Ethical competence as a coping resource for moral distress in nursing

Abstract

The study's objectives were: to seek evidence on ethical situations experienced by nurses in the health services; to identify the coping resources which they use; and to ascertain the role of ethical competence in coping with moral distress. The integrative literature review was used as the method. The search was made in the LILACS, IBECS, MEDLINE, SciELO, CINAHL, PubMed, RCAAP and BDTD databases. A total of 23 studies was selected, based on previously established inclusion and exclusion criteria. The results indicate ethical questions experienced by the nurses in their relations with patients and family members, the team and the health system. Coping resources used by the professionals and implemented by the researchers are described. It may be concluded that the ethical challenges and moral distress are present in the nurses' work context, and the strategies aimed at promoting ethical competence, have positive consequences in coping with, and in reducing, levels of moral distress.

Healthcare professionals’ ethical competence: A scoping review

“…The third focus area of the studies was the realization of ethical competence as they explored the role of ethical competence in coping with moral distress (Schaefer & Vieira, ), fostering hope (Peter et al, ) and handling conflicts of interest (Falkenström et al, ). Furthermore, the studies have focused on moral case deliberation in terms of improving ethical competence (Molewijk, Verkerk, et al, ) and on supporting nurses’ ethical competence (Poikkeus, Leino‐Kilpi, & Katajisto, ).…”

“…Positive resources included discussion with work colleagues, holding meetings, reflection, learning from earlier experiences, changes in protocols, creativity and collective actions. Negative ones included avoiding ethically difficult situations, nondiscussion or reflection of the case and the option to change jobs (Schaefer & Vieira, ). Nurses’ moral competence related to fostering hope in patients and their families was identified as “Reimagining hopeful possibilities,” “Exercising caution within the social–moral space of nursing” and “Maintaining nurses’ own hope” (Peter et al, ).…”

“…The majority of the studies used statistical analysis methods, followed by content analysis. Description of the data analysis process was not provided or the description was vague in three studies (Cusveller & Schep‐Akkerman, ; Lechasseur et al, ; Schaefer & Vieira, ).…”

“…General discussion about study validity without any specific criterion was provided in six studies. Six studies provided no reliability or validity assessments, or the discussion on these matters was vague (Cusveller & Schep‐Akkerman, ; Höglund et al, ; Lechasseur et al, ; Peter et al, ; Schaefer & Vieira, ).…”

Ressignificating theory of professional links in nursing work

“…They report that the work process can influence in the ethical issues and that the lack of institutional support, the conflicts with other professionals, the institutional policies and the different ethical and legal values related to the decision-making process by the nursing may leave them prone to experience ethically problematic situations. [25][26] For this purpose, nursing professionals can use administrative principles to address the individual and collective work that seeks talent in the group, by reducing the interpersonal conflicts to Ressignificating theory of professional links Carvalho LA, Thofehrn MB, Barlem ELD, Nunes NJS achieve their objectives. From this perspective, the professional competence is also linked to the skill to manage, whether human relationships or care units.…”