Moral Distress Assessment in the Nursing Team of a Hematology-Oncology Sector

To identify the frequency and intensity of Moral Distress, and to analyze the associations between Moral Distress and sociodemographic and labor characteristics of the nursing team of a Hematology-Oncology.

Method:

A cross-sectional study was carried out with 46 nursing professionals from a Hematology-Oncology sector of a hospital institution in Rio Grande do Sul State, Brazil, through the application of the Moral Distress Scale - Brazilian version. In the data analysis, descriptive statistics and nonparametric association tests were used.

Results:

Mortal Distress intensity of 3.27 (SD= 1.79) and frequency of 1.72 (SD= 1.02) were found in this team. The Moral Distress of greater intensity and frequency were related to the denial of the role of Nursing as a patient's advocate and the disrespect to the patient's autonomy, respectively.

Conclusion:

It is suggested a greater space for discussion among professionals, multiprofessional team and managers, so that adequate conditions of action and communication are provided.

Descriptors:
Nursing; Ethics in Nursing; Occupational Health; Oncology; Psychological Stress

Lack of competence in the team	Intensity			Frequency
Issues	Mean	SD	Me	Mean	SD	Me
i24- Working with nurses who do not have the necessary competence that the patient's condition requires.	3.07	2.05	3.00	1.41	1.42	1.00
i25- Working with nursing technicians/assistants who do not have the necessary competence that the patient's condition requires.	3.11	2.10	3.50	1.67	1.49	1.00
i26- Working with medical or nursing students who do not have the necessary competence that the patient's condition requires.	3.22	2.04	4.00	1.96	1.53	2.00
i27- Working with doctors who do not have the required competence that the patient's condition requires.	3.70	2.11	4.5	2.37	1.78	2.00
i28- Working with support services that do not have the necessary competence that the patient's condition requires.	3.37	1.99	4.00	2.17	1.65	2.00
i29- Working with nurses who do not have the competence to act.	3.22	2.18	4.00	1.37	1.24	1.00
i30- Work with technicians/assistants who do not have the competence to act.	3.11	2.14	3.50	1.41	1.34	1.00
i31- Working with doctors who do not have the competence to act.	3.48	2.27	4.0	1.87	1.63	1.00
i32- Working with support services that do not have the competence to act.	3.33	2.03	4.00	1.83	1.64	1.00
i33- Working with medical or nursing students who do not have the competence to act.	3.37	1.99	4.00	1.96	1.58	2.00

Denial of the role of Nursing as a patient's advocate	Intensity			Frequency
Issues	Mean	SD	Me	Mean	SD	Me
i07- Ignoring situations where the patient has not been given the appropriate information to ensure informed consent.	3.35	2.06	4.00	2.17	1.58	2.00
i09- Avoiding taking action when finding that a member of the nursing team applies the wrong medication and fails to report it.	3.44	2.46	5.00	1.28	1.38	1.00
i10- Allowing medical students to perform painful procedures on patients just to hone their skills.	3.57	2.37	5.00	1.43	1.77	1.00
i11- Assisting doctors who are performing procedures on patients after cardiorespiratory recovery has not been satisfactory.	3.02	2.32	3.00	1.04	1.37	1.00
i12- Performing medical prescriptions for unnecessary exams and treatments in terminally ill patients.	3.02	2.25	3.00	1.67	1.92	1.00
i13- Working with nursing staff at a level that they consider "unsafe".	3.24	2.13	4.00	1.62	1.51	1.00
i16- Observing, without taking action, when the nursing team does not respect the patient's privacy.	2.98	2.20	3.00	1.50	1.43	1.00
i17- Obeying the medical request not to tell the truth to the patient, even when the patient asks the truth.	3.17	2.16	4.00	1.24	1.45	1.00
i18- Assisting a doctor who, in his opinion, is acting incompetently with the patient.	3.35	2.45	4.00	1.59	1.60	1.00
i34- Avoiding taking action in situations of death of patients associated with professional negligence.	3.85	2.28	5.00	1.78	1.67	1.00
i38- Avoiding taking action when you notice the terminal patient's abandonment by the health team.	3.58	2.16	5.00	1.50	1.39	1.00
i39- Avoiding taking action when realizing the termination of the terminal patient by the family.	3.69	2.29	5.00	1.78	1.83	1.00

Disrespect to the patient's autonomy	Intensity			Frequency
Issues	Mean	SD	Me	Mean	SD	Me
i02- Following the family's will to maintain the patient's life, although this is not the best for him/her.	3.28	1.91	4.00	2.96	1.92	3.00
i21- Accomplishing the doctor's request not to discuss with the patient his or her resuscitation in case of cardiac arrest.	2.63	2.10	3.00	1.63	1.68	1.00
i22- Accomplishing the doctor's request not to discuss with the family resuscitation of the patient in case of cardiac arrest, when the patient is devoid of discernment.	2.83	2.11	3.00	1.50	1.62	1.00
i36- Acting with professionals who do not clarify the patient about his state of health and illness.	3.00	1.89	3.00	2.00	1.59	2.00

Variables	Intensity			Frequency
Variables	Mean	SD	Me	Mean	SD	Me
Lack of competence in the team	3.30	1.95	3.75	1.80	1.28	1.45
Denial of the role of Nursing as a patient's advocate	3.37	1.95	4.25	1.57	1.10	1.36
Disrespect to the patient's autonomy	2.93	1.91	4.00	2.02	1.30	1.88
General Moral Distress	3.27	1.79	3.71	1.72	1.02	1.62

Variables	Lack of competence in the team			Denial of the role of Nursing as a patient's advocate			Disrespect to the patient's autonomy
Variables	n	M	P	n	M	P	n	M	P
Professional Category
Nurse	23	26.9	0.08	23	25.6	0.27	23	28.1	0.05^* *()** Statistical difference at the level of 5%.
Nursing technician	18	22.1		18	23.2		18	20
Nursing assistant	05	12.8		05	15		5	14.9
Schooling
High School	1	16	0.13	1	10.5	0.16	1	15.5	0.04^* *()** Statistical difference at the level of 5%.
Undergraduate Degree	7	13		7	15.3		7	11
Specialization	30	25.7		30	26.4		30	25.6
Master's Degree	8	25.4		8	21.5		8	27.5
Work Time
≤ 21 years	23	24.9	0.46	23	24.6	0.47	23	24.8	0.51
> 21 years	23	22.1		23	22.4		23	22.2
Institution Time
≤ 5 years	18	19.9	0.14	18	19.2	0.07	18	21.9	0.52
>5 years	28	25.8		28	26.3		28	24.5
Sector
1. CTCRIAC	23	21.3	0.51	23	21.6	0.51	23	28.2	0.54
2. CTMO	11	28.6		11	28.7		11	28.2
3. Chemotherapy Ambulatory	7	24.1		7	23.6		7	23.2
4. Radiotherapy	5	21.9		5	20.9		5	24.6
Sector Time
≤ 5 years	27	20.7	0.09	27	20.1	0.03^* *()** Statistical difference at the level of 5%.	27	21.0	0.13
> 5 years	19	27.5		19	28.4		19	27
Work shift
Morning	29	21.2	0.12	29	19.7	0.12	29	22.6	0.53
Evening	17	27.5		17	30.0		17	28.1
Dialogue with the Institution
Yes	21	21.6	0.63	21	21.1	0.61	21	21.7	0.78
No	2	18.5		2	21.8		2	21.3
Sometimes	22	24.8		22	25		22	24.4
Dialogue with the Chief
Yes	27	21.7	0.66	27	21.8	0.65	27	21.3	0.23
No	2	21.5		2	29.5		2	37.3
Sometimes	16	25.4		16	24.2		16	24.1
Dialogue with the Team
Yes	36	21.4	0.10	36	21.6	0.15	36	21.0	0.03^* *()** Statistical difference at the level of 5%.
Sometimes	9	29.4		9	28.6		9	31.2
Meetings
Monthly	1	34.0	0.18	1	31.0	0.29	1	35.0	0.15
When needed	37	19.1		37	19.2		37	19.1
Knowledge on Ethics Comission
Yes	22	27.6	0.02^* *()** Statistical difference at the level of 5%.	22	27.3	0.02^* *()** Statistical difference at the level of 5%.	22	25.3	0.30
No	4	12.9		4	11.8		4	15.6
I don't know	18	18.5		18	19		18	20.4
Permanent Education
Yes	34	25.1	0.04^* *()** Statistical difference at the level of 5%.	34	25.6	0.02^* *()** Statistical difference at the level of 5%.	34	24.9	0.02^* *()** Statistical difference at the level of 5%.
No	3	6.0		3	5.5		3	3.5
I don't know	8	20.5		8	18.3		8	22.4

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[1] Corresponding Author: Isolina Maria Alberto Fruet E-mail: isolina_chuca@yahoo.com.br