Original Article

Clarifying the concept of conscience in nurses’ ethical performance in Iran: a concept analysis study


Although conscience, as an ethical concept, has emerged widely in the field of nursing, its functional meaning and its effects on nurses' performance are not clear. Therefore, the present study aimed to analyze the concept of conscience in the context of Iranian nurses’ ethical performance.  This study used a hybrid model including theoretical, fieldwork, and final analytic stages. In the theoretical phase, English and Persian articles published up to 2020 and indexed by scientific databases were analyzed. In the fieldwork phase, semi-structured in-depth interviews were conducted on nurse participants. The last two stages were jointly considered to draw the study’s conclusions. In the theoretical phase, conscience was considered as a context-dependent concept, an inner voice, and a criterion for distinguishing right from wrong. The fieldwork phase’ results were categorized into three themes: “perception of conscience”, “commands of conscience”, and “obedience to conscience. The final definition was reached by merging the theoretical and field stages. This article aimed at investigating the relevance of conscience to ethical practice in the nursing field. Findings show that conscience is an inner feeling or voice that plays a vital role in providing ethical care by nurses.  

Gorbanzadeh B, Rahmani A, Mogadassian S, Behshid M, Azadi A, Taghavy S. Levels of conscience and related factors among Iranian oncology nurses. Asian Pac J Cancer Prev. 2015; 16(18): 8211-4.

Glasberg AL, Eriksson S, Dahlqvist V, et al. Development and initial validation of the stress of conscience questionnaire. Nurs Ethics. 2006; 13(6): 633-48.

Lamb C, Evans M, Babenko-Mould Y, Wong CA, Kirkwood KW. Conscience, conscientious objection, and nursing: a concept analysis. Nurs Ethics. 2019; 26(1): 37-49.

Dahlqvist V, Eriksson S, Glasberg AL, Lindahl E, et al. Development of the perceptions of conscience questionnaire. Nurs Ethics. 2007; 14(2): 181-93.

Nelms TP. Living a caring presence in nursing: a Heideggerian hermeneutical analysis. J Adv Nurs. 1996; 24(2): 368-74.

Jansson L, Norberg A, Sandman P-O, Astrom G. When the severely ill elderly patient refuses food ethical reasoning among nurses. Int J Nurs Stud. 1995; 32(1): 68-78.

Hasani P, Jalali R, Abedsaeedi Z. Nurses’ experience of the perception of nursing conscience: a phenomenological study. Iranian Jurnal of Nursing Research. 2013; 8(3): 1-9.

Mazaheri M, Ericson-Lidman E, Zargham-Boroujeni A, Ohlen J, Norberg A. Clear conscience grounded in relations: expressions of Persian-speaking nurses in Sweden. Nurs Ethics. 2017; 24(3): 349-61.

Juthberg C, Sundin K. Registered nurses’ and nurse assistants’ lived experience of troubled conscience in their work in elderly care- a phenomenological hermeneutic study. Int J Nurs Stud. 2010; 47(1): 20-9.

Ford NJ, Austin W. Conflicts of conscience in the neonatal intensive care unit: perspectives of Alberta. Nurs Ethics. 2018; 25(8): 992-1003.

Tuvesson H, Eklund M, Wann-Hansson C. Stress of conscience among psychiatric nursing staff in relation to environmental and individual factors. Nurs Ethics. 2012; 19(2): 208-19.

Mazaheri M, Ericson‐Lidman E, Joakim Ö, Norberg A. Meanings of troubled conscience and how to deal with it: expressions of Persian‐speaking enrolled nurses in Sweden. Scand J Caring Sci. 2018; 32(1): 380-8.

Schwartz-Barcott D, Hesook K. An expansion and elaboration of the hybrid model of concept development. Concept Development in Nursing Foundations, Techniques, and Applications. 2000; 2:107-33.

Madden BP. The hybrid model for concept development: its value for the study of therapeutic alliance. ANS Adv Nurs Sci. 1990; 12(3): 75-87.

Polit DF, Beck CT. Study Guide for Essentials of Nursing Research, 9th ed. USA: Lippincott Williams & Wilkins; 2017.

Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004; 24(2): 105-12.

Ahlin J, Ericson Lidman E, Norberg A, Strandberg G. A comparison of assessments and relationships of stress of conscience, perceptions of conscience, burnout and social support between healthcare personnel working at two different organizations for care of older people. Scand J Caring Sci. 2015; 29(2): 277-87.

Saarnio R, Sarvimaki A, Laukkala H, Isola A. Stress of conscience among staff caring for older persons in Finland. Nurs Ethics. 2012; 19(1): 104-15.

Ahlin J, Ericson-Lidman E, Norberg A, Strandberg G. Revalidation of the perceptions of conscience questionnaire (PCQ) and the stress of conscience questionnaire (SCQ). Nurs Ethics. 2012; 19(2): 220-32.

Jensen A, Lidell E. The influence of conscience in nursing. Nurs Ethics. 2009; 16(1): 31-42.

Juthberg C, Eriksson S, Norberg A, Sundin K. Perceptions of conscience, stress of conscience and burnout among nursing staff in residential elder care. J Adv Nurs. 2010; 66(8): 1708-18.

Cleary M, Lees D. The role of conscience in nursing practice. Issues Ment Health Nurs. 2019; 40(3): 281-3.

Glasberg AL, Eriksson S, Norberg A. Burnout and ‘stress of conscience’among healthcare personnel. J Adv Nurs. 2007; 57(4): 392-403.

Ko CM, Koh CK, Lee YS. An ethical issue: nurses’ conscientious objection regarding induced abortion in South Korea. BMC Medical Ethics. 2020; 21:106.

Morton NT, Kirkwood KW. Conscience and conscientious objection of health care professionals refocusing the issue. HEC Forum. 2009 ; 21(4): 351-64.

Zhang H, Wang K, Liu Y, Chan DKS. Factors associated with stress of conscience among emergency medical technicians in China. Int J Nurs Pract. 2013;19(Suppl.3): 89-96.

Genuis SJ, Lipp C. Ethical diversity and the role of conscience in clinical medicine. Int J Family Med. 2013; 2013: 587541.

Nasirzadeh F. The impact of management ethics and moral consciousness and intelligence agencies. Ethics. 2015; 4: 38.

Vanaki Z, Memarian R (2009). Professional ethics: beyond the clinical competency. J Prof Nurs. 2009; 25(5): 285-91.

Jalali R, Hasani P, Abedsaeedi Z. Nurses’ experiences of the factors leading to commit unconscionable acts: a phenomenological study. Journal of Inflammatory Diseases (The Journal of Qazvin Uuniverstity of Medical Sciences). 2014; 17(5): 56-61.

Jasemi M, Aazami S, Hemmati Maslak Pak M, Habibzadeh H, Esmaeili Zabihi R. Factors affecting conscience-based nursing practices: a qualitative study. Nurs Ethics. 2019; 26(5): 1350-60.

Foolad Z, Amini Rarani M, Salehi S. Exploring social health and work conscience among nurses working in hospitals of Shiraz, Iran. Medical Science. 2019; 23: 54-7.

Lak S, Zahedi S, Davodabady F, Khosravani M. Conscience understanding among nurses working at education hospital of Arak. Revista Latinoamericana De Hipertension. 2018;13(3): 246-50.

Armstrong AE. Towards a strong virtue ethics for nursing practice. Nurs Philos. 2006; 7(3): 110-24.

Alirezaei N, Masah H, Akrami N. The Relation between work conscientiousness with job performance. Ethics in Science and Technology. 2013; 8(2): 76-86.

Imani JR, Rezae Hakimi H, Mirzai M. Evaluation the effect of work conscientiousness and moral sensitivity with ethical stress in nurses working in intensive care units in educational and therapeutic centers affiliated to Zahedan University of Medical Sciences. Journal of Iranian Society Anaesthesiology and Intensive Care. 2017; 39: 4(100): 20-7.

Ericson‐Lidman E, Norberg A, Persson B, Strandberg G. Healthcare personnel’s experiences of situations in municipal elderly care that generate troubled conscience. Scand J Caring Sci. 2013; 27(2): 215-23.

Juthberg C, Eriksson S, Norberg A, Sundin K. Stress of conscience and perceptions of conscience in relation to burnout among care‐providers in older people. J Clin Nurs. 2008; 17(14): 1897-906.

Gustafsson G, Eriksson S, Strandberg G, Norberg A. Burnout and perceptions of conscience among health care personnel: a pilot study. Nurs Ethics. 2010; 17(1): 23-38.

IssueVol 14 (2021) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jmehm.v14i14.7669
Conscience; Concept analysis; Ethics; Nursing.

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How to Cite
Jodaki K, Esmaeili M, Cheraghi MA, Pashaeypoor S, Sadat Hoseini AS. Clarifying the concept of conscience in nurses’ ethical performance in Iran: a concept analysis study. J Med Ethics Hist Med. 2021;14.