Validation of a moral distress instrument in nurses of primary health care

Abstract

Objective:to validate an instrument to identify situations that trigger moral distress in relation to intensity and frequency in primary health care nurses. Method:this is a methodological study carried out with 391 nurses of primary health care, applied to the Brazilian Scale of Moral Distress in Nurses with 57 questions. Validation for primary health care was performed through expert committee evaluation, pre-test, factorial analysis, and Cronbach’s alpha. Results:there were 46 questions validated divided into six constructs: Health Policies, Working Conditions, Nurse Autonomy, Professional ethics, Disrespect to patient autonomy and Work Overload. The instrument had satisfactory internal consistency, with Cronbach’s alpha 0.98 for the instrument, and between 0.96 and 0.88 for the constructs. Conclusion:the instrument is valid and reliable to be used in the identification of the factors that trigger moral distress in primary care nurses, providing subsidies for new research in this field of professional practice.

Generating situations of Moral Distress in Primary Care Nurses

“…The conflict is due to the recognition of unjust situations that obedience to the norm entails in managerial processes that are detrimental to daily work, established vertically, partially and not without personal interests. This does not consider that the prioritization and choices of a given health action to respond to one and not another person/ demand can already produce ethical differences and problems with management, directly influencing the nurse's experience of MD (9) .…”

“…In Brazil, MD studies have been developed with some variations of approaches, such as bibliographic reviews, methodological studies, reflection, validation, quantitative research and qualitative research (3,(5)(6)(7)(8)(9)(10) . Thus, it is evident the importance of understanding the process of MD in the different contexts of the nurse's performance.…”

Intensity and frequency of moral distress in Brazilian nurses

“…Labor aspects, such as working conditions, overload, skills and competences for the performance, relationship with the team and institutional norms, permeate the work process of nurses and are associated with physical, emotional and moral distress (MD) (1)(2)(3)(4)(5)(6) . The occurrence of MD is associated with concrete conditions and the subjective work experience, especially the daily challenges, such as clinical decisions and care management.…”

Aspectos sociodemográficos e laborais associados ao distresse moral em enfermeiros brasileiros

“…(15,16) This association was also found in a study that validated the instrument to identify situations triggering MD in nurses in the specific context of Primary Health Care. (17) In addition, linear interpretations of cause and effect are also impossible, as if lesser feelings reported in the situations described in all constructs indicated better conditions or fewer problems faced, or only less awareness/attention to them. Nor can it be supposed that some associations, such as the ethical infringements factor (only with sex and level of education), indicate more or less importance of these situations, but only that there is greater homogeneity in their perception, in different contexts.…”