Framing the Issues: Moral Distress in Health Care

Moral distress in health care has been identified as a growing concern and a focus of research in nursing and health care for almost three decades. Researchers and theorists have argued that moral distress has both short and long-term consequences. Moral distress has implications for satisfaction, recruitment and retention of health care providers and implications for the delivery of safe and competent quality patient care. In over a decade of research on ethical practice, registered nurses and other health care practitioners have repeatedly identified moral distress as a concern and called for action. However, research and action on moral distress has been constrained by lack of conceptual clarity and theoretical confusion as to the meaning and underpinnings of moral distress. To further examine these issues and foster action on moral distress, three members of the University of Victoria/University of British Columbia (UVIC/UVIC) nursing ethics research team initiated the development and delivery of a multi-faceted and interdisciplinary symposium on Moral Distress with international experts, researchers, and practitioners. The goal of the symposium was to develop an agenda for action on moral distress in health care. We sought to develop a plan of action that would encompass recommendations for education, practice, research and policy. The papers in this special issue of HEC Forum arose from that symposium. In this first paper, we provide an introduction to moral distress; make explicit some of the challenges associated with theoretical and conceptual constructions of moral distress; and discuss the barriers to the development of research, education, and policy that could, if addressed, foster action on moral distress in health care practice. The following three papers were written by key international experts on moral distress, who explore in-depth the issues in three arenas: education, practice, research. In the fifth and last paper in the series, we highlight key insights from the symposium and the papers in the series, propose to redefine moral distress, and outline directions for an agenda for action on moral distress in health care

Vivência do sofrimento moral na enfermagem: percepção da enfermeira

Objetivando conhecer a percepção do sofrimento moral vivenciado, relacionando frequência e intensidade, realizou-se pesquisa Survey, utilizando escala Likert variando de 0 a 6 pontos, com 124 enfermeiras em hospitais do sul do Brasil, no ano de 2008. Mediante questionário autoaplicável e análise fatorial, foram identificados e validados quatro constructos. Os resultados finais foram obtidos através de três diferentes análises: 1) estatística descritiva; 2) análises de variância 3) regressão múltipla. O constructo que apresentou maior intensidade de percepção de vivência do sofrimento moral foi a falta de competência na equipe de trabalho (4,55), seguido pela negação do papel da enfermeira como advogada do paciente (4,30), obstinação terapêutica (3,60) e desrespeito à autonomia do paciente (3,57). Em relação à percepção da frequência do sofrimento moral, destacou-se, novamente, o constructo falta de competência na equipe de trabalho (2,42), seguido da obstinação terapêutica (2,26), negação do papel da enfermeira como advogada do paciente (1,71) e desrespeito à autonomia do paciente (1,42)

Moral distress in everyday nursing: hidden traces of power and resistance

To know the strategies of resistance adopted by nursing staff, facing situations of moral distress, from an ethical perspective. Method: The authors conducted qualitative research through semi-structured interviews, with fifteen nursing staff members of a university hospital in the extreme south of Brazil, using textual discourse analysis and the theoretical reference of Foucault. Results: Two categories were constructed: denial of oneself and the other - in which one perceives that the nursing staff can perform actions that are governed predominantly by immobility and conformism, avoiding confrontations with whoever represents power in situations that provoke moral distress in them; possibility to care for oneself and for the other - in which nursing workers in situations that provoke moral distress for them exercise power and endurance. Conclusion: it was perceived that some professionals seem to use ethical coping strategies, in order to ensure and preserve their professional values. However, often the choice of some nursing professionals may be to relapse into immobility and the absence of building strategies of endurance. This situation may represent their reduced exercise of power and insufficient resistance in the face of ethical problems, contributing to the intensification of their invisibility in the area of health

Sofrimento moral e a dimensão ética no trabalho da enfermagem Sufrimiento moral y la dimensión de ética en el trabajo de enfermería Moral distress and the ethical dimension in nursing work

Trabalhadores de enfermagem vivenciam problemas morais, dilemas morais e sofrimento moral, no seu cotidiano profissional. O sofrimento moral manifesta-se quando os trabalhadores apresentam dificuldades para executar situações moralmente adequadas, segundo suas consciências. O texto tem como objetivo enfocar o sofrimento moral dos trabalhadores de enfermagem e sua relação com problemas morais e dilemas morais, abordando conceitos, vivências de sofrimento moral e possíveis estratégias a serem adotadas para o seu enfrentamento. Enfocar o sofrimento moral provocado pelo enfrentamento de problemas e dilemas morais no trabalho da enfermagem parece fundamental, não apenas para desvelar um fenômeno ainda pouco conhecido, mesmo que vivenciado quase que diariamente, mas, também, para destacar a necessidade de problematização e valorização da dimensão ética do trabalho em saúde.<br>Trabajadores de enfermería vivencian problemas morales, dilemas morales y sufrimiento moral en su trabajo diario. Sufrimiento moral surge mientras los trabajadores de enfermería presentan dificultades para el desempeño de situaciones moralmente adecuadas según su conciencia. El texto tiene como objetivo centrarse sufrimiento moral de trabajadores de enfermería y su relación con problemas morales y dilemas morales, centrándose en conceptos, experiencias de sufrimiento moral y posibles estrategias a adoptar para su enfrentamiento. Direccionar sufrimiento moral causado por enfrentamiento de problemas y dilemas morales en el trabajo de enfermería, parece esencial no soló para develar un fenómeno todavía poco conocido, incluso experimentado casi a diario, pero también, poner de relieve la necesidad de problematización y recuperación de la dimensión ética del trabajo en salud.<br>Nurses face moral problems, moral dilemmas and moral distress in their professional daily. The moral distress manifests itself when nurses demonstrate difficulties to face situations morally appropriate following their conscious. The study aims to focus about the nurses' moral distress and their relationship with moral problems and moral dilemmas presenting concepts, moral distress experiences and possible strategies to be adopted to face it. To focus on the moral distress provoked by facing the moral problems and dilemmas in nursery work seems to be primordial not just to reveal a phenomenon still a little known even experienced almost every day but, also to headline the need of problematization and valorization of the ethical dimension of work in health