Resumo
Objetivo: Este estudo examina a relação entre o sofrimento moral e a liderança de enfermagem, identificando os desafios enfrentados pelos líderes de enfermagem na tomada de decisões éticas. Empregando estruturas teóricas com base empírica e a literatura disponível, esta pesquisa explora como os líderes de enfermagem, posicionados entre a equipe da linha de frente e a administração organizacional, experimentam o sofrimento moral e como esse sofrimento afeta seus processos de tomada de decisão ética. Métodos: Este artigo apresenta um modelo conceitual que descreve a responsabilidade da liderança pela resiliência moral das práticas de enfermagem. É dada atenção ao sofrimento moral dos indivíduos, ao apoio da equipe em dilemas éticos, à criação de um ambiente de prática ética e ao desenvolvimento da liderança para um domínio moralmente resiliente. Resultados: Enfatiza as preocupações éticas nas funções de liderança, o discurso ético estruturado, o apoio à agência moral e as abordagens de construção de resiliência para fortalecer a tomada de decisões éticas em ambientes de saúde. Conclusão: O sofrimento moral da liderança de enfermagem excede os dilemas morais do atendimento individual ao paciente, incluindo preocupações éticas em nível de sistema que afetam os enfermeiros e a política institucional. Uma abordagem multifacetada que inclua conversas éticas sólidas, apoio à agência moral e práticas de resiliência é essencial para reduzir o sofrimento e promover a tomada de decisões éticas.
Referências
Karlsson M, Karlsson C, Barbosa da Silva A, Berggren I, Söderlund M. Community nurses’ experiences of ethical problems in end-of-life care in the patient’s own home. Scand J Caring Sci. 2013; 27(4):831-838. https://doi.org/10.1111/j.1471-6712. 2012.01087.x
DeKeyser Ganz F, Berkovitz K. Surgical nurses’ perceptions of ethical dilemmas, moral distress and quality of care. J Adv Nurs. 2012;68(7):1516-1525. https://doi.org/10.1111/j.1365-2648.2011.05897.x
Epstein EG, Delgado S. Understanding and Addressing Moral Distress. Online J Issues Nurs. 2010;15(3). https://doi.org/10.3912/OJIN.Vol15No0 3Man01
Jameton A. Nursing practice: the ethical issues. Englewood Cliffs: Prentice-Hall; 1984.
Edmonson C. Moral Courage and the Nurse Leader. Online J Issues Nurs. 2010;15(3). https://doi.org/10. 3912/OJIN.Vol15No03Man05
Mitton C, Peacock S, Storch J, Smith N, Cornelissen E. Moral Distress among Healthcare Managers: Conditions, Consequences and Potential Responses. Healthcare policy (Online). 2010;6(2):99-112. https://doi.org/10.12927/hcpol.2010.22036
Storch J, Makaroff KS, Pauly B, Newton L. Take me to my leader: the importance of ethical leadership among formal nurse leaders. Nurs Ethics. 2013;20(2): 150-157. https://doi.org/10.1177/0969733012474291
Li H, Guo J, Ren Z, Bai D, Yang J, Wang W, et al. Moral courage level of nurses: a systematic review and meta-analysis. BMC Nurs. 2024;23:530. https:// doi.org/10.1186/s12912-024-02082-w
Miller PH, Epstein EG, Smith TB, Welch TD, Smith M, Bail JR. Moral distress among nurse leaders: A qualitative systematic review. Nurs Ethics. 2023;30 (7-8):939-959. https://doi.org/10.1177/09697330231 191279
Miller PH. Moral distress among nurse leaders: A conceptual framework. Nurs Ethics. 2025;32(7):2163 -2174. https://doi.org/10.1177/09697330251339420
Kalani Z, Barkhordari-Sharifabad M, Chehelmard N. Correlation between moral distress and clinical competence in COVID-19 ICU nurses. BMC Nurs. 2023;22(1):107. https://doi.org/10.1186/s12912-023-01277-x
Meng J, Guo X. The relationship between ethical leadership, moral sensitivity, and moral courage among head nurses. BMC Nurs. 2025;24(1):538. https://doi.org/10.1186/s12912-025-03170-1
Haghighinezhad G, Atashzadeh-Shoorideh F, Ashktorab T, Mohtashami J, Barkhordari-Sharifabad M. Relationship between perceived organizational justice and moral distress in intensive care unit nurses. Nurs Ethics. 2019;26(2):460-470. https://doi. org/10.1177/0969733017712082
Orgambídez A, Borrego Y, Alcalde FJ, Durán A. Moral Distress and Emotional Exhaustion in Healthcare Professionals: A Systematic Review and Meta-Analysis. Healthcare (Basel). 2025;13(4):393. https://doi.org/10.3390/healthcare13040393
Buchbinder M, Browne A, Berlinger N, Jenkins T, Buchbinder L. Moral Stress and Moral Distress: Confronting Challenges in Healthcare Systems under Pressure. Am J Bioeth. 2024;24(12):8-22. https://doi. org/10.1080/15265161.2023.2224270
Cheraghi R, Valizadeh L, Zamanzadeh V, Hassankhani H, Jafarzadeh A. Clarification of ethical principle of the beneficence in nursing care: an integrative review. BMC Nurs. 2023;22(1):89. https://doi.org/10.1186/s12912-023-01246-4
Storaker A, Heggestad AKT, Sæteren B. Ethical challenges and lack of ethical language in nurse leadership. Nurs Ethics. 2022;29(6):1372-1385. https://doi.org/10.1177/09697330211022415
Epstein EG, Hamric AB. Moral distress, moral residue, and the crescendo effect. J Clin Ethics. 2009; 20(4):330-342. https://doi.org/10.1086/JCE2009204 06
Corley MC. Nurse moral distress: a proposed theory and research agenda. Nurs Ethics. 2002;9(6):636-650. https://doi.org/10.1191/0969733002ne557oa
Wilkinson JM. Moral distress in nursing practice: experience and effect. Nurs Forum. 1987;23(1):16-29. https://doi.org/10.1111/j.1744-6198.1987.tb0079 4.x
Pont J, Stöver H, Wolff H. Dual loyalty in prison health care. Am J Public Health. 2012;102(3):475-480. https://doi.org/10.2105/ajph.2011.300374
Thompson JE, Thompson HO. Bioethical decision making for nurses. Norwalk (CT): Appleton-Century-Crofts; 1985.
Jonsen AR, Siegler M, Winslade WJ. Clinical ethics: A practical approach to ethical decisions in clinical medicine. 7th ed. New York: McGraw-Hill; 2010.
Shapiro JP, Stefkovich JA. Ethical leadership and decision making in education: Applying theoretical perspectives to complex dilemmas. New York: Routledge; 2016.
Brown ME, Treviño LK, Harrison DA. Ethical leadership: A social learning perspective for construct development and testing. Organizational Behavior and Human Decision Processes. 2005;97(2):117-134. https://doi.org/10.1016/j.obhdp.2005.03.002
Rushton CH. Moral resilience: A capacity for navigating moral distress in critical care. AACN Adv Crit Care. 2016;27(1):111-119. https://doi.org/10.403 7/aacnacc2016275
Scott PA, Harvey C, Felzmann H, Suhonen R, Habermann M, Halvorsen K, et al. Resource allocation and rationing in nursing care: A discussion paper. Nurs Ethics. 2019;26(5):1528-1539. https:// doi.org/10.1177/0969733018759831
Haahr A, Norlyk A, Martinsen B, Dreyer P. Nurses experiences of ethical dilemmas: A review. Nurs Ethics. 2020;27(1):258-272. https://doi.org/10.1177/ 0969733019832941
Maunder RG, Heeney ND, Greenberg RA, Jeffs LP, Wiesenfeld LA, Johnstone J, et al. The relationship between moral distress, burnout, and considering leaving a hospital job during the COVID-19 pandemic: a longitudinal survey. BMC Nurs. 2023;22(1):243. https://doi.org/10.1186/s12912-023-01407-5
Andersson H, Svensson A, Frank C, Rantala A, Holmberg M, Bremer A. Ethics education to support ethical competence learning in healthcare: an integrative systematic review. BMC Med Ethics. 2022;23(1):29. https://doi.org/10.1186/s12910-022-0 0766-z
Stucky CH, Wymer JA. Ethical Reasoning as a Core Nurse Leader Competency: Maximizing Strategic Decision-Making and Operational Outcomes. Nurse Lead. 2024;22(2):187-193. https://doi.org/10.1016/j. mnl.2023.09.009
Emam SM, Fakhry SF, Abdrabou HM. Leaders development program by 360 degree feedback: reflection on head nurses’ leadership practices. BMC Nurs. 2024;23(1):772. https://doi.org/10.1186/s1291 2-024-02395-w
Boeske J. Leadership towards Sustainability: A Review of Sustainable, Sustainability, and Environmental Leadership. Sustainability. 2023;15(16):12626. https:// doi.org/10.3390/su151612626
Lindberg C, Schneider M. Combating infections at Maine Medical Center: Insights into complexity-informed leadership from positive deviance. Leadership. 2013;9(2):229-253. https://doi.org/10.11 77/1742715012468784
Hargreaves J. Using patients: exploring the ethical dimension of reflective practice in nurse education. J Adv Nurs. 1997;25(2):223-228. https://doi.org/10.10 46/j.1365-2648.1997.1997025223.x
Crawford A, Eldardiri D, Leibecke A, Sloan R. Professional growth and development for nurse leaders [Internet]. Silver Spring (MD): American Nurses Association; 2019 Aug 13 [cited 2019 Jun 6]. Available from: https://www.myamericannurse.com/ professional-growth-and-development-for-nurse-lea ders/
Dell’Osso L, Lorenzi P, Nardi B, Carmassi C, Carpita B. Post Traumatic Growth (PTG) in the Frame of Traumatic Experiences. Clin Neuropsychiatry. 2022; 19(6):390-393. https://doi.org/10.36131/cnfioritiedit ore20220606

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