About this website

For my PhD studyI designed and led a photographic process for critical care nurses to participate in, in order to explore their experiences of moral distress. The whole process involved semi-structured interviews, the recollection and description of moral events and distress, photo-taking and photo-sharing. This website collates photographs taken by the participants and excerpts from the interviews. It also includes a written, anonymised profile of each nurse, detailing their background and career.

What is moral distress?

Moral distress is a complex concept, with no agreed upon definition, so I have adopted the definition proposed by Dr Georgina Morley et al. in this paper, where they propose that Moral Distress is:

“the combination of (1) the experience of a moral event, (2) the experience of ‘psychological distress’ and (3) a direct causal relation between (1) and (2) .”

This proposed definition allows for the possibility of a moral event occurring that does not lead to psychological distress, something that several of the nurse I worked with mentioned during the interviews.

What do you mean by photography?

The definition of photography I’m using comes from Ariella Azoulay’s definition of photography in this book as:

“a series of infinite encounters”

This encompasses all of the moments when the nurses planned, took, reflected upon and shared a photograph. It also includes the people who will see the photos via this website and encompasses all future acts of discussing and exhibiting the photographs.

Why photography?

Photography, using the definition above, has been used throughout its history, both consciously and unconsciously, to communicate complex narratives. Both amateur and professional photographers have pushed the edges of the medium since its inception, in order to highlight subjective experiences and articulate personal perspectives.

When I talk about photography as a participatory practice, I am including all of the myriad ways that cameras can be used with either a group or an individual to create photographs. In my work and project design this practice often expands to bring in elements of other disciplines such as performance, sculpture, literature, sport, sound and drawing. The participatory processes are a dance between the purpose of the research project and the needs, availability and emerging creative work of the participants.

I have extensive experience facilitating photography projects in different settings and have developed skills in working responsively with individuals and groups. This form of working often involves a type of reflective practice, unique to artists as detailed by Linda Candy in the conclusion of her book:

“creative practitioners reflect and reflect again before, during and after everything they do”

The outcomes of working with photography, with these 9 nurses, created a space for reflection which gave a rich insight into both their embodied experiences and reflections on moral distress. It is my view that by engaging in this process new forms of narratives about moral distress are discovered. By concentrating on the process as well as the resulting photographs a more complex and multi-layered picture is created and this can operate as both a useful creative reflective practice as well as a rich creative body of work about a topic of growing concern.

How did the photography process work?

After choosing to take part, the process began with an initial interview lasting a minimum of 30 minutes. These were semi-structured and aimed to gain an understanding of each nurse’s background and pathway through the profession. In these conversations moral distress was discussed or introduced to participants, depending upon their existing understanding of the concept.

All participants were sent the following information during or after the first interview:

Thank you for participating in this research, your experiences as a nurse are valuable insights and I’m grateful that you’re sharing them with me. The photography for this research project can be done using any type of camera that you have and want to use, and there is no wrong way of responding to any of the exercises and tasks that I’ve included below. All responses are very welcome! Please choose an experience that you have had at work where you had a challenging moral situation or decision to make, an event that could be described as creating:

Tension, Uncertainty, Conflict, Constraint or Dilemma

Use the words as a starting point to take a photograph that encapsulates some of this event. Some possibilities and approaches you can use to do this are:

Re-enactment - use yourself and/or other people (with their signed consent), or pets(!) to re-create a scene from this event.

Still life / constructed scene  - use objects or existing scenes indoors or outdoors, to represent the event without people. i.e – using fruit on a table, or objects found outside like bricks or plants

Atmospheric echoes – take photographs that create an atmosphere that is similar to how you felt during this event. These can be very abstract if you like.

If you have any questions, or want further clarification on these tasks, please don’t hesitate to contact me.