The Covid-19 effect on medical students’ perceptions of their profession: A mixed methods study from South India

Covid-19 has devastated human lives and stretched the limits of the medical profession and health systems. Using the mixed methods of online survey and online focus group discussions, we assessed how medical students and interns of two medical colleges in South India viewed the profession they had chosen. Of the 900 participants, 571(63.4%) had a positive perception of the medical profession, 77(8.6%) a negative perception and 252(28%) were undecided. The year of study in medical school was significantly associated with their perception of the medical profession, with interns more likely to have a negative perception (p<0.001). An overwhelming 823(91.4%) participants remained confident of their career choice, but a higher proportion of interns were less confident or regretful about their choice of profession compared to first to fourth year students (p<0.001). Most participants experienced moral distress; they acknowledged a duty to care but were troubled by personal risk, inadequate protection, and limited resources. Gaps were identified in medical and ethics training particularly regarding uncertainties and coping with deficiencies of the health system as encountered in the pandemic. The essential role played by doctors with its required competence, care and ethics cannot be assumed or expected without investment in the making of the future doctor through more socially embedded medical education imparting the skills of understanding the public, responding to them and being the advocate for their equitable and optimal care. An ethics of responsiveness emerges as important for healthcare, also for medical education in preparation for future health crises.

Research progress on moral distress of nursing interns / 中国实用护理杂志

Moral distress generally exists in the nursing interns and has a far-reaching impact. This paper analyzed and summarized the current situation, influencing factors and coping strategies of the nursing interns at home and abroad, in order to provide reference for promoting the professional development of nursing students, strengthening their professional beliefs and stabilizing the nursing team.

Moral distress experienced by online suicide prevention volunteers: qualitative research / La angustia moral experimentada por los voluntarios de la prevención del suicidio en línea: investigación cualitativa / Stress moral experimentado por voluntários de prevenção de suicídio online

Abstract: Background: With the increasing number of internet users, it becomes feasible to identify individuals at high risk of suicide and then carry out online suicide prevention. At the same time, online suicide prevention volunteers may encounter moral distress, which requires more attention. Purpose: This study aimed to explore the experience of moral distress in online suicide prevention. Method: The study was carried out as a qualitative study following the method of phenomenology. 11 interviewers were recruited through the purposive sampling method. Data were collected through semi-structured, in-depth face-to-face interviews. Colaizzi's phenomenological framework was used for data analysis. Results: All participants reported they encountered moral distress during online suicide prevention. Four themes were condensed, including: "constraints from the surrounding," "be cruel to be kind," "baby spoiled by free milk," and "when face death and depression" Participants also described their emotional experiences and response when they encountered moral distress. Conclusion: Moral distress in the process of online suicide prevention exists. More attention should be paid to the moral distress and ethical issues in online suicide prevention as the internet gradually becomes a brand-new way to prevent suicide.

Resumen: Antecedentes: Con el creciente número de usuarios de Internet, es posible identificar a las personas con alto riesgo de suicidio y llevar a cabo la prevención del suicidio en línea. Al mismo tiempo, los voluntarios de esta prevención pueden encontrarse con angustia moral, lo que requiere más atención. Objetivo: Este estudio tiene como objetivo explorar la experiencia de la angustia moral en la prevención del suicidio en línea. Método: El estudio se llevó a cabo como un estudio cualitativo siguiendo el método de la fenomenología. Se reclutó a 11 entrevistadores mediante el método de muestreo intencional. Los datos se recogieron mediante entrevistas semiestructuradas y en profundidad, cara a cara. Se utilizó el marco fenomenológico de Colaizzi para el análisis de los datos. Resultados: Todos los participantes informaron que habían encontrado angustia moral durante la prevención del suicidio en línea. Se condensaron cuatro temas, a saber: "limitaciones del entorno", "ser cruel para ser amable", "bebé mimado por la leche gratis" y "cuando se enfrenta a la muerte y la depresión". Los participantes también describieron sus experiencias emocionales y su respuesta cuando se encontraron con la angustia moral. Conclusión: La angustia moral en este proceso existe. Hay que prestar más atención a la angustia moral y a las cuestiones éticas en la prevención del suicidio en línea, ya que Internet se convierte gradualmente en una nueva forma de prevenir el suicidio.

Resumo: Antecedentes: Com o crescente número de usuário de internet, torna-se viável identificar indivíduos com alto risco de suicídio e então conduzir prevenção de suicídio online. Ao mesmo tempo, voluntários de prevenção de suicídio online podem enfrentar stress moral, o qual requer mais atenção. Proposta: Esse estudo objetiva explorar a experiência de stress moral em prevenção de suicídio online. Método: O estudo foi conduzido como um estudo qualitativo seguindo o método da fenomenologia. Foram recrutados 11 entrevistados do método de amostragem intencional. Foram coletados dados através de entrevistas face a face, semiestruturadas e em profundidade. O referencial fenomenológico de Colaizzi foi utilizado para análise dos dados. Resultados: Todos os participantes relataram terem experimentado stress moral durante a prevenção de suicídio online. Quatro temas foram condensados: "limitações do ambiente", "ser cruel para ser gentil", "bebê mimado com leite gratuito" e "quando encarando a morte e a depressão". Os participantes também descreveram suas experiências emocionais e respostas quando enfrentaram stress moral. Conclusão: Stress moral no processo de prevenção de suicídio online existe. Mais atenção deve ser dada ao stress moral e aspectos éticos em prevenção de suicídio online na medida em que a internet se torna gradualmente uma maneira totalmente nova de prevenção de suicídio.

Continue with ICU care – she is a spiritual being

This case study discusses a dispute between the healthcare team and the patient’s surrogate decision maker at a cancer centre. While the healthcare team deemed further care to be futile, the patient’s husband argued that they should continue to try to reverse his wife’s acute decline. This case study illustrates the inertia and moral distress that can result when there are differences between patients/surrogates and the healthcare team in their goals for intensive care. The issues of moral distress and an inability to make decisions were addressed by involving an ethics consultant, and by creating institutional mechanisms to address end-of-life issues at an earlier stage

Insulating frontline COVID warriors from moral and mental distress during COVID pandemic- An Evidence based review

The commencement of Covid-19 pandemic has bothered moral and mental health of frontline Covid warriors. Scarcity of personal protective equipments, protracted working hours, improper hydration, hostile healthcare system, unprecedented settings and hurdles in provision of quality care have constituted a deterioration of mental health in healthcare workers. Frontline health care workers often experience burnout, anxiety, depression, insomnia and stress-related disorders. Moral distress rearing from baffl ing decisions regarding issuance of scarce resources and care to Covid-19 positive patients further amplify to strain health worker loads. Therefore, it is vital to admonish mental health of health care workers consistently using collaborative strategies at individual, system and organisational level. This article reviews the moral distress and mental health problems confronted by frontline health care workers and explores various strategies which ought to be executed to cope with them.

Research progress on the current status of research and influencing factors of moral distress in pediatric nurses / 中国实用护理杂志

The moral distress of nurses is an important ethical issue in nursing practice, especially in pediatric nursing, which is unique and specialized. It can lead to burnout and compassion fatigue, resulting in lower job engagement and job satisfaction, and higher turnover rates. In order to provide a comprehensive and timely understanding of the current state of moral distress of pediatric nurses and their influencing factors, this article reviews the current state of domestic and international research on the moral distress of pediatric nurses and the influencing factors. It showed that overseas research on the moral distress of pediatric nurses is more in-depth, while there was less research in China at present, and the research and attention on the moral distress of pediatric nurses in China was insufficient. The influencing factors mainly include three aspects: personal factors, organizational factors and external environment. The review provided a theoretical basis for implementing targeted interventions to prevent and mitigate moral distress among pediatric nurses and calls for nursing researchers, nursing educators, nursing managers and individuals in China to pay more attention to moral distress.

Distrés moral y burnout en el personal de salud durante la crisis por COVID-19 / Moral distress and burnout among health professionals during COVID-19

El presente artículo revisa los principales aspectos relativos al concepto de distrés moral y burnout en el personal sanitario, los factores de riesgo general y específicos propios de la actual emergencia sanitaria, los instrumentos de evaluación disponibles, así como las principales estrategias y recomendaciones de prevención y manejo del cuadro.

This article reviews the main aspects related to the concept of moral distress and burnout among health professionals, general and specific risk factors for the current public health emergency, considering the available assessment instruments, as well as the main strategies and recommendations for its prevention and management.

Moral Distress, Sign of Ethical Issues in the Practice of Oncology Nursing: Literature Review / Angustia moral, señal de problemas éticos en la práctica de enfermería oncológica: revisión de literatura / Angústia moral, sinal de problemas éticos na prática de enfermagem oncológica: revisão de literatura

ABSTRACT Objective: To describe the factors that influence the emergence of moral distress in oncology nurses. Methodology: integrative review of the literature whose search will be performed in Web of Science databases, CINAHL (EBSCO), Scielo, Proquest, Pubmed and PsycInfo using the keywords moral distress and oncology nursing and their similes in Spanish, without restriction for years of publication until 2017. Results: The results of this review were grouped into three groups of factors each with subgroups: 1) Organizational factors: ethical climate, evasive culture and resources for ethics delivered by the organization. 2) Particular clinical situations: pain management, information delivery, futile treatment, and assistance to the patient and their family in the process of death, 3) Interpersonal relationships: poor communication, power relations, trust in the team's competence. Conclusion: the three factors described are triggers of moral distress in oncology nurses. When there are ethical problems and the nurses do not participate in the deliberation process, these problems can be hidden and be normalized, which can diminish the moral sensitivity of the professionals, as well as the possibility of acting as moral agents.

RESUMEN Objetivo: describir los factores que influyen en el surgimiento de la angustia moral en enfermeras oncológicas. Metodología: revisión integradora de la literatura cuya búsqueda se realizó en las bases de datos Web of Science, CINAHL (EBSCO), Scielo, Proquest, Pubmed y PsycInfo, a partir del uso de las palabras clave moral distress y oncology nursing y sus símiles en español, sin restricción por años de publicación hasta 2017. Resultados: se clasificaron en tres grupos de factores, cada uno con subgrupos: 1) factores organizacionales: clima ético, cultura evasiva y los recursos para la ética que entrega la organización; 2) situaciones clínicas complejas: el manejo del dolor, la entrega de información, el tratamiento fútil, y la asistencia al paciente y su familia durante el proceso de muerte; 3) relaciones interpersonales: una comunicación deficiente, las relaciones de poder, la confianza en la competencia del equipo. Conclusión: los tres factores son desencadenantes de angustia moral en las enfermeras oncológicas. Cuando existen problemas éticos, y las enfermeras no participan del proceso de deliberación, estos pueden quedar ocultos y, así, disminuir la sensibilidad moral de los profesionales, así como la posibilidad de actuar como agentes morales. Es necesario explorar la relación entre la angustia moral y las implicancias en el cuidado del paciente.

RESUMO Objetivo: descrever os fatores que influenciam no surgimento da angústia moral em enfermeiras oncológicas. Metodologia: revisão integradora da literatura cuja pesquisa foi realizada nas bases de dados Web of Science, CINAHL (EBSCO), Scielo, Proquest, Pubmed e PsycInfo, a partir do uso das palavras-chave moral, distress e oncology nursing e seus pares em espanhol, sem restrição por ano de publicação até 2017. Resultados: criou-se três grupos de fatores, cada um deles com subgrupos: 1) fatores organizacionais - clima ético, cultura evasiva e recursos para a ética que a organização entrega; 2) situações clínicas complexas - o tratamento da dor, a entrega de informação, o tratamento fútil e a assistência ao paciente e à sua família durante o processo de morte; 3) relações interpessoais - uma comunicação deficiente, as relações de poder, a confiança na competência da equipe. Conclusão: os três fatores são desencadeantes de angústia moral nas enfermeiras oncológicas. Quando existem problemas éticos e as enfermeiras não participam do processo de deliberação, estes podem ficam ocultos e, assim, diminuir a sensibilidade moral dos profissionais, bem como a possibilidade de atuar como agentes morais. É necessário explorar a relação entre a angústia moral e suas implicações no cuidado do paciente.

Relationship of ICU Nurses' Difficulties in End-of-Life Care to Moral Distress, Burnout and Job Satisfaction / 간호행정학회지

PURPOSE: The aim of this study was to identify the relationships between the difficulty of end-of-life care and moral distress, burnout and job satisfaction of nurses working in intensive care units (ICUs). METHODS: This descriptive study was conducted using self-report questionnaires. Participants were nurses who had more than one year of ICU experience and were recruited from three university hospitals (N=168). RESULTS: The mean scores for ICU nurses' difficulty in end-of-life care, moral distress, burnout and job satisfaction were 3.42, 113.88, 3.16 and 2.58 points, respectively. Difficulty in end-of-life care was positively correlated with moral distress (r=.48, p < .001) and burnout (r=.26, p=.001) and was negatively correlated with job satisfaction (r=−.17, p=.024). Difficulties in end-of-life was identified as a predictor of moral distress (β=.44, p < .001), burnout (β=.26, p=.001) and job satisfaction (β=−.18, p=.024). CONCLUSION: The results of this study suggest the following: it is important to have a deep understanding of ICU nurses who experience various difficulties in end-of-life care and to provide realist support for these nurses. And practical efforts by nursing organizations are needed, including support systems and education programs to alleviate ICU nurses' difficulties in end-of-life care.

The Correlation Analysis of Turnover Intention,Moral Distress and Stressor in Nurses / 中华劳动卫生职业病杂志

Objective@#To explore the turnover intention of nurses in Quzhou and its influential factors.@*Methods@#From July to August in 2017 cross-sectional study and self-filled questionnaire are used to investigate 980 nurses from 7 hospitals in Quzhou, including two third-level hospitals and five second-level ones. T-test, F-test, Pearson and linear regression are used in data with the method of statistical analysis.@*Results@#The total score of turnover intention of nurses was (14.95±3.17) points, and the index value was 62.27%, of which the turnover intention was above 78%. The analysis of Single factor showed that age (F=4.895) , Department (F=2.971) , title, nursing age (F=5.863) , self-assessment of physical conditions (F=4.092) were closely related to nurses’ turnover intention(P<0.05). According to Person’s correlation analysis, there are positive correlations between turnover intention and source of stressor, and moral distress (P<0.05) . Multiple linear regression showed that the nurses’ turnover intention was age, Department, health selfevaluation, stressor and moral distress.@*Conclusion@#The turnover intention of nurses is high, which is related to age, Department, self-evaluation of health, stressor and moral distress.

O sofrimento moral nas situações de final de vida em Unidades de Terapia Intensiva pediátrica: desenvolvimento do conceito / Moral distress in end-of-life situations in pediatric intensive care units: concept development

Introdução: Apesar de o conceito de sofrimento moral ter sido definido há mais de 30 anos, existe uma variedade de definições sobre o conceito e não há consenso sobre as principais características do fenômeno. Embora essa variação seja comum quando os conceitos são inicialmente explorados, tal variabilidade dificulta substancialmente a construção de um corpo coerente de conhecimento. Objetivo: Desenvolver o conceito de sofrimento moral nas situações de final de vida em unidades de terapia intensiva pediátrica (UTIp) e identificar antecedentes, atributos e consequências do fenômeno. Método: O Modelo Híbrido de Desenvolvimento de Conceitos foi aplicado em suas três fases: Teórica, de Campo e Analítica Final. Na Fase Teórica, foram analisados 18 estudos que descreveram o sofrimento moral nas situações de final de vida no contexto da UTIp. A Fase de Campo foi conduzida por meio de entrevistas semiestruturadas, com 10 enfermeiros e 9 médicos que trabalham em UTIp. Os dados da Fase de Campo foram analisados utilizando-se os resultados da Fase Teórica como eixo teórico e a Análise Temática como referencial metodológico. Na Fase Analítica Final, os resultados das fases Teórica e de Campo foram comparados, analisados e integrados, permitindo chegar a uma definição do conceito. Resultados: Os dados evidenciam que sofrimento moral nas situações de final de vida em UTIp é o profissional sentir-se incapaz para agir, realizar ações que esse profissional percebe como inadequadas e manifestar alterações emocionais diante das metas irreais impostas pelas suas crenças e conflitos internos. O sofrimento moral pode ter consequências negativas, como o desejo de abandonar a profissão, e/ou positivas, como criar estratégias de enfrentamento que repercutem na vida pessoal e laborativa do profissional. Considerações finais: A abordagem híbrida ofereceu avanço na exploração do conceito de sofrimento moral nas situações de final de vida em UTIp, ao investigar o fenômeno na prática clínica. Identificar aspectos empíricos de um conceito pessoal, subjetivo e abstrato como o sofrimento moral é um processo complexo. Entretanto, por meio da Fase de Campo, foi possível identificar o componente experiencial que está por trás das condutas dos profissionais ante aos problemas morais nas situações de final de vida em UTIp. Dessa forma, pôde-se compreender como se dá o desenvolvimento do conceito na prática clínica, possibilitando a ampliação dos dados identificados na Fase Teórica.

Introduction: Although the concept of moral suffering has been defined more than 30 years ago, there are a variety of definitions about the concept and there is no consensus on the main features of the phenomenon. Although this variation is common when concepts are first explored, such variability substantially hinders the construction of a coherent body of knowledge. Objective: To develop the concept of moral suffering in end-of-life situations in pediatric intensive care units (ICUs) and to identify antecedents, attributes and consequences of the phenomenon. Method: The Hybrid Concepts Development Model was applied - in its three phases: Theoretical, Field and Final Analytic. In the Theoretical Phase, 18 studies were analyzed that described the moral suffering in the situations of end of life in the context of the PICU. The Field Phase was conducted through semi-structured interviews, with ten nurses and nine physicians working in the PICU. The data of the Field Phase were analyzed using the results of the Theoretical Phase as theoretical axis and the Thematic Analysis as a methodological reference. In the Final Analytical Phase, the results of the Theoretical and Field phases were compared, analyzed and integrated, allowing a definition of the concept. Results: The data show that moral suffering in end-of-life situations in the ICU is the professional feeling unable to act, to perform actions that the professional perceives as inadequate and to manifest emotional changes in the face of the unrealistic goals imposed by their internal beliefs and conflicts. Moral suffering can have negative consequences, such as the desire to leave the profession, and / or positive, such as creating coping strategies - that have repercussions on the professional and personal life of the professional. Final considerations: The hybrid approach offered an advance in the exploration of the concept of moral suffering in end-of-life situations in the PICU, when investigating the phenomenon in clinical practice. Identifying empirical aspects of a personal, subjective, abstract concept such as moral suffering is a complex process. However, through the Field Phase, it was possible to identify the experiential component that is behind the behavior of professionals before the moral problems in end-of-life situations in the PICU. In this way, it was possible to understand how the concept develops in clinical practice, allowing the amplification of the data identified in the Theoretical Phase.

The Relation Among Moral Distress, Physical Symptoms and Burnout of Hospital Nurses / 한국간호교육학회지

PURPOSE: The purpose of this study was to explore the relationship between moral distress, physical symptoms, and burnout among clinical nurses. METHODS: Data were collected by self-report questionnaires targeting 140 nurses from a university hospital in Chungju. The data were analyzed by, Kruskal-Wallis, Pearson correlation coefficient, and stepwise multiple regression. RESULTS: Moral distress due to the general characteristics of the participants showed a statistically significant difference at the current working department (χ2=36.01, p<.001). Hospital nurses' moral distress had a statistically significant correlation with burnout (r=.358, p<.001) and physical symptoms (r=.440, p<.001). Factors influencing hospital nurses' burnout, pro were physical symptoms, moral distress, and marital status, accounting for 36% of the variance. CONCLUSION: The findings indicate that moral distress and physical symptoms influence burnout among hospital nurses. Therefore, interventions for burnout among hospital nurses should include an empowerment program to reduce physical symptoms and moral distress.

Effects of moral distress on nurses: Integrative literature review / Consequências do sofrimento moral em enfermeiros: Revisão integrativa / Consecuencias del sufrimiento moral en enfermeros: Revisión integrativa

The present study aimed to identify the effects of moral distress on nurses. Integrative literature review with data collection from May to September 2013 and updated in July 2015 in database Biblioteca Virtual em Saúde, using the terms: Moral Distress, Moral Suffering, Nurse andNursing.The final sample was composed of eighty-five studies.The outcomes are presented in four categories. The first one (Feelings) includes dissatisfaction, frustration and anger; the second (Sickening) emerged from the experience of physical and emotional sickening; the third (Quality of care) concerns the actions that resulted in ineffective care and denial of patient advocacy; and the fourth (Coping Strategies)showed the types of coping such as:abandonment of the profession and denaturalization of the practices. The effects are present in the daily routine of the professionals, causing damage often irreversible and, abandonment of the employment (AU).

O objetivo foi identificar as consequências de sofrimento moral em enfermeiros. Trata-se de uma revisão integrativa, com coleta dos dados realizada de maio a setembro de 2013 e atualizada em julho de 2015 na Biblioteca Virtual em Saúde, com os termos: Moral Distress, Moral Suffering, Nurse e Nursing. Oitenta e cinco estudos compuseram a amostra final. Os resultados são apresentados em quatro categorias. A primeira: Sentimentos composta pela presença de sentimentos como insatisfação, frustração, raiva; a segunda: Adoecimento emergiu da vivência de adoecimento físico e emocional; a terceira Qualidade do cuidado pela presença de ações que levavam ao cuidado ineficaz e negação da advocacia do paciente; e a quarta: Estratégias de enfrentamento, demonstrou as formas de enfrentamento utilizadas, como: abandono da profissão e a desnaturalização das práticas. Evidencia-se que as consequências estão presentes no cotidiano dos profissionais, e causam danos muitas vezes irreversíveis, inclinando para o abandono da profissão (AU).

Estudio cuyo objetivo fue identificar las consecuencas de sufrimiento moral en enfermeros. En esa revisión integrativa, los datos fueron obtenidos de mayo a septiembre de 2013, siendo actualizada en julio de 2015 en la Biblioteca Virtual en Salud, por medio de los términos: Moral Distress, Moral Suffering, Nurse y Nursing. La muestra final fue compuesta de ochenta y cinco estudios. Los resultados son presentados en cuatro categorías. La primera: Sentimientos, compuesta por sentimientos como insatisfacción, frustración, ira; y la segunda, Proceso de enfermarse, de donde surgieron: vivencia de la enfermedad física y emocional; la tercera, Cualidad del cuidado, por la presencia de acciones que llevaban al cuidado ineficaz y negación de la agocacía del paciente; y la cuarta: Estrategias de enfrentamiento, que demostró las formas de enfrentamiento utilizadas, como: abandono de la profesión y la desnaturalización de las prácticas. Se evidencía que las consecuencas están presentes en el cotidiano de los profesionales, y causan daños muchas veces irreversibles, podendo llevar al abandono de la profesión (AU).

The Experience of Nursing Students' Moral Distress in Clinical Practice / 한국간호교육학회지

PURPOSE: This study explores the moral distress that nursing students experience during their clinical practice in Korea. METHODS: Data were collected using focus group interviews, and analyzed using qualitative content analysis. Participants were recruited from three nursing schools in three different cities; each focus group interview lasted between one to two hours. RESULTS: Twenty-two nursing students with more than one year of clinical practice experience participated. Three categories and ten themes were extracted. The following situational categories: "unprotected patients' right and dignity," "clinical settings in which standards of care are not upheld," "disrespectful hospital culture," and "inconsistent and unsystematic clinical education" caused moral distress. Types of responses to moral distress included: "shock and confusion over the gap between reality and moral standards," "powerlessness when cannot advocate patients," "fear and doubts about nursing career," and "moral desensitization and disappointment in oneself." "Expressions of moral distress and the need for advice" and "a search for meaning and hope" were identified as coping strategies. CONCLUSION: These results demonstrate the need for systematic clinical practicum and education programs to minimize moral distress. These programs may offer opportunities for students to turn moral distress into opportunities for learning and growth in the future.

Validity and Reliability of the Korean version of the Moral Distress Scale-Revised for Korean Hospital Nurses / 한국간호교육학회지

PURPOSE: To develop and test the validity and reliability of the Korean version of the Moral Distress Scale-Revised (KMDS-R) to assess its applicability to Korean hospital nurses. METHODS: The KMDS-R was articulated through forward-backward translation methods. Internal consistency reliability, construct and criterion validity was calculated using SPSSWIN(19.0). Survey data were collected from 188 nurses from a university hospital in Gangwon-do, South Korea. RESULTS: The KMDS-R showed reliable internal consistency with a Cronbach's alpha of .69-.87 and a Guttman Split-half of .69-.82 for the total scale. Factor loading of the 21 items on the five subscales ranged from .41-.80. The KMDS-R was validated by factor analysis and explained 63% of moral distress for Korean hospital nurses. Criterion validity compared to Yoo's MDS showed significant correlation. CONCLUSION: The results suggest promising evidence of the KMDS-R's reliability and validity. It is used to measure moral distress for Korean hospital nurses.

Conflictos éticos que se presentan a médicos de tres centros hospitalarios de Bogotá, Colombia / Ethical conflicts presented to doctors in three hospitals in Bogotá, Colombia / Conflitos éticos apresentados aos médicos de três centros hospitalares de Bogotá, Colômbia

La transformación del sistema de salud colombiano a partir de la Ley 100/1993 planteó nuevos conflictos éticos a los médicos. Como parte de una tesis doctoral cuyo objetivo general era comprender las tensiones que emergen entre los tipos de clima ético organizacional y los conflictos éticos que se presentan a médicos y enfermeros en tres instituciones prestadoras de salud (IPS) de Bogotá, se propuso identificar y describir los conflictos éticos que se presentan a los médicos y la manera como los resuelven, para que fuera posible indagar si desde los comités de ética pueden resolverse estos conflictos, como ha sido sugerido por algunos bioeticistas. Para ello se realizaron 23 entrevistas a médicos que laboraban en tres centros hospitalarios con servicios de alta complejidad de Bogotá: uno público, uno privado y uno de un régimen especial. Los resultados sugieren la presencia de conflictos de interés, por una parte, y conflictos de obligación que se expresan como dilemas éticos y angustia moral, por otra. Con base en ello, se formulan recomendaciones para la formación profesional, la investigación y los comités de ética hospitalarios.

The transformation of the Colombian health system from the 100/1993 law raised new ethical conflicts to physicians. As a part of a doctorate thesis oriented to understand emerging tensions among ethical climate and ethical conflicts faced by physicians and nurses in three hospitals located in Bogota, it was proposed to identify and describe the ethical conflicts presented to physicians and the way they are faced. In order to achieve this goal, 23 interviews were carried out with physicians who worked in three hospitals located in Bogota: one private, one public and one with a special regime. The results suggest the presence of interest conflicts on the one hand, and commitment conflicts expressed as ethical dilemmas and moral distress on the other. Based on these results, recommendations to physicians education, research and committees of ethics are suggested.

A transformação do sistema de saúde colombiano a partir da Lei 100/1993 levantou novos conflitos éticos para os médicos. Como parte de uma tese de doutorado cujo objetivo geral foi compreender as tensões que surgem entre os tipos de clima ético organizacional e os conflitos éticos apresentados aos médicos e enfermeiros em três instituições de saúde (IPS) em Bogotá, propôs-se a identificar e descrever os conflitos éticos apresentados aos médicos e como eles os resolvem, para que seja possível pesquisar si a partir dos comitês de ética esses conflitos podem se resolver, como foi sugerido por alguns bioeticistas. Para isso foram realizadas 23 entrevistas com médicos que trabalhavam em três centros hospitalares com serviços de alta complexidade de Bogotá: um público, um privado e um de regime especial. Os resultados sugerem da presença de conflitos de interesses, por um lado, e conflitos de obrigação que são expressos como dilemas éticos e sofrimento moral, do outro lado. Com base nisso, são formuladas recomendações para a formação profissional, a investigação e os comitês de ética hospitalares.

Ethical competence as a coping resource for moral distress in nursing / Competencia ética como recurso para combatir sufrimiento moral en enfermería / Competência ética como recurso de enfrentamento do sofrimento moral em enfermagem

The study's objectives were: to seek evidence on ethical situations experienced by nurses in the health services; to identify the coping resources which they use; and to ascertain the role of ethical competence in coping with moral distress. The integrative literature review was used as the method. The search was made in the LILACS, IBECS, MEDLINE, SciELO, CINAHL, PubMed, RCAAP and BDTD databases. A total of 23 studies was selected, based on previously established inclusion and exclusion criteria. The results indicate ethical questions experienced by the nurses in their relations with patients and family members, the team and the health system. Coping resources used by the professionals and implemented by the researchers are described. It may be concluded that the ethical challenges and moral distress are present in the nurses' work context, and the strategies aimed at promoting ethical competence, have positive consequences in coping with, and in reducing, levels of moral distress.

Los objetivos del estudio eran buscar temas éticos experimentados por las enfermeras en los servicios de salud, identificar los recursos de afrontamiento que utilizan, y encontrar cuál es el papel de la competencia ética para sobrellevar el sufrimiento moral. El método se utiliza como una revisión integradora de la literatura. La búsqueda se realiza em LILACS, IBECS, MEDLINE, SciELO, CINAHL, PubMed, RCAAP y BDTD. Fueron seleccionados 23 estudios desde critérios de inclusión y de exclusión. Los resultados apuntan a desafios éticos vivenciados por enfermeros en las relaciones con pacientes, personal y sistema de salud. Describe los recursos de afrontamiento asumidos por los profesionales y puestos en práctica por los investigadores. Se puede concluir que los desafios éticos y el sufrimiento moral están presentes en la realidad del trabajo de las enfermeras y las estrategias para promover la competencia ética puede tener efectos positivos en el afrontamiento de sufrimiento moral.

Os objetivos do estudo foram: buscar evidências sobre situações éticas vivenciadas por enfermeiros nos serviços de saúde; identificar os recursos de enfrentamento que utilizam; e verificar qual o papel da competência ética no enfrentamento do sofrimento moral. Utilizou-se como método a revisão integrativa da literatura. A busca foi feita nas bases de dados LILACS, IBECS, MEDLINE, SciELO, CINAHL, PubMed, RCAAP e BDTD. Foram selecionados 23 estudos, a partir de critérios de inclusão e exclusão previamente estabelecidos. Os resultados apontam para questões éticas vivenciadas pelos enfermeiros nas relações com pacientes e familiares, equipe e sistema de saúde. Descrevem-se recursos de enfrentamento protagonizados pelos profissionais e implementados por pesquisadores. Pode-se concluir que os desafios éticos e o sofrimento moral estão presentes na realidade de trabalho dos enfermeiros e que estratégias no sentido de promover a competência ética podem ter reflexos positivos no enfrentamento e na redução dos níveis de sofrimento moral.

Research on current situation and influencing factors of moral distress among nurses / 中国实用护理杂志

Objective To explore the current situation and influencing factors of moral distress among nurses.Methods 252 clinical registered nurses from 3 Grade-3 Level-A hospitals in Jinan were investigated by the Chinese version of Moral Distress Scale-Revised and Job Diagnostic Survey.Results The mean score of MDF was (1.06±0.46) points and the mean score of MDI was (1.05±0.63) points.The total score of MDS-R was (38.86+26.26) points.Futile care was the main source for the high frequency and high intensity of moral distress among nurses.There were significant differences in the level of moral distress among different groups of age,years of nursing experience,first education degree,professional title,position,department,staffing of government affiliated institutions and income.The result of multiple linear regression analysis showed that age,first education degree,department,professional title,and the importance of assignment,autonomy,collaboration of work were the influencing factors for moral distress of nurses.Contusions It suggested that nurses should strengthen the study of knowledge about ethics to improve their capacity of ethical decision-making,and nurse managers should pay attention to department management,strengthen the medical cooperation,and improve nurses' job autonomy to improve nurses' capacity of coping and decision-making and reduce the level of moral dilemmas.

The current status and influencing factors of moral distress in clinical nurses / 中国实用护理杂志

Objective To investigate the current status of moral distress in clinical nurses,and analyze its influential factors.Methods A total of 240 clinical nurses were recruited by stratified sampling method.They were investigated with general situation questionnaire and moral distress scale.Results The average score of moral distress was (2.66±0.41).Multiple linear regression analysis showed that department of work and qualification were influencing factors on moral distress of clinical nurses.Conclusions This study found that nurses' moral distress was above the middle level.Some targeted measures should be taken by nursing managers,in order to help decrease nurses' moral distress.

Confronting moral distress in Nursing: recognizing nurses as moral agents / Fazendo frente ao sofrimento moral na Enfermagem: reconhecendo as enfermeiras como agentes morais / Enfrentando la angustia moral en Enfermería: reconociendo las enfermeras como agentes morales

The concept of moral distress has brought forth a substantively different way of understanding some of the difficulties confronted by nurses in their practice. This concept highlights that nurses' distress can be an indication of nurses' conscientious moral engagement with their professional practice that has confronted practices or an environment that impedes them from acting according to their own ethical standards. Moral distress can be an indicator of problems in nurses' practice environments. This concept is described and related to moral agency in nursing practice. Selected research on moral distress is reviewed, followed by a discussion of recommendations for addressing this problem.

O conceito de sofrimento (ou angústia) moral trouxe à luz uma maneira substancialmente diferente de compreender algumas das dificuldades enfrentadas pelos enfermeiros em sua prática. Este conceito destaca que o sofrimento dos enfermeiros pode ser um indicador de um engajamento moral consciencioso dos enfermeiros com sua prática profissional, que têm confrontado práticas ou um ambiente que os impede de agir de acordo com seus próprios padrões éticos. Sofrimento moral pode ser um indicador de problemas nos ambientes de prática dos enfermeiros. Este conceito é descrito e relacionado a agência moral na prática da Enfermagem. É revista uma pesquisa selecionada sobre sofrimento moral, seguida de uma discussão de recomendações para enfrentar este problema.

El concepto de angustia moral ha iluminado una forma sustancialmente diferente de entender algunas de las dificultades enfrentadas por los enfermeros en su práctica. Este concepto pone de relieve que el sufrimiento de los enfermeros puede ser una indicación de conciencia de compromiso moral con su práctica profesional, en que han enfrentado prácticas o un entorno que les impide de actuar de acuerdo con sus propias normas éticas. Angustia moral puede ser un indicador de problemas en los entornos de la práctica de los enfermeros. Este concepto es descrito y relaciona con la agencia moral en la práctica de Enfermería. Investigación seleccionada en la angustia moral es revisado, seguido de un debate sobre las recomendaciones para hacer frente a este problema.