Moral distress in nursing in emergency rooms and hospice care Abstract This article provides

Moral distress in nursing in emergency rooms and hospice care Abstract: This article provides an operational definition of the concept of moral distress in nursing, as a first step in the methodical analysis of the concept. Using the concept described by Walker and Avant (2005), the authors identify the attributes and characteristics of moral distress in nursing and its theoretical application in this profession. Examples of clinical research cases illustrate the concept even more. Additional nursing research needs to prove the theoretical relationships of moral distress and the variables of consequence. Introduction: Death has always been and will be a subject that few want to talk about, however since time immemorial man has worshipped his dead and this has been reflected in the different rituals and forms of burial. Time appears as a line that binds life to death. Death, for many people, inspires fear and respect, is shrouded in an atmosphere of mystery, has an arcane language, hard to decipher, which in turn transmits ambiguous messages that invite to march with her, in search of total peace in a new life without more Death. The anguish of death has been regarded as the deepest anguish of man. Most health care professionals choose this profession to benefit people, who ask for help, but when that helps has to do with the experience of death and mourning, there is something that limits our ability to help. All of us who work in the area of health have suffered a number of losses throughout our lives, and we feel fears about future losses, for example, that of our parents, our children or our partner. As human beings, the members of the health team, we must recognize vulnerable to be able to understand that grieving situations in our patients, because this will affect us. This analysis is directed based on the general theory of self-care of Dorotea Orem. Self-care is a way to take care of your-self. Universal self-care requirements are common to all human beings and include the conservation of air, water, food, elimination, activity and rest, loneliness and healthy social interaction, prevention of risks (physical and emotional) and Promotion of human activity. Using the conceptual analysis method described by Walker and Avant (2005), we explain the meaning of moral distress in hospice nursing and examine its attributes and characteristics. Examples of cases of our research and practice with homeless families that illustrate the concept even more and help us develop a definition. The results of this analysis will improve understanding of the concept and its theory and practical implications for nursing in general. Definitions and uses of the concept: According to Merriam-Webster’s dictionary, it means pain or suffering that affects the body, body or mind, or a state of danger or desperate need. Noun and synonymous with anguish, suffering, misery, agony means the state of being in big trouble. Distress implies an external and usually temporary cause of great physical or mental stress and stress. Its antonym on the other hand refers calm, composure, quietness, tranquility. The study titled, Moral Suffering in nursing staff, a study that uses the qualitative methodology, obtaining information through a discussion group. The number of attendees was six and they worked in different areas. This defines the moral distress as the grouping in three dimensions related to the personal dimension, in relation to the patient and its environment, and finally, by conflicts with the health team. In the phytosociological environment, it has been defined more exactly as the state of distress, more or less permanent, experienced by the subject within a concrete society and culture, when facing a perceived threat as capable of destroying its own integrity Physical or psychosocial, and to which he feels vulnerable and helpless (Montoya Juárez, Schmidt Río-Valle, and Prados Peña, 2006). On the other hand, in the workplace, suffering may be related to the lack of definitions of tasks and functions, abuse of power, promotion of aggressive competition between partners, precarious work, authoritarian style of command, Non-existence of procedures to resolve conflicts, non-existence of acceptable codes of conduct (Dalmolin, Lunardi, Lunardi, Barlem and Silveira, 2014). Another important aspect to consider is the suffering that death generates. The suffering, is the emotional/affective response negative, unpleasant, generated in the highest nervous centers for pain and other situations that psychologically resemble, as loss of loved ones or important objects of love, with the Consequent depression, stress, anxiety and frustration that usually accompanies it. When you experience a loss of a loved one, suffering accompanies the whole process of mourning. Defining attributes and definition of moral distress in emergency rooms and hospice care: Defining attributes, similar to signs and symptoms, are critical features that help differentiate a concept from another related concept and clarify its meaning (Walker & Avant, 2005). Three keys have been identified as defining attributes for the concept of moral distress, which are: • When it causes suffering and pain, in the face of the loss of a patient, • Recognize guilt about the unwanted result. • When resources are limited to a problem, they will improve the patient’s quality of life. Moral distress in hospice nursing; It is defined in this analysis of concept, like the pain, alteration of behavior, suffering or feeling of guilt before the experience or experiencing the process the death of our patients and pain of the relatives. Background The members of the health team are in daily contact with situations of mourning and death in the care centers, therefore, in order to be able to respond to the fears, distress and suffering of the patients before the death, it is necessary to confront one and to have into account the holistic vision in doing that introspection. The World Health Organization (WHO), relates that the interdisciplinary health team will only be able to cope and accept death (the feelings and distress that are experienced in relation to it), if it has sources of support, if it has been able to overcome their own duels and if they have an adequate ability to tolerate stress. In this same order of ideas, it can be argued that the work of the health professional, when faced with situations of significant losses, is to orient healthy the duel, ie, to accompany the person in mourning (including the patient terminal) , by a slow, long and extremely painful path that implies to undo little by little the bond, the relationship with that loved one that is no longer and to keep in the internal world its image, its memory and/or the memory of its life experiences. Unfortunately, in our midst, the health team has been trained to promote health, prolong life, control risks, heal and rehabilitate patients, alleviate physical pain; But not to understand, that sometimes his intervention professional is aimed at helping the sick and his family to face death and grief dignifiedly and to support them in their decisions, which implies facing not only professional and technical problems, but also emotional and spiritual. According to a study titled “It’s a Burden You Carry””: Describing Moral distress in Emergency Nursing