Vivência do sofrimento moral na enfermagem: percepção da enfermeira

Objetivando conhecer a percepção do sofrimento moral vivenciado, relacionando frequência e intensidade, realizou-se pesquisa Survey, utilizando escala Likert variando de 0 a 6 pontos, com 124 enfermeiras em hospitais do sul do Brasil, no ano de 2008. Mediante questionário autoaplicável e análise fatorial, foram identificados e validados quatro constructos. Os resultados finais foram obtidos através de três diferentes análises: 1) estatística descritiva; 2) análises de variância 3) regressão múltipla. O constructo que apresentou maior intensidade de percepção de vivência do sofrimento moral foi a falta de competência na equipe de trabalho (4,55), seguido pela negação do papel da enfermeira como advogada do paciente (4,30), obstinação terapêutica (3,60) e desrespeito à autonomia do paciente (3,57). Em relação à percepção da frequência do sofrimento moral, destacou-se, novamente, o constructo falta de competência na equipe de trabalho (2,42), seguido da obstinação terapêutica (2,26), negação do papel da enfermeira como advogada do paciente (1,71) e desrespeito à autonomia do paciente (1,42).

Moral distress: challenges for an autonomous nursing professional practice

Constantly experiencing limiting situations that hinder a professional practice coherent with its principles - of autonomy and advocacy of users' interests -, and often conditioned to experience moral distress, the nursing profession plays a prominent role in the current health model because it has the characteristic of managing the care rendered to users in a perspective of social inclusion, both in the basic health network and in hospitals. Aiming at carrying out a reflection on the nursing practice and the difficulties present in its work routine, and considering its characteristics as a profession, this article sought to make a reflection between the practice of nursing and the numerous moral challenges imposed by the routine, resulting, in many cases, in a value crisis that can reverberate directly on the quality of the service rendered, and in abandonment of the ideals of advocacy for users.

Catholic Confession of Sins as Third-Party Moral Enforcement

Catholicism has built up a legalistic religion based on two pillars: salvation by works and 'auricular' confession of sins to a priest with judicial functions. Since the Reformation, many consider auricular confession inferior to less institutional and more individual conceptions of faith. This article analyzes how all these historical solutions trade off specialization advantages against exchange costs to produce moral enforcement. After showing the behavioral foundations of confession and the adaptiveness of its historical evolution, it tests hypotheses on its efficacy, exploitation and opportunity cost. Econometric evidence supports the efficacy but not the exploitative character of Catholic confession. It also explains its secular decline as a consequence of two factors. First, the rise in education, which makes moral self-enforcement less costly. Second, the productivity gap suffered by confession, given its necessarily interpersonal nature.

A Formacao Moral, Profissional e Social Nas Escolas Secundarias de Cabo Verde

O estudo sobre a formação moral, profissional e social nas escolas secundárias de Cabo Verde mostra, substancialmente, o nosso anseio e as nossas aspirações em relação à necessidade de elaborar um instrumento pedagógico e didáctico que tenha por finalidade a orientação, a educação e a formação integral da personalidade dos estudantes adolescentes em fase de crescimento e a sua devida integração e inserção social através da realização de um projecto de vida pessoal e profissional. Partindo desta consideração básica, fizemos uma abordagem abrangente do ponto de vista histórico, teórico, empírico e operativa-didáctico (prospectivo), tendo em conta vários aspectos pessoais, institucionais, sociais, ambientais e culturais que englobam a adolescência nas suas diversas fases de crescimento. E no que se refere ao estudo empírico, os dados reflectem, essencialmente, sobre os alunos do Ensino Secundário, abrangendo a faixa etária de 11 aos 21 anos de idade. Entretanto, as respostas dadas pelos alunos revelam e confirmam algumas ideias hipotéticas à volta das escolas e do perfil dos professores da disciplina de formação pessoal e social. Na generalidade, trata-se de um estudo eminentemente pedagógico, educativo e formativo com o intuito de apoiar os professores e os alunos no desenrolar das suas acções educativas, esperando que, juntos, saberão colocar-se numa atitude de reciprocidade, quer no processo da aprendizagem quer na consolidação e estruturação efectiva e integral da própria personalidade.

Nurses, nursing technicians and assistants: who experiences more moral distress?

Objective: To identify the frequency and intensity of moral distress experienced by nurses, technicians and nursing assistants who worked in hospitals in the South of Rio Grande do Sul State. Method: A survey research was conducted with 334 nursing workers from three institutions, through a questionnaire of moral distress. Constructs were validated through factorial analysis and Cronbach’s alpha: lack of competence of the working team, disrespect to the patient’s autonomy, insufficient working conditions and therapeutic obstinacy. Results: With descriptive statistics and analysis of variance, it was found that nurses and nursing assistants have higher perception of moral distress when compared to nursing technicians. Organizational questions and ways of communication influence lower perception of moral distress.Conclusion: Implementation of actions to favor coping, decision making and autonomy exercise from those workers.


The role of moral values in the economic analysis of crime: A general equilibrium approach

In this paper, we develop a general equilibrium model of crime and show thatlaw enforcement has different roles depending on the equilibrium characterization and the value of social norms. When an economy has a unique stable equilibrium where a fraction of the population is productive and the remaining predates, the government can choose an optimal law enforcement policy to maximize a welfare function evaluated at the steady state. If such steady state is not unique, law enforcement is still relevant but in a completely different way because the steady state that prevails depends on the initial proportions of productive and predator individuals in the economy. The relative importance of these proportions can be changed through law enforcement policy.

Rules or consequences? The role of ethical mindsets in moral dynamics

Recent research on the dynamics of moral behavior has documented two contrastingphenomena - moral consistency and moral balancing. Moral balancing refers to thephenomenon whereby behaving (un)ethically decreases the likelihood of doing so againat a later time. Moral consistency describes the opposite pattern - engaging in(un)ethical behavior increases the likelihood of doing so later on. Three studies supportthe hypothesis that individuals' ethical mindset (i.e., outcome-based versus rule-based)moderates the impact of an initial (un)ethical act on the likelihood of behaving ethicallyin a subsequent occasion. More specifically, an outcome-based mindset facilitates moralbalancing and a rule-based mindset facilitates moral consistency.

Specialization and rent-seeking in moral enforcement: The case of confession

Moral codes are produced and enforced by more or less specialized means and are subject to standard economic forces. This paper argues that the intermediary role played by the Catholic Church between God and Christians, a key difference from Protestantism, faces the standard trade-off of specialization benefits and agency costs. It applies this trade-off hypothesis to confession of sins to priests, an institution that epitomizes such intermediation, showing that this hypothesis fits cognitive, historical and econometric evidence better than a simpler rent-seeking story. In particular, Catholics who confess more often are observed to comply more with the moral code; however, no relationship is observed between mass attendance and moral compliance. The data also links the current decline in confession to the rise in education, which makes moral self-enforcement less costly, and to the productivity gap suffered by confession services, given its necessarily interpersonal nature.

A note on the convergence to competitive equilibria in economies with moral hazard

We examine the conditions under which competitive equilibria can beobtained as the limit, when the number of strategic traders getslarge, of Nash equilibria in economies with asymmetric informationon agents' effort and possibly imperfect observability of agents'trades. Convergence always occur when either effort is publiclyobserved (no matter what is the information available tointermediaries on agents' trades); or effort is private informationbut agents' trades are perfectly observed; or no information at allis available on agents' trades. On the other hand, when eachintermediary can observe its trades with an agent, but not theagent's trades with other intermediaries, the (Nash) equilibriawith strategic intermediaries do not converge to any of thecompetitive equilibria, for an open set of economies. The source ofthe difficulties for convergence is the combination of asymmetricinformation and the restrictions on the observability of tradeswhich prevent the formation of exclusive contractual relationshipsand generate barriers to entry in the markets for contracts.

Moral hazard and non-exclusive contracts

This paper studies equilibria for economies characterized by moral hazard(hidden action), in which the set of contracts marketed in equilibrium isdetermined by the interaction of financial intermediaries.The crucial aspect of the environment that we study is thatintermediaries are restricted to trade non-exclusive contracts: theagents' contractual relationships with competing intermediaries cannot bemonitored (or are not contractible upon). We fully characterize equilibrium allocations and contracts. In thisset-up equilibrium allocations are clearly incentive constrainedinefficient. A robust property of equilibria with non-exclusivity isthat the contracts issued in equilibrium do not implement the optimalaction. Moreover we prove that, whenever equilibrium contracts doimplement the optimal action, intermediaries make positive profits andequilibrium allocations are third best inefficient (where the definitionof third best efficiency accounts for constraints which capture thenon-exclusivity of contracts).