Moral distress: challenges for an autonomous nursing professional practice

Abstract

RESUMo AbStRActConstantly experiencing limiting situations that hinder a professional practice coherent with its principles -of autonomy and advocacy of users' interests -, and often conditioned to experience moral distress, the nursing profession plays a prominent role in the current health model because it has the characteristic of managing the care rendered to users in a perspective of social inclusion, both in the basic health network and in hospitals. Aiming at carrying out a reflection on the nursing practice and the difficulties present in its work routine, and considering its characteristics as a profession, this article sought to make a reflection between the practice of nursing and the numerous moral challenges imposed by the routine, resulting, in many cases, in a value crisis that can reverberate directly on the quality of the service rendered, and in abandonment of the ideals of advocacy for users RESUMEnEl profesional de enfermería presenta un rol destacado en el actual modelo de salud. Adquiere la característica de administrar los cuidados brindados a los pacientes en una perspectiva de inclusión social, tanto en la red básica como en las instituciones hospitalarias. Sin embargo, enfrenta constantemente limitaciones que dificultan el ejercicio profesional coherente con principios de autonomía de abogar por los intereses de los pacientes, lo que muchas veces lo lleva a experimentar sufrimiento moral. Objetivando reflexionar acerca de la práctica de enfermería y considerando sus características profesionales, el presente artículo procuró realizar una reflexión entre el quehacer de enfermería y los innumerables desafíos morales impuestos por el día a día; resultando, a menudo, en una crisis de valores que puede tener repercusión directamente en la calidad de la atención brindada y en el abandono del ideal de abogar por el bienestar de los pacientes. dEScRiPtoRESEnfermería Práctica profesional Ética en enfermería Estrés psicológico Defensa de la salud

Cross-cultural adaptation and validation of the Moral Distress Scale-Revised for nurses

“…Seeing how treatments considered unnecessary could cause moral distress, it is necessary to motivate autonomy in nurses, which is strengthened by effective communication and harmonization in their work sites (20) . In a study with nursing workers in the extreme south of Brazil (17) , therapeutic obstinacy was identified as a source of moral distress.…”

“…Studies with nurses practicing at hospital context in various countries found that working with health professionals seen as insecure strongly influences experiences of moral distress, decreasing decision-making capacity (6,(16)(17)(18)(19)(20) . The main negative characteristic perceived in the work context was lack of ability of technical and scientific competence, which are crucial for conducting specific health activities (16) .…”

Psycometric characteristics of the Moral Distress Scale in Brazilian nursing professionals

“…In Brazil, the first adaptation and validation of the MDS occurred in 2009, 14 when it was concluded that the instrument did not seem to have sufficiently explored MD related to problems experienced by the nursing staff in their work environment, in the Brazilian reality, many of them related to organizational issues that have been identified in other studies, such as insufficient professional staff, poor resource materials, [17][18][19] and lack of professional autonomy.…”

Educational process in palliative care and the thought reform

“…Problematizing, to be surprised by daily facts, with established relationships, to be intrigued by what is considered natural, demonstrating the need to review the rationalities imposed by society and also by the very construction of subjects, nursing workers. 17 Also, recognition of mortality allows the confrontation of the uncertainty of life, translated by the uncertain destiny of each, recognizing the limits of knowledge. No matter how much has been evolved in the discoveries for the cure of diseases and the management of chronic diseases, maintaining the quality of life of the individual, some are still incurable and with poor prognosis, hindering to control by the curing treatment programs.…”