Sufrimiento moral en profesionales de la salud durante la pandemia de COVID-19: una revisión integradora

Autores/as

DOI:

https://doi.org/10.33448/rsd-v11i14.36435

Palabras clave:

Sufrimiento moral; Profesionales de la salud; COVID-19; Moral.

Resumen

Introducción: la pandemia de la COVID-19 trajo varios conflictos morales al contexto de la atención a la salud. La imposibilidad de actuar de la forma que el profesional considere éticamente correcta, debido a barreras externas o internas, puede causar sufrimiento moral. Este fenómeno es perjudicial para la moral profesional y puede afectar la calidad de la atención. Objetivo: analizar qué circunstancias, durante la pandemia de COVID-19, provocaron sufrimiento moral en los profesionales de la salud. Método: esta revisión integrativa de la literatura se realizó con las bases de datos SCIELO y PubMed, utilizando los descriptores “moral distress” y “COVID-19”. Se incluyeron artículos publicados entre 2019-2021, en portugués, español o inglés. Se siguieron los criterios PRISMA. Resultados: De una búsqueda inicial de 171 documentos, 102 fueron revisados ​​completamente y 29 fueron incluidos en esta revisión. Las situaciones que provocaron sufrimiento moral en los profesionales de la salud fueron distribuidas en las siguientes categorías: personales; pacientes y familiares; equipo; y organización La falta de recursos, los tratamientos intermitentes, el miedo a contraer el virus, las restricciones de visitas y la ausencia de lineamientos explícitos fueron algunos de los hechos mencionados en los artículos. Conclusiones: la pandemia de COVID-19 ha provocado sufrimiento moral en los profesionales. El fenómeno puede tener graves consecuencias para la salud de los trabajadores y la atención que estos brindan. Se deben fomentar programas de educación y apoyo, además de estudios adicionales, para minimizar el impacto de las próximas etapas de la pandemia y en futuras ocasiones relacionadas con dilemas éticos.

Citas

Altaker, K. W., Howie-Esquivel, J., & Cataldo, J. K. (2018). Relationships Among Palliative Care, Ethical Climate, Empowerment, and Moral Distress in Intensive Care Unit Nurses. American Journal of Critical Care, 27(4), 295–302. https://doi.org/10.4037/ajcc2018252

Aquino, E. M. L., Silveira, I. H., Pescarini, J. M., Aquino, R., Souza-Filho, J. A., Rocha, A. S., … Lima, R. T. (2020). Medidas de distanciamento social no controle da pandemia de COVID-19: potenciais impactos e desafios no Brasil. Ciencia e Saude Coletiva, 25 (suppl 1), 2423–2446. https://doi.org/10.1590/1413-81232020256.1.10502020

Berg, S. (2020). 4 ways COVID-19 is causing moral distress among physicians. Retrieved from https://www.ama-assn.org/practice-management/physician-health/4-ways-covid-19-causing-moral-distress-among-physicians#:~:text=With COVID-19%2C the numbers,can lead to moral distress.

Boer, J. C., van Rosmalen, J., Bakker, A. B., & van Dijk, M. (2015). Appropriateness of care and moral distress among neonatal intensive care unit staff: Repeated measurements. Nursing in Critical Care, 21(3), e19–e27. https://doi.org/10.1111/nicc.12206

Browning, E. D., & Cruz, J. S. (2018). Reflective Debriefing: A Social Work Intervention Addressing Moral Distress among ICU Nurses. Journal of Social Work in End-of-Life and Palliative Care, 14 (1), 44-72. https://doi.org/10.1080/15524256.2018.1437588

Butler, C. R., Wong, S. P. Y., Wightman, A. G., & O’Hare, A. M. (2020). US Clinicians’ Experiences and Perspectives on Resource Limitation and Patient Care During the COVID-19 Pandemic. JAMA Network Open, 3(11), e2027315. https://doi.org/10.1001/jamanetworkopen.2020.27315

Corradi-Perini, C., Beltrão, J. R., & Ribeiro, U. R. V. de C. O. (2020). Circumstances Related to Moral Distress in Palliative Care: An Integrative Review. American Journal of Hospice and Palliative Medicine, 1–7. https://doi.org/10.1177/1049909120978826

Dantas, C. D. R., Azevedo, R. C. S. de, Vieira, L. C., Côrtes, M. T. F., Federmann, A. L. P., Cucco, L. da M., … Cassorla, R. M. S. (2020). O luto nos tempos da COVID -19 : desafios do cuidado durante a pandemia. Revista Latinoamericana de Psicopatología Fundmaental, 23(3), 509–533. https://doi.org/10.1590/1415-4714.2020v23n3p509.5.

Ditwiler, R., Swisher, L., & Hardwick, D. (2021). Professional and Ethical Issues in United States Acute Care Physical Therapists Treating Patients With COVID-19: Stress, Walls, and Uncertainty. Phys Ther., 101(8). https://doi.org/10.1093/ptj/pzab122

Doherty, A. M., Colleran, G. C., Durcan, L., Irvine, A. D., & Barrett, E. (2021). A pilot study of burnout and long covid in senior specialist doctors. Irish Journal of Medical Science (1971 -), (0123456789). https://doi.org/10.1007/s11845-021-02594-3

Donkers, M. A., Gilissen, V. J. H. S., Candel, M. J. J. M., van Dijk, N. M., Kling, H., Heijnen-Panis, R., … van Mook, W. N. K. A. (2021). Moral distress and ethical climate in intensive care medicine during COVID-19: a nationwide study. BMC Medical Ethics, 22(1), 73. https://doi.org/10.1186/s12910-021-00641-3

Ducharlet, K., Trivedi, M., Gelfand, S. L., Liew, H., McMahon, L. P., Ashuntantang, G., … Martin, D. E. (2021). Moral Distress and Moral Injury in Nephrology During the COVID-19 Pandemic. Seminars in Nephrology, 41(3), 253–261. https://doi.org/10.1016/j.semnephrol.2021.05.006

Epstein, E. G., Whitehead, P. B., Prompahakul, C., Thacker, L. R., & Hamric, A. B. (2019). Enhancing Understanding of Moral Distress: The Measure of Moral Distress for Health Care Professionals. AJOB Empirical Bioethics. https://doi.org/10.1080/23294515.2019.1586008

Estes, B. A., Varghese, J. J., Jacques, J., & Naidu, S. S. (2021). Logistical, Financial, and Psychological Impact of the COVID-19 Pandemic on Cardiac Catheterization Lab Nurses and Technologists: A U.S. National Survey. The Journal of Invasive Cardiology, 33 (1), 9-15.

Evans, A. M., Jonas, M., & Lantos, J. (2020). Pediatric palliative care in a pandemic: Role obligations, moral distress, and the care you can give. Pediatrics, 146(1). https://doi.org/10.1542/peds.2020-1163

Faro, A., Bahiano, M. de A., Nakano, T. de C., Reis, C., Silva, B. F. P., & Vitti, L. S. (2020). COVID-19 e saúde mental: a emergência do cuidado. Estud. Psicol., 37, e200074. https://doi.org/10.1590/1982-0275202037e200074

Gopichandran, V. (2020). Clinical ethics during the Covid-19 pandemic: Missing the trees for the forest. Indian Journal of Medical Ethics, 05(03), 182–187. https://doi.org/10.20529/ijme.2020.053

Gray, K., Dorney, P., Hoffman, L., & Crawford, A. (2021). Nurses’ pandemic lives: A mixed-methods study of experiences during COVID-19. Applied Nursing Research, 60. https://doi.org/10.1016/j.apnr.2021.151437

Guan, T., Nelson, K., Otis-Green, S., Rayton, M., Schapmire, T., Wiener, L., & Zebrack, B. (2021). Moral Distress Among Oncology Social Workers. JCO Oncology Practice, 17(7), e947–e957. https://doi.org/10.1200/op.21.00276

Hesselink, G., Straten, L., Gallée, L., Brants, A., Holkenborg, J., Barten, D. G., & Schoon, Y. (2021). Holding the frontline: a cross-sectional survey of emergency department staff well-being and psychological distress in the course of the COVID-19 outbreak. BMC Health Services Research, 21(1), 525. https://doi.org/10.1186/s12913-021-06555-5

Hines, S. E., Chin, K. H., Levine, A. R., & Wickwire, E. M. (2020). Initiation of a survey of healthcare worker distress and moral injury at the onset of the COVID-19 surge. American Journal of Industrial Medicine, 63(9), 830–833. https://doi.org/10.1002/ajim.23157

Jameton, A. (1984). Nursing practice, the ethical issues. Englewood Cliffs: Prentice-Hall.

Kimhi, S., Eshel, Y., Marciano, H., & Adini, B. (2020). A renewed outbreak of the COVID−19 pandemic: A longitudinal study of distress, resilience, and subjective well-being. International Journal of Environmental Research and Public Health, 17(21), 1–13. https://doi.org/10.3390/ijerph17217743

Kok, N., van Gurp, J., Teerenstra, S., van der Hoeven, H., Fuchs, M., Hoedemaekers, C., & Zegers, M. (2021). Coronavirus Disease 2019 Immediately Increases Burnout Symptoms in ICU Professionals. Critical Care Medicine, 49 (3), 419–427. https://doi.org/10.1097/ccm.0000000000004865

Kreh, A., Brancaleoni, R., Magalini, S. C., Chieffo, D. P. R., Flad, B., Ellebrecht, N., & Juen, B. (2021). Ethical and psychosocial considerations for hospital personnel in the Covid-19 crisis: Moral injury and resilience. PLoS ONE, 16(4). https://doi.org/10.1371/journal.pone.0249609

Lake, E. T., Narva, A. M., Holland, S., Smith, J. G., Cramer, E., Rosenbaum, K. E. F., … Rogowski, J. A. (2021). Hospital nurses’ moral distress and mental health during COVID-19. Journal of Advanced Nursing. https://doi.org/10.1111/jan.15013

Maaskant, J. M., Jongerden, I. P., Bik, J., Joosten, M., Musters, S., Storm-Versloot, M. N., … Eskes, A. M. (2020). Strict isolation requires a different approach to the family of hospitalised patients with COVID-19: A rapid qualitative study. International Journal of Nursing Studies, 117, 103858. https://doi.org/10.1016/j.ijnurstu.2020.103858

Maffoni, M., Argentero, P., Giorgi, I., Hynes, J., & Giardini, A. (2018). Healthcare professionals’ moral distress in adult palliative care: A systematic review. BMJ Supportive and Palliative Care, 9(3), 245-254. https://doi.org/10.1136/bmjspcare-2018-001674

Mazza, M., Attanasio, M., Pino, M. C., Masedu, F., Tiberti, S., Sarlo, M., & Valenti, M. (2020). Moral Decision-Making, Stress, and Social Cognition in Frontline Workers vs. Population Groups During the COVID-19 Pandemic: An Explorative Study. Frontiers in Psychology, 11(November). https://doi.org/10.3389/fpsyg.2020.588159

Mccarthy, J., & Deady, R. (2008). Moral Distress Reconsidered. Nursing Ethics, 15(2), 254–262. https://doi.org/10.1177/0969733007086023.

Meese, K. A., Colón-López, A., Singh, J. A., Burkholder, G. A., & Rogers, D. A. (2021). Healthcare is a Team Sport: Stress, Resilience, and Correlates of Well-Being Among Health System Employees in a Crisis. Journal of Healthcare Management / American College of Healthcare Executives, 66(4), 304–322. https://doi.org/10.1097/JHM-D-20-00288

Miljeteig, I., Forthun, I., Hufthammer, K. O., Engelund, I. E., Schanche, E., Schaufel, M., & Onarheim, K. H. (2021). Priority-setting dilemmas, moral distress and support experienced by nurses and physicians in the early phase of the COVID-19 pandemic in Norway. Nursing Ethics, 28(1), 66–81. https://doi.org/10.1177/0969733020981748

Minayo, M. C. de S. (2014). O Desafio do Conhecimento: pesquisa qualitativa em saúde (14th ed.). São Paulo: Hucitec.

Moock, M., & De Carvalho Mello, P. M. V. (2020). Pandemia COVID-19. Revista Brasileira de Terapia Intensiva, 32(1), 1. https://doi.org/10.5935/0103-507X.20200001

Morley, G., Sese, D., Rajendram, P., & Horsburgh, C. C. (2020). Addressing caregiver moral distress during the COVID-19 pandemic. Cleveland Clinic Journal of Medicine, 1–5. https://doi.org/10.3949/ccjm.87a.ccc047

Nathiya, D., Suman, S., Singh, P., Raj, P., & Tomar, B. S. (2021). Mental Health outcome and Professional quality of Life among Healthcare Worker during COVID-19 pandemic: A (FRONTLINE-COVID) survey. Annales Médico-Psychologiques, 196–202. https://doi.org/10.1016/j.amp.2020.12.017

Ness, M. M., Saylor, J., DiFusco, L. A., & Evans, K. (2021). Leadership, professional quality of life and moral distress during COVID-19: A mixed-methods approach. Journal of Nursing Management, 29 (8), 2412-2422. https://doi.org/10.1111/jonm.13421

Neville, T. H., Wiley, J. F., Yamamoto, M. C., Flitcraft, M., Anderson, B., Randall Curtis, J., & Wenger, N. S. (2015). Concordance of nurses and physicians on whether critical care patients are receiving futile treatment. American Journal of Critical Care, 24(5), 403-410. https://doi.org/10.4037/ajcc2015476

Norman, S., Feingold, J., Kaye-Kauderer, H., Kaplan, C., Hurtado, A., Kachadourian, L., … Pietrzak, R. (2021). Moral distress in frontline healthcare workers in the initial epicenter of the COVID‐19 pandemic in the United States: Relationship to PTSD symptoms, burnout, and psychosocial functioning. Depression and Anxiety, 1007-1017. https://doi.org/10.1002/da.23205.

O’Neal, L., Heisler, M., Mishori, R., & Haar, R. J. (2021). Protecting providers and patients: results of an Internet survey of health care workers’ risk perceptions and ethical concerns during the COVID-19 pandemic. International Journal of Emergency Medicine, 14(1), 18. https://doi.org/10.1186/s12245-021-00341-0

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. The BMJ, 372. https://doi.org/10.1136/bmj.n71

Petrella, A. R., Hughes, L., Fern, L. A., Monaghan, L., Hannon, B., Waters, A., & Taylor, R. M. (2021). Healthcare staff well-being and use of support services during COVID-19: A UK perspective. General Psychiatry, 34(3). https://doi.org/10.1136/gpsych-2020-100458

Rao, H., Mancini, D., Tong, A., Khan, H., Santacruz Gutierrez, B., Mundo, W., … Cervantes, L. (2021). Frontline interdisciplinary clinician perspectives on caring for patients with COVID-19: A qualitative study. BMJ Open, 11(5). https://doi.org/10.1136/bmjopen-2021-048712

Rose, L., Yu, L., Casey, J., Cook, A., Metaxa, V., Pattison, N., … Meyer, J. (2021). Communication and Virtual Visiting for Families of Patients in Intensive Care during COVID19- A UK National Survey .pdf. Ann Am Thorac Soc, 18(10), 1685-1692. https://doi.org/10.1513/AnnalsATS.202012-1500OC.

Silverman, H. J., Kheirbek, R. E., Moscou-Jackson, G., & Day, J. (2021). Moral distress in nurses caring for patients with Covid-19. Nursing Ethics. https://doi.org/10.1177/09697330211003217

Souza, M., Silva, M., & Carvalho, R. (2010). Revisão integrativa: o que é e como fazer. Einstein, 8(1), 102–106. https://doi.org/10.1590/S1679-45082010RW1134.

Sukhera, J., Kulkarni, C., & Taylor, T. (2021). Structural distress: experiences of moral distress related to structural stigma during the COVID-19 pandemic. Perspectives on Medical Education, 10(4), 222–229. https://doi.org/10.1007/s40037-021-00663-y

Sulkowski, J. P. (2020). Reducing Moral Distress in the Setting of a Public Health Crisis. Annals of Surgery, 272(6), e300–e302. https://doi.org/10.1097/SLA.0000000000004480

Descargas

Publicado

27/10/2022

Cómo citar

BELTRÃO, J. R.; FIGUEIREDO, B. de H. .; SACHETIM , G. P. B. .; AIHARA, L. T. .; AIHARA, L. A.; CORRADI-PERINI, C. . Sufrimiento moral en profesionales de la salud durante la pandemia de COVID-19: una revisión integradora. Research, Society and Development, [S. l.], v. 11, n. 14, p. e281111436435, 2022. DOI: 10.33448/rsd-v11i14.36435. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/36435. Acesso em: 17 jul. 2024.

Número

Sección

Ciencias de la salud