La angustia moral y la sensibilidad ética en profesionales de cuidados críticos: Una revisión de alcance
DOI:
https://doi.org/10.1344/rbd2025.63.45061Palabras clave:
sensibilidad ética, personal sanitario, angustia moral, Unidad de Cuidados Intensivos, COVID-19Resumen
Objetivo: Describir y sintetizar la literatura científica publicada entre 2017 y 2023 sobre las repercusiones psicológicas de la angustia moral y la sensibilidad ética en profesionales sanitarios de Unidades de Cuidados Intensivos. Metodología: se diseñó una Revisión de alcance realizando búsquedas en las siguientes bases de datos: Medline,Scopus,Sciencedirect,Dialnet,Scielo. Se utilizaron ecuaciones de búsqueda como: “Effects of moral distress AND health personnel”, “effects of ethical sensitivity AND healthcare personnel”. Se extrajo información sobre variables relacionadas con angustia moral y sensibilidad ética, se diseñó una base de datos para clasificar la información, sintetizarla y realizar un análisis hermenéutico. Resultados: se identificaron factores internos y externos relacionados con angustia moral y sensibilidad ética. Los factores internos fueron frustración, impotencia y enojo; los factores externos estuvieron relacionados con las políticas del hospital, la jerarquía en la UCI y la falta de comunicación. Al sufrir angustia moral y disminuir la sensibilidad ética se identificó falta de empatía y fatiga mental. Sin embargo, hay mayor desarrollo de la sensibilidad ética cuando se realizan actividades grupales para búsqueda de nuevos conocimientos y estrategias de comunicación asertiva. Conclusión: los profesionales sanitarios que trabajan en UCI están expuestos a sufrir angustia moral y su sensibilidad ética se pone a prueba diariamente. A raíz de la pandemia por COVID-19 los desafíos éticos experimentados se hacen más evidentes, esto ha aumentado síntomas de angustia moral como sentimientos de culpa, preocupación y pérdida de confianza. La sensibilidad ética es importante en las UCI para reconocer y comprender los problemas del personal sanitario.
Citas
Alimoradi, Z., Jafari, E., Lin, C.-Y., Rajabi, R., Marznaki, Z. H., Soodmand, M., Potenza, M. N., & Pakpour, A. H. (2023). Estimation of moral distress among nurses: A systematic review and meta-analysis. Nursing Ethics, 30(3), 334-357. https://doi.org/10.1177/09697330221135212.
Altmayer, V., Weiss, N., Cao, A., Marois, C., Demeret, S., Rohaut, B., Guennec, L. L., Altmayer, V., Weiss, N., Cao, A., Goudard, G., Mignon, M., Gilis-Richard, L., Aix, S., Flament, A., Bourmaleau, J., Cadet, E., Marois, C., Demeret, S., … Guennec, L. L. (2021). Coronavirus disease 2019 crisis in Paris: A differential psychological impact between regular intensive care unit staff members and reinforcement workers. Australian Critical Care, 34(2), 142-145. https://doi.org/10.1016/j.aucc.2020.11.005.
Andersson, M., Fredholm, A., Nordin, A., & Engström, Å. (2023). Moral Distress, Health and Intention to Leave: Critical Care Nurses’ Perceptions During COVID-19 Pandemic. SAGE Open Nursing, 9, 23779608231169218. https://doi.org/10.1177/23779608231169218.
Andersson, M., Nordin, A., & Engström, Å. (2022). Critical care nurses’ perception of moral distress in intensive care during the COVID-19 pandemic—A pilot study. Intensive & Critical Care Nursing, 72, 103279. https://doi.org/10.1016/j.iccn.2022.103279.
Bolívar, A. (2020). Análisis del discurso y hermenéutica como métodos en la interpretación de textos. Interpretatio. Revista de Hermenéutica, 5(1), 17-34. https://doi.org/10.19130/iifl.it.2020.5.1.0003.
Boulton, A. J., Slowther, A.-M., Yeung, J., & Bassford, C. (2023). Moral distress among intensive care unit professions in the UK: A mixed-methods study. BMJ Open, 13(4), e068918. https://doi.org/10.1136/bmjopen-2022-068918.
Carola, V., Vincenzo, C., Morale, C., Cecchi, V., Rocco, M., & Nicolais, G. (2022). Psychological Health in Intensive Care Unit Health Care Workers after the COVID-19 Pandemic. Healthcare, 10(11), Article 11. https://doi.org/10.3390/healthcare10112201.
Christodoulou-Fella, M., Middleton, N., Papathanassoglou, E. D. E., & Karanikola, M. N. K. (2017). Exploration of the Association between Nurses’ Moral Distress and Secondary Traumatic Stress Syndrome: Implications for Patient Safety in Mental Health Services. BioMed Research International, 2017, 1-19. https://doi.org/10.1155/2017/1908712.
Colville, G., Dawson, D., Rabinthiran, S., Chaudry-Daley, Z., & Perkins-Porras, L. (2019). A survey of moral distress in staff working in intensive care in the UK. Journal of the Intensive Care Society, 20(3), 196-203. https://doi.org/10.1177/1751143718787753.
Crowe, S., Howard, A. F., Vanderspank-Wright, B., Gillis, P., McLeod, F., Penner, C., & Haljan, G. (2021). The effect of COVID-19 pandemic on the mental health of Canadian critical care nurses providing patient care during the early phase pandemic: A mixed method study. Intensive and Critical Care Nursing, 63, 102999. https://doi.org/10.1016/j.iccn.2020.102999.
da Silva, F. C. T., & Barbosa, C. P. (2021). The impact of the COVID-19 pandemic in an intensive care unit (ICU): Psychiatric symptoms in healthcare professionals. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 110, 110299. https://doi.org/10.1016/j.pnpbp.2021.110299.
Digby, R., Manias, E., Haines, K. J., Orosz, J., Ihle, J., & Bucknall, T. K. (2023). Staff experiences, perceptions of care, and communication in the intensive care unit during the COVID-19 pandemic in Australia. Australian Critical Care, 36(1), 66-76. https://doi.org/10.1016/j.aucc.2022.10.004.
Donkers, M. A., Gilissen, V. J. H. S., Candel, M. J. J. M., van Dijk, N. M., Kling, H., Heijnen-Panis, R., Pragt, E., van der Horst, I., Pronk, S. A., & 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.
Elliott, R., Crowe, L., Pollock, W., & Hammond, N. E. (2023). The impact of the COVID-19 pandemic on critical care healthcare professionals’ work practices and wellbeing: A qualitative study. Australian Critical Care, 36(1), 44-51. https://doi.org/10.1016/j.aucc.2022.10.001.
Fourie, C. (2017). Who Is Experiencing What Kind of Moral Distress? Distinctions for Moving from a Narrow to a Broad Definition of Moral Distress. AMA Journal of Ethics, 19(6), 578-584. https://doi.org/10.1001/journalofethics.2017.19.6.nlit1-1706.
Goktas, S., Aktug, C., & Gezginci, E. (2023). Evaluation of moral sensitivity and moral courage in intensive care nurses in Turkey during the COVID-19 pandemic. Nursing in Critical Care, 28(2), 261-271. https://doi.org/10.1111/nicc.12820.
Goris, G., & Adolf, S. J. (2015). Usefulness and types of literature review. Ene, 9(2), 0-0. https://doi.org/10.4321/S1988-348X2015000200002.
Guillen-Burgos, H. F., Gomez-Ureche, J., Renowitzky, C., Acevedo-Vergara, K., Perez-Florez, M., Villalba, E., Escaf, J., Maloof, D., Torrenegra, R., Medina, P., Dau, A., Salva, S., Perez, A., Tapia, J., Salcedo, S., Maestre, R., Mattar, S., Parra-Saavedra, M., Torres, J., … Galvez-Florez, J. F. (2022). Prevalence and associated factors of mental health outcomes among healthcare workers in Northern Colombia: A cross-sectional and multi-centre study. Journal of Affective Disorders Reports, 10, 100415. https://doi.org/10.1016/j.jadr.2022.100415.
Guttormson, J. L., Calkins, K., McAndrew, N., Fitzgerald, J., Losurdo, H., & Loonsfoot, D. (2022). Critical Care Nurse Burnout, Moral Distress, and Mental Health During the COVID-19 Pandemic: A United States Survey. Heart & Lung: The Journal of Cardiopulmonary and Acute Care, 55, 127-133. https://doi.org/10.1016/j.hrtlng.2022.04.015.
Kalani, Z., Barkhordari-Sharifabad, M., & Chehelmard, N. (2023). Correlation between moral distress and clinical competence in COVID-19 ICU nurses. BMC Nursing, 22(1), 107. https://doi.org/10.1186/s12912-023-01277-x.
Karakachian, A., & Colbert, A. (2018). Angustia moral: Un caso práctico. Nursing (Ed. española), 35(3), 7-9. https://doi.org/10.1016/j.nursi.2018.05.002.
Kubitza, J., Große, G., Schütte-Nütgen, K., & Frick, E. (2023). Influence of spirituality on moral distress and resilience in critical care staff: A scoping review. Intensive and Critical Care Nursing, 76, 103377. https://doi.org/10.1016/j.iccn.2022.103377.
Lamiani, G., Biscardi, D., Meyer, E. C., Giannini, A., & Vegni, E. (2021). Moral Distress Trajectories of Physicians 1 Year after the COVID-19 Outbreak: A Grounded Theory Study. International Journal of Environmental Research and Public Health, 18(24), Article 24. https://doi.org/10.3390/ijerph182413367.
Latimer, A. L., Otis, M. D., Mudd- Martin, G., & Moser, D. K. (2023). Moral distress during COVID-19: The importance of perceived organizational support for hospital nurses. Journal of Health Psychology, 28(3), 279-292. https://doi.org/10.1177/13591053221111850.
Malik, M., Rehan, S. T., Malik, F., Ahmed, J., Fatir, C. A., Hussain, H. ul, Aman, A., & Tahir, M. J. (2022). Factors associated with loss of motivation and hesitation to work amongst frontline health care providers during the COVID-19 pandemic: A cross-sectional survey from a developing country. Annals of Medicine and Surgery, 83, 104766. https://doi.org/10.1016/j.amsu.2022.104766.
Malliarou, M., Nikolentzos, A., Papadopoulos, D., Bekiari, T., & Sarafis, P. (2021). ICU Nurse’s Moral Distress as an Occupational Hazard Threatening Professional Quality of Life in the Time of Pandemic COVID 19. Materia Socio-Medica, 33(2), 88-93. https://doi.org/10.5455/msm.2021.33.88-93.
Manterola, C., Asenjo-Lobos, C., & Otzen, T. (2014). Hierarchy of evidence: Levels of evidence and grades of recommendation from current use. Revista chilena de infectología, 31(6), 705-718. https://doi.org/10.4067/S0716-10182014000600011.
Mantri, S., Lawson, J. M., Wang, Z., & Koenig, H. G. (2020). Identifying Moral Injury in Healthcare Professionals: The Moral Injury Symptom Scale-HP. Journal of Religion and Health, 59(5), 2323-2340. https://doi.org/10.1007/s10943-020-01065-w.
Nazari, S., Poortaghi, S., Sharifi, F., Gorzin, S., & Afshar, P. F. (2022). Relationship between moral sensitivity and the quality of nursing care for the elderly with Covid-19 in Iranian hospitals. BMC Health Services Research, 22(1), 840. https://doi.org/10.1186/s12913-022-08258-x.
Nordin, A., Engström, Å., Fredholm, A., Persenius, M., & Andersson, M. (2023). Measuring moral distress in Swedish intensive care: Psychometric and descriptive results. Intensive and Critical Care Nursing, 76, 103376. https://doi.org/10.1016/j.iccn.2022.103376.
Petrișor, C., Breazu, C., Doroftei, M., Mărieș, I., & Popescu, C. (2021). Association of Moral Distress with Anxiety, Depression, and an Intention to Leave among Nurses Working in Intensive Care Units during the COVID-19 Pandemic. Healthcare (Basel, Switzerland), 9(10), 1377. https://doi.org/10.3390/healthcare9101377.
Pountney, J., Butcher, I., Donnelly, P., Morrison, R., & Shaw, R. L. (2023). How the COVID-19 crisis affected the well-being of nurses working in paediatric critical care: A qualitative study. British Journal of Health Psychology, 28(4), 914-929. https://doi.org/10.1111/bjhp.12661.
Prokopová, T., Hudec, J., Vrbica, K., Stašek, J., Pokorná, A., Štourač, P., Rusinová, K., Kerpnerová, P., Štěpánová, R., Svobodník, A., Maláska, J., Maláska, J., Rusinová, K., Černý, D., Klučka, J., Pokorná, A., Světlák, M., Duška, F., Kratochvíl, M., … RIPE-ICU study group. (2022). Palliative care practice and moral distress during COVID-19 pandemic (PEOpLE-C19 study): A national, cross-sectional study in intensive care units in the Czech Republic. Critical Care, 26(1), 221. https://doi.org/10.1186/s13054-022-04066-1.
Riedel, P.-L., Kreh, A., Kulcar, V., Lieber, A., & Juen, B. (2022). A Scoping Review of Moral Stressors, Moral Distress and Moral Injury in Healthcare Workers during COVID-19. International Journal of Environmental Research and Public Health, 19(3), 1666. https://doi.org/10.3390/ijerph19031666.
Rodriguez-Ruiz, E., Campelo-Izquierdo, M., Boga Veiras, P., Mansilla Rodríguez, M., Estany-Gestal, A., Blanco Hortas, A., Rodríguez-Calvo, M. S., & Rodríguez-Núñez, A. (2022). Impact of the Coronavirus Disease 2019 Pandemic on Moral Distress Among Nurses and Physicians in Spanish ICUs. Critical Care Medicine, 50(5), e487. https://doi.org/10.1097/CCM.0000000000005434.
Romero-García, M., Delgado-Hito, P., Gálvez-Herrer, M., Ángel-Sesmero, J. A., Velasco-Sanz, T. R., Benito-Aracil, L., & Heras-La Calle, G. (2022). Moral distress, emotional impact and coping in intensive care unit staff during the outbreak of COVID-19. Intensive & Critical Care Nursing, 70, 103206. https://doi.org/10.1016/j.iccn.2022.103206.
Scott, H. R., Stevelink, S. A. M., Gafoor, R., Lamb, D., Carr, E., Bakolis, I., Bhundia, R., Docherty, M. J., Dorrington, S., Gnanapragasam, S., Hegarty, S., Hotopf, M., Madan, I., McManus, S., Moran, P., Souliou, E., Raine, R., Razavi, R., Weston, D., … Wessely, S. (2023). Prevalence of post-traumatic stress disorder and common mental disorders in health-care workers in England during the COVID-19 pandemic: A two-phase cross-sectional study. The Lancet. Psychiatry, 10(1), 40-49. https://doi.org/10.1016/S2215-0366(22)00375-3.
Seino, Y., Aizawa, Y., Kogetsu, A., & Kato, K. (2021). Ethical and Social Issues for Health Care Providers in the Intensive Care Unit during the Early Stages of the COVID-19 Pandemic in Japan: A Questionnaire Survey. Asian Bioethics Review, 14(2), 115-131. https://doi.org/10.1007/s41649-021-00194-y.
St Ledger, U., Reid, J., Begley, A., Dodek, P., McAuley, D. F., Prior, L., & Blackwood, B. (2021). Moral distress in end-of-life decisions: A qualitative study of intensive care physicians. Journal of Critical Care, 62, 185-189. https://doi.org/10.1016/j.jcrc.2020.12.019.
Tomaschewisk-Barlem, J. G., Schallenberger, C. D., Ramos-Toescher, A. M., Barlem, E. L. D., Rocha, L. P., & Castanheira, J. S. (2020). Estratégias para o desenvolvimento da sensibilidade moral: Perspectiva dos enfermeiros de unidades de terapia intensiva. Escola Anna Nery, 24, e20190311. https://doi.org/10.1590/2177-9465-EAN-2019-0311.
Torres-Reyes, A., Morales-Castillo, F. A., Contreras-Torres, M. D. R., García-Domínguez, J., Pacheco-Vera, E., Molina-Guzmán, J., Dávila-De-Román, M. A., & Morales-Nieto, E. (2021). Sensibilidad ética en estudiantes versus profesionales de enfermería. Journal Health NPEPS, 6(2), 252-263. https://doi.org/10.30681/252610105652.
van Zuylen, M. L., de Snoo-Trimp, J. C., Metselaar, S., Dongelmans, D. A., & Molewijk, B. (2023). Moral distress and positive experiences of ICU staff during the COVID-19 pandemic: Lessons learned. BMC Medical Ethics, 24(1), 40. https://doi.org/10.1186/s12910-023-00919-8.
Xu, H., Stjernswärd, S., & Glasdam, S. (2021). Psychosocial experiences of frontline nurses working in hospital-based settings during the COVID-19 pandemic—A qualitative systematic review. International Journal of Nursing Studies Advances, 3, 100037. https://doi.org/10.1016/j.ijnsa.2021.100037.
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2024 Daniela Alejandra Giraldo Valencia, Luis Alberto Sánchez-Alfaro
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
Las/os autoras/es conservan los derechos de autoría de los artículos y autorizan a la Universitat de Barcelona a publicarlos en su Revista de Bioética y Derecho y a incluirlos en los servicios de indexación y abstracts, bases de datos académicas y repositorios en los que participa la revista.
Los trabajos publicados en la Revista de Bioética y Derecho están bajo la licencia Creative Commons Reconocimiento - NoComercial - SinObraDerivada 4.0 Internacional (by-nc-nd 4.0), que permite compartir la obra con terceros, siempre que éstos reconozcan su autoría, su publicación inicial en esta revista y las condiciones de la licencia. No se permite un uso comercial de la obra original ni la generación de obras derivadas.
