Doctor of Philosophy
Health and Rehabilitation Sciences
Polzer, Jessica C.
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.
Summary for Lay Audience
Pediatric cancer, or cancer in children and teenagers aged 0-18, is one of the most highly publicized cancers in Canada. Advertising campaigns that feature stories about children with cancer have shaped how society has come to understand what pediatric cancer is like, and what caring for someone with pediatric cancer entails. Pediatric oncology nurses do not typically appear in public representations of pediatric cancer caregiving, yet they spend the most time with patients and families and have a unique range of caregiving tasks that they must complete in their daily work. This study collected and analyzed the caregiving stories of nurses who work in pediatric cancer care settings in order to understand what their caregiving involves and the difficulties associated with their caregiving. The nurses’ stories provide evidence of how they experienced moral distress; that is, they felt as though they could not be the nurses they wanted to be because their institutional contexts and working conditions often prevented them from providing the care they found meaningful and important. In their stories, they described their chaotic and relentless schedules, demanding workload conditions and constraints, not being supported by management, bonding together with other nurses to survive working in difficult working conditions, and bearing witness to suffering. Their stories also show the meaning they assign to their relational caregiving, such as getting to know the patients, families, and their stories, and how this knowledge enabled them to enact their moral identities (being a good nurse) and moral responsibilities (doing what they felt was aligned with the interests and needs of their patients). The study findings show how storytelling can be used to connect individual experiences of caregiving with broader institutional contexts, and provide greater understanding of the constraints that shape how nurses provide care to children with cancer and their families. Further, this study has implications for how stories can be used in nursing education, practice, and policy as a way to bridge nurses’ views with management, other health care providers, the general public, and to stimulate social change.
Molinaro, Monica L., "“I can’t be the nurse I want to be”: Stories of moral distress in pediatric oncology nurses’ caregiving narratives" (2021). Electronic Thesis and Dissertation Repository. 7994.