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.

Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.

Objective: to identify the coping strategies of oncology services of nurses in highly complex hospital care before the person with cancer. Method: it is a qualitative research, with 18 nurses in inpatient oncology units and/or outpatient chemotherapy in two cities in southern Brazil, sampled by a snowball and carrying out semi-structured interviews. Data were submitted to thematic analysis. Results: three categories emerged that show strategies such as denial and resignation in care, for support in the health team and the plurality and multiplicity of perspectives on the care, including the patient and his family and the search for personal and professional improvement. Conclusion: coping strategies are expressed in the cultural understanding of what it means to have cancer or not and management of health institutions for nurses to work with satisfaction. The service in education is a major factor in the development of ethical competence.

The student nurses saw themselves both as actors and spectators in situations involving ethical problems and demanding moral deliberation, demonstrating the ability to base their arguments soundly. They tended to emphasise the possibilities offered by dialogue and that different ethical values must be respected to find fair solutions to ethical problems.

o tema da violência contra a mulher é complexo e de difícil abordagem nos serviços de saúde, requerendo dos enfermeiros maior interação e conhecimento sobre o assunto para qualificar a terapêutica dos casos. Conclusão: a pesquisa pode contribuir para a visibilização da violência contra a mulher, no contexto da Atenção Básica, da região em estudo.Descritores: Violência Contra a Mulher, Programa de Educação Permanente, Atenção Básica, Enfermagem. PRIMARY CARE NURSES' PERFORMANCE WITH WOMEN IN SITUATIONS OF VIOLENCEObjective: To identify how primary care nurses act in the cases of women in situations of violence, in a municipality in Pará. ACTUACIÓN DE LOS ENFERMEROS DE LA ATENCIÓN BÁSICA ANTE MUJERES EN SITUACIÓN DE VIOLÊNCIAObjetivo: Identificar cómo los enfermeros de la atención básica actúan ante los casos de mujeres en situación de violencia, en un municipio en Pará. Método: Estudio con abordaje cualitativo. Participaron 10 enfermeras de la Estrategia de Salud de la Familia. Recolección por medio de un grupo focal. Se utilizó el análisis de contenido, resultando en cuatro categorías: Silenciada e Invisibilizada; El SIM de la violencia como cuestión de Salud Pública; El desconocido de la notificación; Saliendo de escena.Resultados: El tema de la violencia contra la mujer es complejo y de difícil abordaje en los servicios de salud, requiriendo de los enfermeros mayor interacción y conocimiento sobre el tema, para calificar la terapéutica de los casos. Conclusión: La investigación puede contribuir a la visibilización de la violencia contra la mujer, en el contexto de la Atención Básica, de la región en estudio.Descriptores: Violencia contra la Mujer, Programa de Educación Permanente, Atención Básica, Enfermería.

Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.

No abstract

Pesquisa qualitativa, tipo estudo de caso, realizada no Núcleo de Cuidados Paliativos do Hospital de Clínicas de Porto Alegre, Brasil, com os objetivos de conhecer como é prestado o cuidado paliativo ao paciente em uma unidade especializada e como a equipe de enfermagem atua junto ao cuidador(a)/familiar para a continuação das medidas de conforto e alívio da dor. Projeto aprovado pelo Comitê Ética em Pesquisa. Procedeu-se a coleta dos dados por observação do funcionamento da unidade e entrevista semiestruturada com enfermeiras e técnicas de enfermagem. Os resultados são apresentados por meio das temáticas: características do Núcleo de Cuidados Paliativos, sua equipe e a interação inicial desta com o paciente e familiares; e os modos de cuidar, a importância da abordagem da dor e da comunicação. Conclui-se que neste tipo de serviço é ressignificado o papel da tecnologia e dos atributos das relações de cuidado, enfatizando valores éticos, como a confiança e a autonomia.