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NURSES LIVED EXPERIENCES OF CONSCIENCE REACTION: A QUALITATIVE 

PHENOMENOLOGICAL STUDY 

 

Parkhideh Hasani
1
 Rostam Jalali

2
 Zhila Abedsaeedi

3
 

1. Assistant Professor, PhD of Nursing, Shahid Beheshti University of Medical Sciences. 

2. MsN, PhD Student of Nursing. Shahid Beheshti University of Medical Sciences. Nursing 
Department, Shahid Beheshti's Faculty of Nursing and Midwifery, Taqatoae Niayesh-Vali ASR, 
Tehran-Iran. Ks_jalali@yahoo.com  Cell Phone +989181324821 (Corresponding Author) 

3. Assistant Professor, PhD of Management in Health Services, Shahid Beheshti University of 
Medical sciences. 

 

Abstract:  Background and objectives: Conscience is a cornerstone of ethics, affecting both our 
private and professional lives. Everyday health care practice raises questions about conscience and 
how to understand its role. Conscience has also been described as inducing self-growth and 
protecting personal integrity. Nurses views on their reactions to behaviors consistent or contrary to 
conscience could therefore help us to understand the meaning of the reactions of conscience. This 
study aimed to illuminate meanings of nurses lived experience of conscience reaction in their daily 
practices.  

Material and methods: Interviews with nine nurses were interpreted using a phenomenological 
hermeneutic (Colaizzi, 1978) method. Data was collected in 2010 among nurses working in various 
hospitals in Kermanshah. The nurses were selected for participation purposively. 

Results: The nurses lived experience of conscience reaction was formulated in three themes and ten 
sub-themes. The first theme is ‘being peace, which includes three sub-themes: Being calm, being 
pleased, and being satisfying. The second theme is ‘trouble conscience’ which includes four sub-
themes: guilt, thinking engagement, discomfort, and fretfulness. The third theme is responding which 
includes three sub-themes: expressing, compensation, and lack of repeat. 

Conclusions: The nurses lived experience of conscience reaction showed that nurses considered 
conscience reaction to be an important factor in the exercise of their profession, as revealed by the 
descriptive categories: being peace when they act consistent with conscience; trouble conscience 
when they act contrary on conscience; and responding after doing an anti conscience practice. They 
perceived that conscience played a role in nursing actions involving patients and next of kin, and 
guided them in their efforts to provide high quality care. 

Keywords: phenomenology, conscience reaction, nurses, lived experience. 

 

Introduction and statement of the problem: Nurses are considered as the conscience of health 
care systems. Thus, they not only have positive effect on public health, but also play a key role in 
improvement of health care systems. They are responsible for fulfillment of the methods that enhance 
access to safe, high quality, and competent heath care (Sincox, 2005). Moreover, they are in charge 
of providing nursing care to all patients without any prejudice and judgment, in a direct and timely 
manner with high quality. Respecting people’s rights and treating people with regard to their dignity is 
an inseparable part of heath care systems (Jansen and Lidell, 2009). In nursing, moral topics point to 
the values that govern the relationship of nurses and patients (Fawcett, 2005). To direct the 
relationship and moral acts, a sensitive conscience is needed; thus it is an important item for health 
care providers, and violating it without bringing about major adverse effects on moral integrity is not 
possible (Dahlqvist et al. 2009). Conscience is the foundation of morality and influences private and 
professional life (Dahlqvist et al. 2007). When nurses are taking care of critically ill patients, they 
remember the patients they did not sufficiently take care of. Sorlie quoting from Ricoure discusses 



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morality memory. According to him, people never want or never can, and in fact should not, forget 
good or bad events in their life. Thus, nurses do not forget the patients whom they did not sufficiently 
look after (Sorlie et al. 2003). Conscience originates from the living experience and is a part of our 
daily and professional life and we cannot get rid of or escape from it (Kulka, 2002). When a nurse 
stands contrary to his/her interest, there are conflicts of value, that mean; the nurses prohibited to 
delivery care appropriately, or when they haven't choices and must participate in caring that is 
contrary to human dignity, and also may emerge when the nurses can't defend for his/her ideals 
(Post, 1998). Conscience conflict can lose the individual integrity. Nurses coercion to engaging in 
activities that is inconsistent with conscience, cause to desertion nursing profession. Although 
protecting of nursing conscience must be guarantee against professional coercion (Curtin, 1993). 
Otherwise cause troubled conscience and shame and guilt for not following conscience (Post, 1998). 
If we do not follow conscience, blaming and expostulation phenomenon seen clearly. Clearance and 
consistency of this phenomenon is more than other conscience phenomena. Absolutely blaming is the 
aspect of conscience that protects our ideal personality, and promotes it more ever is an antecedent 
for psychological development. This phenomenon is the greatest humanistic condition that human 
being has a clear conscience. These people benefits of all conscience activities  (Jafari, 2009).  
Guiltiness and conscience permit us to promote our actions; now, past and in the next. In continuum 
we decide, which of the actions must be accepted or rejected. Inability in balancing can cause guilty in 
persons that they are susceptible to guiltiness. If we have guiltiness and blaming, then we left animal 
hostility and entering to humanity domain (Gaylin, 1994).  In contrast, when a nurse practice 
accordance with his/her conscience, he/she hasn't anxiety, and with resolve the cause of anxiety and 
comprehension, the conscience become calm and find normal condition (Jafari, 2009). The morally 
sensitive and susceptible individuals have grief when they act against their conscience, but the others 
hadn't (May, 2001). Having conflict before or after doing an action and nurse's reaction to consistency 
with conscience practice must be investigated precisely. Nurse's experiences from their reactions to 
consistent and inconsistent behaviors can help us to understand meaning of conscience reaction.  

In his working experience, the author has observed how nurses encounter conscionable issues during 
care providing, and due to different reasons they cannot act in accordance with their conscience. 
Thus, the current study was carried out with a qualitative approach, which is suitable for evaluation of 
individuals’ experience, beliefs, and priorities. By understanding the experience of nurses, the study 
would be helpful to elucidate the nature of conscience's reaction in nursing. 

 

Methodology: The current study was carried out to perceive the nurses’ living experience of 
conscience with a phenomenological method. It is a study with a qualitative approach. 
Phenomenological research is a type of qualitative research with philosophical roots focused on the 
experience of man’s life (Polit et al., 2005). Phenomenology is in fact an attempt to describe living 
experience without previous theories about their objective reality (Strubert and Carpenter, 2007). In 
phenomenology, the context of the event and the occurrence of the phenomenon are the 
interpretational factors in understanding the world of participants or the events and phenomena under 
evaluation. With the language of participants, the qualitative researcher associates the practical items 
and the living experience of the individual by rational involvement and entering the unique world of the 
participant of the study (Benner, 1994). The participants were chosen purposively and their number 
was determined by data saturation criterion, and the task was consequently repeated until the data 
saturated and the themes repeated (Strubert and Carpenter, 2007).  

Characteristics of data gathering tools and method of data gathering: The main tool for data 
gathering was extensive, in-depth, unstructured, and interactive (face-to-face) interview. The 
interviews were recorded, transcribed at the earliest possible time, and then immediately encoded 
and analyzed. Moreover, the goal-oriented observation of phenomenon under study (observation of 
verbal and non-verbal behaviors) in the natural context and in appropriate time by the observer as a 
participant were performed, recorded, encoded, and then analyzed. 

Inclusion criteria: The participants were selected from among the individuals who have direct 
experience of nursing conscience (the background of working as a nurse) and were willing to attend 
the study. The lowest educational level was B.Sc. of nursing. The participants did not have speaking 
or hearing problems. Furthermore, they were willing to narrate their perceptions (experience). The 
participants were informed and attended the program voluntarily. 



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Sampling method: The participants were asked to attend the study by an invitation letter. After 
returning the invitation letter and accepting to participate the study, the time of interview was set by 
telephone or in person. Following the signing of an informed written consent, according to the 
schedule, the participants attended an unstructured interview at their working place or whenever they 
preferred. Face-to-face interview provides first hand information by discovering the real experience 
and brining the researcher to the context of the topic. Moreover, during the interview, the participant is 
given feedback, and thus verifying and additional data can be obtained. The interviews were recorded 
and then transcribed. Combination of in-depth interview and observation increase the validity of data 
and weakness of a data gathering method is covered by another method. Each interview took 20 to 
60 minutes. If needed, the interview with a single participant carried out in several sessions. After 
performing each interview, the recorded interview was carefully listened several times. Then, word for 
word, the interviews transcribed with Microsoft Word Software and then printed. The procedure 
performed for all interviews. After transcription, the researcher reviewed the texts when listening the 
recorded interviews. This was carried out to enhance the preciseness of transcribed data and to 
increase the researcher’s comprehension of the data. After carrying out these steps, the transcribed 
data was considered as the raw data to be analyzed. 

General steps of data analysis: The data were analyzed according to the steps of Colaizzi’s data 
analysis (1978). The method includes nine steps as follows: 

1- Describing the interested phenomenon, 2- Gathering the participants’ description of the 
phenomenon, 3- Reading all the participants’ description of the phenomenon, 4- Return the original 
transcripts and extract significant statements, 5- Trying to spell out the meaning of each significant 
statements, 6- Organizing the aggregate formalized meaning into clusters of themes, 7- Write an 
exhaustive description, 8- Return to the participants for validation the description, and 9- If new data 
are revealed during the validation, incorporate them into an exhaustive description (Colaizzi, 1978). In 
the current study, we followed the stages of data analysis step by step. Moreover, for recording 
behaviors, non-verbal communications, appearance, facial expression, and eye contact of 
participants, we used observation and note taking during the unstructured interview with the 
unstructured observation method. To do so, the observations were recorded if possible during the 
interview, or immediately after that. The data was used in transcription of interview data and its 
analysis. 

Trustworthiness of research data: Common methods of qualitative studies were used to verify the 
trustworthiness of the data. In the current study, the method suggested by Guba and Lincoln (1994) 
was used. 

To verify the creditability of the data, we used a combination of data collection method (unstructured 
interview, field note taking, and memoing), revision by participants, and revision of codes and 
categories by professionals. To verify the reliability and dependability of the data, we used detailed 
description of the study. Thus, it can be evaluated by external observers. To justify the confirmability 
of the research, all steps of the study, including data collection and analysis and extraction of codes 
and categories were described such that other people could judge them by reading the descriptions. 
To check the transferability, the results were given to three nurses who did not attend the study and 
their experience was compared with the results of the current study. 

Ethical considerations: After receiving the approval of observation of ethical issues from the Ethics 
Committee of Research Department of Shahid Beheshti Medical University, all participants signed an 
informed written consent and then we came to an agreement with the participant on the time and 
place of the interview. After describing the objectives of the study and the voluntary involvement in the 
study, the permission to record the interviews was taken. 

 

Findings: In general, nine participants from among the nurses working in educational hospitals of 
Kermanshah attended in-depth interviews (Table 1). If there were any ambiguity in content analysis of 
the interview, we removed the ambiguity by re-visiting the participant or calling him/her. The 
interviews were carried out by the researcher (the first author). Encoding and extraction of main items 
was also done by the researcher and the main coworkers, and then the results were revised and 
modified by external observers and the participants. With continuous analysis of the data and analysis 
of the interview notes on the experience and beliefs of nurses about the reaction of conscience was 



Bangladesh Journal of Bioethics 2011; 2(3):3-9 
 
 

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formulated in three themes and ten sub-themes. The first theme is ‘being peace, which includes three 
sub-themes: Being calm, being pleased, and being satisfying. The second theme is ‘trouble 
conscience’ which includes four sub-themes: guilt, thinking engagement, discomfort, and fretfulness. 
The third theme is reaction which includes three sub-themes: expressing, compensation, and lack of 
repeat (Table 2). 

 

Table 1: Characteristics of the participants 

Educational level BS 8 nurse, MS 1 nurse 

Sex Female 6, Male 3 

Age Mean 32.5 Range 26-45 yrs 

Nursing experience Mean 9.5  Range 2-22 yrs 

Interview duration 20´ to 60 ´; mean =35´ 

Nursing role Head nurse 1, Supervisor 1, clinical nurse 7 

 

 

Being Peace: One of the major concepts extracted from the data was the peace of conscience, which 
includes three sub-themes: Being calm, being pleased, and being satisfying. Most participants talked 
about being peace of conscience. However, they mentioned that being peace is as being calm, being 
pleased and being satisfying. In this regard, the nurses mentioned: 

"Often occurred these things, I have a sense of calming, often occurred that I say, I do widget; I have 
calming sense, I sense today is a day that go on to my willingness…" 

"… if I do some things accordance to my conscience; I'll very glad …" 

"In the time of acting accordance with conscience; I sense satisfying, that mean; I do correct action 
…" 

Trouble of Conscience: A pivotal concept extracted from the data and on the basis of experience of 
the participants was trouble of conscience. This concept consist four sub-themes: guilt, thinking 
engagement, discomfort, and fretfulness. Regarding this fact, nurses mentioned that: 

"If I do some things against my conscience … I think; I am not appropriate for this job and I have an 
internal sense of discomfort …" 

"… but I have a challenge with myself; I am engaging in my inward; there is more conscience 
engagement …" 

"If I do some things against my conscience; I am discomfort; because it is different from happiness. It 
cause more discomfort for me" 

"If I do some things against my conscience; the first thing for me is a blaming condition and internal 
discomfort …" 

Reaction of Conscience: Of the main concepts extracted by the data analysis were reaction of 
conscience, which included three sub-themes; expressing, compensation, and lack of repeat. In this 
regard, the nurses considered that: 



Bangladesh Journal of Bioethics 2011; 2(3):3-9 
 
 

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"… Because I do a positive action; and … I have a good sleep after it, fortunately or regret; I express 
always and very soon in my home; I say: I do a good action today …" 

"If I being the cause of this encounter; I try to compensate anyways; to convince them… but anyway I 
do to compensate it…" 

"If I do some things against my conscience; I try to don't repeat in the next time… but I don't repeat 
this wrong action never … I try to don't repeat in the next time forever". 

 

Table 2: Major and minor categories of reaction of conscience 

Theme Sub-theme codes 
Being Peace Being Calm "… I have a sense of calming, … I have calming sense, …" 

Being Pleased if I do some things accordance to my conscience; I'll very glad 
Being Satisfying I have a complete satisfying with acting accordance to 

conscience; I sense that lost my exhaustion. 
Trouble of 

Conscience 
guilt, thinking Reaction to work against conscience!  sense of guiltiness… 
engagement I have a challenge with myself; I am engaging in my inward 
discomfort If I do some things against my conscience; It cause more 

discomfort for me 
fretfulness The first thing is blaming; you ashamed yourself anyway 

Reaction of 
Conscience 

expressing I express always and very soon; I say: I do a good action today 
compensation I compensate it as soon as possible 
lack of repeat I try to don't repeat in the next time 

 

 

Discussion : The findings showed that reaction of conscience in nurses’ experiments include three 
pivotal concept; the being peace, trouble conscience, and reaction of conscience. One of the findings 
was the being peace. Participants expressed their experience on acting accordance with conscience 
as calming, pleased and having satisfied. In this regard, Jafari wrote; the human conscience has 
capacity to accepting authenticity, and good practices followed by conscience satisfaction. Really, the 
conscience has a sense of satisfaction on justice and fairness. He says; our relative knowledge 
doesn't give us the peace that we expect it, but, only conscience can create the calming (Jafari, 
2009).  On the basis of the dictate of conscience, a person can perform an action that will provide the 
basis for the development of the relevant virtues (Stanford University, 2011). The calm conscience 
presents us certainty and calming. One of the amazing phenomenon in our inside is that, this certainty 
from the view of exploration is marked, but, when created by conscience; is the same as seeing it and 
still, higher than seeing, can sensed as the component of the our body(Jafari, 2009). Participant in 
this study, paid attention to calming, satisfying and pleased after following their conscience.  

Another theme that emerged from analysis of data was trouble of conscience; because of threatening 
of moral integrity. Nurses have reported feeling of trouble conscience in situation in which they felt 
unable to provide the quality of care they believed their duty required for them. Nurses feel guilty and 
inadequate when they fall short of perceived performance standards (Sorlie et al., 2003). Troubled 
conscience has been described as a positive force that develops our moral values; it makes us aware 
of our values, even though its negative consequences are more frequently described. For nurses, an 
inability to act according to their conscience is associated with several phenomena: decreased well-
being in nurses and patients, high turnover rates and shortage of nurses, burnout, and distancing 
from patients (Glasberg et al., 2006). Troubled conscience, such as feelings of guilt, is experienced by 
care providers, for instance, when not fulfilling their perceived obligations to patients. These 
obligations can be dictated either by oneself or by others, such as patients, management or the 
organization (Juthberg et al., 2007). Circumstances and demands may conflict with the care 
providers’ moral values. Conscience can be understood as a person’s integrated moral values and 
discrepancies between circumstances, demands and the care providers’ moral values may trouble the 
care providers’ conscience (Juthberg & Sundin., 2010).  Conscience relates to moral responsibility. 
Failing one’s moral responsibility, whether related to personal failures or to situational constraints may 



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lead to moral distress and stress of conscience (stress related to troubled conscience) which are both 
related to burnout. Stress of conscience is found to be associated with factors such as not being able 
to follow one’s conscience and of being morally burdened (Glasberg et al., 2008). The nurses try to 
resolve these stress and burden simultaneously with having discomfort, guiltiness and blaming; by 
performing several actions such as compensating, don't repeating and expressing under the name of 
reaction of conscience theme. Consciences call the people to left wrongness and attend to rightness 
and establish a level of selfish and authenticity (Lederman, 2003). Conscience acts as; internal 
restrain and individual moral authority (Johnston, 2006). Conscience has also been described as 
inducing self-growth and protecting personal integrity. It can be consulted in care situations with the 
intention of protecting the integrity and dignity of all individuals involved (Dahlqvist et al., 2007).  Guilt 
helps to shape the morality or character of a person, and anticipation of guilt prevents wrongdoing. 
Ricoeur points to the warning function of conscience and underlines its significance for being and 
acting ethically. In the dialectics between attestation and suspicion, coming from questioning what is 
good, we develop as moral beings (Glasberg et al., 2008). In health care, conscience perceived as a 
warning against doing wrong helps to protect the fundamental integrity, wholeness and harmony of 
persons involved in care. Nurses refer to their previous experiences of troubled conscience to help 
them make decisions in future situations and to teach them to use their conscience to make 
controversial decisions (Post, 1998). 

 

Conclusion: The lived experience of nurse on reaction of conscience was specified in three 
categories; being peace, trouble of conscience, and reaction of conscience. Though the nurses in this 
study showed troubled conscience; when acting against their conscience and being peace; when 
acting consistent with conscience, but, they told; troubled conscience is a developing factor for 
conscience.  Although the results were consistence with those of other studies, the emphasis of 
participants on different aspects of conscience was different from the findings of other studies; such 
that the item of the highest importance in another study did not have the same level of importance in 
the current study. Furthermore, the participants were nurses of different wards, while it seems that the 
nurses’ perception of conscience in various wards or different hospitals can be different. Thus, 
besides providing some mechanisms to reinforce nursing conscience or removing the factors that 
impair the nursing conscience, it is suggested to carry out some more specific studies in specialized 
wards or hospitals. 

 

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