Ethical problems experienced by nurses in primary health care: integrative literature review

Abstract

The aim of this study is to identify ethical problems experienced by nurses in primary health care and resources for coping based on publications on the subject. An integrative literature review was performed between the months of October and November 2013, using the databases: BDTD, CINAHL, LILACS, MEDLINE, Biblioteca Cochrane, PubMed, RCAAP and SciELO. Articles, dissertations and theses published in Portuguese, English and Spanish were included, totalling 31 studies published from 1992 to 2013. This analysis resulted in four categories: ethical problems in the relationship between team members, ethical problems in the relationship with the user, ethical problems in health services management and resources for coping with ethical problems. Results showed that nurses need to be prepared to face ethical problems, emphasizing the importance of ethics education during the education process before and during professional practice to enhance the development of ethical sensitivity and competence for problem resolution.

Moral sensitivity in Primary Health Care nurses

“…As it is possible to show in the results, 57% of PHC nurses already needed counseling for ethical problems in their professional practice, that is, most professionals have experienced some type of ethical problem in their practice. The literature corroborates this finding by describing that the main ethical problems of nurses in PHC occur in the relationship with patients, in the relationship between the team and the management of the health service (16) .…”

“…The results show that few nurses (12%) had any type of ethical or bioethical training in the last year. This is a disturbing fact, because it is important that nurses have spaces for ethical discussion, with moments of sharing, exchange of experiences and discussion of ethical problems that may occur in services (16) . As it is possible to show in the results, 57% of PHC nurses already needed counseling for ethical problems in their professional practice, that is, most professionals have experienced some type of ethical problem in their practice.…”

“…The knowledge of the professional was the second dimension that has an influence on the moral sensitivity of nurses, and this knowledge is fundamental when dealing with moral issues (28) . The study (16) describes that it is necessary to maintain permanent educational processes in ethics, developing practical skills, competence and moral sensitivity to lead the nurse to reflection, discussions and prudent and responsible resolution of ethical problems. In this context, it is essential to encourage not only nursing students, but also PHC nurses, to exercise ethical judgment so that they can develop the capacity to reflect and question decisions about care, so as not to obscure the ethical dimension of Clinical decisions.…”

“…The moral conflict and moral meaning dimensions had a reduced moral sensitivity referred by the nurses of Rio Grande do Sul. The moral conflict perceived by PHC professionals is described in the literature in different studies (16,31) . The SUS has been following a difficult process of consolidation, mainly in what concerns the financing, being urgent the need to rethink its organization in the sustainability of the current conformation.…”

Elements and Strategies for Ethical Decision-Making in Nursing

“…This review shows that to develop intellectual and cognitive skills for ethical decision-making, it is essential that continuing education initiatives and training programs are able to awaken professionals to reflect on their work process and the ethical problems present in this context, aiming for the extension of their ethical horizons. A study 40 corroborates this finding, noting that nurses need support for the resolution of ethical problems and, therefore, proposes training and ethical education as a strategy.…”