Intensidad y frecuencia de distrés moral en enfermeros brasileños

Ramos, Flavia Regina Souza; Barth, Priscila Orlandi; Brehmer, Laura Cavalcanti de Farias; Dalmolin, Graziele de Lima; Vargas, Mara Ambrosina; Schneider, Dulcinéia Ghizoni

doi:10.1590/S1980-220X2018020703578

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Original Article • Rev. esc. enferm. USP 54 • 2020 • https://doi.org/10.1590/S1980-220X2018020703578 linkcopiar

Intensidad y frecuencia de distrés moral en enfermeros brasileños

Autoría SCIMAGO INSTITUTIONS RANKINGS

Objetivo: Evaluar la frecuencia y la intensidad de distrés moral en enfermeros brasileños.

Método: Estudio transversal desarrollado con enfermeros de los 27 estados brasileños mediante la aplicación de la Escala Brasileña de Distrés Moral y análisis estadístico descriptivo.

Resultados: Participaron en el estudio 1.226 enfermeros brasileños. La intensidad y la frecuencia de distrés moral general fueron evaluadas como nivel moderado, con promedios de 3,08(±1,45) y 2,94(±1,37), respectivamente. Específicamente, la mayor intensidad y frecuencia estuvo relacionada con los factores Reconocimiento, poder e identidad y Equipos de trabajo, mientras que la menor con el factor Defensa de valores y derechos.

Conclusión: Se denota la ocurrencia del distrés moral en ambientes precarios de trabajo y con poca expresividad del papel del enfermero. Se destaca la importancia del problema en términos de su amplitud y multicausalidad, alcanzando a los profesionales que actúan en distintos contextos laborales.

Descriptores:
Ética en Enfermería; Condiciones de Trabajo; Grupo de Atención al Paciente; Moral; Agotamiento Profesional

Country regions	North	Northeast	Midwest	South	Southeast	No answer	Total
Distribution of sample participants (n=1,226)	6.6%	14.1%	8.4%	22.2%	41.9%	6.8	100
Distribution of registered nurses (n=451,666)	6.6%	24.4%	7.9%	13.0%	48.1%	_	100

Variables	Intensity		Frequency
Variables	N	Md (IIq)	n	Md(IIq)
Factor 1 - Acknowledgement, power and professional identity
14 Feeling discriminated by/in relation to other professionals	1163	3.00 (1.00-5.00)	1202	3.00 (1.00-4.00)
15 Feeling unappreciated in relation to other professionals	1161	3.00 (2.00-6.00)	1203	3.00 (2.00-6.00)
16 Executing actions that are not inherent in one's function	1158	3.00 (2.00-6.00)	1199	3.00 (2.00-5.00)
34 Having one's autonomy limited in the decision about the nursing team's specific conducts	1148	3.00 (2.00-5.00)	1191	3.00 (2.00-5.00)
35 Experiencing conflicting relations concerning the health team members' attributions	1160	3.00 (2.00-5.00)	1194	3.00 (2.00-5.00)
36 Working under pressure due to the insufficient time to reach goals or accomplish tasks	1161	3.00 (2.00-6.00)	1196	3.00 (2.00-6.00)
37 Recognizing situations insulting to the professional	1159	3.00 (2.00-6.00)	1193	3.00 (2.00-5.00)
38 Recognizing situations of disrespect for the professional's privacy	1148	3.00 (2.00-5.00)	1196	3.00 (2.00-5.00)
40 Feeling disrespected by hierarchical superiors	1154	3.00 (2.00-6.00)	1196	3.00 (1.00-5.00)
41 Recognizing ethically incorrect attitudes of managers or hierarchical superiors	1153	3.00 (2.00-6.00)	1193	3.00 (2.00-5.00)
43 Feeling pressured by the user due to situation one cannot intervene in	1153	3.00 (2.00-6.00)	1194	3.00 (2.00-5.00)
Factor 2 - Safe and qualified care
23 Recognizing the insufficient service access for the user	1152	3.00 (2.00-6.00)	1204	3.00 (2.00-5.00)
24 Recognizing that the users' welcoming is inadequate	1162	3.00 (2.00-5.00)	1205	3.00 (2.00-5.00)
25 Recognizing that the patient/user's demand for continuing care are not attended	1153	3.00 (2.00-6.00)	1199	3.00 (2.00-5.00)
26 Recognizing the lack of problem-solving ability of health actions due to social problems	1155	3.00 (2.00-6.00)	1194	3.00 (2.00-5.00)
27 Recognizing the lack of problem-solving ability due to the low quality of attendance	1153	3.00 (2.00-5.00)	1196	3.00 (1.00-4.75)
28 Recognizing that educative actions involving the user are insufficient	1155	3.00 (2.00-5.00)	1189	3.00 (2.00-5.00)
29 Experiencing disrespect for the humanized care practices recommended in public policies	1157	3.00 (2.00-5.00)	1196	3.00 (2.00-5.00)
30 Recognizing routines and practices that are inappropriate to professional safety	1160	3.00 (2.00-5.00)	1195	3.00 (2.00-5.00)
31 Recognizing routines and practices that are inappropriate to patient safety	1152	3.00 (2.00-5.00)	1195	3.00 (1.00-5.00)
32 Recognizing routines and practices that are inappropriate to the relatives/companions' safety	1150	2.00 (1.00-4.00)	1197	2.00 (1.00-4.00)
33 Recognizing care impairments due to inappropriate integration among the services/sectors	1152	3.00(2.00-5.00)	1194	3.00 (2.00-5.00)
Factor 3 - Defense of values and rights
39 Experiencing care conducts that ignore the patients' beliefs and culture	1148	1.00 (0-3.00)	1201	1.00 (0-3.00)
42 Feeling pressured to consent or silence in response to frauds for the benefit of the institution	1152	2.00 (0-5.00)	1198	2.00 (0-4.00)
44 Feeling impotent to defend the patient's autonomy	1148	3.00 (1.00-5.00)	1198	3.00 (1.00-4.00)
45 Recognizing situations of disrespect/mistreatment by professionals toward the user	1148	2.00 (1.00-4.00)	1199	2.00 (1.00-3.00)
46 Recognizing situations of disrespect for users' right to privacy/intimacy	1141	2.00 (1.00-4.00)	1194	2.00 (1.00-3.25)
47 Recognizing situations of disrespect for the user's right to confidentiality/secrecy	1147	2.00 (1.00-3.00)	1200	2.00 (1.00-3.00)
48 Recognizing situations of disrespect for patients and relatives' right to information	1147	2.00 (1.00-4.00)	1198	2.00 (1.00-3.00)
49 Feeling unable to defend the user in situations of social vulnerability	1145	2.00 (1.00-4.00)	1199	2.00 (1.00-4.00)
Factor 4 - Work conditions
08 Recognizing that the consumption material is insufficient	1156	3.00 (2.00-6.00)	1202	3.00 (2.00-5.00)
09 Recognizing that the consumption material is unsuitable	1162	3.00 (2.00-5.00)	1206	3.00 (1.00-5.00)
10 Recognizing that the fixed equipment/material available is insufficient	1158	3.00 (2.00-5.00)	1203	3.00 (2.00-5.00)
11 Recognizing that the fixed equipment/material available is unsuitable	1152	3.00 (2.00-5.00)	1206	3.00 (2.00-5.00)
12 Recognizing that the service facilities are insufficient	1152	3.00 (2.00-6.00)	1198	3.00 (2.00-5.00)
13 Recognizing that the service facilities are unsuitable	1153	3.00 (2.00-6.00)	1201	3.00 (2.00-5.00)
Factor 5 - Ethical infractions
17 Experiencing omission by the physician	1160	3.00 (2.00-5.75)	1204	3.00 (2.00-5.00)
18 Experiencing imprudence by the physician	1156	3.00 (1.00-5.00)	1202	3.00 (1.00-4.00)
19 Experiencing omission by the nurse	1153	2.00 (1.00-4.00)	1200	2.00 (1.00-3.00)
20 Experiencing imprudence by the nurse	1155	2.00 (1.00-4.00)	1205	2.00 (1.00-3.00)
21 Experiencing omission by professionals in other categories	1154	2.00 (1.00-4.00)	1202	2.00 (1.00-4.00)
22 Experiencing recklessness by professionals from other categories	1149	2.00 (1.00-4.00)	1206	2.00 (1.00-4.00)
Factor 6 - Work teams
1Working with an insufficient number of professionals to attend to the demand	1155	4.00 (2.00-6.00)	1209	3.00 (2.00-6.00)
2 Working with an incomplete multiprofessional health team	1150	3.00 (2.00-5.00)	1208	3.00 (2.00-5.00)
3 Experiencing conditions of work overload	1159	4.00 (3.00-6.00)	1202	4.00 (2.00-6.00)
4 Working with unprepared physicians	1153	3.00 (2.00-5.00)	1206	3.00 (2.00-5.00)
5 Working with unprepared nurses	1149	3.00 (1.00-5.00)	1207	3.00 (1.00-4.00)
6 Working with unprepared auxiliary nurses and nursing technicians	1157	3.00 (1.00-5.00)	1206	3.00 (1.00-4.00)
7 Working with unprepared professionals from other categories	1161	3.00 (2.00-5.00)	1203	3.00 (2.00-4.00)

Factor	Intensity		Frequency
Factor	µ(±S)	Md(IIq)	µ(±S)	Md(IIq)
Acknowledgement, power and professional identity	3.36(±1.59)*	3.18(2.00-4.74)	3.23(±1.56)*	3.00(1.93-4.55)
Safe and qualified care	3.31(±1.66)	3.18(2.00-4.81)	3.18(±1.61)	3.00(1.91-4.55)
Defense of values and rights	2.47(±1.67)	2.13(1.13-3.50)	2.25(±1.52)	2.00(1.13-3.25)
Work conditions	3.33(±1.78)	3.00(2.00-5.00)	3.22(±1.75)	3.00(1.83-4.83)
Ethical infractions	2.80(±1.74)	2.50(1.33-4.17)	2.54(±1.55)	2.33(1.33-3.67)
Work teams	3.35(±1.55)*	3.29(2.00-4.71)	3.20(±1.50)*	3.14(2.00-4.46)
Overall MD	3.08(±1.45)*	3.00(1.87-4.27)	2.94(±1.37)*	2.89(1.82-4.05)

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E-mail: reeusp@usp.br

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[TFN1] * COFEN (Federal Council of Nursing), 2016.