Salient vulnerability theory: a grounded theory study of nurses’ ethical decisions in the context of workplace violence
| dc.contributor.author | Dunsford, Jennifer | |
| dc.contributor.examiningcommittee | Simpson, Christy (Peace and Conflict Studies) | |
| dc.contributor.examiningcommittee | Brownridge, Douglas (Community Health Sciences) | |
| dc.contributor.examiningcommittee | Schwartz, Lisa (McMaster University) | |
| dc.contributor.guestmembers | Schultz, Annette (Rady Faculty of Health Sciences, College of Nursing) | |
| dc.contributor.supervisor | Senehi, Jessica | |
| dc.date.accessioned | 2025-03-14T21:00:57Z | |
| dc.date.available | 2025-03-14T21:00:57Z | |
| dc.date.issued | 2025-01-07 | |
| dc.date.submitted | 2025-01-12T14:38:30Z | en_US |
| dc.degree.discipline | Interdisciplinary Program | |
| dc.degree.level | Doctor of Philosophy (Ph.D.) | |
| dc.description.abstract | This qualitative study examines the problem of how nurses navigate the moral dilemmas that arise when they encounter workplace violence. It considers the ethical decisions that nurses make, the considerations that factor into decisions about the course of action, and the experience of moral distress when workplace violence occurs. The study was conducted using a constructivist grounded theory methodology. Data from 36 interviews and six narrative documents were analyzed. The core category of Managing Intersecting Vulnerabilities was identified. With respect to ethical decisions, three subcategories were found: Getting the Job Done (Stay), Shifting the Dynamic (Pause), and Withdrawing from the Situation (Leave). In terms of determining a course of action, participants identified factors that increase risks, such as factors related to the nurse, patient or environment, and factors that mitigate risks, including risk assessment, the availability of supports, and skills and tools. The experience of moral distress fell into four categories: Choosing to Disengage, Living with Moral Residue, Witnessing Patient Impacts, and Working Under Structural Constraints. This analysis resulted in the development of Salient Vulnerability Theory, a substantive theoretical framework for understanding how nurses navigate decisions about providing care in the context of violence. The theory proposes that patient vulnerability provides a moral obligation to provide care, however that obligation is limited by violence that places the nurse at risk. When this happens, the nurse’s vulnerability becomes salient, and a decision to leave the situation can be practically and ethically justified until such a time as a balance is restored and the nurse can safely resume care. The recommendations issuing from this new theory are intended to reduce the incidence and impact of violence and the resulting moral distress by addressing the problem at a structural level, and include ensuring adequate staffing, the implementation of effective training and equipment, well-designed workspaces, and holding space for healing and practices of support. Empirical confirmation of Salient Vulnerability Theory and the effectiveness of suggested interventions is recommended. | |
| dc.description.note | May 2025 | |
| dc.description.sponsorship | Graduate Fellowship, Centre for Professional and Applied Ethics, University of Manitoba | |
| dc.identifier.uri | http://hdl.handle.net/1993/38929 | |
| dc.language.iso | eng | |
| dc.subject | Nursing | |
| dc.subject | Ethics | |
| dc.subject | Workplace Violence | |
| dc.title | Salient vulnerability theory: a grounded theory study of nurses’ ethical decisions in the context of workplace violence | |
| local.subject.manitoba | no | |
| oaire.awardNumber | 752-2023-1233 | |
| oaire.awardTitle | SSHRC Doctoral Fellowship | |
| oaire.awardURI | https://www.sshrc-crsh.gc.ca/funding-financement/programs-programmes/fellowships/doctoral-doctorat-eng.aspx | |
| project.funder.identifier | SSHRC: https://doi.org/10.13039/501100000155 | |
| project.funder.name | Social Sciences and Humanities Research Council of Canada |