Sociodemographic and work-related aspects of moral distress in Brazilian nurses

Cross-sectional study developed across the Brazilian territory between November 2015 and May 2016, in a sample of 1227 nurses, based on the application of the Brazilian Moral Distress Scale in Nurses (EDME-Br), by means of an electronic questionnaire. Descriptive and analytical statistics were used for the analysis.

Results

Statistically significant associations were established in all six factors, namely: 1. Recognition, power and personal identity; 2. Safe and qualified care; 3. Defense of values and rights; 4. Working conditions; 5. Ethical infringements; 6. Work teams. The variables with the largest number of associations were: hour load; graduate degree, nature of service care/complexity, nature, type and duration of employment bond. The role of experience and enhanced education in higher perceived and/or experienced moral distress stood out.

Conclusion

The range of the study and the diversity of the context reveal specificities in the occurrence of moral distress in the Brazilian context, highlighting the need to discover elements that play a role in the nurses’ moral experience.

Ethics, nursing; Stress, psychological; Stress disorders; Post-traumatic

Variables	n(%)
Age
20 to 29 years	210(17.1)
30 to 39 years	512(41.8)
40 to 49 years	299(24.4)
50 years or older	204(16.6)
Sex
Female	1148(93.6)
Male	78(6.4)
Time since graduation
Less than 1 year	24(2.0)
1 to 5 years	349(28.5)
6 to 10 years	386(31.5)
11 to 15 years	178(14.5)
16 to 20 years	93(7.6)
More than 20 years	189(15.4)
Complementary and postgraduate education
Undergraduate with or without training	168(22.3)
Specialization/Residency	800(65.3)
Master’s	127(10.4)
Doctoral	20(1.6)
Number of jobs
One	863(70.4)
Two	323(26.3)
Three or more	33(2.7)
Nature of bond
Public	824(67.2)
Private	347(28.3)
Other	49(4.0)
Type of contract (Main)
Brazilian Labor Code	523(42.7)
Tenured	531(43.3)
Self-employed	16(1.3)
Temporary	80(6.5)
Other	71(5.8)
Length of experience/bond (Main)
Up to 5 years	625(51.0)
6 to 10 years	269(21.9)
11 to 15 years	144(11.7)
16 to 20 years	69(5.6)
More than 20 years	116(9.5)
Weekly workload (Main)
Up to 20 hours	38(3.1)
21 to 30 hours	237(19.3)
31 to 40 hours	619(50.5)
More than 40 hours	330(26.9)
Institution/service (Main)
Primary Care services	273(22.3)
General and specialized inpatient services	231(18.8)
Emergency and mobile services	207(16.9)
Intensive Care Units	150(12.2)
Other services and specialized and support services	365(29.7)
Regions of the Country
North	87(6.6)
Northeast	186(14.1)
Central-West	111(8.4)
South	292(22.2)
Southeast	552(41.9)

Variables		Factor1-RPI		Factor2-SQC		Factor3-DVR		Factor4-WC		Factor5-EI		Factor6-WT
Variables	n**	Md	p	Md	p	Md	p	Md	p	Md	p	Md	p
Sex
Male	78	626.76	0.438	648.05	0.160	654.15	0.076	572.14	0.638	679.27	0.017*	644.72	0.169
Female	1116	595.45		590.84		581.94		591.21		582.40		588.92
Age
Younger than 30	208	591.15	0.005*	567.82	0.640	565.64	0.353	541.12	0.140	587.11	0.488	574.36	0.755
30 to 39 years	507	625.90		603.52		606.41		603.70		601.71		601.37
40 a 49 years	285	600.42		591.59		569.78		602.15		585.57		596.09
50 years or older	193	522.34		600.79		579.16		586.22		557.00		580.51
Time since graduation
Up to 5 years	366	587.31	0.497	561.20	0.026*	565.46	0.160	537.66	<0.001*	593.25	0.479	566.36	0.081
6 years or more	828	602.00		609.15		595.68		612.92		586.39		604.01
Postgraduate education
No	164	533.25	0.176	510.29	<0.001*	515.37	<0.001*	518.32	0.001*	527.84	0.004*	519.33	0.001*
Training	100	597.13		526.76		564.61		537.27		598.49		567.83
Spec/Resid	780	604.10		593.06		580.31		593.43		580.49		592.24
Master’s	127	613.56		701.43		682.71		648.31		658.31		648.38
Doctoral	18	620.39		856.47		751.58		770.26		757.44		825.28
Number of Bonds
1	840	599.27	0.785	581.66	0.046*	578.12	0.188	575.58	0.024*	585.14	0.598	585.55	0.278
2 or more bonds	354	593.31		625.24		606.68		624.57		596.60		609.20
Nature bond
Public	802	603.44	0.386	632.42	<0.001*	606.99	0.001*	644.74	<0.001*	600.01	0.104	609.84	0.012*
Private	339	579.04		496.99		524.32		453.28		554.98		548.05
Other	47	553.53		568.61		599.60		558.35		555.96		538.86
Type Contract
Labor law	513	587.01	0.265	533.91	<0.001*	543.81	0.001*	504.31	<0.001*	561.09	0.073	565.73	0.071
Tenured	521	612.57		656.85		623.06		670.49		615.04		617.81
Self-employed	15	591.40		566.00		692.36		624.50		670.29		641.25
Temporary	74	598.68		583.09		611.19		628.18		574.36		607.04
Other	66	515.09		543.77		526.30		523.54		542.31		528.44
Length bond
Up to 5 years	614	603.95	<0.001*	571.08	0.015*	584.87	0.071	560.28	0.011*	589.26	0.172	582.99	0.217
6 to 10 years	264	606.79		599.16		570.16		617.17		594.67		610.83
11 to 15 years	136	643.04		674.01		643.15		659.81		613.99		627.24
16 to 20 years	66	619.03		647.44		626.21		621.66		606.06		604.17
More than 20 years	111	455.04		568.41		527.90		569.04		514.22		535.81
Nature
Primary care	368	593.19	0.181	570.74	0.029*	555.83	0.027*	615.09	0.016*	525.09	<0.001*	560.20	0.086
Secondary	352	624.83		634.51		623.79		610.94		626.91		613.77
Tertiary	474	580.55		582.98		582.48		555.11		609.03		601.53
Weekly workload
Up to 20 hours	37	478.05	0.058	552.10	0.002*	607.75	0.008*	589.03	0.010*	544.58	0.004*	490.47	0.026*
21 to 30 hours	232	614.21		671.11		649.83		656.88		654.54		632.23
31 to 40 hours	600	583.71		575.51		559.99		573.38		560.40		572.78
More than 40 hours	323	621.11		575.50		584.28		570.63		594.34		610.24

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author Flávia Regina Souza Ramos E-mail: flavia.ramos@ufsc.br