Generating situations of Moral Distress in Primary Care Nurses

Barth, Priscila Orlandi; Ramos, Flávia Regina Souza; Barlem, Edison Luiz Devos; Rennó, Heloiza Maria Siqueira; Brehmer, Laura Cavalcanti de Farias; Rocha, Jéssica Mendes

doi:10.1590/0034-7167-2018-0378

Cited by 12 publications

(12 citation statements)

References 22 publications

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“…Many factors trigger moral distress in nurses, many of which are related to everyday life, such as poor organization of the working process; conflicting interpersonal relationships among the patient, the community, and the healthcare professionals; controversial management of the ruling system and services provided [ 25 , 32 ]. Barth et al [ 25 ] also identified “lack of qualification of the professional himself”, explained by the contrasting evolution of primary care systems and settings. This is confirmed by findings from Burston et al [ 31 ].…”

Section: Resultsmentioning

confidence: 99%

“…The majority (n = 7) of the studies were qualitative in design [19][20][21][22][23][24][25]: three studies were quantitative [26][27][28], three were validation studies [29][30][31], one study was an integrative review [32], and one was a case study [33].…”

Section: Characteristics Of the Studies Includedmentioning

confidence: 99%

“…The most productive country was Brazil, with seven studies included [20,21,25,26,29,30,32]. Two studies were conducted in Canada [24,33]; two in Sweden [22,23]; one each in Germany [19], the Netherlands [28], Turkey [27], and Australia [31].…”

Section: Characteristics Of the Studies Includedmentioning

confidence: 99%

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Ethical Problems and Moral Distress in Primary Care: A Scoping Review

Giannetta

Villa

Pennestrì

et al. 2021

IJERPH

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Background: Since 1997, nursing ethics research has focused on solving ethical dilemmas, enhancing decision-making strategies, and introducing professional education. Few studies describe the triggers of ethical dilemmas among primary care nurses. The aim of this study was to explore the moral distress and ethical dilemmas among primary care nurses. Methods: A scoping review was performed following Arskey and O’Malley’s framework. PubMed, CINAHL, PsycINFO, Embase, and Scopus were searched systematically to retrieve relevant titles and abstracts. A temporal filter was applied to focus on the most recent literature (years of 2010–2020). The research was completed on 17 November 2020. Results: Of 184 articles retrieved, 15 were included in the review. Some (n = 7) studies had a qualitative design, and the most productive country was Brazil (n = 7). The total number of nurses involved in quantitative studies was 1137 (range: 36–433); the total number of nurses involved in qualitative studies was 144 (range: 7–73). Three main focus areas were identified: (a) frequent ethical conflicts and moral distress episodes among nurses working in primary care settings; (b) frequent moral distress measures here employed; (c) coping strategies here adopted to prevent or manage moral distress. Conclusion: Further research is needed to examine the differences between moral distress triggers and sources of ethical dilemmas among the different care environments, such as primary care and acute care settings.

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Section: Resultsmentioning

confidence: 99%

Section: Characteristics Of the Studies Includedmentioning

confidence: 99%

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Ethical Problems and Moral Distress in Primary Care: A Scoping Review

Giannetta

Villa

Pennestrì

et al. 2021

IJERPH

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“…Somando barreiras culturais, dificuldade de acesso aos serviços, sobrecarga de trabalho vivenciada pelos profissionais e carência de inovação às adversidades atreladas ao tratamento proposto, totalizam obstáculos sociais/organizacionais de complicada resolução. A falta de continuidade do cuidado, articulada a problemas relacionados aos encaminhamentos e a organização de fluxos reforça a vulnerabilidade do usuário e do próprio profissional (Barth et al, 2019).…”

Section: Discussionunclassified

Sensibilidade moral dos profissionais da atenção primária nas situações de vulnerabilidades relacionadas ao comportamento suicida

Ferreira

Vargas

Zilli

et al. 2021

RSD

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Objetivo: Analisar atuação dos profissionais da atenção primária à saúde sobre o comportamento suicida na perspectiva conceitual da vulnerabilidade e sensibilidade moral em um município catarinense. Método: Estudo qualitativo mediante entrevista semiestruturada com 19 profissionais da Atenção Primária em Saúde. Os dados foram analisados com base na análise de conteúdo. Resultados: A partir da percepção dos profissionais, foi possível identificar uma visão ampliada quanto à multicausalidade/manifestações do comportamento suicida, ainda, foi possível pontuar que, a abordagem profissional somada à resposta das instituições e coparticipação da família/sociedade podem gerar, perpetuar e transformar vulnerabilidades, e por fim, evidenciou-se insuficiência de ações em saúde, representando oposição ao objetivo de ultrapassar vulnerabilidades. Conclusão: Na sensibilidade moral, perceber o problema deve estar atrelado ao repensar a prática. Inovação das ações e busca por recursos que perpassem barreiras vão em direção à defesa dos direitos da pessoa em sofrimento, rompimento das vulnerabilidades e amenização do sofrimento profissional. O diferencial da problemática do comportamento suicida está na compreensão a partir da perspectiva da vulnerabilidade e sensibilidade moral, que permitiu apontar a necessidade contínua de aprimoramento de habilidades que impactam nas estratégias de intervenção, assim como, direcionar o olhar para o trabalhador o qual passa a lidar com angústias desencadeadas dos problemas éticos.

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“…The studies on moral distress in the field of nursing, especially in the last five years and also in Brazilian settings, have pointed out several generating situations or risk factors, strongly associated with the environment, including the structure and organization of the work process, as well as such as interpersonal relationships that are established (9)(10)(11)(12)(13) . After decades of studies, it is confirmed that the necessary and sufficient conditions to define moral suffering refer to the combination of the experience of a moral event and psychological suffering, in a direct causal relationship.…”

Section: Introductionmentioning

confidence: 99%

Association between moral distress and supporting elements of moral deliberation in nurses

Ramos

Brehmer

Dalmolin

et al. 2020

Rev. Latino-Am. Enfermagem

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Objective: to identify the association between moral distress and the supporting elements of moral deliberation in Brazilian nurses. Method: a cross-sectional study conducted with Brazilian nurses working in health services at different complexity levels. The research protocol consisted of the Brazilian Scale of Moral Distress in Nurses, a sociodemographic and labor questionnaire, and a list of bases and ethical elements used for moral deliberation. For analysis, descriptive statistics, chi-square test, and Poisson regression were used. Results: 1,226 nurses took part in the study. The 12 elements associated with the moral deliberation process were classified as important for nurses’ actions, especially the professional experience acquired, code of ethics/law of professional practice, and ethical and bioethical principles. The relationship of moral distress showed higher prevalence in the Beliefs, culture and values of the patient, Beliefs and personal values, and Intuition and Subjectivity elements. Conclusion: the results showed a balance between the subjective criteria of professional experience and the objective ones of deontology for moral deliberation.

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Generating situations of Moral Distress in Primary Care Nurses

Cited by 12 publications

References 22 publications

Ethical Problems and Moral Distress in Primary Care: A Scoping Review

Ethical Problems and Moral Distress in Primary Care: A Scoping Review

Sensibilidade moral dos profissionais da atenção primária nas situações de vulnerabilidades relacionadas ao comportamento suicida

Association between moral distress and supporting elements of moral deliberation in nurses

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