The Experience of Nurses’ Moral Dilemma in Intensive Care Unit: A Qualitative Study / 中国医学伦理学

【Objective:】 To understand the true experience and feelings of nurses in the intensive care unit on the clinical experience of moral dilemmas, and to provide strategies for reducing the impact of moral dilemmas. 【Methods:】 Thirteen nurses in the intensive care unit were interviewed face to face by descriptive nature research method. The traditional content analysis method were used to compute the data, and the coding, categorization and topic extraction were carried out cyclically until the data were saturated and the interview was stopped. 【Results:】 The moral dilemma experience of nurses in the intensive care unit had the following three themes: negative psychological experience, negative behavior experience, and life and death cognitive experience. 【Conclusion:】 Nurses in the intensive care unit will have complex negative experiences after experiencing moral dilemmas. This negative experience threatens nurses’ mental health. Nursing managers should pay attention to the impact of moral dilemmas on nurses and formulate effective measures, thereby ensure nursing safety and maintain the healthy development of the nursing team.

Moral Dilemma and Research on Coping Style of Frontline Nurses During the Outbreak of COVID -19 / 中国医学伦理学

【Objective:】 To understand the moral dilemma, coping style of frontline nurses and their correlation during the COVID -19. 【Methods:】 From March to April, 2021, 651 nurses working in designated hospitals for COVID -19 were selected by convenient sampling, and the Chinese version of Moral Distress Scale-Revised (MDS-R) and Chinese version of Coping Style Questionnaire (CSQ) were used for investigation. 【Results:】 Frontline nurses’ MDS-R score was 91.0, "value conflicts" was the moral dilemma with the highest frequency and intensity, more than half (51.0%) of the respondents had considered leaving their position because of moral dilemma. "Problem solving" and "seeking for help" were the major coping strategies adopted by the nurses. Nurses who directly provide medical services for COVID -19 patients, dissatisfied with hospital-related training and adopted negative coping strategies had higher moral dilemmas than other nurses. 【Conclusion:】 The moral dilemma of frontline nurses is at a high level during the period of epidemic prevention and control. Nursing managers should pay attention to guiding and helping nurses to establish positive coping styles and improve their ability to respond to major public health emergencies.

A study on the relationship between occupational fitness, moral dilemma and resilience of nurses in emergency department / 中国实用护理杂志

Objective:To explore the correlation between nurses′ workplace adaptability, moral dilemma and resilience after suffering workplace violence in emergency department, in order to provide reference about improving the workplace adaptability and formulating intervention.Methods:A cross-section survey was conducted, we selected 248 nurses who had suffered workplace violence in the emergency department of five tertiary hospitals in Qingdao from January 2022 to January 2023 by convenient sampling method, and used self-designed general information questionnaire, moral dilemma scale, resilience evaluation scale for medical staff and nurses′ workplace adaptability scale to conduct a questionnaire survey on nurses who had suffered workplace violence, and found out the factors affecting their workplace adaptability.Results:The score of workplace adaptability of 248 nurses who had suffered workplace violence was (39.37 ± 12.77) points. Univariate analysis showed that education, length of emergency service, department or social part-time job, professional title, number of night shifts and sleep condition were the influencing factors of workplace fitness for emergency nurses ( t/ F values were -12.72 to 132.15, all P<0.05). The correlation analysis showed that the nurses′ workplace adaptability after workplace violence was negatively correlated with the scores and total scores of all dimensions of moral dilemma ( r values were -0.725 to -0.194, P<0.05), and positively correlated with the scores and total scores of all dimensions of resilience ( r values were 0.135 to 0.732, P<0.05). Multi-factor results showed that education background, department/social part-time job, working years, professional title, sleep status, moral dilemma and resilience were the influencing factors of nurses′ workplace adaptability after workplace violence ( t values were -9.25 to 15.25, P<0.05). Conclusions:Nurses with specialized education, emergency service for 1-3 years, no department/social part-time job, primary professional title, sleep disorder, higher degree of moral dilemma and low level of resilience have low occupational adaptability. Nursing managers should focus on such nurses and improve their occupational adaptability.

A Study on the Tendency of Medical Students’ Choice of Moral Dilemma / 中国医学伦理学

【Objective:】 Using classic moral dilemma cases, this paper investigates the choice tendency of medical students when facing the moral dilemma, and analyzes their cognitive status and characteristics when facing the "moral dilemma", in order to provide effective enlightenment for optimizing the teaching cases of medical ethics. 【 Method:】 771 medical students in Shanghai Jiao Tong University School of Medicine were investigated by electronic questionnaire and SPSS 20.0 for statistical description and statistical analysis. 【Result:】 In the emergency room doctors and transition scenes, medical students tend to the principle of maximum happiness, and in the ring track scene and pedestrian overpass scene, they tend to the principle of deontology; In the loop track scene and pedestrian overpass scene, boys are more inclined to deontological principles than girls, and undergraduates are more inclined to deontological principles than postgraduates, and the difference is statistically significant (P<0.05). 【Conclusion:】 Although medical students have different moral tendencies in different scenes, they generally do not agree with the practice of sacrificing one person to save five people. Especially when more rigorous sacrifice conditions cause greater moral pressure, the vast majority of medical students will tend to the latter between utilitarianism and deontological principles.

Dilemas morais da gestão pública brasileira no enfrentamento da pandemia do novo coronavírus / Dilemas morales de la gestión pública brasileña en el afrontamiento de la pandemia del nuevo coronavirus / Moral dilemmas of the Brazilian public management in the face of the COVID-19 pandemic

Resumo Devido à pandemia do novo coronavírus, a gestão pública brasileira tem tomado decisões de interesse público que impactam diretamente a vida de praticamente todos os brasileiros e apresentam diversas questões éticas intrínsecas. Diante deste contexto, este short paper tem como objetivo identificar e debater alguns dos principais dilemas morais que desafiam a gestão pública brasileira no enfrentamento da pandemia. Para tanto, foram selecionadas notícias de websites jornalísticos que apresentassem situações éticas que ocorreram ou ainda estão ocorrendo no Brasil. Seis áreas temáticas com dilemas foram identificadas: distanciamento social; uso de big data no gerenciamento da pandemia; atuação dos profissionais de saúde; auxílio emergencial federal e burocracia; suspensão de aulas e atividades educacionais presenciais; e liberação de presidiários como medida de prevenção. Percebeu-se que, em contextos de crise, cidadãos e gestores públicos são afastados de seu status quo, o que leva a que novas formas de raciocínio moral sejam desenvolvidas. Essas questões demandam uma contínua reflexão e debate sobre os aspectos éticos da pandemia, principalmente em relação às obrigações sociais e morais dos governos e aos limites dessa interferência no direito individual dos cidadãos em um período de crise.

Resumen Debido a la pandemia del nuevo coronavirus, la administración pública brasileña ha tomado decisiones de interés público que afectan directamente la vida de prácticamente todos los brasileños y presentan varios problemas éticos intrínsecos. Ante este contexto, este breve documento tiene como objetivo identificar y discutir algunos de los principales dilemas morales que desafían a la administración pública brasileña en el afrontamiento de la pandemia. Para ello, se seleccionaron noticias de sitios web periodísticos que presentaban situaciones éticas que ocurrieron o aún ocurren en Brasil. Se identificaron seis áreas temáticas con dilemas: distanciamiento social; uso de big data en el manejo de la pandemia; desempeño de los profesionales de salud; ayuda federal de emergencia y burocracia; suspensión de clases y actividades educativas presenciales; y la liberación de prisioneros como medida preventiva. Se observó que, en contextos de crisis, los ciudadanos y los administradores públicos son sacados de su status quo, lo que hace que se desarrollen nuevas formas de razonamiento moral. Estas cuestiones exigen una reflexión y un debate continuos sobre los aspectos éticos de la pandemia, especialmente en relación con las obligaciones sociales y morales de los gobiernos y los límites de las interferencias en el derecho individual de los ciudadanos en un período de crisis.

Abstract Due to the pandemic of the new coronavirus, Brazilian public management has made decisions of public interest that directly impact the lives of practically all Brazilians and present several intrinsic ethical issues. From this context, this article aims to identify and discuss some of the main moral dilemmas that challenge Brazilian public management in the face of the pandemic. To this end, news reports were selected from journalistic websites that presented dilemmas that occurred or are still occurring in Brazil. Six thematic areas were identified: social distancing; use of big data in the pandemic's management; the performance of health professionals; federal emergency aid and bureaucracy; school closures and online learning; and release of prisoners as a preventive measure. It was observed that, in contexts of crisis, citizens and public managers are displaced from their status quo, which leads to new forms of moral reasoning. These issues demand continuous reflection and debate on the ethical aspects of the pandemic, especially to the governments' social and moral obligations and the limits of such disruption to citizen's rights in a period of crisis.

O sofrimento moral dos profissionais de enfermagem no exercício da profissão / El sufrimiento moral de los profesionales de enfermería en el ejercicio de la profesión / Moral distress of nursing workers in their professional exercise

A enfermagem depara-se, cotidianamente, com situações problemáticas, das quais emergem conflitos/dilemas morais, o que pode ser potencialmente gerador de sofrimento moral para os profissionais envolvidos. Com o objetivo de conhecer como os trabalhadores da equipe da enfermagem, de diferentes instituições e localidades, vivenciam dilemas e sofrimentos morais no exercício profissional, realizou-se um estudo de etnoenfermagem em dois hospitais do Rio Grande do Sul, em 2006 e 2007. Após a organização e análise dos dados, foram definidas três categorias: o ambiente organizacional como fonte de sofrimento moral, o que envolve a sobrecarga de trabalho, a deficiência de recursos humanos e materiais e as relações interpessoais no trabalho; o desrespeito aos direitos do paciente; e a morte como fonte de sofrimento. Embora presente, esse tipo de sofrimento é raramente discutido, sendo fundamental o aprofundamento da temática para favorecer a construção de ambientes de trabalho mais saudáveis.

The exercise of Nursing has to face problematic situations daily, including emerging moral conflicts/dilemmas, which can create a potentially moral distress for the professionals involved. Aiming at learning how the members of a nursing team, from different institutions and locations, experience moral dilemmas and moral distress at work, an ethnonursing study was conducted in two hospitals of Rio Grande do Sul, Brazil, in 2006 and 2007. After data organization and analysis three categories were defined: the organizational environment as a source of moral suffering, which involves work overload, lack of human and material resources, and interpersonal relations at work; disrespect to the patient’s rights, and death as a source of suffering. Although present, this kind of suffering is seldom discussed. It turns out to be fundamental to deepen the theme to encourage the construction of a healthier work environment.

La enfermería, se depara, todos los días, con situaciones problemáticas, de las cuales surgen conflictos/ dilemas morales, que pueden potencialmente generar sufrimiento moral para los profesionales envueltos. Con el objetivo de conocer como los trabajadores del equipo de enfermería, de distintas instituciones y sitios, viven en la práctica dilemas morales y sufrimiento moral en el ejercicio de la profesión, se realizó un etnoenfermería en dos hospitales del Rio Grande do Sul-Brasil, en 2006 y 2007. Después de organizar y analizar los datos, se definieron tres categorías: el contexto organizativo como fuente de sufrimiento moral, lo que envuelve exceso de trabajo, falta de recursos humanos y materiales y las relaciones interpersonales en el trabajo; la falta de respeto a los derechos del paciente; y la muerte como fuente de sufrimiento. Aunque en la actualidad este tipo de sufrimiento sea poco discutido, haciéndose fundamental profundizar el tema para fomentar la construcción de un ambiente de trabajo más saludable.