Intensity and frequency of moral distress in mental health nurses in Brazil.

OBJECTIVE: To assess the intensity and frequency of moral distress in mental health nurses in Brazil. METHOD: Cross-sectional study with 173 nurses from the Psychosocial Care Network in Brazil. The Brazilian Scale of Moral Distress in Nurses, adapted for the context of mental health, was used. For data processing, descriptive and inferential statistical analysis was used. RESULTS: Mostly moderate levels of intensity and frequency of moral distress (medians between 2.25 - 3.73 and 2.00 - 3.22, respectively) were observed, with emphasis on the factors working conditions and social conflicts. CONCLUSION: The level of moral distress evidenced in mental health nurses in Brazil reflects the dimension and amplitude of the phenomenon in different points of the Psychosocial Care Network. The relevance of discussions on coping strategies for moral distress is highlighted, articulating elements such as sensitivity, resilience, and moral courage, so that ethical deliberation is applied in care and management settings.

Intensity and frequency of moral distress in mental health nurses in Brazil / Intensidad y frecuencia del sufrimiento moral en enfermeros de salud mental en Brasil / Intensidade e frequência de distresse moral em enfermeiros de saúde mental no Brasil

ABSTRACT Objective: To assess the intensity and frequency of moral distress in mental health nurses in Brazil. Method: Cross-sectional study with 173 nurses from the Psychosocial Care Network in Brazil. The Brazilian Scale of Moral Distress in Nurses, adapted for the context of mental health, was used. For data processing, descriptive and inferential statistical analysis was used. Results: Mostly moderate levels of intensity and frequency of moral distress (medians between 2.25 - 3.73 and 2.00 - 3.22, respectively) were observed, with emphasis on the factors working conditions and social conflicts. Conclusion: The level of moral distress evidenced in mental health nurses in Brazil reflects the dimension and amplitude of the phenomenon in different points of the Psychosocial Care Network. The relevance of discussions on coping strategies for moral distress is highlighted, articulating elements such as sensitivity, resilience, and moral courage, so that ethical deliberation is applied in care and management settings.

RESUMEN Objetivo: Evaluar la intensidad y frecuencia del sufrimiento moral en enfermeros de salud mental en Brasil. Método: Estudio transversal con 173 enfermeros de la Red de Atención Psicosocial del territorio brasileño. Se utilizó la Escala Brasileña de Sufrimiento Moral en Enfermeros adaptada para el contexto de la salud mental. Se utilizó análisis estadístico descriptivo e inferencial para el procesamiento de datos. Resultados: Se observó, en su mayoría, niveles moderados de intensidad y frecuencia de sufrimiento moral (medianas entre 2,25 - 3,73 y 2,00 - 3,22, respectivamente), con énfasis en los factores condiciones de trabajo y conflictos sociales. Conclusión: El nivel de sufrimiento moral evidenciado en enfermeros de salud mental en Brasil refleja la dimensión y amplitud del fenómeno en los diferentes puntos de la Red de Atención Psicosocial. Se destaca la relevancia de las discusiones sobre estrategias de enfrentamiento del sufrimiento moral, articulando elementos como la sensibilidad, la resiliencia y el coraje moral, para que la deliberación ética sea aplicada en contextos de cuidado y gestión.

RESUMO Objective: To assess the intensity and frequency of moral distress in mental health nurses in Brazil. Method: Cross-sectional study with 173 nurses from the Psychosocial Care Network in Brazil. The Brazilian Scale of Moral Distress in Nurses, adapted for the context of mental health, was used. For data processing, descriptive and inferential statistical analysis was used. Results: Mostly moderate levels of intensity and frequency of moral distress (medians between 2.25 - 3.73 and 2.00 - 3.22, respectively) were observed, with emphasis on the factors working conditions and social conflicts. Conclusion: The level of moral distress evidenced in mental health nurses in Brazil reflects the dimension and amplitude of the phenomenon in different points of the Psychosocial Care Network. The relevance of discussions on coping strategies for moral distress is highlighted, articulating elements such as sensitivity, resilience, and moral courage, so that ethical deliberation is applied in care and management settings.

Adaptation and Validation of a Moral Distress Instrument in Mental Health Nurses.

Background and Purpose: To adapt and validate the Brazilian Scale of Moral Distress in Nurses for the mental health field. Methods: A cross-sectional methodological study was carried out, adapted with the contribution of 34 specialists, and validated by 173 mental health nurses. Results: The validated scale consists of 37 items divided into seven factors, and they were responsible for 77.2% of variance-working conditions, advocacy for the values and rights, professional safety and autonomy, ethical violations, social conflicts, ethical-professional competence, and conflicts with the management, with Cronbach's alpha at .972 for the entire instrument, and ranging from .852 to .949 for the constructs. Conclusion: The results provide evidence that the adapted instrument is reliable, valid, and consistent in measuring moral distress in mental health nurses.

Problemas éticos na experiência clínica hospitalar de estudantes e profissionais de enfermagem / Ethical problems in hospital clinical experiences of nursing students and professionals / Problemas éticos en la experiencia clínica hospitalaria de estudiantes y profesionales de enfermeira

Resumo Enquadramento: Os problemas éticos são frequentes na prática da enfermagem. Saber identificá-los, buscando soluções prudentes, é fundamental para promover um cuidado ético e seguro. Objetivo: Conhecer experiências e compreensão de estudantes e profissionais de enfermagem sobre problemas éticos e tomada de decisão nos contextos da prática da enfermagem hospitalar. Metodologia: Pesquisa qualitativa, exploratório-descritiva realizada com 30 estudantes de graduação em enfermagem e 20 profissionais de enfermagem de um hospital universitário do sul do Brasil. Os dados foram recolhidos através de dois questionários contendo questões abertas e submetidos a análise textual discursiva. Resultados: Os estudantes compreendem o problema ético a partir de vivências concretas de desrespeito e afronta a princípios e regras, enquanto os profissionais o conceptualizam como um desafio ao julgamento nas complexas fronteiras entre certo e errado. Há similaridades e especificidades das vivências e tomada de decisão. Conclusão: Estudantes e profissionais demonstram sensibilidade moral para compreender os problemas éticos da prática; senso crítico e reflexivo é decisivo na identificação e nas condutas face aos conflitos éticos no ambiente laboral.

Abstract Background: Ethical problems often emerge in nursing practice. Knowing how to identify them and seeking prudent solutions is essential to promoting ethical and safe care. Objective: To know the experiences and understanding of nursing students and professionals regarding ethical issues and decision-making in hospital nursing practice. Methodology: Qualitative, exploratory-descriptive research was carried out with thirty undergraduate nursing students and twenty nursing professionals from a University Hospital in Southern Brazil. Data were collected through two questionnaires containing open questions and submitted to Discursive Textual Analysis. Results: Students perceive the ethical problem based on concrete experiences of disrespect and insult to principles and rules. Professionals conceptualize it as a challenge to judgment in the complex boundaries between right and wrong. The experiences and decision-making share similarities and have their specificities. Conclusion: Students and professionals display moral sensitivity to understand the ethical problems of practice; critical awareness and reflection are crucial to identifying and responding to workplace ethical conflicts.

Resumen Marco contextual: Los problemas éticos son frecuentes en la práctica de la enfermería. Saber identificarlos, buscando soluciones prudentes, es esencial para promover una atención ética y segura. Objetivo: Conocer las experiencias y la comprensión de los estudiantes y profesionales de enfermería sobre los problemas éticos y la toma de decisiones en los contextos de la práctica enfermera hospitalaria. Metodología: Investigación cualitativa, exploratoria-descriptiva, realizada con 30 estudiantes del grado de Enfermería y 20 profesionales de enfermería de un hospital universitario del sur de Brasil. Los datos se recogieron mediante dos cuestionarios con preguntas abiertas y se sometieron a un análisis textual discursivo. Resultados: Los estudiantes entienden el problema ético a partir de experiencias concretas de falta de respeto y afrenta a los principios y normas, mientras que los profesionales lo conceptualizan como un desafío al juicio en los complejos límites entre lo correcto y lo incorrecto. Hay similitudes y especificidades en las experiencias y la toma de decisiones. Conclusión: Los estudiantes y profesionales demuestran sensibilidad moral para comprender los problemas éticos de la práctica; el sentido crítico y reflexivo es decisivo en la identificación y las conductas ante los conflictos éticos en el entorno laboral.

Construção de um saber coletivo para implantação do processo de enfermagem em um hospital psiquiátrico especializado / Development of a collective knowledge for implementation of the nursing process in a specialized psychiatric hospital / Construcción de conocimiento colectivo para la aplicación del proceso de enfermería en un hospital psiquiátrico especializado

OBJETIVO: construir um saber coletivo para implantação do processo de Enfermagem em um hospital psiquiátrico especializado. MÉTODO: pesquisa qualitativa na modalidade pesquisa-ação, desenvolvida em um hospital psiquiátrico especializado de referência em Santa Catarina, Brasil, com a participação de 18 enfermeiros. A coleta de dados foi realizada em junho de 2014, por meio de um questionário semiestruturado e oficinas. RESULTADOS: foram construídos e implantados em prontuário eletrônico do paciente: histórico, diagnósticos, intervenções e avaliação de Enfermagem, pautados na Resolução nº 358/2009 do Conselho Federal de Enfermagem, tendo como suporte teórico a teoria da relação pessoa-pessoa de Joyce Travelbee. CONCLUSÃO: o rigor científico aliado à prática assistencial dos enfermeiros viabilizou a construção coletiva e implantação do processo de Enfermagem no prontuário eletrônico do paciente. Destaca-se o papel transformador dos enfermeiros para a implementação dessa tecnologia assistencial na instituição em prol de uma assistência segura e qualificada, apoiada pelos aspectos éticos, técnicos e legais da profissão.(AU)

Objective: to develop a collective knowledge for the implementation of the nursing process in a specialized psychiatric hospital. Method: qualitative research in the action research modality, developed in a referral specialized psychiatric hospital in Santa Catarina, Brazil, with the participation of 18 nurses. Data collection was performed in June 2014 through a semi-structured questionnaire and workshops. Results: were elaborated and implanted in the patient's electronic medical record: history, diagnoses, interventions and nursing evaluation, based on Resolution Nº 358/2009 of the Conselho Federal de Enfermagem, having as theoretical support the theory of person-person relationship of Joyce Travelbee. Conclusion: the scientific rigor allied to the nurses' care practice enabled the collective elaboration and implementation of the nursing process in the patient's electronic medical record. It highlights the innovative role of nurses for the implementation of this assistive technology in the institution in favor of safe and qualified care, supported by the ethical, technical and legal aspects of the profession.(AU)

Objetivo: construir conocimiento colectivo para la implementación del proceso de enfermería en un hospital psiquiátrico especializado. Método: investigación cualitativa en la modalidad de investigación de acción, desarrollada en un hospital psiquiátrico especializado de referencia de Santa Catarina, Brasil, con la participación de 18 enfermeros. La recogida de datos se realizó en junio de 2014 a través de un cuestionario semiestructurado y de talleres. Resultados: fueron construidos y colocados en la historia clínica electrónica del paciente: historial,diagnósticos, intervenciones y evaluación de enfermería, en base a la Resolución No. 358/2009 del Consejo Federal de Enfermería, teniendo como soporte teórico la teoría de la relación persona-persona de Joyce Travelbee. Conclusión: el rigor científico aunado a la práctica de atención de enfermería permitió la construcción e implementación colectiva del proceso de enfermería en la historia clínica electrónica del paciente. Destacamos el papel transformador de los enfermeros para la implementación de esta tecnología asistencial en la institución a favor de una atención segura y calificada, respaldada por los aspectos éticos, técnicos y legales de la profesión.(AU)

Philosophy and conceptual framework: collectively structuring nursing care systematization. / Filosofia e marco conceitual: estruturando coletivamente a sistematização da assistência de enfermagem.

OBJECTIVE: To build the Nursing Philosophy and Conceptual Framework that will support the Nursing Care Systematization in a hospital in southern Brazil with the active participation of the institution's nurses. METHODS: Convergent Care Research Data collection took place from July to October 2014, through two workshops and four meetings, with 42 nurses. As a result, the nursing philosophy and conceptual framework were created and the theory was chosen. Data analysis was performed based on Morse and Field. RESULTS: The philosophy involves the following beliefs: team nursing; team work; holistic care; service excellence; leadership/coordination; interdisciplinary team commitment. The conceptual framework brings concepts such as: human being; nursing; nursing care, safe care. The nursing theory defined was that of Wanda de Aguiar Horta. CONCLUSIONS: As a contribution, it brought the construction of the institutions' nursing philosophy and conceptual framework, and the definition of a nursing theory.

Filosofia e marco conceitual: estruturando coletivamente a sistematização da assistência de enfermagem / Filosofía y marco conceptual: estructuración colectiva de la sistematización de enfermería / Philosophy and conceptual framework: collectively structuring nursing care systematization

RESUMO Objetivo Construir, com os enfermeiros, a Filosofia de Enfermagem e o Marco Conceitual que servirão como suporte para a implantação da Sistematização da Assistência de Enfermagem em um hospital do Sul do Brasil. Métodos Pesquisa Convergente Assistencial. A coleta de dados ocorreu de julho a outubro de 2014, através de duas oficinas e quatro encontros, com 42 enfermeiros. Foram criados a filosofia de enfermagem, o marco conceitual e foi feita a escolha da teórica. Para análise de dados foi utilizada a proposta de Morse e Field. Resultados A filosofia envolve as crenças de: equipe de enfermagem; trabalho em equipe; cuidado holístico; excelência no atendimento; liderança/coordenação; equipe interdisciplinar, comprometimento. O marco conceitual traz os conceitos de: ser humano; enfermagem; assistência de enfermagem, cuidado seguro. A teórica definida foi Wanda de Aguiar Horta. Conclusões Trouxe como contribuição a construção da filosofia de enfermagem e do marco conceitual da instituição e a definição da teoria de enfermagem.

RESUMEN Objetivo Construir con enfermeras Filosofía de la Enfermería, el marco conceptual que servirá de apoyo a la implementación de la sistematización de la atención de enfermería en un hospital en el sur de Brasil. Métodos Investigación Convergente Asistencial. Los datos fueron recolectados entre julio y octubre de 2014, a través de dos talleres y cuatro reuniones con 42 enfermeras. Se creó la filosofía de la enfermería, marco conceptual y teórico de la elección. Para el análisis de los datos se utilizaron para elaborar Morse y campo. Resultados La filosofía implica en la creencia: en el equipo de enfermería; en el trabajo en equipo; en la atención integral; en la excelencia en el servicio; liderazgo / coordinación; en el compromiso del equipo interdisciplinario. El marco conceptual que involucra los conceptos del ser humano; enfermería; cuidados de enfermería, atención segura. La teoría de conjuntos era Wanda de Aguiar Horta. Conclusiones traído como contribución a la construcción de la filosofía de enfermería y el marco conceptual de la institución y la definición de la teoría de enfermería.

ABSTRACT Objective To build the Nursing Philosophy and Conceptual Framework that will support the Nursing Care Systematization in a hospital in southern Brazil with the active participation of the institution’s nurses. Methods Convergent Care Research Data collection took place from July to October 2014, through two workshops and four meetings, with 42 nurses. As a result, the nursing philosophy and conceptual framework were created and the theory was chosen. Data analysis was performed based on Morse and Field. Results The philosophy involves the following beliefs: team nursing; team work; holistic care; service excellence; leadership/coordination; interdisciplinary team commitment. The conceptual framework brings concepts such as: human being; nursing; nursing care, safe care. The nursing theory defined was that of Wanda de Aguiar Horta. Conclusions As a contribution, it brought the construction of the institutions’ nursing philosophy and conceptual framework, and the definition of a nursing theory.