Moral distress among nursing professors: The exercise of parrhesia.

BACKGROUND: Mismatch between the perception of one's moral duty and one's real social contribution may trigger moral distress, especially when no specific resistance strategies are used to counteract morally distressing situations. Considering a philosophical-ethical conception, individuals need to first reflect upon themselves to later turn to the world and confront their current situation in order to change it. OBJECTIVES: To understand moral distress experienced by nursing professors teaching in higher education institutions and the use of parrhesia as a coping strategy. METHOD: This qualitative exploratory-descriptive study addressed 33 nursing professors working in Brazilian federal public universities using an open-ended question form. Data were collected between June and December 2018 and analyzed using discursive textual analysis. ETHICAL CONSIDERATIONS: The Institutional Review Board at the Federal University of Rio Grande approved this study. FINDINGS: Three categories emerged: performance of nursing professors and potentially distressing situations, the experience of moral distress, and parrhesia as a strategy to deal with moral distress. Nursing professors face situations that cause moral distress in the context of higher education, however, those who adopt parrhesia as a coping strategy find it easier to express their beliefs from the perspective of moral duty, even in the face of conflicts. CONCLUSION: When the nursing professors in this study acknowledge elements in the power structure that hinder their actions, they express parrhesia, as an essential virtue in an attempt to modify unsymmetrical power relations that can trigger moral distress.

Psychic workload in the process of work of maternity and obstetric centers nurses. / Cargas de trabalho psíquicas no processo de trabalho de enfermeiros de maternidades e centros obstétricos.

OBJECTIVE: To identify the psychic workload present in the work process of nurses working in Maternity and Obstetric Centers. METHOD: A descriptive qualitative study developed with 14 nurses working in obstetric centers and maternity units of two hospitals. The data were collected through a semi-structured interview, developed from October of 2015 to January of 2016, and exploited based on Content Analysis. RESULTS: The results were grouped into two categories: the nurses' working process and their psychic workload; and the maintenance of (in)appropriate practices such as psychic workload, demonstrating that the psychic workload is materialized in multiple elements of the work process, passing through assignments, interpersonal relationship and maintaining inadequate pipelines. CONCLUSIONS: It was identified that the psychic workload in the nurses' work process in the studied context is related to the perpetuation of dehumanized practices and to the challenge of maintaining humanized practices.

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.

Mental Health of Elementary Schoolteachers in Southern Brazil: Working Conditions and Health Consequences.

The mental health of educators is a growing problem in many countries. This study sought to identify self-reported stressful working conditions of elementary schoolteachers and the biopsychosocial consequences of those working conditions and then identify working conditions that promote well-being for teachers in the workplace. Exploratory study was done with 37 teachers. Data collection was performed using a structured interview with a questionnaire. Results show that stressful working conditions are related to inadequate salary, an excessive number of activities, and having to take work home. Biopsychosocial consequences include anxiety, stress, and sleep disorders. There was a statistically significant association between inadequate salary and anxiety (p = 0.01) and between an excessive number of activities and stress (p = 0.01). Teachers reported that a good relationship among colleagues is a working condition that promotes well-being in the workplace. The identification of stressful working conditions for teachers, the biopsychosocial consequences, and working conditions that promote well-being in the workplace are relevant to determining actions that improve the work environment and, consequently, the health of teachers.

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.

Analysis of moral courage and related factors among undergraduate nursing students: a scoping review.

OBJECTIVE: to analyze scientific evidence on moral courage and related factors among nursing undergraduate students. METHOD: the protocol of this scoping review was registered on Open Science Framework. A search was performed in five databases, according to the method provided by Joanna Briggs Institute Reviewers, the mnemonic strategy Population, Concept and Context, and a specific checklist. RESULTS: a total of 2,812 results were identified, but only nine studies were eligible and presented three thematic approaches: Moral courage from the perspective of nursing students; Moral courage and related factors; and The teaching of moral courage in the training of nursing students. The factors related to moral courage include moral distress, moral sensitivity, age, and having a previous degree in the health field. FINAL CONSIDERATIONS: few studies were found with a low evidence level. Most were performed in developed countries, indicating some gaps that need to be addressed in the future.

Risk communication as a tool for training apprentice welders: a study about risk perception and occupational accidents.

The present study has aimed to identify the perceptions of apprentice welders about physical, chemical, biological, and physiological risk factors to which they are exposed; identify types of occupational accidents involving apprentice welders; and report the development of a socioenvironmental education intervention as a tool for risk communication for apprentice welders. A quantitative study was performed with 161 apprentice welders in Southern Brazil in 2011. Data collection was performed via structured interviews with the apprentice welders about risk perception, occupational accidents, and time experienced in welding. The data were analyzed using SPSS 19.0. The participants identified the following risk types: physical (96.9%), chemical (95%), physiological (86.3%), and biological (51.5%). In this sample, 39.7% of apprentice welders reported occupational accidents and 27.3% reported burning. The inferential analysis showed that the frequency of risk perception factors increases with the length of experience, and apprentice welders who have experienced accidents during welding activity perceive a higher amount of risk factors than those who have never experienced them. It is concluded that apprentice welders perceive risks and that they tend to relate risks with the occurrence of occupational accidents as an indicator of the dangerous nature of their activity.

Nursing students: the use of digital social network to profile nurses.

OBJECTIVES: to analyze the profile of nursing students at a university in southern Brazil and verify the effectiveness of the use of social networks in students' location and adherence. METHODS: a quantitative, descriptive and exploratory study, carried out with 314 students through a questionnaire prepared on Google Forms, made available through digital social networks and e-mails. RESULTS: students were women, without training in a technical/assistance nursing course, participants in projects and research groups, with a graduate degree. Furthermore, more than 75% obtained their first job within six months after graduation, more than 80% worked in healthcare, with public employment, workload of up to 40 hours a week, income between four and ten minimum wages, and 92% indicated that they were satisfied and/or very satisfied with the course. CONCLUSIONS: the strategic use of social networks enabled greater adherence by the target audience and nursing students' profile design.

Postgraduate nursing students' conceptions on scientific integrity and research ethics.

OBJECTIVES: to understand the conceptions of postgraduate Nursing students regarding integrity in scientific research. METHODS: a qualitative, descriptive and exploratory study conducted in October 2020, with 40 students from a postgraduate program in Nursing from a public university in Southern Brazil. The interviews had an emphasis on scientific integrity and its importance for scientific research; they were conducted using synchronous communication tool and analyzed by textual discourse analysis. RESULTS: two categories emerged: "Scientific integrity: the ethical dimension of research" and "Implications of academic productivism for scientific integrity". Such integrity is intrinsically related to the supporting ethical elements, as well as to the nuances of productivism and its impacts on integrity. FINAL CONSIDERATIONS: the cross-sectionalism of ethical practices is necessary in the production spheres of science, so that knowledge is perpetuated in harmony with integrity and its representations to the community.

The performance of nursing students in a tele-health service during the COVID-19 pandemic.

OBJECTIVE: To identify the experiences of nursing students working in a telehealth service to fight the COVID-19. METHOD: Qualitative, exploratory, and descriptive study, addressing 31 undergraduate nursing students at a Federal University located in the extreme south of Brazil. Data were collected in October 2020 using an online questionnaire. Textual discourse analysis was used to interpret data. RESULTS: The students identified facilities, weaknesses, and potentialities of a telehealth service, verifying that it is a strategy that favors the development of skills and competencies during the training of students and to fight the COVID-19 pandemic. CONCLUSION: The results reveal the students' experiences in a telehealth service designed to fight the COVID-19, showing the importance of including this service in the routine of healthcare services.

Workloads in nursing activities performed in university hospitals.

OBJECTIVE: Analyze the exposure of nursing workers to workloads present in university hospitals located in southern Brazil. METHOD: Cross-sectional quantitative study performed with 361 nursing workers from two University Hospitals between November 2019 and February 2020. An instrument addressing sociodemographic and occupational variables was used together with the previously validated Workloads in Nursing Activities Scale. The distribution of frequencies, measures of location, and variability were identified, and analysis of variance and the Tukey test were performed. RESULTS: The construct that obtained the highest mean was F3 - Biological Loads (3.00), revealing that nursing workers are very intensively exposed to biological loads. Workloads were significantly different between the work units - physiological (p = 0.001), biological (p = 0.007), psychological (p = 0.042), mechanical (p = 0.014), chemical (p = 0.001), and physical (p = 0.001). CONCLUSION: The workers identified that exposure to workloads varies in intensity, showing aspects of the work performed in health institutions that either aggravate or mitigate workloads through the activities performed by nursing workers.

Relationship between workloads and presenteeism among nursing workers.

OBJECTIVE: to analyze the relationship between exposure to workloads and presenteeism among nursing workers in the socio-environmental context of university hospitals. METHOD: this is a quantitative, cross-sectional and analytical study with 355 nursing workers from two university hospitals in southern Brazil. Data were collected from November 2019 to February 2020. The Workload Scale in Nursing Activities and the Work Limitations Questionnaire were used. Descriptive statistics, variance analysis and Pearson's correlation test were used. RESULTS: there was a significant correlation between chemical loads and time management; biological loads and time management, physical demand and productivity loss; physiological loads and mental and interpersonal demand, production demand and loss of productivity; psychological loads and production demand. CONCLUSIONS: there is a relationship between workloads and nursing presenteeism, verified by limitations and loss of productivity.

Work accidents and occupational risks identified in the Mobile Emergency Service. / Acidentes de trabalho e os riscos ocupacionais identificados no Serviço de Atendimento Móvel de Urgência.

OBJECTIVE: To analyze the occurrence of work accidents among Mobile Emergency Service workers and the association with the identified occupational risks. METHOD: A quantitative, exploratory, descriptive and cross-sectional study conducted with Mobile Emergency Service workers in Rio Grande do Sul, between January 2016 and November 2017, using an online instrument. RESULTS: A total of 265 workers participated. There was a significant association between the occurrence of accidents at work and professional category (p = 0.041); as well as the occurrence of work accidents and the mesoregion (p = 0.015). In the significant associations between the occurrence of accidents at work and occupational risks, accidents with sharps, physical aggression, animal bites, verbal aggression, traffic accidents during commuting and falls were highlighted. In addition, a significant association between the occurrence of an accident at work and work leave (p = 0.000) was found. CONCLUSION: The occurrences of work accidents during pre-hospital service activities are related to the professional category of workers, the work mesoregion, work leave and the exposure of workers to different occupational risks.

Musculoskeletal pain in undergraduate health students: prevalence and associated factors.

OBJECTIVE: To assess the prevalence and factors associated with musculoskeletal pain in undergraduate health students. METHOD: A cross-sectional study was conducted with undergraduate students from a university in the south of Brazil between April and July 2017. The Brazilian version of the Standardized Nordic Questionnaire and a questionnaire for the characterization of students were used. Descriptive statistics, the chi-square test and Poisson regression were used for the analysis. RESULTS: Participation of 792 undergraduate health students. The region of the vertebral column had a higher prevalence (74.9%) of musculoskeletal pain. The variables of female sex, age between 18 and 20 years, overweight, not having time for leisure, six or more daily hours of mobile phone use, having a clinical condition with medical diagnosis and attending the intermediate or final semesters of the course were associated with musculoskeletal pain. CONCLUSION: The high prevalence of musculoskeletal pain demonstrates the need for strategies aimed at preventing this aggravation still in the academic setting.

Patient safety culture in intensive care units: perspective of health professionals. / Cultura de segurança em unidades de terapia intensiva: perspectiva dos profissionais de saúde.

OBJECTIVE: To identify the patient safety culture in intensive care units. METHOD: This qualitative, exploratory-descriptive study was conducted with five physicians, five nurses and 24 nursing technicians working in the intensive care units of two hospitals in the South of Brazil: one public and one philanthropic. Semi-structured interviews were held in September and October 2016 and analyzed using discursive textual analysis. RESULTS: Two categories emerged: Perception of error and Error management. CONCLUSION: The professionals acknowledge the existence of errors in health care and assign their occurrence to individual failures and failures accruing from the organizational system but support a non-punitive culture of safety and encourage collective learning.

Construction and validation of a tool to assess nursing interpersonal relations.

OBJECTIVE: construct and validate a tool to identify the factors that influence interpersonal relations and the health of nursing workers in a University Hospital in the South of Brazil. METHOD: methodological study, in nine steps. The face validation was carried out, with the participation of five experts, professor nurses doctors in Nursing, content with 26 nurses, stricto sensu Nursing Postgraduate students, and the validation of the construct was performed through a quantitative approach with 213 nursing workers. We used the exploratory factorial analysis and the Cronbach's Alpha in the validation of the construct. RESULTS: the tool consisted of 29 questions and six constructs were identified. The Cronbach's Alpha value.879 showed satisfactory internal consistency. CONCLUSION: the tool was valid and reliable for use in the assessment of interpersonal relations among nursing workers in Brazilian University Hospitals.

Moral sensitivity components identified among nurses from Intensive Care Units.

OBJECTIVE: to identify ethical problems from the components of moral sensitivity among nurses of Intensive Care Units. METHOD: qualitative, exploratory-descriptive study developed in a hospital in the South of Brazil with 19 nurses working in intensive care units through semi-structured interviews that were analyzed through discursive textual analysis. RESULTS: ethical education, dialogue, relationships with other health team members, professional autonomy, knowledge, personal values, effective communication, leadership and patients' positive outcomes were identified as important components of nurses' moral sensitivity, and comprise the domains of moral consciousness, benevolent motivation, and spontaneous moral perception. FINAL CONSIDERATIONS: the components of moral sensitivity identified in this study facilitate nurses' instrumentalization in the face of decision making and ethical problems in the intensive care setting.

Workloads and burnout of nursing workers.

OBJECTIVE: to identify workloads in nursing work and its association with nursing worker burnout. METHOD: a cross-sectional study, including 211 nursing workers from a university hospital, between July and August 2016. For the analysis, the descriptive statistics, Chi-Square Test, Fisher's Exact Test and Mann Whitney U-Test were used. RESULTS: the most evidenced loads were biological. A significant association was found between workloads and workers' occupation, as well as a significant association between workloads and worker burnout. Burnout caused upper limb pain, neck and lumbar pain, lower limb pain, muscle spasm, lower limb edema, mental fatigue, headache, nervousness, and forgetfulness. CONCLUSION: workloads identification is a subsidy for the promotion of interventions that minimize the burnout generated to the health of the nursing worker.

Analysis of fatigue among nurse educators in brazilian public universities during the covid-19 pandemic / Análisis de la fatiga en enfermeros docentes de universidades públicas brasileñas durante la pandemia de covid-19 / Análise da fadiga em enfermeiros docentes de universidades públicas brasileiras durante a pandemia da covid-19

ABSTRACT Objective: to analyze fatigue among nurse educators affiliated with Brazilian public universities while teaching online and hybrid courses during the Covid-19 pandemic. Method: qualitative, cross-sectional study addressing 318 nurse educators teaching in federal and state public universities between July and November 2021. The adapted and validated version of the Three-Dimensional Work Fatigue Inventory (3D-WFI) was used to assess fatigue. The means were compared, and variance analysis (ANOVA) was performed with the Bonferroni test and t-test. The statistically significant variables (p<0.05) remained in the model. Results: the participants were 42 (± 9.4) on average; most were women, 279 (87.7%); 225 (70.8%) had children; and 313 (98.4%) reported performing house chores along with online teaching. In addition to the activities concerning undergraduate programs, 88 (27.7%) participants also performed activities in graduate programs. An association was found between course modality (entirely online or face-to-face, or hybrid) and the dimensions: physical fatigue (p=0.041), mental fatigue (p=0.001), and emotional fatigue (p=0.019), and between taking care of children and help them with school tasks while also teaching classes online and physical fatigue (p=0.012), mental fatigue (p=0.001), and emotional fatigue (p=0.000). Conclusion: the significant differences between course modality and the three dimensions of fatigue (physical, mental, and emotional) showed that the participants experienced physical and mental fatigue during and after work.

Objetivo: analizar la fatiga en enfermeros docentes de universidades públicas brasileñas durante el trabajo remoto e híbrido en la pandemia de Covid-19. Método: estudio de abordaje cuantitativo, del tipo transversal, realizado en 318 enfermeros docentes de universidades públicas federales y estatales brasileñas, entre los meses de julio y noviembre de 2021. Para evaluar la ocurrencia de fatiga; se utilizó la escala Three-Dimensional Work Fatigue Inventory (3D-WFI) adaptada y validada para el portugués. Se realizó la comparación de las medias, el análisis de variancia (ANOVA) con empleo del test de Bonferroni y el teste t. En el modelo, permanecieron las variables estadísticamente significativas (p< 0,05). Resultados: la media de edad de los participantes fue de 42 años (± 9,4). La mayoría era del sexo femenino 279 (87,7%), 225 (70,8%) tenían hijos y 313 (98,4%) refirieron realizar actividades domésticas, junto con el trabajo remoto. Además de las actividades en la graduación, 88 (27,7%) docentes también realizaron actividades en la postgraduación. Se observó asociación entre el modo de trabajo (totalmente online, híbrido o presencial) con las dimensiones: fatiga física (p= 0,041), fatiga mental (p= 0,001) y fatiga emocional (p= 0,019); y, cuidar de los hijos y ayudar con las actividades escolares durante el trabajo remoto con fatiga física (p=0,012), fatiga mental (p= 0,001) y fatiga emocional (p= 0,000). Conclusión: las diferencias significativas entre el modo de trabajo y las tres dimensiones de fatiga (física, mental y emocional) permitieron evidenciar que los enfermeros docentes de la muestra investigada identificaron agotamiento físico y mental durante y al final del día de trabajo.

RESUMO Objetivo: analisar a fadiga em enfermeiros docentes de universidades públicas brasileiras durante o trabalho remoto e híbrido na pandemia da Covid-19. Método: estudo de abordagem quantitativa, do tipo transversal, realizado com 318 enfermeiros docentes de universidades públicas federais e estaduais brasileiras entre os meses de julho a novembro de 2021. Para avaliar a ocorrência de fadiga, utilizou-se a escala Three-Dimensional Work Fatigue Inventory (3D-WFI) adaptada e validada para o português. Realizou-se a comparação das médias, análise de variância (ANOVA) com emprego do teste de Bonferroni, e teste t. No modelo, permaneceram as variáveis significantes estatisticamente (p< 0,05). Resultados: a média de idade dos participantes foi de 42 anos (± 9,4). A maioria era do sexo feminino 279 (87,7%), 225 (70,8%) tinham filhos e 313 (98,4%) referiram desenvolver atividades domésticas junto com o trabalho remoto. Além das atividades na graduação, 88 (27,7%) docentes também desenvolviam atividades na pós-graduação. Observou-se associação entre o modo de trabalho (totalmente online, híbrido ou presencial) e as dimensões: fadiga física (p= 0,041), fadiga mental (p= 0,001) e fadiga emocional (p= 0,019), e cuidar dos filhos e ajudar com as atividades escolares durante o trabalho remoto com fadiga física (p=0,012), fadiga mental (p= 0,001) e fadiga emocional (p= 0,000). Conclusão: as diferenças significativas entre o modo de trabalho e as três dimensões de fadiga (física, mental e emocional) permitiram evidenciar o que os enfermeiros docentes da amostra pesquisada identificaram como esgotamento físico e mental durante e ao final do dia de trabalho.

Validity study of the Three-Dimensional Work Fatigue Inventory among higher education nursing faculty / Estudio de validación del Three-Dimensional Work Fatigue Inventory entre profesores de enfermería de enseñanza superior / Estudo de validação do Three-Dimensional Work Fatigue Inventory entre docentes de enfermagem da educação superior

ABSTRACT 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.

RESUMEN Objetivo: adaptar y validar el Three-Dimensional Work Fatigue Inventory (3D-WFI) para la realidad cultural de Brasil y evaluar las propiedades psicométricas. Métodos: estudio metodológico desarrollado en seis etapas: traducción inicial; síntesis de traducciones; traducción inversa; revisión por comité de expertos; preprueba; y revisión del proceso de adaptación por parte de los investigadores. Para la validación, el instrumento se aplicó a una muestra de 318 profesores individuales de enfermería de universidades públicas federales y estatales brasileñas. Los datos se analizaron mediante análisis factorial exploratorio y confirmatorio, confiabilidad compuesta y confiabilidad del instrumento (alfa de Cronbach y omega de McDonald). Resultados: el instrumento 3D-WFI mostró excelente consistencia interna (α=0,95 y ω=0,97), tres dimensiones y varianza explicada de 62.77%. Conclusiones: la versión brasileña del instrumento mostró excelentes propiedades psicométricas para evaluar la fatiga entre trabajadores brasileños.

RESUMO Objetivo: adaptar e validar o Three-Dimensional Work Fatigue Inventory (3D-WFI) para a realidade cultural do Brasil e avaliar as propriedades psicométricas. Métodos: estudo metodológico, desenvolvido em seis etapas: tradução inicial; síntese das traduções; retrotradução; revisão pelo comitê de especialistas; pré-teste; e revisão do processo de adaptação pelos pesquisadores. Para a validação, o instrumento foi aplicado em uma amostra de 318 indivíduos enfermeiros docentes de universidades públicas federais e estaduais brasileiras. Os dados foram analisados mediante análise fatorial exploratória e confirmatória, fidedignidade composta e confiabilidade do instrumento (alfa de Cronbach e ômega de McDonald). Resultados: o instrumento 3D-WFI apresentou excelente consistência interna (α=0,95 e ω=0,97), três dimensões e variância explicada de 62,77%. Conclusões: a versão brasileira do instrumento mostrou excelentes propriedades psicométricas para avaliação da fadiga entre trabalhadores brasileiros.