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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.

Objective: Understanding the practice of reporting adverse events by health professionals. Method: A qualitative case study carried out in a teaching hospital with participants of the Patient Safety Center and the nursing team. The collection took place from May to December 2015, and was conducted through interviews, observation and documentary research to treat the data using Content Analysis. Results: 31 professionals participated in the study. Three categories were elaborated: The practice of reporting adverse events; Barriers in the effective practice of notifications; The importance of reporting adverse events. Conclusion: Notification was permeated by gaps in knowledge, fear of punishment and informal communication, generating underreporting. It is necessary to improve the interaction between leaders and professionals, with an emphasis on communication and educational practice.

The aim of this study was to investigate the role and influence of nursing in the hospital accreditation process. It is a qualitative study, conducted in a private hospital of Belo Horizonte.The study subjects were nine nurses and 15 nursing technicians. Data collection was through semi-structured interviews, which were subjected to content analysis. The results showed that the role of the nursing team in the accreditation involves care, administrative, educational and research issues. The study subjects presented different perceptions regarding the influence of the accreditation process in their work. The positive aspects of personal growth and valorization of the curriculum were highlighted as well as negative aspects such as stress and little professional valorization. Therefore, it is necessary that the professionals understand the logic of the process and act with a view to the interdisciplinarity and overcoming the fragmentation of care, thus achieving integral healthcare and the quality of care desired.Descriptors: Nursing; Quality of Health Care; Accreditation. La enfermería en hospital en proceso de acreditación: su papel y las consecuencias en el trabajo diarioEste estudio investigó el papel y la influencia de la enfermería en el proceso de acreditación de hospitales. Se trata de un estudio cualitativo realizado en un hospital en Belo Horizonte.Los sujetos del estudio fueron 09 enfermeras y 15 técnicos de enfermería. Los datos fueron recolectados a través de entrevistas semiestructuradas, las que fueron sometidas a análisis de contenido. Los resultados mostraron que la actuación de la enfermería en el proceso de acreditación implica cuestiones relacionadas con la atención, administración, educación e investigación. Los profesionales tenían percepciones diferentes acerca de la influencia del proceso de acreditación en su trabajo. Se destacaron aspectos positivos como el crecimiento personal y el desarrollo del currículo; los negativos fueron estrés y poco desarrollo profesional. Por lo anterior es necesario que los profesionales entiendan la lógica del proceso y actúen con una finalidad interdisciplinaria superando la fragmentación en el cuidado, logrando así la atención integral y la calidad de la atención.Descriptores: Enfermería; Calidad de la Atención de Salud; Acreditación.

The undergraduates in nursing manifest moral distress in different stages of their education, particularly during their professional training. The academic community should reflect and seek solutions for the reality of moral distress in undergraduates.