The process

I used a semi-structured interview approach, so I chose a few questions or subjects to explore for the first interviews: the nurse’s background and career trajectory, their understanding of moral distress, and their relationship to photography. I let them know that the interview would last about 30 minutes, but if they wanted to talk more that was fine. The responses they gave determined the follow-up questions that I asked and as these lead to more, often personal stories and information about both the participant and their work as a nurse I would categorise these interviews as in-depth.

During this interview the background to the research and its objectives were explained and the practical activity was introduced. The subject of moral distress is a sensitive one and even before beginning to explore it I knew that it would lead to nurses sharing deeply personal and emotional stories as well as opinions that criticised aspects of their work.

Following the first interview the nurses were asked to take photographs to communicate a moral event or experience of moral distress. To support them in doing this, I invited them to use one or more of the five words from a research study that described the five different types of moral distress, through a series of interviews with ICU nurses (Morley, Bradbury-Jones and Ives, 2020). The words are moral: tension, dilemma, uncertainty, constraint and conflict.

I also offered a few possible approaches to get the nurses started: the re-enactment of an event or scenario, a constructed scene - using objects or props, an atmospheric photo that symbolises the mood of an event or your feelings towards it. This proved to be a helpful aspect, as many of the nurses had never engaged in a guided photographic process before and the translation of text to image came more naturally to some than others. Participants could then ask questions to further clarify the tasks and a rough timeline was agreed for taking the photos and sending them to me via email or WhatsApp.

The choice to work in a way that uses text as prompts to generate photographs builds on my previous participation in the Writing Photographs Research group at London College of Communication, where I was invited to lead a photography and performance workshop for members of the group at LCC and also at the Writing Photographs Conference at Tate Modern in 2018 (LCC, 2023) The workshops highlighted the thinking and the decision-making that occurs when shifting between different mediums and also when translating one form of creative practice into another. They became laboratories for trying out, performing and embodying words and images, and re-working them into photographs.