ABSTRACT
BACKGROUND: Pediatric nursing care involves many significant ethical challenges. Although nurses are broadly recognized as professionals with relevant knowledge about children and families, little is known about how nurses experience ethical concerns in their everyday practice. OBJECTIVE: The objective of this study was to better understand the moral experiences and related moral distress experiences of nurses working in pediatric settings in Brazil. DESIGN: Interpretative phenomenological study conducted through narrative interviews. PARTICIPANTS AND RESEARCH CONTEXT: Nine nurses working in three pediatric settings of a teaching hospital in a city of Southern Brazil. ETHICAL CONSIDERATIONS: The study was approved by the Research Ethics Committee of the research site, and research ethics principles were respected throughout the study. FINDINGS: This investigation illuminated a broader dimension of nurses' moral distress, which was recognized as moral experience. In advancing our understanding of nurses' moral experiences, engagement was identified as a central phenomenon that is present in the understandings and actions of nurses within their relationships in their daily practice and lived experiences. Three themes were described with regard to nurses' relationships and their moral experiences: (a) relationship with the healthcare team; (b) relationship with the family; and (c) relationship with the child. DISCUSSION: The findings of this study are congruent with emerging health literature that demonstrated the focus on moral distress as limiting for bioethical inquiry. Moreover, it is important to better understand and recognize nurses' relational environment and engagements to advance understandings of the ethical dimensions of pediatric nursing practice. CONCLUSION: This study provides a better understanding on how engagement affects moral experiences, demonstrating how nurses can experience distress but also satisfaction, gratification, rewarding feelings, and a sense of responsibility for the care they provide.
Subject(s)
Interpersonal Relations , Morals , Nurses, Pediatric/psychology , Stress, Psychological/psychology , Brazil , Ethics, Nursing , Humans , Qualitative Research , Stress, Psychological/complicationsABSTRACT
Trata-se de uma pesquisa qualitativa bicêntrica que objetivou descrever a trajetória de familiares de crianças menores de cinco anos atendidas em pronto-atendimento infantil. Os sujeitos desta pesquisa foram os familiares cuidadores das crianças atendidas em dois pronto-atendimentos (PA) no ano de 2010 em dois municípios do sul do Brasil. Os resultados apontaram três categorias: a busca pelo pronto-atendimento como a primeira escolha; as dificuldades de acesso ao atendimento em unidades básicas de saúde; as facilidades e dificuldades para o atendimento a essas crianças no pronto atendimento. Concluiu-se que a dificuldade de acesso aos serviços de atenção primária faz com que os familiares optem pelo PA como primeira escolha. Também, que a trajetória destes familiares não segue a lógica preconizada pelas políticas públicas em que a porta de entrada deveria ser na atenção primária. Recomenda-se a formulação de estratégias para reorganização dos serviços de atenção primária, viabilizando o acesso e a qualificação da atenção à saúde da criança.
This is a double centric qualitative research that aimed to describe the trajectory of relative caregivers of children younger than five years of age treated in emergency care for children. The subjects of this research were relative caregivers of children seen in two emergency units in 2010 in two municipalities in the south of Brazil. As technique for data collection it was conducted semi-structured interviews with 10 caregivers in domiciliary visits. The results showed three categories: the search for emergency care as the first choice, the difficulties of access to care in primary health care units, advantages and difficulties for the care of these children in the emergency department. It was concluded that the difficulty of access to primary care services makes the family to opt for emergency units as first choice.
Se trata de una investigación cualitativa becéntrica, que objetivó describir la trayectoria de los familiares de niños menores de cinco años, atendidos en un servicio de urgencia pediátrica. Los sujetos fueron los familiares cuidadores de niños atendidos en dos servicios de urgencias, en el año 2010, en dos municipios del sur de de Brasil. Para la recolecta de datos se utilizó la entrevista semiestructurada con 10 familiares cuidadores durante las visitas domiciliarias. Los resultados permitieron establecer tres categorías: la búsqueda por la atención de emergencia como primera opción; las dificultades de acceso a los servicios de atención primaria de la salud; facilidades y dificultades para la atención a esos niños en los servicios de urgencias. Se concluye que, la dificultad de acceso a los servicios de atención primaria, hace con que los familiares opten por los servicios de urgencias como primera opción. Se recomienda la reorganización de estrategias de los servicios de atención primaria, viabilizando el acceso y la cualificación de la atención de la salud para el niño.
