Moral distress in everyday nursing: hidden traces of power and resistance

Abstract

Objective: To know the strategies of resistance adopted by nursing staff, facing situations of moral distress, from an ethical perspective. Method: The authors conducted qualitative research through semi-structured interviews, with fifteen nursing staff members of a university hospital in the extreme south of Brazil, using textual discourse analysis and the theoretical reference of Foucault. Results: Two categories were constructed: denial of oneself and the other -in which one perceives that the nursing staff can perform actions that are governed predominantly by immobility and conformism, avoiding confrontations with whoever represents power in situations that provoke moral distress in them; possibility to care for oneself and for the other -in which nursing workers in situations that provoke moral distress for them exercise power and endurance.Conclusion: it was perceived that some professionals seem to use ethical coping strategies, in order to ensure and preserve their professional values. However, often the choice of some nursing professionals may be to relapse into immobility and the absence of building strategies of endurance. This situation may represent their reduced exercise of power and insufficient resistance in the face of ethical problems, contributing to the intensification of their invisibility in the area of health.Descriptors: Burnout, Professional; Power; Ethics; Nursing. IntroductionIn daily professional life, many situations seem to reflect suffering and distress for the nursing staff.We highlight the power relationships with patients, supervisors and the various teams in the health area, involving moral issues and values related to identified fragilities in care, insufficient nursing staff, lack of material resources and the predominantly bureaucratic work organization, cold and technical .

Everyday Practices of Professional in the Mobile Emergency Service

“…Entretanto, o conhecimento localizado, situado e fugaz pode responder, de acordo com os interesses em jogo, pela diversidade de verdades existentes, ligadas ao contexto, ao tempo, ao lugar e à linguagem. 23 Nessa compreensão, configura-se um espaço em branco entre o conhecimento formado pelos trabalhadores do SAMU, que participaram na construção dos saberes, de funcionamento e organização desse serviço peculiar, e aquele colocado como saber técnico--científico e legal para o serviço. Os saberes desses profissionais estão entre as várias questões relegadas pelo saber chancelado institucionalmente, como os instituídos pelo Ministério da Saú-de e/ou pelas Secretarias Estadual e Municipal de Saúde para o funcionamento e organização dos serviços.…”

“…22 Entretanto, há de se considerar, nesse caso, que o atendimento irá ocorrer por força da normalização. Isso não implica dizer que não haja resistência, pois esta pode se manifestar a partir de outras expressões, 23 tais como demora na recepção do paciente, retenção de materiais como macas e colares cervicais, entre outras táticas dos serviços que recebem o usuário.…”

Advocacia Do Paciente Na Enfermagem: Barreiras, Facilitadores E Possíveis Implicações

“…11,31 Therefore, the work environment has been considered the factor that most influences the efficacy of nursing actions related to patient advocacy. 4,6,29,32 The efficacy of patient advocacy efforts does not depend only on the nurses' traits, skills, and the knowledge they hold as advocates, but also on a receptive environment.29 Therefore, it is important to note that advocacy always occurs in a social environment so that the identification of the characteristics of such an environment that can facilitate patient advocacy is essential.…”

“…Many barriers, however, are faced by nurses, impeding them from satisfactorily fulfilling this role in accordance with their ideals. [10][11] Both Brazilian and international studies have identified that the practice of patient advocacy in the face of ethical conflicts can either generate relief or intensify moral distress if nursing workers are prevented from performing the role that corresponds to their ideals. 5,[11][12][13][14] Therefore, nurses experience moral distress when they recognize a need to advocate in favor of their patients but, due to external pressure, are prevented from proceeding with such an action.…”

“…[10][11] Both Brazilian and international studies have identified that the practice of patient advocacy in the face of ethical conflicts can either generate relief or intensify moral distress if nursing workers are prevented from performing the role that corresponds to their ideals. 5,[11][12][13][14] Therefore, nurses experience moral distress when they recognize a need to advocate in favor of their patients but, due to external pressure, are prevented from proceeding with such an action. 15 Therefore, patient advocacy may be a response to the constant moral problems experienced by nurses in healthcare settings, especially given the possibility of nurses, in the face of situations arising in their work environment, taking a stand that can potentially benefit patients and contribute to the profession.…”