Problemas éticos na pandemia da COVID-19: visão de enfermeiros gestores em um hospital universitário

Abstract

The general objective of this study was to understand the ethical problems experienced by nurse managers at a university hospital in the context of the COVID-19 pandemic.This is a single case study of qualitative approach that was conducted at the Clinical Hospital of the Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. Nineteen nurse managers participated in the study. Data were collected between August and October 2021 through individual interviews with a semi-structured script and document analysis. Subsequently, the data were analyzed according to the Content Analysis proposed by Bardin and based on the theoretical framework of Alasdair MacIntyre's virtue ethics. Through data analysis five thematic categories emerged: "Ethical problems experienced by nurse managers in the Covid-19 pandemic in a university hospital", "Nurse coordinator: experiences of ethical issues in a university hospital", "Ethical problems of nurse managers in the hospital context: an analysis from the Macintyrian perspective", "Decision making by the nurse manager in the face of the ethical problem", and "Nursing absenteeism: ethical confidences in the administrative notebook during the Covid-19 pandemic". We assume the thesis that ethical problems in the hospital environment are complex to be identified and managed by nurses, causing uncertainties in their actions, and generating losses in team integration, in patient care, with repercussions in managerial decisions. The COVID- 19 pandemic highlighted already existing ethical problems, but also exposed nurses to new situations that compromised work dynamics. The ethical problems experienced in the Covid-19 pandemic are related to duplicity and lack of information; communication; absenteeism and presenteeism of the nursing staff; refusal of reassignment by technicians; nursing professionals who chose to work in the Covid-19 sector and earn additional unhealthy pay and those who did not due to fear of the disease; and conflicts arising from the patient. Furthermore, the data revealed that the nurse managers already experienced the non-recognition of the exercise of the nursing coordination position that generates the invisibility of nursing in the institution. Nurse managers also define ethical problems as an action or behavior that hurts a person's right and does not comply with the institutional code of ethics, norms, and rules. In addition, they report that the ethical problem occurs when care is denied, neglected, and reckless, or when the professional is exposed, assaulted, disrespected, and has his or her conduct questioned. Faced with ethical problems, nurses find it difficult to make decisions, due to the hierarchy of decisions, limited autonomy of nursing, inter professional conflicts, and the unavailability of discussion spaces to improve the nurse's performance. It is concluded that there are ethical problems that compromise the work dynamics of nurse managers that weaken nursing, the organization, and that compromise patient care.