Conceptual framework for the ethical climate in health professionals.

The ethical climate is the perception of health professionals about the work environment, meaning the reflection on care practices and ethical-related decisions. There are extensive studies in the international literature about the ethical climate, but there are still theoretical gaps about it in health services. In this reflection article, the objective was to explore conceptual components about the ethical climate, proposing new elements of analysis of the construct. The starting point was the accumulated knowledge itself, the possibilities for expansion, and the conceptual progress emerging from contributions from studies on nursing ethics. It was understandable that the ethical climate is considered in its procedural model and cyclically, being articulated with organizational elements, as established in the literature, and, expanding the concept, with the worker's health and the ethical expressiveness at work. Regarding this last contribution, the suggestion is to think about the potential for work to allow, limit, or favor professionals to express their ethical and esthetic values in the most daily decisions and relationships, in care, management, and education. The conceptual framework of this study progressed by addressing the ethical climate as a process articulating several concepts and elements regarding the organizational aspect, ethics, and the workers' well-being.

Moral distress and professors of nursing: A cluster analysis.

BACKGROUND: Professors of nursing sometimes experience specific situations in their daily practice that conflict with their values and ethical principles and may culminate in moral distress. Moral distress occurs when one is prevented from acting according to his or her knowledge or values, or what one considers to be ethically sound. OBJECTIVES: To identify the profile of professors of nursing through grouping sociodemographic characteristics and intensity of moral distress. METHOD: Cross-sectional and exploratory study addressing 373 nurses teaching in Brazilian federal public higher education institutions. Data were collected from June to December 2018 through email, using the Google Docs tool. A moral distress scale directed to nurse educators was used. Data were analyzed using descriptive statistics, variance analysis, and cluster analysis. ETHICAL CONSIDERATIONS: The Institutional Review Board at the Federal University of Rio Grande approved this study. FINDINGS: Initially, four clusters emerged for each variable predicting the profile of Brazilian professors of nursing: sex; whether the individual worked in a graduate program; age; experience in years in their respective higher education institution; and intensity of moral distress. The profile of Brazilian professors of nursing was represented by the largest cluster, 36.5% (n = 136), composed of women working in graduate programs, aged 37 years old on average, having worked in their respective institutions for approximately 5 years, and presenting a moderate intensity of moral distress. CONCLUSION: Assigning individuals into groups facilitates seeing similarities among the predictors that compose the profile of Brazilian professors of nursing, thus recognizing those workers experiencing moral distress in their daily work routine. In addition, this study's results are expected to encourage reflection on the planning of efficacious interventions directed to the context of education and health.

Moral distress in undergraduate nursing students.

BACKGROUND: Moral distress is considered to be the negative feelings that arise when one knows the morally correct response to a situation but cannot act because of institutional or hierarchal constraints. OBJECTIVES: To analyze moral distress and its relation with sociodemographic and academic variables in undergraduate students from different universities in Brazil. METHOD: Quantitative study with a cross-sectional design. Data were collected through the Moral Distress Scale for Nursing Students, with 499 nursing students from three universities in the extreme south of Brazil answering the scale. The data were analyzed in the statistical software SPSS version 22.0, through descriptive statistical analysis, association tests (t-test and analysis of variance), and linear regression models. ETHICAL CONSIDERATIONS: Approval for the study was obtained from the Research Ethics Committee at Universidade Federal do Rio Grande. FINDINGS: The mean intensity of moral distress in the constructs ranged from 1.60 to 2.55. As to the occurrence of situations leading to moral distress in the constructs, the frequencies ranged from 1.21 to 2.43. The intensity level of moral distress showed higher averages in the more advanced grades of the undergraduate nursing course, when compared to the early grades of this course (between 5 and 10 grade, average = 2.60-3.14, p = 0.000). CONCLUSION: The demographic and academic characteristics of the undergraduate nursing students who referred higher levels of moral distress were being enrolled in the final course semesters, were at a federal university, and had no prior degree as an auxiliary nurse/nursing technician.

Applicability of the adapted Moral Distress Scale in the context of nursing in hemato-oncology services. / Aplicabilidade da Moral Distress Scale adaptada no cenário da enfermagem em hemato-oncologia.

OBJECTIVE: To verify the applicability of the adapted Moral Distress Scale in the nursing setting of the hemato-oncology sector of a university hospital. METHOD: Cross-sectional study conducted with 46 nursing workers of a university hospital in the southern region of Brazil with data collected between December 2014 and March 2015 by means of the adapted Moral Distress Scale. Factor analysis, Cronbach's alpha, and descriptive statistics were used to analyze the data. RESULTS: Factor analysis resulted in a group of 26 questions validated based on three factors: Lack of Competence in the Team, Denial of the Nursing Role as the Patient's Advocate, and Disrespect for the Patient's Autonomy. Cronbach's alpha of the instrument was 0.98. CONCLUSION: This study showed that the adapted Moral Distress Scale is an appropriate instrument for the identification of moral distress in nursing workers in the hemato-oncology area.

Actions for health advocacy and user empowerment by nurses of the Family Health Strategy. / Ações de advocacia em saúde e empoderamento do usuário por enfermeiros da Estratégia Saúde da Família.

OBJECTIVE: To understand the actions for health advocacy and user empowerment developed by nurses of the Family Health Strategy in Brazil. METHOD: A qualitative study carried out with nurses working in the Family Health Strategy in a city in the South of Brazil. Participants were selected by non-probabilistic, snowball sampling. Data was collected from a semi-structured interview guide, recorded, transcribed and analyzed through discursive textual analysis. RESULTS: Fifteen (15) nurses participated in the study. Three categories emerged: user participation; health environments; health advocacy actions related to the multiprofessional team. CONCLUSION: The closer relationship that the Family Health Strategy enables between the multiprofessional team, users and the community promotes health advocacy practices, while user empowerment favors autonomy in health care, encouraging a healthier life and enabling them to intervene in the health decisions of the local community.

Productivity versus workloads in the nursing working environment.

Objective To analyze the association between the productivity loss of nursing workers and workloads in a teaching hospital. Method Descriptive study with a quantitative approach, conducted with nursing workers. A structured data collection instrument and the Work Limitations Questionnaire were used. Data analysis was performed using descriptive and analytical statistics, with the Kruskal Wallis test and the Spearman rank correlation. Results A total of 211 nursing workers participated in the study. They had an average of 6.38% of lost productivity; 75% of nursing technicians showed 9.57% of productivity loss, followed by nurses (8.75%) and nursing aides (8.50%). The units presenting the highest productivity loss were surgical clinic (8.81%), and medical clinic (8.58%). The rate of productivity loss was significantly associated with chemical loads (p=0.044) and with mechanical loads (p=0.041). Conclusion Workers presented productivity loss and work limitations associated with workloads, which shows they have difficulty performing the activities in part of the work time.

Prevalence and factors associated with minor psychiatric disorders in hospital housekeeping workers.

OBJECTIVE: Investigating the prevalence and factors associated with minor psychiatric disorders (MPDs) in Hospital housekeeping workers. METHOD: A cross-sectional study carried out in 2013 with workers from the cleaning service of a public university hospital in Rio Grande do Sul, Brazil. Data were collected through a form containing sociodemographic, occupational, habits and health variables. The Self-Reporting Questionnaire-20 was used in order to evaluate MPDs. RESULTS: The study population consisted of 161 workers. The overall prevalence of suspected MPD was 29.3%. The chances of suspected MPDs were higher in workers with Effort-Reward Imbalance, those who did not have time or who occasionally had time for leisure activities, and those taking medications. CONCLUSION: The prevalence of MPDs was similar to that found in the literature for health workers. Therefore, we consider it important to include these workers in institutional programs for continuing health education. OBJETIVO: Investigar a prevalência e os fatores associados aos Distúrbios Psíquicos Menores (DPMs) em trabalhadores do Serviço Hospitalar de Limpeza. MÉTODO: Estudo transversal, realizado em 2013, com trabalhadores do serviço de limpeza de um hospital universitário público do Rio Grande do Sul, Brasil. Os dados foram coletados por meio de um formulário contendo variáveis sociodemográficas, laborais, hábitos e saúde. Para avaliação dos DPMs utilizou-se do Self-Reporting Questionnaire-20. RESULTADOS: A população do estudo foi composta pelos 161 trabalhadores. A prevalência global para suspeição de DPM foi de 29,3%. As chances de suspeição de DPMs foram maiores nos trabalhadores em Desequilíbrio Esforço-Recompensa, nos que não tinham ou às vezes tinham tempo para o lazer e naqueles que faziam uso de medicação. CONCLUSÃO: A prevalência de DPMs assemelhou-se à encontrada na literatura em trabalhadores da área saúde. Portanto, considera-se importante a inclusão desses trabalhadores em programas institucionais de educação permanente em saúde.

[Nurses, nursing technicians and assistants: who experiences more moral distress?]. / Enfermeiros, técnicos e auxiliares de enfermagem: quem vivencia maior sofrimento moral ?

OBJECTIVE: To identify the frequency and intensity of moral distress experienced by nurses, technicians and nursing assistants who worked in hospitals in the South of Rio Grande do Sul State. METHOD: A survey research was conducted with 334 nursing workers from three institutions, through a questionnaire of moral distress. Constructs were validated through factorial analysis and Cronbach's alpha: lack of competence of the working team, disrespect to the patient's autonomy, insufficient working conditions and therapeutic obstinacy. RESULTS: With descriptive statistics and analysis of variance, it was found that nurses and nursing assistants have higher perception of moral distress when compared to nursing technicians. Organizational questions and ways of communication influence lower perception of moral distress. CONCLUSION: Implementation of actions to favor coping, decision making and autonomy exercise from those workers.

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.

Association between Moral Distress and Burnout Syndrome in university-hospital nurses.

OBJECTIVE: to analyze the association between moral distress and Burnout Syndrome among nurses in a university hospital. METHOD: descriptive, analytical study conducted with 269 nurses working in a university hospital located in Rio Grande do Sul, Brazil. Data were collected in person in 2019 by previously trained collectors. A sociodemographic and employment questionnaire, the Brazilian Scale of Moral Distress in Nurses and the Maslach Burnout Inventory were applied. Descriptive and analytical statistical analysis was used. RESULTS: an association was identified between moral distress intensity and frequency and its dimensions with Burnout Syndrome and its dimensions. Nurses with low professional achievement and high emotional exhaustion showed a higher prevalence of moral distress. CONCLUSION: an association between moral distress and Burnout Syndrome, as well as between their dimensions, was evidenced. The results suggest the need to investigate urgent interventions to mitigate the situations and manifestations of moral distress and Burnout Syndrome by developing strategies for workers' health.

Influence of the ethical climate on workers' health among healthcare professionals: a systematic review.

OBJECTIVE: To evaluate the influence of the ethical climate on workers' health among healthcare professionals. METHOD: Systematic review and meta-analysis conducted in MEDLINE/PubMed, EMBASE, SciVerse Scopus (Elsevier), Cumulative Index to Nursing and Allied Health Literature and Web of Science. Trained reviewers performed the selection, data extraction, and assessment of methodological quality. Meta-analysis was applied for data synthesis. RESULTS: Among the 2644 studies, 20 were included for analysis, in which three (15.0%) articles were classified as high quality (score ≥ 80%), while 17 (85.0%) were classified as regular (score 50-79%). There was a moderate negative correlation between the ethical climate and overall moral distress (r=-0.43; 95%CI -0.50; -0.36) and the frequency of moral distress (r=-0.36; 95%CI -0.45; -0.25), as well as the positive and strong correlation between ethical climate and job satisfaction (r=0.71; 95%CI 0.39-0.88). CONCLUSION: The negative and positive perception of the ethical climate among healthcare professionals, respectively, influenced the increase in moral distress and job satisfaction.

Validity study of the Three-Dimensional Work Fatigue Inventory among higher education nursing faculty.

OBJECTIVE: to adapt and validate the Three-Dimensional Work Fatigue Inventory (3D-WFI) for Brazil's cultural reality and assess the psychometric properties. METHODS: a methodological study developed in six stages: initial translation; synthesis of translations; back translation; review by expert committee; pretest; and review of the adaptation process by the researchers. For validity, the instrument was applied to a sample of 318 nursing professors from Brazilian federal and state public universities. Data were analyzed using exploratory and confirmatory factor analysis, composite reliability and instrument reliability (Cronbach's alpha and McDonald's omega). RESULTS: the 3D-WFI instrument showed excellent internal consistency (α=0.95 and ω=0.97), three dimensions and explained variance of 62.77%. CONCLUSIONS: the Brazilian version of the instrument showed excellent psychometric properties for assessing fatigue among Brazilian workers.

Burnout, ethical climate and work organization in covid-19 intensive care units: mixed method study.

OBJECTIVES: to analyze the association between burnout and the perception of the ethical climate in nursing professionals in the covid-19 Intensive Care Unit and the relationship with the organization of work from the perspective of managers of these units. METHODS: mixed method study conducted in three university hospitals in southern Brazil from December 2021 to March 2022. A cross-sectional study was developed with 110 nursing professionals, followed by an exploratory-descriptive study through semi-structured interviews with six managers. Descriptive and analytical statistics and discursive textual analysis were used. RESULTS: the prevalence of burnout was 10% and the perception of negative ethical climate was 24.5%. The association between burnout and ethical climate revealed overload and fatigue during working hours, related to tension, fear, and stress that emerged from the consequences of the organization and relations of work in the covid-19 Intensive Care Unit. CONCLUSIONS: there was an association between burnout and ethical climate and elements of the work organization.

[The experience of moral distress in nursing: the nurses' perception]. / Vivência do sofrimento moral na enfermagem: percepção da enfermeira.

With the objective to understand the nurses' perception of moral distress, as well as its frequency and intensity, this study used a survey utilizing a six-point Likert scale, with 124 nurses working in hospitals in southern Brazil in 2008. Using a self-administered questionnaire and factorial analysis, four constructs were identified and validated. The final results were obtained through three different analyses: 1) descriptive statistical analysis; 2) analysis of variance; and 3) multiple regression. The construct that showed the highest intensity of perception regarding moral distress was the lack of competency in the work team (4.55), followed by the nurse's denial of their role as patient advocate (4.30), therapeutic obstinacy (3.60) and disrespecting the patient's autonomy (3.57). Regarding the perception of the frequency of moral distress, once again, the highlighted construct was the lack of competency within the work team (2.42), followed by therapeutic obstinacy (2.26), the nurse's denial of their role as patient advocate (1.71) and disrespecting the patient's autonomy (1.42).

The impact of the SARS-CoV-2 pandemic on sickness absenteeism among hospital workers.

Introduction: Worker illness and, more recently, infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can manifest as sickness absence, considerably increasing absenteeism rates, which were already rising. Objectives: To determine the impact of the SARS-CoV-2 pandemic on sickness absence rates among hospital workers and on the costs associated with them. Methods: A cross-sectional study with 1,229 workers at a University Hospital in the South of Brazil. Data were collected from absenteeism records for the period from September 2014 to December 2020 held in the Occupational Health Service database. Data were analyzed using descriptive and inferential statistics. Results: The mean sickness absenteeism rate was 3.25% and a significant increase was observed during the pandemic (5.10%) when compared to the pre-pandemic period (2.97%) (p = 0.02). During the pandemic, the mean number of sickness absence days was 2.03 times greater and the mean daily cost increased 2.49 times. Administrative assistants had the lowest relative risk (RR) of infection (RR: 0.5120; 95% confidence interval [95%CI] 0.2628-0.9974). In turn, the nursing team (RR: 1.37; 95%CI 1.052-1.787), physiotherapists (RR: 1.7148; 95%CI 1.0434-2.8183), and speech therapists (RR: 2.7090; 95%CI 1.5550-4.7195) were at greatest risk of SARS-CoV-2 infection. Conclusions: The SARS-CoV-2 pandemic led to an increase in sickness absence among workers in a hospital setting. The nursing team, physiotherapists, and speech therapists were at greatest risk of SARS-CoV-2 infection.

Support provided to nursing students in the face of patient safety incidents: a qualitative study.

OBJECTIVES: to identify the support provided to nursing students after a patient safety incident. METHODS: qualitative study developed with 23 students attending an undergraduate nursing program in southern Brazil. Data were collected between September and November 2021 and submitted to textual discursive analysis using the Iramuteq software. RESULTS: the students reported that mainly classmates and professors of the practical courses provided support. The students showed no knowledge of organizational support or protocols available to students who become second victims of such incidents. FINAL CONSIDERATIONS: the primary support sources available to nursing students involved in patient safety incidents were identified. Note that support provided to nursing students is still incipient both in Brazil and internationally. Hence, further studies are needed to address potential victims and support resources to mitigate this phenomenon.

Absenteeism-disease in health care workers in a hospital context in southern Brazil.

INTRODUCTION: Absenteeism is a pervasive and growing worldwide problem. In hospital settings, it is often associated with a fast-paced environment, shift work and high occupational demands. Absenteeism in hospitals can also be attributed to poor working conditions and the high emotional burden associated with daily exposure to illness and death. These conditions often lead to sickness absence. OBJECTIVES: To assess sickness absence among health care workers in hospital settings. METHODS: A cross sectional study was conducted using the data and medical records of health care workers in a hospital in Rio Grande do Sul, Brazil. The data covered the period of September 2014 to December 2018. RESULTS: The sample consisted of 559 workers, 233 of whom were absent for at least 1 day in the year. Sickness absence was most common among women (79%) and nursing technicians (45.5%). The mean duration of absence was 5.53 days (standard deviation: 20.42), and the sickness absence rate was 2.01%. The most common reasons for sickness absence were injury, poisoning and other consequences of external causes (20.19%), followed by mental and behavioral disorders (17.90%) and diseases of the musculoskeletal system and connective tissue (11.69%). CONCLUSIONS: Greater awareness of the factors associated with sickness absence in hospital settings can contribute to the planning of occupational health initiatives targeting the most vulnerable workers.

Patient safety culture in critical and non-critical areas: a comparative study.

OBJECTIVE: to compare the perception of patient safety culture among health workers from critical and non-critical areas. METHOD: cross-sectional study with health workers from critical and non-critical areas of a large hospital. Data collection used a characterization instrument and the Safety Attitudes Questionnaire. The analysis was performed in the Predictive Analytics Software Statistic®. RESULTS: a total of 393 workers participated, predominantly women, over 43 years old, nursing technicians, with a partner, and children. Results indicated that the areas have a negative perception of patient safety (66.5%, ±12.7 critical; 63.5%, ±14.4 non-critical). Only job satisfaction had a positive score (83.0%, ±15.9 critical; 80.1%, ±17.5 non-critical). There was a relationship between being a worker in critical areas and having a positive perception of the unit's management (p = 0.041). CONCLUSION: both areas have a negative perception of the safety culture. Although critical areas have obtained more positive evaluations, the results did not show statistical significance when compared to non-critical areas.

Salivary cortisol concentrations in hematogy/oncology nurses on working days and days off.

OBJECTIVE: to assess salivary cortisol concentrations in hematology/oncology nurses on working days and days off. METHODS: a cross-sectional study carried out with 28 nurses from a university hospital. A sociodemographic, employment and health profile questionnaire was applied. For saliva collection, Salivette® tubes were used. Descriptive and analytical analysis was used. RESULTS: there was no significant difference in cortisol concentrations between working days and days off (p>0.05). The high cortisol concentration was associated with not having children (0.621±0.340; p=0.046), not using medication (0.623±0.133; p=0.017) and birth control pills (0.556 ± 0.228; p=0.047) and intention to leave work (0.951±0.154; p=0.001). A positive correlation was identified between cortisol and absence from work due to health issues (0.72; p=0.05) and weight gain (0.935; p=0.02). CONCLUSION: in general, cortisol concentration is within the reference parameters, with no significant difference in its secretion on working days and days off.

Presenteeism and safety culture: evaluation of health workers in a teaching hospital.

OBJECTIVES: to verify associations between presenteeism and safety culture among health workers. METHODS: a descriptive, cross-sectional study with health workers from a teaching hospital in Rio Grande do Sul. Data collection took place through instruments of sample characterization, the Brazilian version of the Stanford Presenteeism Scale and the Safety Attitudes Questionnaire were analyzed using descriptive statistics and chi-square tests. RESULTS: a total of 758 (48%) professionals participated; 330 (43.5%) presenteeism were identified, who evaluated the safety culture more negatively compared to non- presenteeism. The safety culture had a mean less than 75; associations between presenteeism and general safety culture were observed, and with the domains of teamwork climate, safety climate, stress recognition and working conditions. CONCLUSIONS: presenteeism was associated with a safety culture, which requires investment by hospital management, with consideration to the health of workers.