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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.
- 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.
- 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.
- 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.