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. (shrink)

Although organizational and situational factors have been found to predict burnout, not everyone employed at the same workplace develops it, suggesting that becoming burnt out is a complex, multifaceted phenomenon. The aim of this study was to elucidate perceptions of conscience, stress of conscience, moral sensitivity, social support and resilience among two groups of health care personnel from the same workplaces, one group on sick leave owing to medically assessed burnout (n = 20) and one group who showed no indications (...) of burnout (n = 20). The results showed that higher levels of stress of conscience, a perception of conscience as a burden, having to deaden one’s conscience in order to keep working in health care and perceiving a lack of support characterized the burnout group. Lower levels of stress of conscience, looking on life with forbearance, a perception of conscience as an asset and perceiving support from organizations and those around them (social support) characterized the non-burnout group. (shrink)

Health care often involves ethically difficult situations that may disquiet the conscience. The purpose of this study was to develop a questionnaire for identifying various perceptions of conscience within a framework based on the literature and on explorative interviews about perceptions of conscience (Perceptions of Conscience Questionnaire). The questionnaire was tested on a sample of 444 registered nurses, enrolled nurses, nurses’ assistants and physicians. The data were analysed using principal component analysis to explore possible dimensions of perceptions of conscience. The (...) results showed six dimensions, found also in theory and empirical health care studies. Conscience was perceived as authority, a warning signal, demanding sensitivity, an asset, a burden and depending on culture. We conclude that the Perceptions of Conscience Questionnaire is valid for assessing some perceptions of conscience relevant to health care providers. (shrink)

The aim of this observational longitudinal cohort study was to describe relationships over time between degrees of stress of conscience, perceptions of conscience, burnout scores and assessments of person-centred climate and social support among healthcare personnel working in municipal care of older people. This study was performed among registered nurses and nurse assistants (n = 488). Data were collected on two occasions. Results show that perceiving one’s conscience as a burden, having feelings of emotional exhaustion and depersonalization and noticing disturbing (...) conflicts between co-workers were positively associated with stress of conscience. No significant changes were observed during the year under study, but degrees of stress of conscience and burnout scores were higher than in previous studies, suggesting that downsizing and increased workloads can negatively affect healthcare personnel. Following and expressing one’s conscience in one’s work, and perceiving social support from superiors are of importance in buffering the effects of stress of conscience. (shrink)

Troubled conscience may jeopardize the health of healthcare personnel and, hence, the quality of care provided. Learning more about how personnel deal with their troubled conscience therefore seems important. The aim of this study was to describe personnel’s experiences of how they deal with troubled conscience generated in their daily work in municipal care of older people. Interviews were conducted with 20 care providers and analysed with a thematic content analysis. The findings show that in order to deal with troubled (...) conscience, personnel dialogued with themselves and with others. They took measures in a direction they perceived to be correct, and they expressed a need for distancing and re-energizing. It is of importance to share situations that generate troubled conscience in order to find ways to deal with them. Reconsidering one’s ways of dealing with troubled conscience may give care providers an opportunity to reach consensus within themselves. (shrink)

The Perceptions of Conscience Questionnaire (PCQ) and the Stress of Conscience Questionnaire (SCQ) have previously been developed and validated within the ‘Stress of Conscience Study’. The aim was to revalidate these two questionnaires, including two additional, theoretically and empirically significant items, on a sample of healthcare personnel working in direct contact with patients. The sample consisted of 503 healthcare personnel. To test variation and distribution among the answers, descriptive statistics, item analysis and principal component analysis (PCA) were used to examine (...) the underlying factor structure of the questionnaires. Support for adding the new item to the PCQ was found. No support was found for adding the new item to the SCQ. Both questionnaires can be regarded as valid for Swedish settings but can be improved by rephrasing some of the PCQ items and by adding items about private life to the SCQ. (shrink)

In this article, I examine Reiner Schürmann’s interpretation of Nietzsche’s critique of subjectivity. By focusing on Nietzsche’s reflections on the difference between weight and lightness, I analyze Nietzsche’s critique of the appropriative nature of man and relate it to his understanding of the expropriative tendency in human existence. In the second part of the article, this Nietzschean understanding of subjectivity is developed through Schürmann’s interpretation of Nietzsche. Here, the onus is placed on Schürmann’s understanding of “the will to power.” For (...) Schürmann, the will to power is the completion of man’s appropriative nature at the same time as it is points beyond subjectivity and towards an understanding of man as an expropriative being. The aim of the article is to show up Nietzsche’s importance for Schürmann’s thought and to investigate how his interpretation can shed light on what existence would become if it transcended the limits of the appropriating subject. (shrink)

In this article, Strandberg analyses the development of Swedish cultural policy during the last decades. In contradistinction to the first policy proposition from 1974, which emphasised the importance of counteracting the negative impact of the market, the cultural policies that have been in place for the last twenty to thirty years consider the forces of the market to be conducive to the freedom of culture and the arts. This has entailed a paradigm shift in Swedish culture that has opened up (...) the field of cultural policy for the so-called creative industries, equated culture with creativity, and collapsed the distinction between culture and creative forms of entrepreneurship. When analysing this, Strandberg relates the modern history of Swedish cultural policy to the wider international development that has given rise to the paradigm of the creative industries and discusses how the equation of culture with creativity has made the autonomy of culture and the arts more and more difficult to uphold. (shrink)

This volume contains for the first time in English, Jan Patočka’s seminal essay “The Phenomenology of Afterlife”, as well as contributions surrounding and analyzing this text. In his essay, Patočka reflects on our relation to the dead and on how the departure of a loved one affects our continued existence. The premise of Patočka’s investigation is that our existence always takes place by and through an originary and reciprocal “being for others”. The contributors in the volume extend the field of (...) inquiry into the wider phenomenological and post-phenomenological discussion of death by being cognizant of how works of literature can broaden our understanding of the care of death, grief, forgiveness and non-reciprocal love. Also included are reflections on issues of philosophical anthropology, community, collective memory, and the ecstatic nature of life – issues that can all be related back to Patočka’s initial reflections, but which nonetheless radiate into a myriad of directions. This volume appeals to students and researchers in the field. (shrink)