Contents lists available at ScienceDirect Nurse Education Today journal homepage: www.elsevier.com/locate/nedt The moral deliberation process of college nursing professors in view of moral distress Alessandra Mendes de Barros a , Flávia Regina Souza Ramos a, ⁎ , Priscila Orlandi Barth a , Maria José Menezes Brito b , Heloiza Maria Siqueira Rennó c , Jéssica Mendes Rocha a a Health Science Center, – Federal University of Santa Catarina, Florianópolis, SC, Brazil b Nursing School, – Federal University of Minas Gerais, Belo Horizonte, MG, Brazil c Federal University of São João Del Rei, São João Del Rei, MG, Brazil ABSTRACT Study aim: To discover college nursing professors' deliberation and coping strategies in view of moral distress. Design: Qualitative study with a descriptive and exploratory design. Setting and participants: The participants were 12 college nursing professors who taught at three public universities in Brazil. Methods: The adapted Delphi method was applied. The data were collected in three phases with concomitant data collection and analysis. Findings: Moral distress in teaching can lead to the development of strategies that promote moral deliberation through individual and collective actions, including the defense of principles and dialogue. At the same time, it can produce compensatory mechanisms of preservation and no personal involvement, as well as perceptions of impotence and discouragement, which do not lead to the construction of alternatives of resistance and deliberation. There is no polarization between professor who deliberate or not, as these can be mobile positions taken at certain times and in certain situations, influenced by bonds and support conquered in the group, and not just by leadership and personal characteristics. Conclusion: Dialogue is a fundamental tool for the practice of moral deliberation in the conflicts and challenges of teaching work. Descriptors: Faculty, Nursing; Moral Development; Choice Behavior; Interpersonal Relations. 1. Introduction In view of the restructuring of production modes, increased market competition and constant technological advances, significant changes have been taking place in the world of work (Moraes and Nogueira, 2014). The multiple work environments in the educational area and the various types of university activities include those developed by nursing workers. With regard to the work process of college professors in nursing, demands and overloads permeate this universe, such as: academic production; pedagogical innovations; involvement in research; uni- versity extension; administrative activities (Cupertino et al., 2014; Martins et al., 2013). Lack of time, lack of organizational support, conflicts with other professionals, bullying, academic admission stan- dards, moral harassment, coercive hierarchy, unequal division of tasks, lack of autonomy, lack of interest among students, institutional policies and different ethical and legal limits associated with the decision- making process can make teachers experience what is called moral anguish/distress (Barlem et al., 2013; Emamzadeh Ghasemi et al., 2014; Ganske, 2010; Salminen et al., 2015; Simbula, 2010; Wu et al., 2013). Moral distress was introduced in nursing discussions in the 80's through the philosopher Jameton, who called this phenomenon a psy- chological and physical imbalance that occurs when the nurse experi- ences a situation of moral inquiry, and cannot or is unable to develop the action in a morally correct manner due to the barriers imposed, such as institutional, organizational and relational barriers (Jameton, 2013). With the advancement of discussions about moral distress and stu- dies developed both internationally and in Brazil (McCarthy and Gastmans, 2015), this study encompasses the concept of moral distress as a procedural phenomenon, consisting of ethical-moral elements that interfere in the experience of each individual, these being the moral problem, moral uncertainty, moral sensitivity, moral deliberation and ethical-moral skills. Thus, moral distress is experienced when there is an interruption or failure of the moral deliberation process, generating negative consequences for the professional. At the same time, such in- terruptions or failures can also generate reflections on the deliberation process when the professionals use their ethical-moral competences (Barlem et al., 2014; Borhani et al., 2015; Corley et al., 2005; Dalmolin https://doi.org/10.1016/j.nedt.2018.11.014 Received 3 May 2018; Received in revised form 24 October 2018; Accepted 20 November 2018 ⁎ Corresponding author at: Federal University of Santa Catarina, Campus Reitor João David Ferreira Lima, s/n - Trindade, Florianópolis, - SC 88040-900, Brazil. E-mail address: flavia.ramos@ufsc.br (F.R.S. Ramos). Nurse Education Today 73 (2019) 71–76 0260-6917/ © 2018 Elsevier Ltd. All rights reserved. T