Abstract
Objective:to identify the association between moral distress and the supporting elements of moral deliberation in Brazilian nurses.Method:a cross-sectional study conducted with Brazilian nurses working in health services at different complexity levels. The research protocol consisted of the Brazilian Scale of Moral Distress in Nurses, a sociodemographic and labor questionnaire, and a list of bases and ethical elements used for moral deliberation. For analysis, descriptive statistics, chi-square test, and Poisson regression were used.Results:1,226 nurses took part in the study. The 12 elements associated with the moral deliberation process were classified as important for nurses’ actions, especially the professional experience acquired, code of ethics/law of professional practice, and ethical and bioethical principles. The relationship of moral distress showed higher prevalence in the Beliefs, culture and values of the patient, Beliefs and personal values, and Intuition and Subjectivity elements.Conclusion:the results showed a balance between the subjective criteria of professional experience and the objective ones of deontology for moral deliberation.
Highlights
Given the complexity of the health care system and care, nursing professionals can often face difficult situations related to structural, organizational and relational aspects among colleagues and in the professional-user relationship, during their work process
Conclusion: the results showed a balance between the subjective criteria of professional experience and the objective ones of deontology for moral deliberation
The professionals can experience moral distress, which, classified as a moral problem, occurs when they cannot conduct their action according to their judgments and personal and professional values, perceiving as inadequate their moral participation, that is, they feel powerless to act according to their conscience, either by internal or external constraints[1]
Summary
Given the complexity of the health care system and care, nursing professionals can often face difficult situations related to structural, organizational and relational aspects among colleagues and in the professional-user relationship, during their work process. These situations involve ethical issues and require positions and deliberation, which evoke in the professionals feelings of uncertainty, discomfort and restlessness in the face of conflicts and divergences of opinions with those involved, including other professionals, patients and family members In this perspective, the professionals can experience moral distress, which, classified as a moral problem, occurs when they cannot conduct their action according to their judgments and personal and professional values, perceiving as inadequate their moral participation, that is, they feel powerless to act according to their conscience, either by internal or external constraints[1]. It can be said that the process of moral deliberation can constitute a tool for the ethical positioning of nurses in the face of perceived moral problems and conflicts[5], as in situations that generate moral distress, since this has serious consequences for nursing workers, both in the personal dimension, with physical and emotional symptoms, and in the professional dimension, such as the development of burnout or even abandoning the profession[6]
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