissonant imperatives in nursing: a conceptualization of stress in intensive care in Sweden . Intens Crit Care Nurs 2001; 17: 228-236 .
  • Weinberg A, Creed F. Stress and psychiatric disorder in healthcare professionals and hospital staff . Lancet 2000; 355: 533-537 .[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Ramirez AJ, Graham J, Richards MA, Cull A, Gregory WM. Mental health of hospital consultants: the effects of stress and satisfaction at work . Lancet 1996; 347: 724-728 .[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • McGrath A, Reid N, Boore J. Occupational stress in nursing . Int J Nurs Stud 2003; 40: 555-565 .[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Erlen JA, Sereika SM. Critical care nurses, ethical decision-making and stress . J Adv Nurs 1997; 26: 953-961 .[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Redfern S, Hannan S, Norman I, Martin F. Work satisfaction, stress, quality of care and morale of older people in a nursing home . Health Soc Care Community 2002; 10: 512-517 .[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Healy C, McKay M. Identifying sources of stress and job satisfaction in the nursing environment . Aust J Adv Nurs 1999; 17: 30-35 .[Medline] [Order article via Infotrieve]
  • Prosser D, Johnson S, Kuipers Eet al. Perceived sources of work stress and satisfaction among hospital and community mental health staff, and their relation to mental health, burnout and job satisfaction . J Psychosom Res 1997; 43: 51-59 .[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Kirkcaldy BD, Martin T. Job stress and satisfaction among nurses: individual differences . Stress Med 2000; 16(2): 77-89 .
  • Brown H, Edelmann R. Project 2000: a study of expected and experienced stressors and support reported by students and qualified nurses . J Adv Nurs 2000; 31: 857-864 .[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Coomber S, Todd C, Park G, Baxter P, Firth Cozens J, Shore S. Stress in UK intensive care unit doctors . Br J Anaesth 2002; 89: 873-881 .[Abstract/Free Full Text]
  • Edwards D, Burnard P. A systematic review of stress and stress management interventions for mental health nurses . J Adv Nurs 2003; 42: 169-200 .[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Provis C, Stack S. Caring work, personal obligation and collective responsibility . Nurs Ethics 2004; 11: 5-14 .[Abstract/Free Full Text]
  • Sørlie V, Kihlgren AL, Kihlgren M. Meeting ethical challenges in acute care work as narrated by enrolled nurses . Nurs Ethics 2004; 11: 179-188 .[Abstract/Free Full Text]
  • Austin W, Bergum V, Goldberg L. Unable to answer the call of our patients: mental health nurses’ experience of moral distress . Nurs Inquiry 2003; 10: 177-183 .
  • Corley MC. Nurse moral distress: a proposed theory and research agenda . Nurs Ethics 2002; 9: 636-650 .[Abstract/Free Full Text]
  • Wilkinson JM. Moral distress in nursing practice: experience and effect . Nurs Forum 1987; 23(1): 16-29 .[Medline] [Order article via Infotrieve]
  • Jameton A. Dilemmas of moral distress: moral responsibility and nursing practice . AWHONNS Clin Issues Perinat and Womens Health Nurs 1993; 4: 542-551 .
  • van der Arend AJG, Remmers-van den Hurk CHM. Moral problems among Dutch nurses: a survey . Nurs Ethics 1999; 6: 468-482 .[Abstract/Free Full Text]
  • Georges J-J, Grypdonck M. Moral problems experienced by nurses when caring for terminally ill people: a literature review . Nurs Ethics 2002; 9: 155-178 .[Abstract/Free Full Text]
  • Kälvemark S, Höglund AT, Hansson MG, Westerholm P, Arnetz B. Living with conflicts - ethical dilemmas and moral distress in the health care system . Soc Sci Med 2004; 58: 1075-1084 .[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • Cronqvist A, Theorell T, Burns T, Lützén K. Caring about - caring for: moral obligations and work responsibilities in intensive care nursing . Nurs Ethics 2004; 11: 63-76 .[Abstract/Free Full Text]
  • Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines . J Clin Epidemiol 1993; 46: 1417-1432 .[CrossRef][ISI][Medline] [Order article via Infotrieve]
  • The Swedish Association of Local Authorities and Regions (SALAR). Fakta om Kvinnor och män i landstingen.(Facts about women and men in local and regional authorities.) 2003. Retrieved 10 May, 2006, from: http://www.skl.se
  • Tabachnick BG, Fidell LS. Using multivariate statistics, fourth edition. Allyn and Bacon , 2001.
  • Munro B. Statistical methods for health care research. Lippincott , 2001.
  • Karasek RA, Theorell T. Health work: stress, productivity, and the reconstruction of working life. Basic Books , 1990.
  • Zeller R, Carmines E. Measurement in the social sciences. Cambridge University Press , 1980.
  • Tyler P, Cushway D. Stress, coping and mental well-being in hospital nurses . Stress Med 1992; 8(2): 91-98 .
  • Kasl SV. Measuring job stressors and studying the health impact of the work environment: an epidemiologic commentary . J Occup Health Psychol 1998; 3: 390-401 .[CrossRef][Medline] [Order article via Infotrieve]
  • van der Doef M, Maes S. The Job Demand-Control (-Support) model and psychological well-being: a review of 20 years of empirical research . Work Stress 1999; 13(2): 87-114 .[CrossRef][ISI]
  • Quick JC. Introduction to the measurement of stress at work . J Occup Health Psychol 1998; 3: 291-293 .[CrossRef][Medline] [Order article via Infotrieve]
  • Anderson WJR, Cooper CL, Willmott M. Sources of stress in the national health service: a comparison of seven occupational groups . Work Stress 1996; 10: 88-95 .
  • Hopkinson PJ, Carson J, Brown D, Fagin L, Bartlett H, Leary J. Occupational stress and community mental health nursing: what CPNs really said . J Adv Nurs 1998; 27: 707-712 .[CrossRef][ISI][Medline] [Order article via Infotrieve]

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