Graziele de Lima Dalmolin

Moral distress and Burnout syndrome: are there relationships between these phenomena in nursing workers?

Objective to identify relationships between moral distress and Burnout in the professional performance from the perceptions of the experiences of nursing workers. Methods this is a survey type study with 375 nursing workers working in three different hospitals of southern Rio Grande do Sul, with the application of adaptations of the Moral Distress Scale and the Maslach Burnout Inventory, validated and standardized for use in Brazil. Data validation occurred through factor analysis and Cronbachs alpha. For the data analysis bivariate analysis using Pearsons correlation and multivariate analysis using multiple regression were performed. Results the existence of a weak correlation between moral distress and Burnout was verified. A possible positive correlation between Burnout and therapeutic obstinacy, and a negative correlation between professional fulfillment and moral distress were identified. Conclusion the need was identified for further studies that include mediating and moderating variables that may explain more clearly the models studied.Objetivo: identificar relacoes entre sofrimento moral e sindrome de Burnout nas percepcoes das vivencias de trabalhadores de enfermagem no seu desempenho profissional. Metodos: tratase de uma pesquisa survey com 375 trabalhadores de enfermagem, atuantes em tres distintas instituicoes hospitalares do sul do Rio Grande do Sul, atraves da aplicacao de uma adaptacao do Moral Distress Scale e do Maslach Burnout Inventory, validado e normatizado para uso no Brasil. A validacao dos dados ocorreu via analise fatorial e alfa de Cronbach. Para analise dos dados, procedeu-se a analise bivariada com utilizacao da correlacao de Pearson, e analise multivariada, atraves de regressao multipla. Resultados: verificou-se a existencia de uma correlacao baixa entre o sofrimento moral e a sindrome de Burnout. Identificou-se possivel correlacao positiva entre a obstinacao terapeutica e a sindrome de Burnout, e uma correlacao negativa entre realizacao profissional e sofrimento moral. Conclusao: identificou-se a necessidade de realizacao de novos estudos que incluam variaveis mediadoras e moderadoras que possam explicar mais claramente os modelos estudados.

Sofrimento moral e síndrome de Burnout: existem relações entre esses fenômenos nos trabalhadores de enfermagem?

Objective to identify relationships between moral distress and Burnout in the professional performance from the perceptions of the experiences of nursing workers. Methods this is a survey type study with 375 nursing workers working in three different hospitals of southern Rio Grande do Sul, with the application of adaptations of the Moral Distress Scale and the Maslach Burnout Inventory, validated and standardized for use in Brazil. Data validation occurred through factor analysis and Cronbachs alpha. For the data analysis bivariate analysis using Pearsons correlation and multivariate analysis using multiple regression were performed. Results the existence of a weak correlation between moral distress and Burnout was verified. A possible positive correlation between Burnout and therapeutic obstinacy, and a negative correlation between professional fulfillment and moral distress were identified. Conclusion the need was identified for further studies that include mediating and moderating variables that may explain more clearly the models studied.Objetivo: identificar relacoes entre sofrimento moral e sindrome de Burnout nas percepcoes das vivencias de trabalhadores de enfermagem no seu desempenho profissional. Metodos: tratase de uma pesquisa survey com 375 trabalhadores de enfermagem, atuantes em tres distintas instituicoes hospitalares do sul do Rio Grande do Sul, atraves da aplicacao de uma adaptacao do Moral Distress Scale e do Maslach Burnout Inventory, validado e normatizado para uso no Brasil. A validacao dos dados ocorreu via analise fatorial e alfa de Cronbach. Para analise dos dados, procedeu-se a analise bivariada com utilizacao da correlacao de Pearson, e analise multivariada, atraves de regressao multipla. Resultados: verificou-se a existencia de uma correlacao baixa entre o sofrimento moral e a sindrome de Burnout. Identificou-se possivel correlacao positiva entre a obstinacao terapeutica e a sindrome de Burnout, e uma correlacao negativa entre realizacao profissional e sofrimento moral. Conclusao: identificou-se a necessidade de realizacao de novos estudos que incluam variaveis mediadoras e moderadoras que possam explicar mais claramente os modelos estudados.

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

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.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 Cronbachs alpha: lack of competence of the working team, disrespect to the patients 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.

Sufrimiento moral y síndrome de Burnout: ¿Están relacionados esos dos fenómenos en los trabajadores de enfermería?

Objective to identify relationships between moral distress and Burnout in the professional performance from the perceptions of the experiences of nursing workers. Methods this is a survey type study with 375 nursing workers working in three different hospitals of southern Rio Grande do Sul, with the application of adaptations of the Moral Distress Scale and the Maslach Burnout Inventory, validated and standardized for use in Brazil. Data validation occurred through factor analysis and Cronbachs alpha. For the data analysis bivariate analysis using Pearsons correlation and multivariate analysis using multiple regression were performed. Results the existence of a weak correlation between moral distress and Burnout was verified. A possible positive correlation between Burnout and therapeutic obstinacy, and a negative correlation between professional fulfillment and moral distress were identified. Conclusion the need was identified for further studies that include mediating and moderating variables that may explain more clearly the models studied.Objetivo: identificar relacoes entre sofrimento moral e sindrome de Burnout nas percepcoes das vivencias de trabalhadores de enfermagem no seu desempenho profissional. Metodos: tratase de uma pesquisa survey com 375 trabalhadores de enfermagem, atuantes em tres distintas instituicoes hospitalares do sul do Rio Grande do Sul, atraves da aplicacao de uma adaptacao do Moral Distress Scale e do Maslach Burnout Inventory, validado e normatizado para uso no Brasil. A validacao dos dados ocorreu via analise fatorial e alfa de Cronbach. Para analise dos dados, procedeu-se a analise bivariada com utilizacao da correlacao de Pearson, e analise multivariada, atraves de regressao multipla. Resultados: verificou-se a existencia de uma correlacao baixa entre o sofrimento moral e a sindrome de Burnout. Identificou-se possivel correlacao positiva entre a obstinacao terapeutica e a sindrome de Burnout, e uma correlacao negativa entre realizacao profissional e sofrimento moral. Conclusao: identificou-se a necessidade de realizacao de novos estudos que incluam variaveis mediadoras e moderadoras que possam explicar mais claramente os modelos estudados.

Enfermeiros, técnicos e auxiliares de enfermagem: quem vivencia maior sofrimento moral ?

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.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 Cronbachs alpha: lack of competence of the working team, disrespect to the patients 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.

Moral suffering among nurse educators of technical courses in nursing

OBJECTIVE to understand situations of moral suffering experienced at work by nurse educators of technical courses in nursing. METHOD a qualitative study with discursive textual analysis by means of semi-structured interviews with ten nurse educators at two professional educational institutions in southern Brazil. RESULTS two categories were established: lack of commitment on the part of students to the future profession, expressed through disrespect and disregard for the work of nurse educators, with inappropriate behaviors and attitudes; and lack of commitment to the learning-teaching process, expressed by indifference to the professional profile and lack of interest in lessons and care practices associated with learning gaps. CONCLUSION these situations have an impact on experiences of moral suffering by nurse educators, and show a need for rethinking their practice, relationships, and educational spaces, and implementing strategies to favor the confrontation of dilemmas and conflicts experienced in educational practice in technical courses in nursing.

Incidentes relacionados a medicamentos em um ambulatório de quimioterapia

Dentre os incidentes em saude, os relacionados a medicamentos apresentam-se cada vez mais frequentes nas instituicoes de saude brasileiras. O presente estudo objetivou identificar os incidentes relacionados a medicamentos em um ambulatorio de quimioterapia de um hospital universitario. Estudo transversal, descritivo, com fichas de acompanhamento dos pacientes atendidos no ambulatorio de quimioterapia do Hospital Universitario de Santa Maria, no periodo de junho a agosto de 2016. Para a coleta dos dados, foi utilizado um instrumento de pesquisa dividido em quatro blocos. O bloco A abrange questoes relacionadas a caracterizacao do paciente. O bloco B, contem questoes relacionadas a prescricao medica. O bloco C contem uma questao relacionada a dispensacao dos medicamentos e o bloco D questoes relacionadas a administracao de medicamentos. Os dados coletados foram organizados em planilhas do Statistical Package for the Social Sciences (SPSS) 17.0 for Windows 8. Calculou-se as estatisticas descritivas (media, mediana e desvio padrao) para as variaveis quantitativas e as frequencias absolutas (n) e relativas (%) para as variaveis categoricas. Foram acessados 1403 prontuarios. Destes, 58,4% eram do sexo feminino, na faixa etaria de 53 a 65 anos com media de idade de 57,6 anos. A apresentacao dos resultados baseou-se nas fichas de acompanhamento de 1403 pacientes atendidos no ambulatorio de quimioterapia, na qual foi analisada a prescricao medica, dispensacao dos medicamentos e administracao dos mesmos pela equipe de enfermagem. Os achados demonstraram que: 80% das prescricoes medicas eram informatizadas, 8,1% dos pacientes estavam incorretamente identificados na prescricao, 33,6% das prescricoes nao tinham a identificacao do prescritor, 4,30% das prescricoes tinham a data incorreta, 13,8% das prescricoes continham a escrita ilegivel, 96,2% das prescricoes continham abreviaturas dos medicamentos, doses ou posologia, 34,2% das prescricoes apresentavam medicamentos com nomes semelhantes, 15% das prescricoes nao expressavam corretamente as doses, 98,4 das prescricoes nao apresentavam se o paciente era alergico a algum medicamento, 0,9% das prescricoes nao descreviam as doses dos medicamentos, 37,7% das prescricoes nao apresentavam a duracao correta do tratamento, 16,7% das prescricoes nao apresentavam a posologia dos medicamentos, 97,1% das prescricoes nao apresentavam a diluicao dos medicamentos, 95,2% das prescricoes nao apresentavam o tempo de infusao para determinado medicamento, 1,5% das prescricoes nao descrevia a via de administracao dos medicamentos. Com relacao a dispensacao dos farmacos, 1,5% deles foram dispensados incorretamente. Em 0,6% nao ocorreu o registro da administracao dos medicamentos pela enfermagem sendo que 1,3% dos atendimentos apresentaram reacoes adversas aos farmacos administrados. Os incidentes que causaram danos nos pacientes atendidos apresentaram uma taxa de 0,4%. O numero de incidentes com e sem danos durante as fases de prescricao, dispensacao e administracao dos medicamentos foi 5061. Para tanto, a media de incidentes por atendimento foi de 3,6. Conclui-se que a presente investigacao apresentou dados relevantes sobre a realidade do HUSM frente aos incidentes com medicamentos em ambulatorio de quimioterapia. Portanto, a partir dos resultados evidenciados, espera-se contribuir com o trabalho do enfermeiro no que tange a sua pratica cotidiana e conhecimento teorico a fim de minimizar erros e promover a seguranca do paciente.

Validação de um instrumento de distresse moral em enfermeiras da atenção primária à saúde

ABSTRACT Objective: to validate an instrument to identify situations that trigger moral distress in relation to intensity and frequency in primary health care nurses. Method: this is a methodological study carried out with 391 nurses of primary health care, applied to the Brazilian Scale of Moral Distress in Nurses with 57 questions. Validation for primary health care was performed through expert committee evaluation, pre-test, factorial analysis, and Cronbach’s alpha. Results: there were 46 questions validated divided into six constructs: Health Policies, Working Conditions, Nurse Autonomy, Professional ethics, Disrespect to patient autonomy and Work Overload. The instrument had satisfactory internal consistency, with Cronbach’s alpha 0.98 for the instrument, and between 0.96 and 0.88 for the constructs. Conclusion: the instrument is valid and reliable to be used in the identification of the factors that trigger moral distress in primary care nurses, providing subsidies for new research in this field of professional practice.Objetivo: validar un instrumento para identificar las situaciones desencadenadoras del sufrimiento moral en relacion a la intensidad y frecuencia, en enfermeras de la atencion primaria a la salud. Metodo: estudio metodologico, realizado con 391 enfermeras de la atencion primaria a la salud, aplicado a la Escala Brasilera de Sufrimiento Moral en Enfermeros con 57 preguntas. La validez para la atencion primaria a la salud fue mediante evaluacion de comite de especialistas, realizacion de pre-test, analisis factorial y alfa de Cronbach. Resultados: fueron validadas 46 preguntas divididas en seis constructos: Politicas de Salud, Condiciones de Trabajo, Autonomia de la Enfermera, Competencia etica profesional, Falta de respeto a la autonomia del usuario y Sobrecarga de Trabajo. El instrumento presento consistencia interna satisfactoria, con alfa de Cronbach 0,98 para el instrumento, y entre 0,96 y 0,88 para los constructos. Conclusion: el instrumento es valido y fidedigno para ser utilizado en la identificacion de los factores desencadenadores de sufrimiento moral en enfermeras de la atencion primaria, forneciendo subsidios para nuevas investigaciones en ese campo de actuacion profesional.

Validez de un instrumento de sufrimiento moral en enfermeras de la atención primaria a la salud

ABSTRACT Objective: to validate an instrument to identify situations that trigger moral distress in relation to intensity and frequency in primary health care nurses. Method: this is a methodological study carried out with 391 nurses of primary health care, applied to the Brazilian Scale of Moral Distress in Nurses with 57 questions. Validation for primary health care was performed through expert committee evaluation, pre-test, factorial analysis, and Cronbach’s alpha. Results: there were 46 questions validated divided into six constructs: Health Policies, Working Conditions, Nurse Autonomy, Professional ethics, Disrespect to patient autonomy and Work Overload. The instrument had satisfactory internal consistency, with Cronbach’s alpha 0.98 for the instrument, and between 0.96 and 0.88 for the constructs. Conclusion: the instrument is valid and reliable to be used in the identification of the factors that trigger moral distress in primary care nurses, providing subsidies for new research in this field of professional practice.Objetivo: validar un instrumento para identificar las situaciones desencadenadoras del sufrimiento moral en relacion a la intensidad y frecuencia, en enfermeras de la atencion primaria a la salud. Metodo: estudio metodologico, realizado con 391 enfermeras de la atencion primaria a la salud, aplicado a la Escala Brasilera de Sufrimiento Moral en Enfermeros con 57 preguntas. La validez para la atencion primaria a la salud fue mediante evaluacion de comite de especialistas, realizacion de pre-test, analisis factorial y alfa de Cronbach. Resultados: fueron validadas 46 preguntas divididas en seis constructos: Politicas de Salud, Condiciones de Trabajo, Autonomia de la Enfermera, Competencia etica profesional, Falta de respeto a la autonomia del usuario y Sobrecarga de Trabajo. El instrumento presento consistencia interna satisfactoria, con alfa de Cronbach 0,98 para el instrumento, y entre 0,96 y 0,88 para los constructos. Conclusion: el instrumento es valido y fidedigno para ser utilizado en la identificacion de los factores desencadenadores de sufrimiento moral en enfermeras de la atencion primaria, forneciendo subsidios para nuevas investigaciones en ese campo de actuacion profesional.

Validation of a moral distress instrument in nurses of primary health care

ABSTRACT Objective: to validate an instrument to identify situations that trigger moral distress in relation to intensity and frequency in primary health care nurses. Method: this is a methodological study carried out with 391 nurses of primary health care, applied to the Brazilian Scale of Moral Distress in Nurses with 57 questions. Validation for primary health care was performed through expert committee evaluation, pre-test, factorial analysis, and Cronbach’s alpha. Results: there were 46 questions validated divided into six constructs: Health Policies, Working Conditions, Nurse Autonomy, Professional ethics, Disrespect to patient autonomy and Work Overload. The instrument had satisfactory internal consistency, with Cronbach’s alpha 0.98 for the instrument, and between 0.96 and 0.88 for the constructs. Conclusion: the instrument is valid and reliable to be used in the identification of the factors that trigger moral distress in primary care nurses, providing subsidies for new research in this field of professional practice.Objetivo: validar un instrumento para identificar las situaciones desencadenadoras del sufrimiento moral en relacion a la intensidad y frecuencia, en enfermeras de la atencion primaria a la salud. Metodo: estudio metodologico, realizado con 391 enfermeras de la atencion primaria a la salud, aplicado a la Escala Brasilera de Sufrimiento Moral en Enfermeros con 57 preguntas. La validez para la atencion primaria a la salud fue mediante evaluacion de comite de especialistas, realizacion de pre-test, analisis factorial y alfa de Cronbach. Resultados: fueron validadas 46 preguntas divididas en seis constructos: Politicas de Salud, Condiciones de Trabajo, Autonomia de la Enfermera, Competencia etica profesional, Falta de respeto a la autonomia del usuario y Sobrecarga de Trabajo. El instrumento presento consistencia interna satisfactoria, con alfa de Cronbach 0,98 para el instrumento, y entre 0,96 y 0,88 para los constructos. Conclusion: el instrumento es valido y fidedigno para ser utilizado en la identificacion de los factores desencadenadores de sufrimiento moral en enfermeras de la atencion primaria, forneciendo subsidios para nuevas investigaciones en ese campo de actuacion profesional.