Nursing students facing moral distress: strategies of resistance

Abstract

Objective: To understand the resistance strategies adopted by undergraduate students in nursing, faced with situations of moral distress (MD). Method: Qualitative research, developed in three universities in the south of Brazil, two federal and one private, with 21 undergraduate students in nursing from December 2015 to February 2016; the data was submitted to the discursive textual analysis and Foucauldian theoretical reference. Results: Students resisting demonstrate a sense of self-preservation and moral empowerment. Moreover, non-resistance initiatives are related to the fear of possible sanctions. Thus, by resisting or not, students may experience both positive and negative repercussions. Final considerations: By resisting, students aim to defend what they believe to be right, demonstrating their moral empowerment in the face of their moral distress. However, the exercise of disciplinary power seems to contribute to their moral fragilization, making it diffi cult to implement resistance strategies. Descriptors: Nursing Students; Nursing Education; Power; Moral; Ethics. RESUMO Objetivo: Compreender as estratégias de resistência adotadas pelos estudantes de graduação em enfermagem, diante de situações de sofrimento moral (SM). Método: Pesquisa qualitativa, desenvolvida em três universidades do sul do Brasil, duas federais e uma privada, com 21 estudantes de graduação em enfermagem, entre dezembro de 2015 e fevereiro de 2016; os dados foram submetidos à análise textual discursiva e referencial teórico foucaultiano. Resultados: Os estudantes ao resistirem demonstram um senso de autopreservação e fortalecimento moral. Ainda, ações de não resistência relacionam-se ao medo de possíveis sanções. Assim, ao resistir ou não, os estudantes podem vivenciar repercussões tanto positivas como negativas. Considerações fi nais: Ao resistir, os estudantes visam defender o que acreditam ser o correto, demonstrando seu fortalecimento moral diante do sofrimento moral. No entanto, o exercício do poder disciplinar parece contribuir para sua fragilização moral, difi cultando a implementação de estratégias de resistência. Descritores: Estudantes de Enfermagem; Educação em Enfermagem; Poder; Moral; Ética. RESUMEN Objetivo: Comprender las estrategias de resistencia adoptadas por los estudiantes de graduación en enfermería, ante situaciones de sufrimiento moral (SM). Método: La investigación cualitativa, desarrollada en tres universidades del sur de Brasil, dos públicas y una privada, con 21 estudiantes de graduación en enfermería, entre diciembre de 2015 y febrero de 2016; los datos fueron sometidos al análisis textual discursivo y referencial teórico foucaultiano. Resultados: Los estudiantes al resistir demuestran un sentido de autopreservación y fortalecimiento moral. Aún, acciones de no resistencia se relacionan con el temor de posibles sanciones. Así, al resistir, o no, los estudiantes pueden experimentar repercusiones tanto positivas como negativas. Consideraciones fi nales: Al resistir, los estudiantes pretenden defende...

Moral distress in undergraduate nursing students

“…Nursing students also experience moral distress when they witness situations that are morally inadequate, particularly circumstances of care and behavior that are morally inadequate in the academic environment, situations of disrespect toward patients and their rights. 5,10 In this context, the students opts for silence to preserve the field of practical activity and the opportunities for learning. 4,5 These situations are incompatible with their values, principles, and personal standards learned during academic training and possibly cause them to experience moral distress.…”

“…5,10 In this context, the students opts for silence to preserve the field of practical activity and the opportunities for learning. 4,5 These situations are incompatible with their values, principles, and personal standards learned during academic training and possibly cause them to experience moral distress.…”

“…Interest in this subject nowadays has broadened this field of research, moving from the first investigations focused on health professionals to students in the health area. Specifically, moral distress was investigated in nursing students in Brazil1, 3 –5 and internationally. 6 –13…”

“…Thus, it is relevant to explain that students face their own moral problems 14 in the training environment they are inserted in, which may reveal the confrontation with dubious circumstances related to the exercise of autonomy, ethics, and morality. In this perspective, elucidating the situations that cause moral distress in undergraduate nursing students, in the training environments, can provide a description of the university weaknesses 5 and directly influence the defense and valuation of the students themselves, as well as the qualification of their education.…”

Tendências de teses e dissertações brasileiras acerca do sofrimento moral na enfermagem

“…Ressalta-se que, quanto mais conhecimento o estudante apresentar, mais seguro e confiante irá se sentir para apoiar o que presume ser o mais coerente e advogar em sua defesa e de outras pessoas. Desse modo, estimular o fortalecimento moral do estudante de enfermagem favorece para aprimorar as competências éticos-morais no ambiente acadêmico (Bordignon, et al, 2018).…”