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.

Terminal patient care: advantages on the applicability of anticipated will directives in the hospital context. / Assistência ao doente terminal: vantagens na aplicabilidade das diretivas antecipadas de vontade no contexto hospitalar.

OBJECTIVE: To know the advantages related to the applicability of the advance directives of will in the hospital context from the perspective of nurses, doctors and family members. METHOD: Qualitative, descriptive and exploratory study with semi structured interviews carried out from October to November 2014, with nurses, doctors and family members of patients in the final stage. Afterwards, a discursive textual analysis was carried out. RESULTS: Four categories emerged: respect for patient's autonomy; support in confrontation of conflicts with and from family members; reduction of conflicts in the team about treatments and conducts; disclosure and instrumentation for application of the Advance Directives of Will. CONCLUSION: The respect for personal autonomy permeates the advantages when relating the conduct of treatments at the end of life with the Advance Directives of Will. Thus, disagreements involving the processes at the end of life would be supported by the patient's desire, besides implying in the reduction of the fear of professionals in facing lawsuits and in the support of the family.

[Meanings attributed by family members in pediatrics regarding their interactions with nursing professionals]. / Significados atribuídos por familiares na pediatria acerca de suas interações com os profissionais da enfermagem .

OBJECTIVE: Understanding the meanings attributed by family caregivers of children in hospital environments about their interactions with nursing professionals. METHODS: This qualitative study used Symbolic Interactionism as a theoretical reference and Grounded Theory as the methodological framework. It was carried out in a Pediatrics Center in southern Brazil, in the first half of 2013. Participants were 15 family caregivers of hospitalized children. Data were collected through interviews and submitted to open and axial analysis. RESULTS: Interactions with the nursing team enable family to trust or distrust in the provided child care and to positively evaluate the care received. CONCLUSION: Interactions between family members and the nursing team contribute to the significance attributed by the family to the nursing care received by the child. Nurses should be aware of the attitudes of the nursing team regarding the child and their family, prioritizing humanized care.

[Nursing Actions in practicing inpatient advocacy in a Burn Unit]. / Ações dos enfermeiros no exercício da advocacia do paciente internado em um centro de queimados.

OBJECTIVE: Understanding nursing actions in the practice of inpatient advocacy in a burn unit. METHOD: A single and descriptive case study, carried out with nurses working in a referral burn center in southern Brazil. Data were collected through focus group technique, between February and March 2014, in three meetings. Data was analysed through discursive textual analysis. RESULTS: Three emerging categories were identified, namely: (1) instructing the patient; (2) protecting the patient; and (3) ensuring the quality of care. CONCLUSIONS: This study identified that the nurses investigated exercised patient advocacy and that the recognition of their actions is an advance for the profession, contributing to the autonomy of nurses and the effectiveness of patients' rights and social justice.

[Nursing beliefs and actions in exercising patient advocacy in a hospital context]. / Crenças e ações de enfermeiros no exercício da advocacia do paciente no contexto hospitalar.

OBJECTIVE: Analyzing beliefs and actions of nurses in exercising patient advocacy in a hospital context. METHOD: A quantitative cross-sectional exploratory and descriptive study, conducted with 153 nurses from two hospitals in southern Brazil, one public and one philanthropic, by applying Protective Nursing Advocacy Scale - Brazilian version. Data were analyzed using descriptive statistics and analysis of variance. RESULTS: Nurses believe they are advocating for patients in their workplaces, and agree that they should advocate, especially when vulnerable patients need their protection. Personal values and professional skills have been identified as major sources of support for the practice of advocacy. CONCLUSION: Nurses do not disagree nor agree that advocating for patients in their working environments can bring them negative consequences. It is necessary to recognize how the characteristics of public and private institutions have helped or not helped in exercising patient advocacy by nurses.

[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.

[Nursing undergraduate education in relation to the death-dying process: perceptions in light of the complex thinking]. / Formação do enfermeiro em relação ao processo de morte-morrer: percepções à luz do pensamento complex.

The objective of this study was to perceive the death-dying process from the perspective of nursing students. This is an exploratory, descriptive and qualitative research study. Data were collected between June and July 2013, from three focus groups with six nursing students at a University Center located in the central region of Rio Grande do Sul, Brazil. The meetings were organized with an approach to increase discussions about the death-dying process from the perspective of the complex thinking. Data were analyzed by means of the Strategic Focal Analysis, and three categories were created: Death: a process of rupture or continuity?; Recognizing weaknesses in the undergraduate educational process; and Outlining strategies to broaden academic discussions. It is possible to conclude that the death/dying process is minimally discussed in undergraduate courses, and when it is discussed, it happens in a fragmented and disjunctive manner, without integrating it into the human living process. Descriptors: Death. Education, nursing. Attitude to death.

Moral distress: challenges for an autonomous nursing professional practice.

Constantly 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.

[Implications of the visibility in professional nursing practices]. / Implicações da visibilidade da enfermagem no exercício profissional.

Nursing construction image is permeated by historical socioeconomic and cultural aspects. This theme aims to understand the perception of nurses regarding the visibility of nursing staff's daily work. This qualitative research is exploratory, with 30 nurses at a university hospital in southern Brazil. The data was collected from July to October 2012, through semi-structured interviews and submitted for a discursive textual analysis. The results show that nursing visibility is related to a professional historical trajectory, to an absence of recognition of the scientific aspect of Nursing, to erroneous placement in the media, to improper behavior towards the staff and also to work overload. Thus, the demystification of nursing's image includes greater media visibility, conducting personnel marketing, appropriate behavior in front of health staff and professional demonstrations of autonomy, challenges that must be overcome by nursing.

[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).

[Option and evasion of a bachelor's degree programme in nursing evaded students' perception]. / Opção e evasão de um curso de graduação em enfermagem: percepção de estudantes evadidos.

Qualitative study, developed in a Federal University in southern Brazil aiming to know the motives for choosing and evading a Bachelor's degree programme in Nursing, in the evaded students 'perception. The data were collected through a questionnaire sent by e-mail to 19 evaded students. The 9 questionnaires that returned were submitted to Qualitative Textual Analysis, and two categories emerged motives to opt for the nursing programme and motives to evade from the nursing programme. The results showed that the option for the programme is associated to personal vocation, perception of Nursing as a profession of care, and its closeness to the health area. Evasion seems to be related to passing the first option of undergraduate programme, ignorance about the profession, financial difficulties, and professional depreciation. We demonstrated that greater emphasis should be put on promoting knowledge about the nursing work, areas of activity and attributions.

[The scientific nursing production about the clinic: an integrativa review]. / A produção científica de enfermagem acerca da clínica: uma revisão integrativa.

The objective of this study was to learn about the production of nursing knowledge in Brazil associated with the clinic theme. This is a qualitative study performed by means of an integrative review. Data collection was performed on the SciELO database using the keywords nursing and clinic, present in the abstracts of articles. It was found that the clinic is seen as an instrument used to establish connections between research and nursing care, having a constant movement of constructing and deconstructing knowledge and practices. The study results may contribute with the production of research and knowledge in nursing, providing elements to subsidize improvements in nursing care, in which there is an interaction between practice and biological and non-biological knowledge.

[Woman's participation in the decision process of the pregnancy and puerperal cycle: nursing care integrative review]. / Participação da mulher no processo decisório no ciclo gravídico-puerperal: revisão integrativa do cuidado de enfermagem.

This is an integrative review that aims to identify the contribution of nursing care for woman's participation in the decision process of the pregnancy and puerperal cycle, as described in Brazilian scientific publications. The scientific productions were retrieved in May, 2010, from the Virtual Library of Health (Biblioteca Virtual em Saúde) database. From the eight articles reviewed, two themes stood out: Contributions of nursing care to the woman's participation in the decision process of the pregnancy and puerperal cycle; and Limitations of nursing care to the woman's participation in the decision process of the pregnancy and puerperal cycle. The following review supports the production of knowledge in nursing, by identifying a gap in what nurses know and do about this issue, as shown by the lack of nursing researches that concern, specifically, the participation of the woman in the decision process during the pregnancy and puerperal cycle and the possible contributions of nursing care to ensure women of this right.

Family culture versus institutional hospital culture: a relation between two worlds.

OBJECTIVE: To understand the relation between family culture and hospital institutional culture. METHOD: Qualitative study, carried out in 2017, with relatives of children admitted to a Hospital in southern Brazil. The study included non-participant observation, to gain familiarity with the investigated cultural context; participant observation, to know the respondents' experiences; and interviews. The data were coded and theoretical formulations and recommendations were made. RESULTS: Fifteen family members participated. Hospitalization is a time of encounter and interaction between family culture and institutional culture. CONCLUSION: Hospital culture is presented as an instrument of family care and adaptation and flexibility of norms and routines to humanize cultural care.

[Relationships and interactions in the process of healthily becoming an adolescent]. / Relacionamentos e interaçães no adolescer saudável.

The purpose of this study is to explore how teenagers view the relationships and interactions in the process of healthily becoming an adolescent. This qualitative exploratory research was conducted with ten teenagers in a state college in a town in southern Rio Grande do Sul, Brazil, from August to October, 2007. We used semi-structured interviews to collect the data. Later, we decided to use a thematic analysis, in which two themes emerged: (1) the process of building relationships and interactions in adolescence and (2) the risk in social life. As a result, we realized the importance of interpersonal relationships formed in adolescence, which deserve the nurse's attention. Nurses can help in the guiding of this population in basic health units, hospitals or schools, to a healthy adolescence. Thus, teenagers may enjoy the relationships built in this process in order to grow and to enter into adulthood.

Sociodemographic and occupational aspects associated with burnout in military nursing workers.

OBJECTIVES: to analyze association between burnout and sociodemographic and occupational features of military nursing workers. METHODS: a cross-sectional study, developed in five military hospitals of the Army of Rio Grande do Sul State, among 167 workers from military nursing from December 2015 to May 2016. Sociodemographic and occupational questionnaires and the Maslach Burnout Inventory were applied. For the analysis, it was used descriptive statistics, Chi-Square Test and Poisson Regression. RESULTS: the majority of participants were female; temporary military personnel, nursing technicians, with a median age of 34 years old. Burnout was related to the variables: Military Health Organization, time of practice in military nursing and accomplishment of leisure activities. CONCLUSIONS: burnout assessment may contribute to the Brazilian Army Command in organizing plans for prevention and handling of occupational diseases in military nursing, improving quality of life at work.

Beliefs, values and practices of families in the care of hospitalized children: subsidies for nursing.

OBJECTIVE: To know the beliefs, values and practices of families in the care of hospitalized children. METHOD: Qualitative study developed at the Pediatrics Unit of a University Hospital in southern Brazil through non-participant observation, participant observation and interview with children's family members. The methodological framework of Ethnonursing was adopted. Data were coded, classified and scrutinized to identify saturation of similar or different ideas and patterns, and recoded by making theoretical formulations and recommendations. RESULTS: Beliefs, values and practices of families depend on cultural references and are manifested in the care with feeding, clothing and hygiene, maintenance of sleep and rest, presence, care with medication and exercise of religious belief. CONCLUSION: Family members care for the hospitalized child based on their cultural reference and it is important that nurses take this aspect into consideration during care practice. Cultural care aggregates knowledge and can be considered a new paradigm for nursing care that allows an affective, reflective, human, empathic relationship between nurse/child/family.

Development and Validation of a Moral Distress Scale for Nursing Students.

BACKGROUND AND PURPOSE: This study aimed to develop and validate a scale to measure the frequency and the intensity of the moral distress experienced by nursing students. METHOD: Methodological study in which a guideline with eight steps: (a) to determine what to measure, (b) to produce items, (c) format to measure, (d) review by experts, (e) validation of items, (f) sample, (g) assessment (h) scale length was used to develop and validate a scale. The sample was composed of 499 undergraduate nursing students from three Brazilian universities. RESULTS: Six constructs were identified in the factor analysis. The instrument and dimensions presented satisfactory internal consistency, with Cronbach's alpha coefficients equal to .97 and between .60 and .97, respectively. CONCLUSION: The developed scale is able to analyze the intensity and the frequency of Moral Distress in nursing students, in a valid and reliable way.

Nursing now and always: evidence for the implementation of the Nursing Now campaign.

OBJECTIVE: to identify the guiding axes of the documents that grounded the Nursing Now campaign and relate the recommendations of these documents to the campaign goals. METHOD: documentary research, based on the analysis of the documents that promoted the Nursing Now campaign. The data were collected between March and April 2020, using a form structured into: background, scope, challenges and potentials of health/nursing professionals and recommendations for the future. RESULTS: the challenges and the need for investments in the health and nursing workforce to achieve the Sustainable Development Goals were evidenced. The report of the High Level Commission on health Employment and Economic Growth presents important recommendations, also introduced in the Triple Impact Report and in the Strategic Directions for Nursing and Midwifery, converging to the goals of the Nursing Now campaign, stimulating a profile of nurses with technical, political and leadership skills, engaged in health policy-making, and the effectiveness of their practice is clear to the entire society. CONCLUSION: knowledge about the dynamics of the factors that converged to the development of the Nursing Now campaign may be a condition for achieving its goals. This reality reveals evidence that global health will not be ensured without strengthening Nursing first.