Background Health advocacy is crucial for both patients and healthcare professionals. However, nurses who recognize the importance of health advocacy may experience heightened moral distress, particularly in complex donation and transplantation cases where patient autonomy, respect, and advocacy are paramount. Aim To identify the factors contributing to moral distress among nurses working in solid organ transplant units at a university hospital in São Paulo, with a focus on health advocacy. Research Design This descriptive, cross-sectional study employs both quantitative and qualitative (...) methods. For this, the quantitative phase of the study was conducted utilizing the Moral Distress Scale, while the qualitative phase was executed through focus group discussions. Participants and Research Context The quantitative phase involved 15 nurses using the Moral Distress Scale. The qualitative phase consisted of a focus group with 5 nurse managers/coordinators from the transplant units. Quantitative data were analyzed using R® software, while qualitative data were analyzed using Bardin’s Content Analysis. Ethical Considerations The study was approved by the Research Ethics Committee of the Ribeirão Preto College of Nursing, University of São Paulo. Participation was voluntary and confidentiality was ensured. Results A significant correlation was found between moral distress and the factors of “disregard for patient autonomy” ( p =.0100) and “therapeutic obstinacy” ( p =.0492). Conclusion The primary determinants associated with moral distress in the context of health advocacy were identified as “disregard for patient autonomy” and “therapeutic obstinacy.”. (shrink)

We verified moral distress related to organ shortage for transplantation in nursing students. This quantitative pilot study analyzed data from 104 nursing undergraduate students. Data were collected through a survey composed of four questions and two sociodemographic items. The chi-squared test was used to examine categorical variables, whereas continuous variable data were analyzed using ANOVA and the Pearson Product Moment correlational test for determining the existence of moral distress regarding the availability of one heart for four individuals susceptible to heart (...) transplantation. A high level of moral distress was identified with regard to the hypothetical decision-making process, which justifies the need for further studies on the subject. Given the hypothetical scenario, moral distress was observed among the students, reaching severe distress in some cases. Approval CEP-University of Alberta Pro00068610. (shrink)

Background: Organ donation and transplantation represent one of the most important scientific advances over the last decades. Due to the complexity of these procedures and related ethical–legal aspects, however, there are a lot of doubts and uncertainty about the brain death diagnosis and the maintenance of potential organ donor. Aim: To identify and discuss the different meanings and experiences of registered nurses and physicians from an adult intensive care unit in relation to the diagnosis of brain death and the maintenance (...) of potential organ donors for transplantation purposes. Study Design: Participants were registered nurses and physicians from an adult intensive care unit at a University Hospital from Brazil. Data were collected through semi-structured interviews and analyzed using content analysis. Ethical considerations: This study was approved by the University of São Paulo at Ribeirão Preto College of Nursing Research Ethics Committee. Results: Two main categories emerged from the analysis: (1) brain death diagnosis and its implications and (2) maintenance of the potential organ donor and its repercussion in the donation–transplantation process. Six subcategories were also identified: (1.1) understanding the brain death diagnosis as a tool to aid decision-making; (1.2) diagnosis as guarantee of rights; (1.3) difficulties encountered to establish the diagnosis; (1.4) clinical criteria adopted in Brazil and related ethical–legal aspects; (2.1) specificities of care to the brain dead person and outcomes; and (2.2) nurse’s duties toward the brain dead person. Conclusion: Although the brain death diagnosis is scientifically and legally defined in Brazil and the maintenance of the potential organ donor for transplantation purposes has been addressed during the last years, there are still some doubts about the subject, as its understanding varies according to the personal beliefs, culture, and educational background of individuals, including those who work in this scenario. (shrink)