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.

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.

[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.

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.

Development of the Patient Advocacy Scale for Intensive Care Nurses.

Background and Purpose: To describe the process of developing and validating the content of the Patient Advocacy Scale for Nurses in Intensive Care (EAPEnf-UTI). Methods: Methodological research. To achieve the elaboration objective, five stages were developed: (a) definition of the theme, (b) generation of the number of items, (c) determination of the measurement format, (d) validation of face and content, and (e) content adjustment. Results: The instrument elaborated from a survey and integrative literature review, and the measurement format chosen was the 5-point Likert scale. The validation of face and content was performed by expert judges and by pretest. The final instrument had 57 items. Conclusion: EAPEnf-UTI is a pioneering instrument built in the Brazilian context, whose future validation will allow the capturing of situations specific to intensive care units and the professional practice of intensive care nurses.

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.

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.

Implementation of early will directives: facilities and difficulties experienced by palliative care teams.

OBJECTIVE: To know the facilities and difficulties the palliative care team professionals experience in the implementation process of advance healthcare directives. METHOD: Exploratory-descriptive study with a qualitative approach, involving 51 professionals from seven palliative care teams in the state of Rio Grande do Sul, Brazil. The data were collected between December 2018 and April 2019 and discursive textual analysis was applied. RESULTS: The facilities found were: the approach by the palliative care team; listening and respecting patients' wishes; effective communication between professionals, patients, and family members and resolution of difficult situations. The difficulties reported were: legal issues; the lack of knowledge of professionals about the subject; the lack of institutional protocols; the difficulty in talking about death and the family barrier. CONCLUSION: Despite the perceived facilities and difficulties, palliative care professionals intend to work based on the patients' desires and will, aiming to offer dignity in the dying process.

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.

Advance directives of patients: process of implementation by palliative care teams.

OBJECTIVES: to investigate the process of implementing advance directives in palliative care teams in southern Brazil. METHODS: an exploratory-descriptive study with a qualitative approach conducted with 51 professionals from seven palliative care teams from December 2018 to April 2019. Data were collected through semi-structured online interviews and submitted to discursive textual analysis. RESULTS: the implementation process starts on approach of the advance directives with patients, so that their wishes and desires are the guiding axis for planning care and conduct. FINAL CONSIDERATIONS: the palliative philosophy is important with regard to advance directives, due to the preparation of these professionals in the search for dignity, quality of life and respect for patient autonomy, in addition to reducing suffering and offering dignified death, based on the understanding of human finitude as a natural process that belongs to life.

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.

Patient advocacy actions by intensivist nurses. / Ações de advocacia do paciente pelos enfermeiros intensivistas.

OBJECTIVE: To explore the actions and factors associated to patient advocacy by intensivist nurses using the Protective Nursing Advocacy Scale. METHOD: A quantitative, descriptive-exploratory, cross-sectional study. The questionnaire was answered by nurses who worked in Intensive Care Units in the South and Southeast regions of Brazil. A factorial exploratory analysis of the data, T-tests and the chi-square test were used for association between factors. RESULTS: 451 nurses participated in the study. A greater number of nurses disagreed with the negative consequences that patient advocacy may have or bring to them. Greater dialogue among nursing staff would enhance teamwork results. Nurses with two or more job relationships need more physical and mental effort, which compromises their quality of life and work, leading to them being those who least practice patient advocacy. CONCLUSION: Nurses understand patient advocacy as an important part of their work, as well as factors which may influence their decision to defend their patients, but are still unaware of the benefits of advocacy.

Assessment of health/functioning of older adults who consume psychoactive substances.

OBJECTIVE: To assess the health/functioning of the older adult who consumes psychoactive substances through the International Classification of Functioning, Disability and Health, considering the theory of complexity. METHOD: Qualitative case study, with 11 older adults, held between December 2015 and February 2016 in the state of Rio Grande do Sul, using interviews, documents and non-systematic observation. It was approved by the ethics committee. The analysis followed the propositions of the case study, using the complexity of Morin as theoretical basis. RESULTS: We identified older adults who consider themselves healthy and show alterations - the alterations can be exacerbated by the use of psychoactive substances - of health/functioning expected according to the natural course of aging such as: systemic arterial hypertension; depressive symptoms; dizziness; tinnitus; harmed sleep/rest; and inadequate food and water consumption. Final consideration: The assessment of health/functioning of older adults who use psychoactive substances, guided by complex thinking, exceeds the accuracy limits to risk the understanding of the phenomena in its complexity.

Health advocacy by nurses in the Family Health Strategy: barriers and facilitators.

OBJECTIVE: Identify the barriers and facilitators of health advocacy to users delivered by nurses from the Family Health Strategy. METHOD: Qualitative study carried out with nurses from the Family Health Strategy of a city in the south of Brazil. Study participants were 15 nurses, who were interviewed. The content of the interviews was recorded, transcribed and analyzed in the light of the discursive text analysis. RESULTS: Two categories emerged, one about the lack of organization at the workplace, bureaucracy and limitations to professional work in health environments, and another about the facilitating aspects to exercise advocacy both individually and collectively. CONCLUSION: When nurses, provided with technical, scientific and relational knowledge, are empowered to make decisions, they are not only supported by other professionals at work but also develop actions of health advocacy to users, thus qualifying the care delivered.