Santos Raissa Passos Dos, Garros Daniel, Carnevale Franco
Ingram School of Nursing, McGill University - Montréal, Quebec, Canada.
Stollery Children's Hospital - Edmonton, Alberta, Canada.
Rev Bras Ter Intensiva. 2018 Apr-Jun;30(2):226-232. doi: 10.5935/0103-507X.20180039.
In an ethical dilemma, there is always an option that can be identified as the best one to be chosen. When it is impossible to adopt such option, the situation can lead professionals to experience moral distress. This review aims to define the issue of moral distress and propose coping strategies. Systematic searches in the MEDLINE/PubMed and SciELO databases were conducted using the keywords "moral distress" and "moral suffering" in articles published between 2000 and 2017. This review was non-exhaustive and contextual, with a focus on definitions, etiologies and methods of resolution for moral distress. In the daily practice of intensive care, moral distress was commonly related to the prolongation of patients' suffering and feelings of helplessness, as well as difficulties in communication among team members. Coping strategies for moral distress included organizational, personal and administrative actions. Actions such as workload management, mutual support among professionals and the development of techniques to cultivate open communication, reflection and questioning within the multidisciplinary team were identified. In clinical practice, health professionals need to be recognized as moral agents, and the development of moral courage was considered helpful to overcome ethical dilemmas and interprofessional conflicts. Both in pediatric and adult intensive care, professionals are challenged by questions about their practice, and they may experience moral distress. This suffering can be minimized and solved by understanding that the focus is always on the patient and acting with moral courage and good communication in an environment of mutual respect.
在伦理困境中，总能找到一个可被视为最佳选择的方案。当无法采用该方案时，这种情况可能会导致专业人员经历道德困扰。本综述旨在界定道德困扰问题并提出应对策略。使用关键词“道德困扰”和“道德痛苦”，对2000年至2017年间发表在MEDLINE/PubMed和SciELO数据库中的文章进行了系统检索。本综述并非详尽无遗且基于具体情境，重点关注道德困扰的定义、病因及解决方法。在重症监护的日常实践中，道德困扰通常与患者痛苦的延长、无助感以及团队成员之间的沟通困难有关。道德困扰的应对策略包括组织、个人和管理行动。确定了诸如工作量管理、专业人员之间的相互支持以及开发在多学科团队中培养开放沟通、反思和质疑的技巧等行动。在临床实践中，卫生专业人员需要被视为道德主体，培养道德勇气被认为有助于克服伦理困境和跨专业冲突。在儿科和成人重症监护中，专业人员都面临着关于其执业的问题的挑战，他们可能会经历道德困扰。通过理解始终以患者为中心，并在相互尊重的环境中以道德勇气和良好沟通采取行动，这种痛苦可以最小化并得到解决。
