Academic journal article Nordic Journal of Working Life Studies

Coping with Moral Stress in the Swedish Public Services

Academic journal article Nordic Journal of Working Life Studies

Coping with Moral Stress in the Swedish Public Services

Article excerpt

Introduction

Major changes, due to new public management reforms, have occurred in the public services in many Western countries in recent years (Hood, 1995). The new ways of organizing public work have been related to an increase in occupational stress (Chandler et al., 2002; Denton et al., 2002). Studies of public management reforms relate the increased stress levels to various conditions that have followed the implementation of such organizational changes, for instance, ethical conflicts or dilemmas (Raines, 2000). Studies of health care workers reveal that their work situation easily gives rise to a 'moral stress' or 'moral distress' in situations when one knows the ethically correct action to take but feels powerless to take that action because of institutional or other constraints (Corley, 1995; Glasberg, 2007; Raines, 2000; Wilkinson, 1989). Jameton (1984) defined 'moral distress' as a phenomenon in which one knows the right action to take, but is constrained from taking it. Moral stress or moral distress was first recognized among nurses. Moral distress among nurses occurs when the nurse knows what is best for the patient but that course of action conflicts with what is best for the organization, other providers, other patients, the family, or society as a whole (Corley, 2002). Thus, moral distress occurs when the internal environment of nurses-their values and perceived obligations-is incompatible with the needs and prevailing views of the external work environment (Epstein & Delgado, 2010).

Moral stress has later been identified among several health care professional groups, not only as physicians (Austin et al., 2008; Forde & Aasland, 2008; Hamric & Blackhall, 2007; Lee & Dupree, 2008; Lomis et al., 2009), respiratory therapists (Schwenzer & Wang, 2006), pharmacists (Sporrong et al., 2005), and psychologists (Austin et al., 2005), but also as social workers (McBeath & Webb, 2002). Between the professions, there appear to be differences in what causes moral distress and in how it is manifested (Austin et al., 2008; Forde & Aasland, 2008; Hamric & Blackhall, 2007; Lee & Dupree, 2008; Lomis et al., 2009; Schwenzer & Wang, 2006; Sporrong et al., 2005). However, in an overview of the research field, Epstein and Delgado (2010) argue that moral stress is a 'multi-disciplinary problem'.

Moral stress, not the least if the stressful ethical dilemmas related to new public management reforms are considered, may reasonably affect a larger group than health care and social workers. In fact, the descriptions of moral stress have parallels to the sociological theorizing about the street-level bureaucrat's dilemmas. The research about health care and social workers has identified conflicts between professional standards and the organization's resource allocation and requirements as one source of moral stress (Jameton, 1984; Hamric, 2012). Lipsky (2010) describes this conflict in his classic work on street-level bureaucrats as an inherent conflict in these bureaucrats' working conditions. Health care and social workers have with Lipsky (2010, p. 3) be defined as street-level bureaucrats in being: 'Public service workers who interact directly with citizens in the course of their jobs, and who have substantial discretion in the execution of their work are called street-level bureaucrats in this study.' According to Lipsky, the lack of resources is a constant condition for street-level bureaucrats and they develop strategies, or 'coping behavior', to deal with the contradictions of their work. Lipsky (2010, p. 142) emphasizes 'the tendency of street-level bureaucrats to cope with job stresses by modifying their conceptions of work.' Lipsky (2010, pp. 142-156) claims that because all street-level bureaucrats share the same working conditions of chronically limited resources, they also use similar and universal coping-strategies, as rationing services, setting priorities among cases, modifying goals, and dominating clients. …

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