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.

[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.

[Risk of falls in the elderly: an integrative review based on the North American Nursing Diagnosis Association]. / Risco de quedas em idosos: revisão integrativa pelo diagnóstico da North American Nursing Diagnosis Association.

The objective of this study was to analyze the scientific production regarding risk factors for falls in the elderly, based on the North American Nursing Diagnosis Association found in the Brazilian and international literature from 2005 to 2010. This integrative review was performed using the descriptors: accidental falls and elderly, utilizing the following databases: Cumulative Index to Nursing and Allied Health Literature and Latin-American and Caribbean Health Sciences Literature. Thirty-two articles were selected for content analysis. The results are presented according to the risk factors indicated by the North American Nursing Diagnosis Association, which are: environmental risk factors, such as rooms with excessive furniture and objects/rugs on the floor, poor illumination, and slippery floors; cognitive risk factors such as reduced mental state; risk factors in adults such as age above 65 years; physiological risk factors such as impaired balance, visual difficulties, incontinence, difficulty in walking, and neoplasms; and risk factors associated with the use of certain medications. An examination of the risk factors for falls in the elderly shows the need to develop new strategies to change environments and intrinsic components.

[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.

Humanization of the hospital: participatory construction of knowledge and practices on care and ambience.

OBJECTIVE: To identify and implement care and ambience strategies, with a view to hospital humanization. METHOD: Action-research study, whose investigation process occurred between January and March 2019, with the participation of employees in strategic functions of a medium-sized hospital, through a focus group and strategic focal analysis. The implementation of care and ambience strategies started in May 2019 and remains in progress, with the responsible and multiplying participation of professionals and patients. RESULTS: 18 employees participated in the study. It was found that investigative processes accompanied by practical interventions, especially those related to the promotion of interactive, inclusive, care spaces and the creation of a ludic, attractive and interactive environment favor multi-professional actions, mobilize innovative knowledge and practices, and contribute to the (re)signification of the being and doing of the health professional. CONCLUSION: Care and ambience, with a view to hospital humanization, include the implementation of strategies designed with the responsible and multiplying participation of all actors (professionals and users) of the hospital. It is important that, in this process, everyone feels they are protagonists of new ways of being, living and doing in health.

Right of the citizen and evaluation of health services: theoretical-practical approaches.

This study was carried out at a Family Medical Unit in a city in the south of Brazil, aiming at analyzing how the evaluation process takes place in a Brazilian public health unit, specifically considering a home care service. Data were collected through observation of the work process and interviews with workers, managers and users, between March and June 2006. The subjects were asked about the means applied to evaluate the home care service. No work is done to identify problems and reorient actions taken, evaluating the practices and measuring the impact of service and program actions on the population's health status.

[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.

[Moral distress and the ethical dimension in nursing work]. / Sofrimento moral e a dimensão ética no trabalho da enfermagem.

Nurses face moral problems, moral dilemmas and moral distress in their professional daily. The moral distress manifests itself when nurses demonstrate difficulties to face situations morally appropriate following their conscious. The study aims to focus about the nurses' moral distress and their relationship with moral problems and moral dilemmas presenting concepts, moral distress experiences and possible strategies to be adopted to face it. To focus on the moral distress provoked by facing the moral problems and dilemmas in nursery work seems to be primordial not just to reveal a phenomenon still a little known even experienced almost every day but, also to headline the need of problematization and valorization of the ethical dimension of work in health.

Nursing ethics and its relation with power and work organization.

Difficulties faced in the nursing routine, mainly in hospitals, have been reported without the resulting ethical implications to workers and especially to clients, been sufficiently questioned. The work organization can be the main source of suffering to nursing workers, related to the exercise of power of different actors involved in the health institutions, which can potentially cause multiple problems and distress of ethical order. This study aims to make a critical reflection about some relations between the nursing work organization, power relations and its ethical dimension. Strategies for an ethical performance of nurses and other nursing professionals in the organization of work in the healthcare institutions point to the need of these professionals exercise power in an ethical way.

Cross-cultural adaptation and validation of the Protective Nursing Advocacy Scale for Brazilian nurses.

OBJECTIVE: to adapt culturally and validate the Protective Nursing Advocacy Scale for Brazilian nurses. METHOD: methodological study carried out with 153 nurses from two hospitals in the South region of Brazil, one public and the other philanthropic. The cross-cultural adaptation of the Protective Nursing Advocacy Scale was performed according to international standards, and its validation was carried out for use in the Brazilian context, by means of factor analysis and Cronbach's alpha as measure of internal consistency. RESULTS: by means of evaluation by a committee of experts and application of pre-test, face validity and content validity of the instrument were considered satisfactory. From the factor analysis, five constructs were identified: negative implications of the advocacy practice, advocacy actions, facilitators of the advocacy practice, perceptions that favor practice advocacy and barriers to advocacy practice. The instrument showed satisfactory internal consistency, with Cronbach's alpha values ranging from 0.70 to 0.87. CONCLUSION: it was concluded that the Protective Nursing Advocacy Scale - Brazilian version, is a valid and reliable instrument for use in the evaluation of beliefs and actions of health advocacy, performed by Brazilian nurses in their professional practice environment.

Burnout syndrome among undergraduate nursing students at a public university.

OBJECTIVE: to investigate the burnout syndrome and its relationship with demographic and academic variables among undergraduate nursing students at a public university in Southern Brazil. METHOD: a quantitative study with 168 students, by applying an adaptation of the Maslach Burnout Inventory - Student Survey, validated for this study. We used descriptive and variance analysis of the data analysis. RESULTS: we found that students do not have the burnout syndrome, manifesting high average scores in Emotional Exhaustion, low in Disbelief and high in Professional Effectiveness; that younger students who perform leisure activities have greater Professional Effectiveness, unlike students in early grades with no extracurricular activities; combining work and studies negatively influenced only the Professional Effectiveness factor, while the intention of giving up influenced negatively Disbelief and Professional Effectiveness factors. CONCLUSION: the situations that lead students to Emotional Exhaustion need to be recognized, considering the specificity of their study environments.

Moral distress in nursing personnel.

OBJECTIVE: to analyze the frequency and intensity of moral distress experienced by nursing personnel in southern Brazil, covering elements of their professional practice. METHOD: a survey was undertaken in two hospitals in Rio Grande do Sul, Brazil, with 247 nurses. Data was collected by means of the adapted Moral Distress Scale. RESULTS: the perception of situations that lead to moral distress is enhanced in nurses and in nursing staff working in institutions with greater openness to dialogue, which hold team meetings, with fewer working hours and a greater ratio of professionals to patients. CONCLUSION: understanding moral distress allows us to go beyond solving the problems of the workers themselves, enabling the development of an ethics of active individuals and wide opportunities, defined mainly by the relationship with oneself.