Healthcare Advocacy And Moral Distress In The Practice Of Nurses

Aline Marcelino Ramos; Edison Luiz Devos Barlem; Jamila Geri Tomaschewski Barlem; Laurelize Pereira Rocha; Rosemary Silva da Silveira; Liliane Alves Pereira

doi:10.3823/2578

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

Abstract

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.

References

1. Bu X, Jezewski MA. Developing a mid-range theory of
patient advocacy through concept analysis. J Adv Nurs. 2007;
57(1):101-10.
2. Arries EJ. Patient safety and quality in healthcare: Nursing ethics
for ethics quality. Nursing Ethics. 2014; 21(1):3-5.
3. Selanders L, Crane P. The Voice of Florence Nightingale on
Advocacy. The Online Journal of Issues in Nursing. 2012; 17(1).
4. Negarandeh R. et al. The meaning of patient advocacy for
Iranian nurses. Nurs. Ethics. 2008; 15 (4): 457-67.
5. Barlem ELD. et al. Moral distress in nursing personnel. Rev.
latinoam. enferm. 2013; 21: 79-87.
6. Hanks RG. Development and testing of an instrument to measure
protective nursing advocacy. Nurs Ethics. 2010; 17(2):255-67.
7. Mahlin M. Individual patient advocacy, collective responsibility
and activism within professional nursing associations. Nurs.
ethics. 2010; 17 (2): 247-54.
8. Hanks RG. The medical-surgical nurse perspective of advocate
role. Nurs Forum. 2010; 45(2):97-107.
9. Jameton A. Nursing practice: the ethical issues. Englewood
Cliffs: Prentice-Hall; 1984.
10. Allen R, Cohn TJ, Velasco R, et al. Moral Distress Among
Healthcare Professionals at a Health System. JONAS Healthc
Law Ethics Regul. 2013; 15(3):111-8.
11. Berger JT. Moral Distress in Medical Education and Training.
Journal of General Internal Medicine. 2014; 29,(2):395-398.
12. Barlem ELD. et al. Moral distress in everyday nursing: hidden
traces of power and resistance. Rev. latinoam. enferm. 2013; 21
(1); 293:299.
13. Appolinário F. Metodologia da ciência: filosofia e prática da
pesquisa. 2ª ed. São Paulo: Cengage Learning, 2012.
14. Hill MM, Hill A. Investigação por questionário. Lisboa: Editora
Sí l abo; 2012.
15. Tomaschewski-Barlem JG, Lunardi VL, Barlem ELD, Silveira RS,
Dalmolin GL, Ramos AM. Rev. Cross-cultural adaptation and
validation of the Protective Nursing Advocacy Scale for Brazilian
nurses. Latino-Am. Enfermagem. 2015; 23(4):669-76.
16. Gaya A. Ciências do movimento humano: introdução à
metodologia da pesquisa. Porto Alegre: Artmed, 2008.
17. LaSala CA, Bjarnason, D. Creating Workplace Environments that
Support Moral Courage. Online j. issues nurs. 2010; 15 (3).
18. Edmonson C. Strengthening Moral Courage Among Nurse
Leaders. Online j. issues nurs. 2015; 20 (2).
19. Hamric AB, Borchers CT, Epstein EG. Development and testing
of na instrument to measuremoral distressin healthcare
professionals. AJOB Prim Res. 2012; 3 (2): 1-9.
20. Dalmolin GL, Lunardi VL, Barlem ELD, Silveira RS. Implications of
moral distress on nurses and its similarities with burnout. Text
Context Enferm. 2012; 21(1):200-8.
21. Anke JE, Anneke L, Francke AS, Willems DL. Determinants
of moral distress in daily nursing practice: A cross sectional
correlational questionnaire surveyOriginal. Int. j. nurs. stud.
2013 Jan; 50 (1): 100-108
22. Carnevale FA. Confronting moral distress in Nursing: recognizing
nurses as moral agents. Rev. bras. enferm. 2013; 66.
23. Tomaschewski-Barlem JG, Lunardi VL, Barlem ELD, Ramos AM,
Figueira AB, Fornari NC. Nursing beliefs and actions in exercising
patient advocacy in a hospital context. Rev Esc Enferm USP.2015;
49(5):806-812
24. Jacques, J. P. B. et al. Stress Generators for employees of
surgical nursing center. Semina: Ciências Biológicas e da Saúde,
Londrina. 2015 ago; 36 (1): 25-32.
25. Gomes D, Ramos FRS. Ethics and healthcare professionals’
commitment subsequent to productive restructuration in a
metropolitan region in southern Brazil. Interface comun. saúde
educ. 2014 Mar; 18 (49): 289-300.