Nurses, nursing technicians and assistants: who experiences more
					moral distress?

Dalmolin, Graziele de Lima; Lunardi, Valéria Lerch; Lunardi, Guilherme Lerch; Barlem, Edison Luiz Devos; Silveira, Rosemary Silva da

doi:10.1590/S0080-623420140000300019

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Original Article • Rev. esc. enferm. USP 48 (03) • June 2014 • https://doi.org/10.1590/S0080-623420140000300019 copy

Nurses, nursing technicians and assistants: who experiences more moral distress?^* * Extracted from the thesis "Sofrimento moral e síndrome de Burnout: relações nas vivências profissionais de trabalhadores de enfermagem", Nursing Graduate Program, Universidade Federal do Rio Grande, 2012.

Enfermeros, técnicos y auxiliares de enfermería: ¿quién experimenta el mayor sufrimiento moral?

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: To identify the frequency and intensity of moral distress experienced by nurses, technicians and nursing assistants who worked in hospitals in the South of Rio Grande do Sul State. Method: A survey research was conducted with 334 nursing workers from three institutions, through a questionnaire of moral distress. Constructs were validated through factorial analysis and Cronbach’s alpha: lack of competence of the working team, disrespect to the patient’s autonomy, insufficient working conditions and therapeutic obstinacy. Results: With descriptive statistics and analysis of variance, it was found that nurses and nursing assistants have higher perception of moral distress when compared to nursing technicians. Organizational questions and ways of communication influence lower perception of moral distress.Conclusion: Implementation of actions to favor coping, decision making and autonomy exercise from those workers. 

Ethics, nursing ; Nursing, team ; Professional autonomy ; Burnout, professional ; Interprofessional relations 

Variables	Means
	Intensity				Freq Geral
	Assist	Tech	Nurse	Geral	Freq Geral
Lack of competence of the working team				4.05	2.47
q25 – To work with nursing technician/assistants lacking the necessary competence for the needed condition of the patient.	4.1	3.93	4.46	4.06	2.43
q26 – To work with Medical or Nursing students lacking the necessary competence for the needed condition of the patient.	4.38	3.89	4.37	4.04	2.53
q27 – To work with physicians lacking the necessary competence for the needed condition of the patient.	4.66	3.92	4.69	4.15	2.6
q28 – To work with support services physicians lacking the necessary competence for the needed condition of the patient.	4.07	3.8	4.28	3.93	2.61
q29 – To work with nurses lacking competence to act.	4.17	3.93	4.27	4.02	2.25
q31 – To work with physicians lacking competence to act.	3.93	4.05	4.69	4.17	2.45
q32 –To work with support services lacking competence to act.	3.89	3.82	4.37	3.95	2.37
q33 –To work with Medical and Nursing students lacking competence to act.	4.07	4.02	4.53	4.13	2.5
Disrespect to the patient’s autonomy				3.47	1.81
q17 – To follow the medical order of not telling the truth to the patient, even when the patient asks you the truth.	4.31	3.79	4.31	3.95	2.14
q21 – To consider the medical request of not arguing with the patient about his reanimation in case of heart failure.	3.52	3.18	3.76	3.34	1.71
q22 – To consider the medical request of not arguing with the family about the patient’s reanimation in case of heart failure, when the patient is lacking discernment.	3	3.19	3.87	3.32	1.69
q23 – To consider the medical request about not talking about death with a dying patient when he asks you about death.	3.41	3.11	3.85	3.29	1.7
Insufficient working conditions				3.65	2.45
q01 – To improvise when facing the lack of material in the patient’s care.	3.69	3.41	2.96	3.34	2.95
q06 – Not possess the needed materials to care for the patient.	3.66	3.58	3.72	3.61	2.48
q08 – Not possess the needed equipment for a patient urgency care.	4.41	3.7	4.45	3.92	2.26
q14 – The need to prioritize the patients to be cared of due to insufficient human resources.	3.9	3.81	4.45	3.95	2.32
q15 –The need to delegate nursing care to the patient’s family due to insufficient human resources.	3.45	3.32	3.86	3.44	2.25
Therapeutic Obstinacy				3.6	2.31
q05 – To start intensive procedures to save a life, when you believe they will only postpone death.	4.07	3.65	3.44	3.65	2.57
q11 – To assist doctors who are doing procedures in patients after a non-satisfactory cardiorespiratory recovery.	4.34	3.57	3.54	3.63	2.08
q12 – To execute medical prescriptions for the procedure of exams and treatments in terminally ill patients.	3.93	3.4	3.77	3.53	2.29

Variables	Total n=334	Category			P
Variables	Total n=334	Assistant n=29	Technician n=234	Nurse n=71	P
Lack of competence of the working team	4.05	4.16	3.92	4.45	0.02
Disrespect to the patient’s autonomy	3.47	3.56	3.31	3.93	0.02
Insufficient working conditions	3.65	3.82	3.56	3.89	0.16
Therapeutic obstinacy	3.6	4.11	3.54	3.58	0.17
Total moral distress	3.69	3.91	3.58	3.96	0.04

	Lack of competence of the working team			Disrespect to the patient’s autonomy		Insufficient working conditions		Therapeutic obstinacy		Total moral distress
Variables	N	M	P	M	P	M	P	M	P	M	P
Institution
H1	60	4.85	0.000^* *()** Statistical difference at a 5% level	3.88	0.000^* *()** Statistical difference at a 5% level	4.37	0.000^* *()** Statistical difference at a 5% level	4.02	0.000^* *()** Statistical difference at a 5% level	4.28	0.000^* *()** Statistical difference at a 5% level
H2	183	3.96		3.71		3.69		3.74		3.78
H3	91	3.71		2.72		3.1		3.02		3.14
Time to finish education
≥ 5 years	108	4.31	0.018^* *()** Statistical difference at a 5% level	3.52	0.534	3.95	0.002^* *()** Statistical difference at a 5% level	3.77	0.118	3.89	0.025^* *()** Statistical difference at a 5% level
< 5 years	211	3.92		3.4		3.48		3.47		3.57
Permanent education
Yes	181	3.96	0.063	3.44	0.096	3.59	0.372	3.61	0.065	3.65	0.049^* *()** Statistical difference at a 5% level
No	54	4.46		3.87		3.88		3.96		4.04
I don’t know	97	3.98		3.27		3.64		3.34		3.56
Meetings
Yes	146	4.06	0.978	3.42	0.608	3.52	0.106	3.39	0.032^* *()** Statistical difference at a 5% level	3.6	0.192
No	187	4.05		3.51		3.76		3.77		3.77
	Lack of competence of the working team			Disrespect to the patient’s autonomy		Insufficient working conditions		Therapeutic obstinacy		Total moral distress
Variables	N	M	P	M	P	M	P	M	P	M	P
Institution dialogue
Yes	122	3.96	0.157	3.39	0.6	3.35	0.007^* *()** Statistical difference at a 5% level	3.41	0.221	3.53	0.161
No	72	3.87		3.63		3.86		3.77		3.78
Sometimes	140	4.23		3.46		3.81		3.67		3.79
Management dialogue
Yes	192	4.04	0.975	3.48	0.382	3.5	0.047^* *()** Statistical difference at a 5% level	3.48	0.111	3.63	0.266
No	42	4.08		3.75		3.97		4.03		3.96
Sometimes	100	4.07		3.33		3.81		3.64		3.71

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[1] Correspondence: Graziele de Lima Dalmolin  Universidade Federal de Santa Maria, Departamento de Enfermagem . Av. Roraima, 1000 – Prédio 26A Sala 1305B – Camobi . CEP 97105-900 – Santa Maria, RS, Brasil

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Nurses, nursing technicians and assistants: who experiences more moral distress?* * Extracted from the thesis "Sofrimento moral e síndrome de Burnout: relações nas vivências profissionais de trabalhadores de enfermagem", Nursing Graduate Program, Universidade Federal do Rio Grande, 2012.

Enfermeros, técnicos y auxiliares de enfermería: ¿quién experimenta el mayor sufrimiento moral?

Nurses, nursing technicians and assistants: who experiences more moral distress?^* * Extracted from the thesis "Sofrimento moral e síndrome de Burnout: relações nas vivências profissionais de trabalhadores de enfermagem", Nursing Graduate Program, Universidade Federal do Rio Grande, 2012.