Conceptual Framework for the Study of Moral Distress in Nurses

Ramos, Flávia Regina Souza; Barlem, Edison Luis Devos; Brito, Maria José Menezes; Vargas, Mara Ambrosina de Oliveira; Schneider, Dulcinéia Ghizoni; Brehmer, Laura Cavalcanti de Farias

doi:10.1590/0104-07072016004460015

Cited by 30 publications

(86 citation statements)

References 26 publications

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“…These sources have been shown to reflect various ‘internal’ and ‘external’ causes (Woods et al ). Whilst these distinctions may seem vague, it is often thought that the internal causes of moral distress involve psychological uneasiness related to an individual’s moral perceptions and subsequent actions as a professional nurse; and the external causes are often found to involve morally disturbing factors that are associated with the ‘ethical climate’ of a unit or ward that is often difficult for nurses to control (Ramos et al ). As a result, and whether internally or externally generated, or both, moral distress may occur.…”

Section: Introductionmentioning

confidence: 99%

Moral distress revisited: the viewpoints and responses of nurses

Woods

2020

International Nursing Review

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Aim To present and discuss the main themes that were revealed following an analysis of the qualitative research findings that were extracted from a national survey regarding the causes and effects of moral distress amongst New Zealand nurses. Background/Introduction Moral distress continues to be a major concern amongst nurses around the world. In New Zealand, a country where nurses have just been on strike over their working conditions and the deteriorating state of their roles within the health services, it remains a major issue. Method In the original research project, large numbers of nurses supplied not only quantitative data that revealed the extent and impact of moral distress on their practices, but also extensive notes that more specifically explained the causes and effects of their moral distress. This material has since been thematically analysed and is now presented. Findings/results The data strongly suggested that New Zealand nurses experienced and attempted to respond to several major issues; that is, they were not properly supported by ‘the system’, frequently experienced problems with managers and bullying, witnessing poor care practices and collegial incompetence, and suffered from ongoing problems caused by moral residue. Conclusion Under current working conditions, nurses are struggling under an increasing weight of moral residue to maintain their ethical standards within an increasingly difficult ethical climate. Implications for nursing and health policy This research suggests that although nurses clearly seek out and use various ways to cope with moral distress in their practices, there is a continuing need for moral courage and strengthening of moral resilience that involves greater input from not just nurses themselves, but nurse managers, educators and other health services representatives.

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Section: Introductionmentioning

confidence: 99%

Moral distress revisited: the viewpoints and responses of nurses

Woods

2020

International Nursing Review

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“…Thus, it is deemed important to support and stimulate strategies that enhance this competence to improve professionals' sensitivity to ethical problems of their daily work. (1,26) The study had as limitations low participation, and participants' difficulty to express themselves on such a complex issue, which justifies further studies. It is suggested that this result may be associated with insecurity, institutional political issues, and even the feeling of disbelief in the return that an academic study can bring to professional practice, especially when the reported causes refer to issues affecting nursing activities in various contexts, and not just for the study participants.…”

Section: Discussionmentioning

confidence: 99%

“…Identified as practical wisdom, this sensitivity is a critical and reflective analysis of oneself, one's actions, thinking and being. (1,12) Some discrepancies found in the data collected from the two groups are not surprising, as it is a national level study and a diversity of problems and labor situations among the different realities is expected. A regionalized analysis of the data could reveal interesting differences.…”

Section: Discussionmentioning

confidence: 99%

“…It happens when individuals face issues that require positioning contrary to their personal and/or professional values, and the decision does not produce the outcomes expected. (1) The phenomenon started gaining relevance in the nursing scenario as a result of being considered one of the main problems in the profession, as it affects workers in many activities of daily living. MS was associated with psychological responses (fear, anxiety, insecurity, among others); and work environment (specific situations such as ineffective communication, low autonomy, and insufficient human resources).…”

Section: Introductionmentioning

confidence: 99%

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Sofrimento moral em enfermeiros dos departamentos de fiscalização do Brasil

et al. 2016

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Objective: To identify the frequency and intensity of the causes of moral suffering experienced by nurses in inspection departments in Brazil. Methods: Cross-sectional study with 28 professionals of managerial competence and 113 professionals of inspection competence. The sample was intentional and non-probabilistic. Data were collected through a questionnaire and submitted to descriptive and bivariate analysis. Results: Participants revealed the causes of moral suffering in two stages: firstly, associated with the slow inspection process by the inspected institutions and Corens, and insufficient human resources. Secondly, associated with ethical problems; work conditions; and quality of nursing care. Conclusion: To reflect on the causes of moral suffering in this scenario is to recognize the need for changes that should take place on the basis that sustains the profession's ethical precepts and moral conducts, so as to strengthen the category. ResumoObjetivo: Identificar a frequência e a intensidade das causas de sofrimento moral vivenciado por enfermeiros nos departamentos de fiscalização do Brasil. Métodos: Estudo transversal realizado com 28 profissionais de competência gerencial e 113 profissionais de competência fiscalizatória. A amostra foi intencional e não probabilística. Os dados foram obtidos por meio de questionário e submetidos à análise descritiva e bivariada. Resultados: Os participantes revelaram causas do sofrimento moral em dois momentos: Primeiro associado ao processo de fiscalização lento por parte das instituições fiscalizadas e Corens; e insuficiência de recursos humanos. Segundo associado aos problemas éticos; condições de trabalho; e qualidade da assistência de enfermagem. Conclusão: Refletir sobre as causas do sofrimento moral neste cenário é reconhecer a necessidade de algumas mudanças que devem acontecer na base que sustenta os preceitos éticos e condutas morais da profissão, para assim fortalecer a categoria.

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“…6 The importance of discussing the scope and limits of the construct and the researches performed until now is highlighted. [16][17] The Corley 18 -Moral Distress Scale -is a pioneer in MD studies, resulting in applications and adaptations for different health facilities. Its translation and validation, and subsequent adaptation, were performed in Brazil in 2012 and 2014.…”

Section: Introductionmentioning

confidence: 99%

Construção Da Escala Brasileira De Distresse Moral Em Enfermeiros - Um Estudo Metodológico

Ramos

Barlem

Brito

et al. 2017

Texto contexto - enferm.

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Objective: to develop an instrument called the Brazilian Scale of Moral Distress in Nurses, in order to measure the intensity and frequency of moral distress.Method: a methodological research described in three steps: 1) definition of the theoretical framework (Background); 2) Instrument design; and 3) instrument composition.Step 2 integrated the literature review and survey to identify elements / situations triggering moral distress. The sample consisted of 771 nurses, from the 27 states of Brazil, working in different services.Results: moral distress situations analyzed by the survey were analyzed in five rounds involving a group of researchers, producing an analytical matrix with nine categories and 72 subcategories, which subsidized the formulation of the initial questions, and improved and collated with the findings of the literature (validation of criterion). Three other rounds were performed for the composition of the instrument, with 57 questions and a double Likert scale, with successive revisions of the content, language, format and layout, including the evaluation by experts / judges and analysis of the results of the pre-test (face/content). Conclusion: explore specific conditions of the Brazilian context of nurses' work and the validation of the instrument produced will allow the understanding of the theme of moral suffering in the Brazilian nursing scenario. Constructing instruments capable of measuring expressions of moral distress can validate ethical problems already described with adapted instruments. DESCRIPTORS: Nursing research. Moral. Suffering. Scales. Validation studies. CONSTRUÇÃO DA ESCALA BRASILEIRA DE DISTRESSE MORAL EM ENFERMEIROS -UM ESTUDO METODOLÓGICO RESUMOObjetivo: desenvolver um instrumento denominado Escala Brasileira de Distresse Moral em enfermeiros, para medição da intensidade e frequência do distresse moral.Método: pesquisa metodológica descrita em três etapas: 1) definição do marco teórico (background); 2) concepção do instrumento; e 3) composição do instrumento. A etapa 2 integrou a revisão da literatura e survey para identificar elementos/situações desencadeadoras de distresse moral. A amostra consistiu de 771 enfermeiros, dos 27 estados do Brasil, atuantes em diferentes serviços.Resultados: foram analisadas situações de distresse moral apreendidas pelo survey, em cinco rodadas envolvendo grupo de pesquisadores, produzindo uma matriz analítica com nove categorias e 72 subcategorias, que subsidiaram a formulação das questões iniciais, aprimoradas e cotejadas com os achados da literatura (validação de critério). Outras três rodadas foram realizadas para composição do instrumento, com 57 questões e dupla escala Likert, em sucessivas revisões do conteúdo, linguagem, formato e layout, incluindo a avaliação por experts/ juízes e análise dos resultados do pré-teste (validação de face/conteúdo).Conclusão: explorar condições específicas do contexto brasileiro do trabalho de enfermeiros e a validação do instrumento produzido permitirá compreender o tema do sofrimento mora...

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Conceptual Framework for the Study of Moral Distress in Nurses

Cited by 30 publications

References 26 publications

Moral distress revisited: the viewpoints and responses of nurses

Moral distress revisited: the viewpoints and responses of nurses

Sofrimento moral em enfermeiros dos departamentos de fiscalização do Brasil

Construção Da Escala Brasileira De Distresse Moral Em Enfermeiros - Um Estudo Metodológico

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