TEXTO & CONTEXTO

Estudo reflexivo que objetivou propor elementos conceituais para a análise do distresse moral, como processo que articula diversos conceitos da experiência moral. O distresse moral é explorado como fenômeno manifesto em diversos cenários e dimensões do trabalho - cuidado, gestão e educação. Apesar de um conceito relativamente consensual e resultados empíricos comparáveis em vários países, há limitação de estudos que explorem lacunas teóricas, pontos críticos e possibilidades de ampliação do potencial análitico. Na busca por sustentações teóricas consistentes e atualizadas às novas necessidades do campo, o estado da arte foi retomado e um marco conceitual foi delineado para a abordagem do distresse moral como processo que articula variados conceitos ou momentos da experiência moral, como o de incerteza, sensibilidade moral e deliberação moral. A matriz proposta articula o processo de desenvolvimento de competências morais ou de construção do sujeito ético, presentes em discursos pedagógicos e filosóficos que interessam à profissão.
Palavras chave: Ética em enfermagem/ Moral/ Estresse psicológico/ Dano moral.

Estudio reflexivo orientado a proponer elementos conceptuales para la análisis de la angustia moral como un proceso que articula diversos conceptos de la experiencia moral. La angustia moral como fenómeno que se manifiesta es explotada en varios escenarios y dimensiones laborales - cuidado, de gestión y de educación. A pesar de un concepto relativamente consensual y resultados empíricos comparables en varios países, existen pocos estudios que exploran las lagunas teóricas, puntos críticos y las posibilidades de ampliar el potencial analítico. En la búsqueda de apoyos teóricos consistentes y actualizados a las necesidades cambiantes del campo, el estado de la técnica se ha tomado y un marco conceptual fue diseñado para hacer frente a la angustia moral como un proceso que articula diversos conceptos o momentos de la experiencia moral, como la incertidumbre, la sensibilidad deliberación moral y moral. La matriz propuesta se articula el proceso de desarrollo de la competencia moral o construcción del sujeto ético, presente en los discursos pedagógicos y filosóficos de interés para la profesión
Palabras clave: Ética en enfermería/ Morale/ Estrés psicológico/ Daño moral.

The objective of this reflective study was to propose conceptual elements for the analysis of moral distress as a process that articulates various concepts of moral experience. The moral distress is explored as a phenomenon manifested in different scenarios and dimensions of labor - care, management and education. Although a relative consensus exists on the concept and comparable empirical results in several countries, there are limited studies that explore theoretical gaps, critical points and possibilities to expand the analytical potential. In the search for consistent and updated theoretical supports for the changing needs of the field, the state of the art was surveyedn and a conceptual framework was designed to address moral distress as a process that articulates various concepts or moments of moral experience, such as uncertainty, moral sensitivity and moral deliberation. The proposed matrix articulates the development process of moral competencies or the construction of the ethical subject, present in pedagogical and philosophical discourses of interest to the profession.
Key-words: Nursing ethics/ Moral/ Stress psychological/ Moral damage.

1. Jameton A. Nursing practice: the ethical issues. Prentice-Hall: Englewood Cliffs; 1984.

2. Jameton A. Dilems of moral distress: moral responsibility and nursing practice. AWHONNS Clin Issues Perinat Womens Health Nurs. 1993; 4(4):542-51.

3. Epstein EG, Delgado S. Understanding and addressing moral distress. Online J Issues Nurs [online]. 2010 [cited 2014 Fev 02]; 15(3):25-34. Available from:https://www.nursingworld.org/MainMenuCategories/EthicsStandards/Courage-and-Distress/Understanding-Moral-Distress.html

4. Hardingham LB. Integrity and moral residue: Nurses as participants in a moral community. Nurs Philos. 2004 Jul; 5(2):127-34.

5. Lunardi VL, Barlem ELD, Bulhosa MS, Santos SSC, Lunardi Filho WD, Silveira RS, et al. Sofrimento moral e a dimensão ética no trabalho da enfermagem. Rev Bras Enferm. 2009; 62(1):599-603.

6. Barlem ELD, Ramos FRS. Constructing a theoretical model of moral distress. Nurs Ethics. 2015 Aug [cited 2015 Jun 27]; 22(5):608-15. Available from:https://nej.sagepub.com/content/early/2014/10/31/0969733014551595

7. Hamric AB, Davis WS, Childress MD. Moral distress in health care professionals. Pharos. 2006; 69(1):16-23.

8. Corley MC. Nurse moral distress: a proposed theory and research agenda. Nurs Ethics. 2002; 9(6):636-50.

9. Hanks RG. The lived experience of nursing advocacy. Nurs Ethics. 2008; 15(4):468-77.

10. Mitton C, Peacock S, Storch J, Smith N, Cornelissen E. Moral distress among health system managers: exploratory research in two British Columbia health authorities. Health Care Anal. 2011; 19(1):107-21.

11. Gaudine AP, Beaton MR. Employed to go against one's values: nurse managers' accounts of ethical conflict with their organizations. Can J Nurs Res. 2002; 34(2):17-34.

12. Mccarthy J, Gastmans C. Moral distress: A review of the argument-based nursing ethics literature. Nurs Ethics. 2015; 22(1):131-52.

13. Corley MC, Minick P, Elswick RK, Jacobs M. Nurse moral distress and ethical work environment. Nurs Ethics. 2005; 12(4):381-90.

14. Cohen JS, Erikson JM. Ethical dilemmas and moral distress in oncology nursing practice. Clin J Oncol Nurs. 2006 Dec; 10(6):775-80.

15. Mekechuk J. Moral distress in the pediatric intensive care unit: the impact on pediatric nurses. Int J Health Care Qual Assur Inc Leadersh Health Serv. 2006; 19(4-5):i-vi.

16. Ohnishi K, Ohgushi Y, Nakano M, Fujii H, Tanaka H, Kitaoka K, et al. Moral distress experienced by psychiatric nurses in Japan. Nurs Ethics. 2010; 17(6):726-40.

17. Edmonson C. Moral courage and the nurse leader. Online J Issues Nurs [online]. 2010 [cited 2014 Set 21]; 15(3):5-30. Available from: https://www.nursingworld.org/MainMenuCategories/EthicsStandards/Courage-and-Distress/Moral-Courage-for-Nurse-Leaders.html

18. AFT SLK. Moral distress in medical surgical nurses [thesis]. Cullowhee (US): Western Carolina University; 2011.

19. Barlem ELD, Lunardi VL, Lunardi GL, Tomaschewski-Barlem JG, Almeida AS, Hirsch CD. Psycometric characteristics of the Moral Distress Scale in Brazilian nursing professionals. Texto Contexto Enferm. 2014 [cited 2015 Jun 27]; 23(3):563-72. Available from: https://www.scielo.br/scielo.php?pid=S0104-07072014000300563&script=sci_arttext

20. Barlem ELD, Lunardi VL Tomaschewski-Barlem JG, Lunardi GL, Lunardi Filho WD, Schwonke CRGB. Moral distress: challenges for an autonomous nursing professional practice. Rev Esc Enferm USP. 2013; 47(2):506-10.

21. Barlem ELD, Lunardi VL, Lunardi GL, Tomaschewski-Barlem JG, Silveira RS. Moral distress in everyday nursing: hidden traces of power and resistance. Rev Latino-Am Enfermagem. 2013; 21(1):293-9.

22. Dalmolin GL, Lunardi VL, Barlem ELD, Silveira RS. Implications of moral distress on nurses and its similarities with Burnout. Texto Contexto Enferm. 2012; 21(1):200-8.

23. Dalmolin GL, Lunardi VL, Lunardi GL, Barlem ELD, Silveira RS. Moral distress and Burnout syndrome: are there relationships between these phenomena in nursing workers?. Rev Latino-Am Enfermagem. 2014; 22(1):35-42.

24. Dalmolin GL, Lunardi VL, Lunardi GL, Silveira RS, Barlem ELD. Nurses, nursing technicians and assistants: who experiences more moral distress Rev Esc Enferm USP. 2014; 48(3):521-9.

25. Musto LC, Rodney PA, Vanderheide R. Toward interventions to address moral distress: navigating structure and agency. Nurs Ethics. 2015; 22(1):91-102.

26. Johnstone MJ, Hutchinson A. 'Moral distress' - time to abandon a flawed nursing construct? Nurs Ethics. 2015 Feb; 22(1):5-14.

27. Kant I. Sobre a pedagogia. 3ª ed. Piracicaba (SP): UNIMEP; 2002.

28. Foucault M. O sujeito e o poder In: Rabinow P, Dreyfus H. Michel Foucault, uma trajetória filosófica: para além do estruturalismo e da hermenêutica. 2ª ed. Rio de Janeiro (RJ): Forense Universitária; 2012. p. 231-49.

29. Foucault M. O uso das prazeres a as técnicas de si. In: Foucault M. Ética, política, sexulaidade. 2ª ed. Rio de Janeiro (RJ): Forense Univesitaria; 2010. p.192-217.

30. Huang FF, Yang Q, Zhang J, Khoshnood K, Zhang JP. Chinese nurses' perceived barriers and facilitators of ethical sensitivity. Nurs Ethics [internet]. 2015 Mar 29 [cited 2015 Jun 28]. pii: 0969733015574925. Available from: https://nej.sagepub.com/content/early/2015/03/27/0969733015574925

31. Weaver K, Morse J, Mitcham C. Ethical sensitivity in professional practice: concept analysis. J Adv Nurs. 2008 Jun; 62(5):607-18.

32. Corley MC, Elswick RK, Gorman M, Clor T. Development and evaluation of moral distress scale. J Adv Nurs. 2001 Jan; 33(2):250-6.

33. Gutierrez KM. Critical care nurses' perceptions of and responses to moral distress. Dimens Crit Care Nurs. 2005 Sep-Oct; 24(5):229-41.

34. Crisham P. Moral: how can I do what's right? Critical Care Management Edition. Nurs Manage. 1985; 16(3):42A-42N.

35. Schneider DG, Ramos FR. Moral deliberation and nursing ethics cases: Elements of a methodological proposal. Nurs Ethics. 2012; 19(1):764-76