title: From painful busyness to emotional immunization: Nurses' experiences of ethical challenges.
abstract: BACKGROUND
  The professional values presented in ethical guidelines of the Norwegian Nurses Organisation and International Council of Nurses describe nurses' professional ethics and the obligations that pertain to good nursing practice. The foundation of all nursing shall be respect for life and the inherent dignity of the individual. Research proposes that nurses lack insight in ethical competence and that ethical issues are rarely discussed on the wards. Furthermore, research has for some time confirmed that nurses experience moral distress in their daily work and that this has become a major problem for the nursing profession.
  
  
  OBJECTIVE
  The purpose of this article is to obtain a deeper understanding of the ethical challenges that nurses face in daily practice. The chosen research questions are "What ethical challenges do nurses experience in their daily practice?"
  
  
  METHODS
  We conducted a qualitative interview study using a hermeneutical approach to analyzing data describing nurses' experiences. Ethical considerations: The Norwegian Social Science Data services approved the study. Furthermore, the head of the hospital gave permission to conduct the investigation. The requirement of anonymity and proper data storage in accordance with the World Medical Association Declaration of Helsinki was met.
  
  
  RESULTS
  The context for the study comprised three different clinical wards at a university hospital in Norway. Nine qualified nurses were interviewed. The results were obtained through a systematic development beginning with the discovery of busyness as a painful phenomenon that can lead to conflicts in terms of ethical values. Furthermore, the consequences compromising professional principles in nursing care emerged and ended in moral blindness and emotional immunization of the healthcare providers. Emotional immunization occurred as a new dimension involving moral blindness and immunity in relation to being emotionally touched.
authors.affiliation: Oslo and Akershus University College of Applied Sciences, Norway.
authors.forename: Anne
authors.initials: A
authors.lastname: Storaker
authors.affiliation: Oslo and Akershus University College of Applied Sciences, Norway.
authors.forename: Dagfinn
authors.initials: D
authors.lastname: Nåden
authors.affiliation: Oslo and Akershus University College of Applied Sciences, Norway.
authors.forename: Berit
authors.initials: B
authors.lastname: Sæteren
mesh_terms: D004645:Empathy; D004993:Ethics, Nursing; D006785:Hospitals, University; D006801:Humans; D009014:Morals; D009664:Norway; D009732:Nursing Care / Q000941:ethics*; D009741:Nursing Staff, Hospital / Q000523:psychology*; D036301:Qualitative Research; D016526:Workload / Q000523:psychology
keywords: Emotional immunization; ethical behavior; ethical challenges; ethical values; moral distress; nursing care