Healthcare Advocacy And Moral Distress In The Practice Of Nurses

  • Aline Marcelino Ramos Universidade Federal do Rio Grande
  • Edison Luiz Devos Barlem
  • Jamila Geri Tomaschewski Barlem
  • Laurelize Pereira Rocha
  • Rosemary Silva da Silveira
  • Liliane Alves Pereira


Background: By focusing in prioritizing patients and their rights, occasional limitations may arise and prevent nurses from doing their work according to their social and professional commitment. This may culminate in Moral Distress, resulting from the incoherence between the nurses' actions and their personal convictions.

Research question: Is there any relationship between healthcare advocacy and moral distress in the practice of nurses working in hospitals?

Objective: Analyzing the relation between healthcare advocacy and moral distress in the practice of nurses working in hospitals.

Research design: Quantitative, analytical cross-sectional study. The data collection instruments comprise the Moral Distress Scale Revised – Brazilian version and the Protective Nursing Advocacy Scale – Brazilian version. Data analysis was carried out with elements of descriptive statistics, Pearson's correlation and linear regression analysis.

Participants and research context: The participants comprised 157 nurses working in two hospitals located in a city in southern Brazil. One of the institutions is a public university hospital and the other is a philanthropic institution.

Ethical considerations: All the international directives for research with human beings were observed.

Findings: The constructs barriers to the advocacy practice and negative implications to the advocacy practice were pointed out as predictors of moral distress.  

Discussion: The situations approached in this study illustrate that certain organizational and cultural contexts have negative impacts on nurses, who are in constant contact with the necessity of promoting patient well being and increasing access to healthcare, especially under the perception of vulnerability in risk situations, or when the quality of the services provided decreases and patients are not given adequate assistance.

Conclusion: We hope that this study encourages the reflection about the relationship between patient advocacy and moral distress, and the search for resources that may contribute to the quality of the assistance provided by nurses.


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How to Cite
RAMOS, Aline Marcelino et al. Healthcare Advocacy And Moral Distress In The Practice Of Nurses. International Archives of Medicine, [S.l.], v. 11, dec. 2018. ISSN 1755-7682. Available at: <>. Date accessed: 01 june 2023. doi: