Moral distress has been characterised as one of the main ethical problems affecting nurses in all health systems, and has been depicted as a threat to nurses' integrity and to the quality of patient care. In recent years, several studies tried to investigate moral distress, its causes and consequences for health professionals, clients and organisations. However, such studies are considered controversial and vulnerable, mainly because they lack a solid philosophical and empirical basis. The present article aimed at elaborating a theoretical model for moral distress, considering the process of moral deliberation, spaces of power and resistance and patient advocacy, and sought to carry out a reflection that culminated with the creation of a broader concept of moral distress.

Objective: To know the strategies of resistance adopted by nursing staff, facing situations of moral distress, from an ethical perspective. Method: The authors conducted qualitative research through semi-structured interviews, with fifteen nursing staff members of a university hospital in the extreme south of Brazil, using textual discourse analysis and the theoretical reference of Foucault. Results: Two categories were constructed: denial of oneself and the other -in which one perceives that the nursing staff can perform actions that are governed predominantly by immobility and conformism, avoiding confrontations with whoever represents power in situations that provoke moral distress in them; possibility to care for oneself and for the other -in which nursing workers in situations that provoke moral distress for them exercise power and endurance.Conclusion: it was perceived that some professionals seem to use ethical coping strategies, in order to ensure and preserve their professional values. However, often the choice of some nursing professionals may be to relapse into immobility and the absence of building strategies of endurance. This situation may represent their reduced exercise of power and insufficient resistance in the face of ethical problems, contributing to the intensification of their invisibility in the area of health.Descriptors: Burnout, Professional; Power; Ethics; Nursing. IntroductionIn daily professional life, many situations seem to reflect suffering and distress for the nursing staff.We highlight the power relationships with patients, supervisors and the various teams in the health area, involving moral issues and values related to identified fragilities in care, insufficient nursing staff, lack of material resources and the predominantly bureaucratic work organization, cold and technical .

Objective: to analyze the frequency and intensity of moral distress experienced by nursing personnel in southern Brazil, covering elements of their professional practice. Method: a survey was undertaken in two hospitals in Rio Grande do Sul, Brazil, with 247 nurses. Data was collected by means of the adapted Moral Distress Scale. Results: the perception of situations that lead to moral distress is enhanced in nurses and in nursing staff working in institutions with greater openness to dialogue, which hold team meetings, with fewer working hours and a greater ratio of professionals to patients. Conclusion: understanding moral distress allows us to go beyond solving the problems of the workers themselves, enabling the development of an ethics of active individuals and wide opportunities, defined mainly by the relationship with oneself.Descriptors: Nursing; Nursing Ethics; Burnout. Sufrimiento moral en trabajadores de enfermeríaObjetivo: analizar la frecuencia e intensidad del sufrimiento moral vivido por los profesionales de enfermería del sur de Brasil, abarcando los elementos de su rutina profesional. Método:investigación survey en dos hospitales, con 247 profesionales de enfermería. Los datos fueron recolectados mediante aplicación de la adaptación del Moral Distress Scale. Resultados: la percepción de situaciones que conducen al sufrimiento moral es intensificada en enfermeros; en trabajadores de enfermería que actúan en instituciones con mayor apertura al dialogo, que realizan reuniones de equipo, con menos horas de trabajo y mayor relación del número de profesionales por paciente. Conclusión: entender el sufrimiento moral permite ir más allá de la resolución de los problemas de los propios trabajadores, lo que posibilita la elaboración de una ética de sujetos activos y de amplias posibilidades, definidas principalmente por la relación consigo mismo.

Resumo Objetivo refletir sobre as implicações da pandemia de coronavírus na saúde mental dos profissionais de enfermagem e os principais recursos de apoio em desenvolvimento. Método artigo reflexivo, produzido com base na formulação discursiva acerca da saúde mental dos profissionais de enfermagem frente a pandemia de coronavírus, correlacionado com as atuais recomendações de suporte psicológico do Ministério da Saúde, Organização Mundial da Saúde, Organização Pan-Americana da Saúde e Fundação Oswaldo Cruz. Resultados e discussão em resposta à pandemia, uma crise em saúde mental pode estar a ocorrer entre os profissionais de enfermagem. Por estarem, diretamente, ligados ao atendimento de casos do novo coronavírus, experienciam situações estressoras, adicionais àquelas já vivenciadas nos serviços de saúde, incluindo preocupações, medo e insegurança com a saúde de si e da população. Como resultado, foi possível refletir acerca das principais implicações da pandemia para os profissionais de enfermagem e os principais recursos de apoio em desenvolvimento, especialmente relacionados a identificação e manejo de situações estressantes. Conclusões e implicações para a prática uma série de recursos de apoio úteis aos profissionais de enfermagem foram reunidos, com o objetivo de subsidiar estratégias para enfrentar as implicações da pandemia de coronavírus na saúde mental dos profissionais de enfermagem.

OBJECTIVE: to investigate the burnout syndrome and its relationship with demographic and academic variables among undergraduate nursing students at a public university in Southern Brazil. METHOD: a quantitative study with 168 students, by applying an adaptation of the Maslach Burnout Inventory - Student Survey, validated for this study. We used descriptive and variance analysis of the data analysis. RESULTS: we found that students do not have the burnout syndrome, manifesting high average scores in Emotional Exhaustion, low in Disbelief and high in Professional Effectiveness; that younger students who perform leisure activities have greater Professional Effectiveness, unlike students in early grades with no extracurricular activities; combining work and studies negatively influenced only the Professional Effectiveness factor, while the intention of giving up influenced negatively Disbelief and Professional Effectiveness factors. CONCLUSION: the situations that lead students to Emotional Exhaustion need to be recognized, considering the specificity of their study environments.

Realizou-se uma revisão integrativa, com o objetivo de identificar as implicações do sofrimento moral para os(as) enfermeiros(as), aproximações entre sofrimento moral e burnout, e estratégias de enfrentamento do sofrimento moral, na literatura científica nacional e internacional publicada nos últimos 10 anos. As bases de dados foram CINAHL, MEDLINE e SAGE, e as palavras-chave, sofrimento moral, burnout e enfermagem. Obtiveram-se 21 artigos para análise, realizada em quatro etapas: redução, visualização e comparação dos dados, e verificação e esboço da conclusão. Identificou-se que o sofrimento moral vivenciado pelos(as) enfermeiros(as) manifesta-se na dimensão pessoal, com alterações emocionais e físicas, e na dimensão profissional, com insatisfação no trabalho, burnout e abandono da profissão. Constataram-se estratégias de enfrentamento em três dimensões: educativa, comunicativa e organizacional. Considera-se necessário maior exploração dessa temática, contribuindo para a prevenção do sofrimento moral.

Objetivando conhecer a percepção do sofrimento moral vivenciado, relacionando frequência e intensidade, realizou-se pesquisa Survey, utilizando escala Likert variando de 0 a 6 pontos, com 124 enfermeiras em hospitais do sul do Brasil, no ano de 2008. Mediante questionário autoaplicável e análise fatorial, foram identificados e validados quatro constructos. Os resultados finais foram obtidos através de três diferentes análises: 1) estatística descritiva; 2) análises de variância 3) regressão múltipla. O constructo que apresentou maior intensidade de percepção de vivência do sofrimento moral foi a falta de competência na equipe de trabalho (4,55), seguido pela negação do papel da enfermeira como advogada do paciente (4,30), obstinação terapêutica (3,60) e desrespeito à autonomia do paciente (3,57). Em relação à percepção da frequência do sofrimento moral, destacou-se, novamente, o constructo falta de competência na equipe de trabalho (2,42), seguido da obstinação terapêutica (2,26), negação do papel da enfermeira como advogada do paciente (1,71) e desrespeito à autonomia do paciente (1,42).

Objective to identify relationships between moral distress and Burnout in the professional performance from the perceptions of the experiences of nursing workers. Methods this is a survey type study with 375 nursing workers working in three different hospitals of southern Rio Grande do Sul, with the application of adaptations of the Moral Distress Scale and the Maslach Burnout Inventory, validated and standardized for use in Brazil. Data validation occurred through factor analysis and Cronbach's alpha. For the data analysis bivariate analysis using Pearson's correlation and multivariate analysis using multiple regression were performed. Results the existence of a weak correlation between moral distress and Burnout was verified. A possible positive correlation between Burnout and therapeutic obstinacy, and a negative correlation between professional fulfillment and moral distress were identified. Conclusion the need was identified for further studies that include mediating and moderating variables that may explain more clearly the models studied.