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- Validation of the comprehensiveness of an instrument on ethical problems in primary carePublication . Junges, José Roque; Zóboli, Elma Lourdes Campos Pavone; Schaefer, Rafaela; Nora, Carlise Rigon Dalla; Basso, MikaelaThe study aimed to validate the comprehensiveness of an instrument on the occurrence of ethical problems in primary health care and discuss their results. This is a methodological research. The technique used was Delphi, which seeks to obtain a consensus on a subject by experts, using structured questionnaires that are modified to obtain consensus on the comprehensibility of content. The sample was composed by nine professionals with expertise in primary health care in São Leopoldo. Data collection was in March and April 2011. In the first round, the professional was asked to respond whether the described situation has represented an ethical problem, whether the statement was clear and whether there was any suggestion to rewriting the problem. Were presented thirty-six statements, and to twenty was suggested new rewrite. After the review and systematization the proposed amendments, has begun the second round to seek consensus among all the statements that its writing had changed. In the second round, the consensus required by the method was obtained. Using the method supported significantly to build the instrument in its initial stage, what makes it appropriated and comprehensive for the subsequent steps of the validation.
- Double nursing degree: potentialities and challenges of an international student academic experiencePublication . Nora, Carlise Rigon Dalla; Schaefer, Rafaela; Schveitzer, Mariana Cabral; Zoboli, Elma Lourdes Campos Pavone; Vieira, Margarida MariaObjective: To share the experience of a Double Nursing degree promoted between the Nursing School of the Universidade de São Paulo and the Health Sciences Institute of the Universidade Católica Portuguesa, reflecting on the potentialities and challenges of this opportunity for graduate students. Method: This is an experience report presented in chronological order and of a descriptive nature. The double degree in Nursing was accomplished over a period of 6 months in a different institution from the institution of origin. Results: Among the activities developed during the Double Degree are: participating in examining boards, congresses, seminars, courses, meetings, lectures, colloquium, classes, research groups and technical visits to health services. A table presents and describes the main benefits of the experience experienced by the authors. Conclusion: When well-planned and well-developed, a double degree can promote personal, cultural and professional development of the students, favoring internationalization and contributing to the qualification of graduate programs.
- Competência ética como recurso de enfrentamento do sofrimento moral em enfermagemPublication . Schaefer, Rafaela; Vieira, MargaridaThe study's objectives were: to seek evidence on ethical situations experienced by nurses in the health services; to identify the coping resources which they use; and to ascertain the role of ethical competence in coping with moral distress. The integrative literature review was used as the method. The search was made in the LILACS, IBECS, MEDLINE, SciELO, CINAHL, PubMed, RCAAP and BDTD databases. A total of 23 studies was selected, based on previously established inclusion and exclusion criteria. The results indicate ethical questions experienced by the nurses in their relations with patients and family members, the team and the health system. Coping resources used by the professionals and implemented by the researchers are described. It may be concluded that the ethical challenges and moral distress are present in the nurses' work context, and the strategies aimed at promoting ethical competence, have positive consequences in coping with, and in reducing, levels of moral distress.
- Adolescent and youth health policies in the Portuguese-Brazilian context: specificities and approximationsPublication . Schaefer, Rafaela; Barbiani, Rosangela; Nora, Carlise Rigon Dalla; Viegas, Karin; Leal, Sandra Maria Cezar; Lora, Priscila Schmidt; Ciconet, Rosane; Micheletti, Vania DezotiObjective: To characterize the scientific production on adolescent health policies and programs in Brazil and Portugal in the period 2010-2017. Method: This is a literature review based on the Scoping Review method. The research guidingquestion was: “How is the scientific production on adolescent health policies and programs in Brazil and Portugal characterized?”Search was carried out in October 2017 on the BVS, EBSCO and Google Scholar platforms. Results: Twenty-two studies were selected, namely, 17 Brazilian and 5 Portuguese. Seven cross-cutting thematic categories were identified, as follows: policy and program evaluation; health promotion and education; mental health; sexual and reproductive health; violence; oral health and nutritional health. We canconclude that, albeit in different social contexts, the themes reflect traditional areas of intervention of policies and programs, except for those arising from the phenomenon of structural violence, markedly present in the Brazilian reality. Also, the lack of emerging issues such as gender identities, migratory flows, and morbimortality from external causes reveal a possible care gap in policies and programs and a necessary field to be explored.
- Psychic and moral exhaustion in primary care workersPublication . Pegoraro, Priscilla Brandão Bacci; Schaefer, Rafaela; Zoboli, Elma Lourdes Campos PavoneObjective: To report the experience of developing a workshop proposal to assist local managers with the identification, management and prevention of primary care workers' psychic and moral exhaustion. Method: The workshop was developed through a literature review performed between November 2014 and June 2015. The temporal cut considered studies of the ten previous years. The selection included studies describing collective interventions for situations generating psychic and moral exhaustion, preferably in primary care services. Results: Thirty-five articles were analyzed. The workshop provides five meetings with an average duration of one hour. The themes are: awareness; recognizing personal stress; dealing with personal stress; recognizing team stress; and dealing with team stress. The workshop is based on five key principles: detection and coping; attention to interpersonal relationships; communication; self-knowledge and mindfulness. Conclusion: Psychic and moral exhaustion may reflect negatively on workers' health, the care, and the organization. The proposal of measures to recognize, deal with and prevent psychic and moral exhaustion is relevant and strategic in the constant search for improvement of satisfaction and quality.
- Psychometric evaluation of the Moral Distress Risk Scale: a methodological studyPublication . Schaefer, Rafaela; Zoboli, Elma; Vieira, MargaridaBackground: Moral distress is a kind of suffering that nurses may experience when they act in ways that are considered inconsistent with moral values, leading to a perceived compromise of moral integrity. Consequences are mostly negative and include physical and psychological symptoms, in addition to organizational implications. Objective: To psychometrically test the Moral Distress Risk Scale. Research design: A methodological study was realized. Data were submitted to exploratory factorial analysis through the SPSS statistical program. Participants and research context: In total, 268 nurses from hospitals and primary healthcare settings participated in this research during the period of March to June of 2016. Ethical considerations: This research has ethics committee approval. Findings: The Moral Distress Risk Scale is composed of 7 factors and 30 items; it shows evidence of acceptable reliability and validity with a Cronbach’s α = 0.913, a total variance explained of 59%, a Kaiser–Meyer–Olkin = 0.896, and a significant Bartlett <0.001. Discussion: Concerns about moral distress should be beyond acute care settings, and a tool to help clarify critical points in other healthcare contexts may add value to moral distress speech. Conclusion:Psychometric results reveal that the Moral Distress Risk Scale can be applied in different healthcare contexts.
- Sufrimiento moral en el personal de enfermeríaPublication . Ramos, María Dolores Burguete; Álvarez, Enrique Sáez; Nora, Carlise Rigon Dalla; Schaefer, Rafaela; López-Gómez, Jorge; Berbegal, Pablo Rico; Martínez-Riera, José RamónThe aim of this study is to determine the perception of a group of nurses about the causes of mental suffering in their daily work. Method: This is a study using qualitative methodology, obtaining information through a discussion group. The number of attendees was six and worked in different areas. Results: Moral suffering was grouped into three dimensions related to the personal dimension, in relation to the patient and their environment and ultimately to conflicts with the health team. Conclusions: The conceptualization of moral suffering seems complex, as it is clear from the study a large number of existing factors are involved, in relation to the work environment and the private sphere of individuals. About the latter, factors are related to personality, gender, lack of knowledge and commitment to the profession itself that causes pain when the right conditions to practise are not met.
- Identification of risk factors for moral distress in nurses: basis for the development of a new assessment toolPublication . Schaefer, Rafaela; Zoboli, Elma Lourdes Campos Pavone; Vieira, MargaridaThis article proposes to identify risk factors for moral distress from the literature, validate them through expert analysis and provide the basis for a new tool to assess the risk of moral distress among nurses. Moral distress is related to the psychological, emotional and physiological aspects of nursing. It arises from constraints caused by various circumstances and can lead to significant negative consequences. A scoping review and validation through expert analysis were used. The research question guiding this study was as follows: What is known about risk factors for moral distress in nursing? The research was conducted using multiple sources including electronic databases and lists of references from relevant literature. The final sample consisted of 38 studies. A validation analysis was conducted by experts during December 2014 and June 2015. To exclude a risk factor item, at least 80% of the experts had to agree with the exclusion. In total, 53 risk factors for moral distress were identified, reviewed by the experts and grouped to form a new instrument that may help to identify risk for moral distress and to address its consequences.
- Nursing practices in the primary health care context: a scoping reviewPublication . Barbiani, Rosangela; Nora, Carlise Rigon Dalla; Schaefer, RafaelaObjective: to identify and categorize the practices performed by nurses working in Primary Health Care and Family Health Strategy Units in light of responsibilities established by the profession’s legal and programmatic frameworks and by the Brazilian Unified Health System. Method: a scoping review was conducted in the following databases: LILACS, IBECS, BDENF, CINAHL and MEDLINE, and the Cochrane and SciELO libraries. Original research papers written by nurses addressing nursing practices in the primary health care context were included. Results: the review comprised 30 studies published between 2005 and 2014. Three categories emerged from the analysis: practices in the service; practices in the community; and management and education practices. Conclusion: the challenges faced by nurses are complex, as care should be centered on the population’s health needs, which requires actions at other levels of clinical and health responsibility. Brazilian nursing has achieved important advancements since the implementation of policies intended to reorganize work. There is, however, a need to shift work processes from being focused on individual procedures to being focused on patients so that an enlarged clinic is the ethical-political imperative guiding the organization of services and professional intervention.
- Moral distress in nurses: a description of the risks for professionalsPublication . Schaefer, Rafaela; Zoboli, Elma Lourdes Campos Pavone; Vieira, MargaridaObjective: to describe the profile of nurses and the occurrence and frequency of risk factors regarding moral distress. Method: a quantitative, descriptive, cross-sectional study, with 268 nurses working in hospitals and primary health care units in the Rio Grande do Sul (Brazil), between the months of March and July, 2016. Data collection was performed using the online Google Docs tool. A moral distress risk scale and a set of variables were used to characterize the participants and their context.Results: the sample mainly consisted of young women who worked between 36 and 40 hours a week, with an average monthly income between five and sevem wages and about 10 years of nursing experience. The risk of moral distress was considered moderate, with a considerable percentage of professionals showing an intention to abandon their current job. Conclusion: moral distress is a reality experienced by the nurses under study, and the identification of risk factors is one of the tools used to create coping strategies.