Still, when MD is present and the professional perceives she is powerless to confront the context that causes her suffering, her choice of separation can constitute a barrier to be crossed, not only as an evasive way of facing the problems experienced, but also as a possibility of a positive resistance. Thus, the request for change in work unit can be a strategy to try to ensure the preservation of professional values and continuity of a skilled performance in other environments, avoiding an apparent conformity to what exists, despite the maintenance and continuity of the conditions considered inadequate in the previous work unit.
The highlighted situations demonstrated that no relationship of power existed without resistance, without instability, without flight or escape, without the possibility of an eventual inversion of the intensity of the relationship of forces. The present power relationships among the nursing professionals implied a desire to struggle, confront, an inclination to follow one's own course of action and development, to become effective strategies of action 5.
Possibilities for change in power relationships are concrete realities to the nursing professionals who seek to construct forms of resistence that go beyond a simple acceptance of the context as it appears.
A level of awareness that allows the understanding of the tenuous lines that power weaves in the life of every professional, in their multiple relationships with other beings, becomes necessary to allow them a moral posture consistent with the practice to be exercised The practice identified in interviews as defense of the patients interests, a term related to care and advocacy, showed in its essence an ethical and aesthetic relationship. It was possible to observe in situations in which they used creativity, or when facing adversities from an ethical perspective, that patient advocacy could generate relief for nursing professionals, or differently, greater intensity of MD when the nurses could not perform this role in the manner that matched their ideals 19 and what they believed.
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Patient advocacy is an important dimension of nursing care, and is considered a fundamental value of the profession. Although not an exclusive attribute of nursing, because advocacy is also practiced by other health professionals, it is a role that merits attention in this research. Situations of MD reinforced the need for resistance by nursing staff to act as patient advocates, mainly because of the nature of their work, their proximity to the patient and the character of the continuity of nursing care.
Within situations integral to patient advocacy, they perceived the reinforcement of their autonomy, building relationships of therapeutic care and improving the quality of communication between nursing professinoals and patients Finally, it is understood that, in the daily work, it can be difficult for nursing professionals to recognize, individually, the problems of disrespect for the rights that affect their patients and which they must face.
If the objective of nursing is primarily the care of patients and the protection of their interests, it is emphasized that this target needs to be achieved collectively, because only in this way is nursing enhanced as a profession Along with the problems of daily work faced by the subjects in this research, resulting in situations of MD, it was perceived that some professionals seemed to use ethical coping strategies in order to ensure and preserve their professional values.
However, many times the option of some nurses regressed into immobility and an absence of the construction of ethical strategies of resistance.
This situation may represent their reduced exercise of power and insufficient resistance against ethical problems, contributing to the intensification of their invisibility in the health area. In order to cope with those situations that result in MD, nursing professionals need to exceed dimensions of apparent conformism that, sometimes, they encounter, possibly still believing that the resolution of most problems in their daily work is in the profession itself and not in their relationships, leading to action in an isolated, and not collective, manner.
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It is important to move forward in this context, considering that concrete forms of modification of work environments result from the relationship built with others, the exercise of power relationships and resistance within an ethical perspective, i. Rev Bras Enferm.
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Hardingham LB. Integrity and moral residue: nurses as participants in a moral community. Nurs philos. Registered Nurses' perceptions of moral distress and ethical climate. Nurs Ethics. Rabinow P, Dreyfus H. Foucault and its utilization as scientific production in nursing research. Galiazzi MC, Moraes R. Nursing ethics and its relation with power and work organization. Rev Latino-Am. Foucault M. Vigiar e punir. O uso dos prazeres. A vontade de saber. Ditos e escritos V.
O cuidado de si. Worldview in self-care and care of the other. Enferm Global. Portocarrero V. Rio de Janeiro: Editora Fiocruz; Ditos e escritos IV. Hanks RG. Development and testing of an instrument to measure protective nursing advocacy. Mahlin M.
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Individual patient advocacy, collective responsibility and activism within professional nursing associations. Received: June 23 rd Accepted: Nov. All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License. Services on Demand Journal. She's just shot. Back in September last year, a teaser trailer for the upcoming season dropped, with one very big message: "The situation is critical. His former drug partner and brother in arms must pay for the ultimate betrayal.
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