MORAL DISTRESS IN NURSES: A DESCRIPTION OF THE RISKS FOR PROFESSIONALS

a quantitative, descriptive, cross-sectional study, with 268 nurses working in hospitals and primary health care units in the Rio Grande do Sul (Brazil), between the months of March and July, 2016. Data collection was performed using the online Google Docs tool. A moral distress risk scale and a set of variables were used to characterize the participants and their context.

Results:

the sample mainly consisted of young women who worked between 36 and 40 hours a week, with an average monthly income between five and sevem wages and about 10 years of nursing experience. The risk of moral distress was considered moderate, with a considerable percentage of professionals showing an intention to abandon their current job.

Conclusion:

moral distress is a reality experienced by the nurses under study, and the identification of risk factors is one of the tools used to create coping strategies.

DESCRIPTORS:
Nursing; Ethics, nursing; Professional practice; Worker's health; Moral damage

Characteristics	Categories	n (%)^† † non-respondents excluded	Media±^* * ±: standard deviation;
Sex	Female	239 (89.2)
Sex	Male	29 (10,8)
Age			36.6±8.6 (minimum 23-maximum 62)
Qualifications	Specialization	201 (75)
	Masters	87 (32.5)
	Doctorate	19 (7.1)
Ethics training in the last year	Yes	44 (16.4)
Ethics training in the last year	No	224 (83.6)
Employment links (non- respondents n=5)	1	213 (81)
	2	47 (17.9)
	3 or more	3 (1.1)
Weekly working hours (non-respondents n=8)	Up to 35 hours	20 (7.5)
	36 - 40 hours	199 (74.8)
	More than 40 hours	41 (15.4)
Exceeds the amount of contract hours	Yes	162 (60.4)
Exceeds the amount of contract hours	No	106 (39.6)
If yes, are they paid for overtime work	Yes	46 (28.4)
If yes, are they paid for overtime work	No	116 (71.6)
Monthly salary (non respondents n=3)	From R$788-R$2,364	19 (7.2)
	More than R$2,364-R$3,940	66 (24.9)
	More than R$3,940 -R$5,516	83 (31.3)
	More than R$5,516-R$7,880	63 (23.8)
	More than R$7,880	34 (12.8)
Length of nursing experience			10.1±8.1 (minimum 1- maximum 40)
Time in current working position			6.7±8.1 (minimum 1- maximum 37)
Place of work	Hospital Institution	171 (63.8)
Place of work	Primary Health Care Units	97 (36.2)

Characteristics	n (%)
How often experiencing risk factors can lead to moral distress (non-respondents n=1)
Never	25 (9.4)
Rarely	159 (59.6)
Often/Always	83 (31.1)
Experiencing this situation can cause feelings of
Discomfort	180 (69)
Uselessness	174 (66.7)
Frustration	165 (63.2)
Anguish	156 (59.8)
Dissatisfaction	151 (57.9)
Sadness	109 (41.8)
Anger	82 (31.4)
Distress	81 (31)
Desperation	68 (26.1)
Pain	56 (21.5)
Exhaustion	56 (21.5)
Headaches	51 (19.5)
Malaise	49 (18.8)
Insomnia	36 (13.8)
Lack of appetite	6 (2.3)

Risk Factors	Never		Rarely		Often/Always		Median Scores
Risk Factors	n	%	n	%	n	%	Median Scores
Stress	3	1.1	35	13.1	230	85.8	3.11
Problems related to the physical structure of the institution	9	3.4	60	22.4	199	74.3	3.00
Physical / mental / emotional exhaustion	2	0.7	52	19.4	214	79.9	2.97
Disorganization of the health system	2	0.7	54	20.1	212	79.1	2.96
Lack of time due to excessive work hours	13	4.9	51	19.0	204	76.1	2.90
Lack of financing / resources / equipment	11	4.1	71	26.5	186	69.4	2.84
Health care Commodification	14	5.2	75	28.0	179	66.8	2.81
Excessive number of patients assigned to each nurse	20	7.5	72	26.9	176	65.7	2.77
Lack of nurses	18	6.7	80	29.9	170	63.4	2.75
Professional devaluation	19	7.1	67	25.0	182	67.9	2.74
Observing inappropriate family behavior	5	1.9	92	34.3	171	63.8	2.71
Institutional norms that make caring difficult	14	5.2	103	38.4	151	56.3	2.60
Inappropriate use of available resources	13	4.9	112	41.8	143	53.4	2.56
Care delays	13	4.9	114	42.5	141	52.6	2.55
Inability to challenge the decisions of other professionals profissionais	14	5.2	117	43.7	137	51.1	2.54
Hierarchical structure that determines the impotence and subordination of the nurse to the doctor	39	14.6	91	34.0	138	51.5	2.50
Patient unable to pay for treatment	60	22.4	54	20.1	154	57.5	2.49
Conflicts between patients, family and professionals	11	4.1	138	51.5	119	44.4	2.44
Excluded from decision making	27	10.1	112	41.8	129	48.1	2.44
Work dissatisfaction	25	9.3	126	47.0	117	43.7	2.40
Lack of autonomy at work	33	12.3	139	51.9	96	35.8	2.28
Unpreparedness to deal with death	34	12.7	142	53.0	92	34.3	2.26
Linguistic and cultural obstacles	32	11.9	167	62.3	69	25.7	2.16
Excessive use of high technology in the prolongation of life	66	24.6	106	39.6	96	35.8	2.16
Disrespect to the patient's will	40	14.9	169	63.1	59	22.0	2.09
Fear of not being accepted by the team	46	17.2	162	60.4	60	22.4	2.06
Being questioned about information that is confidential	51	19.0	158	59.0	59	22.0	2.05
Fear of losing the job	77	28.7	126	47.0	65	24.3	2.03
False hopes for patients and families	60	22.4	167	62.3	41	15.3	1.94
Fear of reporting errors	87	32.5	137	51.1	44	16.4	1.88
Total Median							2.50

Moral Distress	Categories	n (%)
Would say they are experiencing moral distress at present (non- respondents n=2)	Yes	87 (32.7)
	No	179 (67.3)
Has experienced moral distress before (non-respondents n=3)	Never	70 (26.4)
	Once	63 (23.8)
	More than once	132 (49.8)
Would feel free to talk to the manager about moral distress (non-respondents n=3)	Never	33 (12.5)
	Rarely	114 (43)
	Frequently	58 (21.9)
	Always	60 (22.6)
Would feel free to talk to their colleagues about moral distress (non-respondents n=3)	Never	9 (3.4)
	Rarely	79 (29.8)
	Frequently	118 (44.5)
	Always	59 (22.3)
Would leave their place of work due to moral distress	Yes	99 (36.9)
Would leave their place of work due to moral distress	No	169 (63.1)
If yes, what type of work would you look for (non-respondents n=8)	Similar work	34 (35.4)
	Another type of work	36 (37.5)
	Work unrelated to nursing	21 (21.9)
Terminated employment due to moral distress (non-respondents n=2)	Yes	88 (33.1)
	No	178 (66.9)

Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

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[1] Correspondence: Rafaela Schaefer, Avenida Unisinos, 950, 93020-190, São Leopoldo, Rio Grande do Sul E-mail: rafaelaschaefer1988@gmail.com

Brasil

Brasil

MORAL DISTRESS IN NURSES: A DESCRIPTION OF THE RISKS FOR PROFESSIONALS1 1 Study financed by the Coordination for the Improvement of Higher Education Personnel - Capes, Full Doctoral Scholarship Abroad. Process BEX 1050/13-3.

ABSTRACT

Objective:

Method:

Results:

Conclusion:

MORAL DISTRESS IN NURSES: A DESCRIPTION OF THE RISKS FOR PROFESSIONALS¹ 1 Study financed by the Coordination for the Improvement of Higher Education Personnel - Capes, Full Doctoral Scholarship Abroad. Process BEX 1050/13-3.