Validation of a Brazilian version of the moral sensitivity questionnaire.

BACKGROUND: Moral sensitivity has been identified as a foundational component of ethical action. Diminished or absent moral sensitivity can result in deficient care. In this context, assessing moral sensitivity is imperative for designing interventions to facilitate ethical practice and ensure that nurses make appropriate decisions. OBJECTIVE: The main purpose of this study was to validate a scale for examining the moral sensitivity of Brazilian nurses. RESEARCH DESIGN: A pre-existing scale, the Moral Sensitivity Questionnaire, which was developed by Lützén, was used after the deletion of three items. The reliability and validity of the scale were examined using Cronbach's alpha and factor analysis, respectively. PARTICIPANTS AND RESEARCH CONTEXT: Overall, 316 nurses from Rio Grande do Sul, Brazil, participated in the study. ETHICAL CONSIDERATIONS: This study was approved by the Ethics Committee of Research of the Nursing School of the University of São Paulo. FINDINGS: The Moral Sensitivity Questionnaire contained 27 items that were distributed across four dimensions: interpersonal orientation, professional knowledge, moral conflict and moral meaning. The questionnaire accounted for 55.8% of the total variance, with Cronbach's alpha of 0.82. The mean score for moral sensitivity was 4.45 (out of 7). DISCUSSION AND CONCLUSION: The results of this study were compared with studies from other countries to examine the structure and implications of the moral sensitivity of nurses in Brazil. The Moral Sensitivity Questionnaire is an appropriate tool for examining the moral sensitivity of Brazilian nurses.

Psychometric evaluation of the Moral Distress Risk Scale: A methodological study.

BACKGROUND:: Moral distress is a kind of suffering that nurses may experience when they act in ways that are considered inconsistent with moral values, leading to a perceived compromise of moral integrity. Consequences are mostly negative and include physical and psychological symptoms, in addition to organizational implications. OBJECTIVE:: To psychometrically test the Moral Distress Risk Scale. RESEARCH DESIGN:: A methodological study was realized. Data were submitted to exploratory factorial analysis through the SPSS statistical program. PARTICIPANTS AND RESEARCH CONTEXT:: In total, 268 nurses from hospitals and primary healthcare settings participated in this research during the period of March to June of 2016. ETHICAL CONSIDERATIONS:: This research has ethics committee approval. FINDINGS:: The Moral Distress Risk Scale is composed of 7 factors and 30 items; it shows evidence of acceptable reliability and validity with a Cronbach's α = 0.913, a total variance explained of 59%, a Kaiser-Meyer-Olkin = 0.896, and a significant Bartlett <0.001. DISCUSSION:: Concerns about moral distress should be beyond acute care settings, and a tool to help clarify critical points in other healthcare contexts may add value to moral distress speech. CONCLUSION:: Psychometric results reveal that the Moral Distress Risk Scale can be applied in different healthcare contexts.

Moral sensitivity in Primary Health Care nurses.

OBJECTIVE: to characterize the profile and describe the moral sensitivity of primary health care nurses. METHOD: this is a quantitative, transversal, exploratory, descriptive study. The data were collected through the Moral Sensitivity Questionnaire translated and adapted to Brazil. 100 primary health care nurses participated, from Rio Grande do Sul, Brazil. The data collection took place during the months of March and July 2016, in an online form. The analysis of the data occurred through descriptive statistical analysis. RESULTS: the nurses had an average moral sensitivity of 4.5 (out of 7). The dimensions with the greatest moral sensitivity were: interpersonal orientation, professional knowledge, moral conflict and moral meaning. CONCLUSION: the nurses of Rio Grande do Sul have a moderate moral sensitivity, which may contribute to a lower quality in Primary Health Care.

Sperm Count Improvement in a Cancer-Surviving Patient.

OBJECTIVE: To describe the case of a cancer-surviving patient who was treated with an aromatase inhibitor for fertility reasons with successful results. CLINICAL CASE: A 30-year-old patient from our institute who had been submitted to bone marrow transplantation in the past as part of treatment for Hodgkin's disease had revealed oligospermia several times. His sperm count mean value was 33,500 cells/ml. He was treated with an aromatase inhibitor (letrozole, 2 mg/day) for 8 months. After this period, his sperm count had increased significantly to 1,000,000 cells/ml. CONCLUSION: A large number of cancer survivors express a wish for having babies. After their cure, a lot of them have a low count of spermatozoids, and we think that our results show an easy way of helping them.

Adipsia in a Diabetes Insipidus Patient.

Central diabetes insipidus is a very common disorder after brain surgery or/trauma or even in the presence of brain inflammatory diseases. Polyuria and polydipsia are the clinical markers, but sometimes clinical situations are presenting with no thirst. These are not frequent but are life-treating conditions. Diagnosis is not easy, and for this reason some cases are treated late. We describe here a very infrequent oncological case of dangerous adipsic diabetes insipidus in a young girl who survived.

Validação por peritos: importância na tradução e adaptação de instrumentos / Validación por expertos: importancia en la traducción y adaptación de instrumentos / Validation by experts: importance in translation and adaptation of instruments

RESUMO Objetivo Apresentar a validação de conteúdo por peritos, como etapa essencial da validação, tradução e adaptação cultural de instrumentos de psicometria, tendo como exemplo o processo de adaptação realizado com o questionário de sensibilidade moral para Portugal e Brasil. Método Trata-se de estudo metodológico, com um comitê de doze peritos, sete do Brasil e cinco de Portugal. A coleta e análise dos dados ocorreu em 2015, entre os meses de setembro e outubro, em Portugal e novembro e dezembro, no Brasil. Resultados Dos 30 itens apresentados aos peritos, 20 tiveram sugestão de adaptação. Algumas adaptações foram necessárias para que os itens ficassem claros e de fácil compreensão. A versão final permaneceu com 28 itens. Conclusão A validação de conteúdo dos instrumentos de psicometria por um comitê de peritos é essencial para pesquisadores e enfermeiros, cada vez mais preocupados em utilizar medidas confiáveis e apropriadas para pesquisas e avaliação da assistência.

RESUMEN Objetivo Presentar una validación de contenido por los expertos como un paso esencial en la validación, la traducción y adaptación cultural de los instrumentos psicométricos, tomando el ejemplo del cuestionario de la sensibilidad moral a Portugal y Brasil. Métodos Se trata de un estudio metodológico, con un comité de doce expertos, siete de Brasil y cinco de Portugal. La recolección y el análisis de los datos se llevó a cabo en 2015, entre los meses de septiembre y octubre en Portugal y en noviembre y diciembre, en Brasil. Resultados De los 30 ítems presentados a los expertos, 20 tuvieron sugerencia de adaptación. Algunos ajustes fueron necesarios para que los elementos quedaran claros y fácilmente comprensibles. La versión final se mantuvo con 28 ítems. Conclusión La validación de contenido de los instrumentos de psicometría por un comité de expertos es esencial para investigadores y enfermeras, cada vez más preocupados en utilizar medidas confiables y apropiadas para investigaciones y evaluación de la asistencia.

ABSTRACT Objective To present the content validation by experts as an essential step in validation, translation and cultural adaptation of psychometric instruments, having the example of the questionnaire of moral sensitivity in Portugal and Brazil. Method This is a methodological study, with a committee of twelve experts, seven from Brazil and five from Portugal. The data collection and analysis occurred in 2015, between the months of September and October in Portugal and November and December in Brazil. Results Of the 30 items presented to the experts, 20 had adaptation suggestions. Some adjustments were necessary so that the items were clear and easily comprehensible. The final version remained with 28 items. Conclusion The content validation of psychometry instruments by a committee of experts is essential for researchers and nurses, who are increasingly concerned about the use of reliable and appropriate measures for research and evaluation of care.

Moral sensitivity in Primary Health Care nurses / Sensibilidad moral de enfermeros de la Atención Primaria a la Salud / Sensibilidade moral de enfermeiros da Atenção Primária à Saúde

ABSTRACT Objective: to characterize the profile and describe the moral sensitivity of primary health care nurses. Method: this is a quantitative, transversal, exploratory, descriptive study. The data were collected through the Moral Sensitivity Questionnaire translated and adapted to Brazil. 100 primary health care nurses participated, from Rio Grande do Sul, Brazil. The data collection took place during the months of March and July 2016, in an online form. The analysis of the data occurred through descriptive statistical analysis. Results: the nurses had an average moral sensitivity of 4.5 (out of 7). The dimensions with the greatest moral sensitivity were: interpersonal orientation, professional knowledge, moral conflict and moral meaning. Conclusion: the nurses of Rio Grande do Sul have a moderate moral sensitivity, which may contribute to a lower quality in Primary Health Care.

RESUMEN Objetivo: caracterizar el perfil y describir la sensibilidad moral de los enfermeros de la Atención Primaria a la Salud. Método: se trata de un estudio cuantitativo, transversal, exploratorio descriptivo. Los datos fueron recogidos por medio del Cuestionario de Sensibilidad Moral traducido y adaptado para Brasil. Participaron 100 enfermeros de la Atención Primaria a la Salud de Rio Grande do Sul, Brasil. La recogida de datos ocurrió durante los meses de marzo y julio de 2016, de forma en línea. El análisis de los datos ocurrió por medio de análisis estadística descriptiva. Resultados: los enfermeros presentaron un promedio de sensibilidad moral de 4,5 (de 7). Las dimensiones con mayor sensibilidad moral fueron: orientación interpersonal, conocimiento del profesional, conflicto moral y significado moral. Conclusión: los enfermeros de Rio Grande do Sul presentan una moderada sensibilidad moral, pudiendo eso aportar para la realización de una asistencia de menor cualidad en la Atención Primaria a la Salud.

RESUMO Objetivo: caracterizar o perfil e descrever a sensibilidade moral dos enfermeiros da Atenção Primária à Saúde. Método: trata-se de um estudo quantitativo, transversal, exploratório descritivo. Os dados foram coletados por meio do Questionário de Sensibilidade Moral traduzido e adaptado para o Brasil. Participaram 100 enfermeiros da Atenção Primária à Saúde do Rio Grande do Sul, Brasil. A coleta de dados ocorreu durante os meses de março e julho de 2016, de forma online. A análise dos dados ocorreu por meio de análise estatística descritiva. Resultados: os enfermeiros apresentaram uma média de sensibilidade moral de 4,5 (de 7). As dimensões com maior sensibilidade moral foram: orientação interpessoal, conhecimento do profissional, conflito moral e significado moral. Conclusão: os enfermeiros do Rio Grande do Sul apresentam uma moderada sensibilidade moral, podendo isso contribuir para a realização de uma assistência de menor qualidade na Atenção Primária à Saúde.

Deliberação ética em saúde: revisão integrativa da literatura / Ethical deliberation in health: an integrative literature review / Deliberación ética en salud: revisión integrativa de la literatura

Trabalho em saúde requer que profissionais dominem meios e instrumentos para resolução de problemas éticos vivenciados. Este estudo analisa o uso da deliberação ética na solução dos problemas éticos vividos pela equipe de saúde. Realizou-se revisão integrativa da literatura em bases de dados da saúde. Incluíram-se artigos de pesquisa originais, relatos de experiências, estudos teóricos, estudos de caso, editoriais, em inglês, espanhol e português, enfocando equipes de saúde que contassem com enfermeiros. A revisão abrangeu 28 estudos, publicados entre 1999 e 2013. Da análise resultaram quatro categorias: conceito de deliberação; estratégias de deliberação; contribuições da deliberação; facilitadores da implementação do processo de deliberação. Conclui-se que a deliberação é estratégia útil e relevante para equipes de saúde na análise, avaliação e indicação do melhor curso de ação para solução dos problemas. Também é instrumento de educação permanente para profissionais, pela troca mútua de experiências e diálogos sobre valores, crenças e princípios.

Working in the health field requires that professionals master means and tools for resolving the ethical dilemmas they face. We conducted an integrative review of the literature in health-related databases. We included original research articles, reports of experience, theoretical studies, case studies and editorials, in English, Spanish and Portuguese carried out with healthcare teams that included nurses. The review covered 28 studies, published between 1999 and 2013. The analysis yielded four categories: concept of deliberation; strategies of deliberation; contributions of deliberation, and facilitators of implemention of the deliberation process. We concluded that deliberation is a useful and relevant strategy for health teams in the analysis, assessment and indication of the best course of action in problem solving. It is also an instrument of continuing education for professionals through mutual exchange of experience and dialogue about values, beliefs and principles.

El trabajo en salud requiere que los profesionales dominen medios y herramientas para resolver los problemas éticos de la práctica. Este estudioanaliza el uso de la deliberación ética en la solución de los problemas éticos vividos por el equipo de salud. Hemos llevado a cabo una revisión integradora de la literatura en las bases de datos de salud. La revisión incluyó artículos originales de investigación, informes de experiencias, estudios teóricos, estudios de casos, columnas de opinión, publicados en los idiomas inglés, español y portugués, realizados enfocándoseen los casos de salud que contasen con enfermeros. La revisión incluyó 28 estudios publicados entre 1999 y 2013. Del análisis hemos extraído cuatro categorías: el concepto de deliberación; estrategias de deliberación; contribuciones de deliberación y facilitadores de la implementación del proceso de deliberación. Se concluyó que la deliberación es una estrategia útil y relevante para los equipos de salud en el análisis, la evaluación y la indicación del mejor curso de acción para resolver los problemas éticos experimentados. También es una forma de educación continua para los profesionales a través del intercambio mutuo de experiencias y conversaciones acerca de los valores, creencias y principios en un ambiente ético de solidaridad y pertenencia.