Moral Suffering in Assistance to Childbirth: Situations Present in the Work of Nurses of Obstetric Centers and Maternities

Abstract

Objective: to know the situations found in the work of nurses working in maternity hospitals and obstetric centers that can lead to moral suffering. Method: qualitative, exploratory and descriptive study, developed with 14 nurses working in bstetric centers and maternities of two hospitals in southern Brazil. Data were collected from October 2015 to January 2016, through a semi-structured interview, analyzed based on Content Analysis. Results: there was an occurrence of moral distress related to the activities that supplanted nurses’ execution capacity, leading them to prioritize administrative and managerial activities, for which they are charged by the institutions, failing to participate directly in the care, an aspect enhanced by the quantitative nursing professionals. Asymmetric relations of power and conflicting interactions compose an atmosphere of toleration for the autonomy of the nurses, preventing them from acting in harmony with their knowledge and moral values. The fruitless attempts to change the dehumanizing context through advocacy and the visualization of disrespectful, interventionist and violent behaviors against women, generate moral suffering. Conclusion: the plurality of nurse actions, reduced autonomy, disrespect for their practice and the visualization of dehumanizing behaviors generate moral suffering. It is important to seek alternatives so that nurses may act and advocate in line with their moral knowledge and values, in an autonomous and empowered way, aiming to provide a dignified and safe childbirth assistance, and an environment that respects the woman and her autonomy.

Distresse moral vivenciado por gestores enfermeiros no contexto de hospitais universitários federais

“…Há, efetivamente, uma relação entre o DM e a quanti--qualidade dos profissionais de enfermagem. (22,23) A alta produtividade, característica do modelo de organização do trabalho da enfermagem, sobrecarga o trabalho, sobressai o subdimensionamento de pessoal, associado com as variáveis que revelam polivalência e multifuncionalidade das práticas de enfermagem, com ênfase na agilidade e disponibilidade imediata, ameaçando a saúde do trabalhador, o próprio usuário e a qualidade do cuidado. (24) Em todas estas situações é possível gerar um risco para a continuidade do -Cuidado seguro e qualificado -considerado o segundo maior fator desencadeador de DM entre os participantes.…”

Moral distress-associated sociodemographic and occupational aspects in nursing managers at federal university hospitals

“…The precarious institutional ethical climate, characterized by representations such as less administrative support, less collaboration, fewer resources, and MD, generate dissatisfaction at work and increase nurses turnover (14) . The quantitative-qualitative studies carried out on DM show the participants' characteristics with a special focus on the areas of hospital performance, complex care units, hemato-oncology, obstetric center, or adult or pediatric surgical clinics (14)(15)(16)(17)(18) . In the present study, large HUFs had the highest significant MD scores.…”

Aspectos sociodemográficos e laborais associados ao distresse moral em gestores de enfermagem de hospitais universitários federais

“…O clima ético institucional precário, caracterizado por representações do tipo menor apoio administrativo, menos colaboração, menos recursos, e o DM, geram insatisfação no trabalho e aumento da rotatividade dos enfermeiros (14) . Os estudos quantiqualitativos realizados sobre DM retratam as características dos participantes com especial foco nas áreas de atuação hospitalar, unidades de cuidados complexos, hemato-oncologia, centro obstétrico, ou clínicas cirúrgicas, adultas ou pediátricas (14)(15)(16)(17)(18) . No presente estudo, os HUF de grande porte apresentaram os maiores escores de DM com significância.…”