“I can’t be the nurse I want to be”: Stories of moral distress in pediatric oncology nurses’ caregiving narratives
Abstract
This thesis presents the caregiving narratives of nine pediatric oncology nurses that illustrate the embeddedness of their caregiving and moral distress within institutional contexts that limit their capacity to be the nurses they want to be. Informed by the concepts of moral distress, bearing witness, and narrative repair, a critical narrative methodology was employed to examine the nurses’ caregiving experiences in relation to broader discourses and neoliberal, corporatized health care settings. The nurses’ stories were marked by ambivalence and moral distress and are presented in four narrative themes, which illustrate: the nurses’ struggles to complete their tasks and address multiple and shifting needs of patients and families in under-resourced and chaotic working conditions; institutional constraints on nurses’ capacities to maintain physical, narrative, and moral proximity to patients and families; how the nurses form collective resilience through their shared moral distress to survive unsupportive working conditions; how the nurses mobilized narrative knowledge of patients and families to enact their moral responsibilities; and how they narratively repaired their fractured moral identities to restore their identities as the nurses they wanted to be. The findings illustrate how the nurses’ counterstories ascribe value and meaning to the relational caregiving that exceeds the physical care associated with treatment and cure, and re-locate the source of moral distress within unsupportive institutions rather than in the emotionally challenging character of pediatric oncology caregiving. By linking individual caregiving narratives to broader contexts, the findings contribute epistemologically grounded narratives to enrich research on the stresses associated with pediatric oncology caregiving, provide narrative depth to enhance theoretical work in nursing on moral distress and bearing witness, and extend the concept of narrative repair to consider how narrative functions to facilitate relational caregiving and restore nurses’ damaged moral identities. The creation of narrative spaces is suggested as a way to complicate cultural and professional understandings of pediatric cancer caregiving. Storytelling can inform nursing education, practice and policy to highlight the ambivalences of pediatric oncology caregiving and to bridge nurses’ experiences of caregiving with management, other health care providers, and the general public, as well as to stimulate social change.