Processo de distresse moral de enfermeiros intensivistas: entre desafios éticos, organizacionais e implicações identitárias

Abstract

Ethical-moral experiences in health practice are constant and require professional skill to deal with them. Such situations include the mobilization of subjectivities, modifying the professional and producing impacts on their identity. In the field of ethical-moral experiences, the Moral Distress Process is configured as a complex event that involves the construction of the ethical subject. It ranges from the individual's sensitivity to perceiving and recognizing moral problems when they arise in practice, the deliberative possibilities in conformity or not with his moral judgment, to the analysis of the impacts of the results of the deliberations on the subject. In the context of intensive care centers, the nurse's practice has unique characteristics, involving greater proximity to the patient and his needs, which promotes the experience of ethical and moral experiences and the moral distress process in this professional. This study aimed to understand the experiences of the moral distress process by nurses who work in an intensive care center at a university hospital in Minas Gerais. Specifically, it sought to elucidate the effects of the experiences on the nurse's identity, on the organization and on the relationships established between the team. It is a qualitative research, with a descriptive, interpretive and analytical focus. The interview, with a semi-structured script, was used as an instrument for data collection and thematic content analysis as the method of data analysis. Twelve nurses who worked on the day shifts of the intensive care center participated, and nurses who were licensed and on vacation or who worked on the night shifts were excluded, considering the singularities of the nurse's work in different shifts. The results pointed to the experience of the moral distress process in the nurse's practice, highlighting that the experiences that refer to the experience of moral distress are mainly related to the impossibility of caring as it is believed to be correct. The practice of patient advocacy was referred to as a positive factor in the identity configuration, triggering moral distress when not performed. The expression of ethics in the ICU is related to the process of moral distress, with the organization of work, existing power relations and interpersonal relationships being fundamental elements for understanding this process. Regarding moral deliberations, deliberative obstructions lead to moral distress and deliberative stagnation. Joint deliberation allows nurses to achieve morally correct action according to their moral judgment. The identity impacts of the experience of moral distress were present in the results, including the evidence of ruptures in the face of stagnation. It was concluded that the moral distress process appears in the nurse's practice, with strong identity repercussions for the professional, being strongly influenced by organizational and relational factors. The promotion of interventions that envisage more collaborative practices, dialogue, better definitions of the team members' duties and permanent education can positively influence this process, reducing experiences of moral distress and strengthening the nurse's identity.