Tensiones éticas, causas y consecuencias del síndrome de burnout en el personal de salud en tiempos de la Covid-19: una revisión y análisis desde la bioética

esta es una revisión bibliométrica sobre el síndrome de burnout que afectó a profesionales de la salud en tiempos de la Covid-19, los conflictos éticos que lo preceden y suceden, y las estrategias para combatirlo. Metodología/ enfoque: se hizo una revisión bibliométrica en la que se identificaron, de manera sistemática, artículos de revisión, estudios transversales, metaanálisis y estudios cualitativos de todo el mundo. Una vez aplicados los filtros de selección, se analizaron los resultados con el método deliberativo de Diego Gracia. Resultados: se identificaron cuatro subtemas principales, incidencia del burnout durante la pandemia de la Covid-19, estresores éticos que favorecen al síndrome de burnout, consecuencias de este síndrome y estrategias para prevenirlo y combatirlo. Cada subtema se describe desde los ámbitos individuales, institucionales y sociales. Discusión/conclusiones: se argumenta con la teoría de Diego Gracia y se presenta una jerarquización de principios éticos implicados en el burnout, existen factores que favorecen la aparición de esta enfermedad profesional con un profundo calado bioético, en el que subyacen problemas de reconocimiento moral y económico, equidad, seguridad laboral, deber de cuidar, buena práctica médica y el bienestar del paciente, la familia y la sociedad en general. De igual, forma, las consecuencias del síndrome tienen repercusiones en los ámbitos sociales, institucionales e individuales, por lo que las intervenciones para su prevención y atención deben de igual forma tener un enfoque pluralista y diverso desde lo macro, meso y micro. En este sentido, es necesario fortalecer las estrategias de investigación y educación, para comprender, explicar y abordar el fenómeno de una forma integral.

this is a bibliometric review of the burnout syndrome that affected health professionals during Covid-19, the ethical conflicts that precede and follow it, and the strategies to combat it. Methodology/approach: a bibliometric review was carried out in which review articles, cross-sectional studies, meta-analyses, and qualitative studies from all over the world were systematically identified. Once the selection filters were applied, the results were analyzed using Diego Gracia's deliberative method. Results: four main subthemes were identified: incidence of burnout during the Covid-19 pandemic, ethical stressors that favor burnout syndrome, consequences of this syndrome, and strategies to prevent and combat it. Each subtopic is described from the individual, institutional, and societal levels. Discussion/conclusions: it is argued with Diego Gracia's theory, and a hierarchy of ethical principles involved in burnout is presented; some factors favor the appearance of this professional disease with a deep bioethical significance, in which problems of moral and economic recognition, equity, job security, the duty of care, good medical practice and the welfare of the patient, the family and society in general underlie. Similarly, the consequences of the syndrome have repercussions in the social, institutional, and individual spheres, so interventions for its prevention and care must also have a pluralistic and diverse approach from the macro, meso, and micro levels. In this sense, it is necessary to strengthen research and education strategies to understand, explain, and comprehensively address the phenomenon.

esta é uma revisão bibliométrica sobre a síndrome de burnout que afetou profissionais da saúde em tempos da covid-19, os conflitos éticos que a precedem e sucedem, e as estratégias para combatê-la. Metodologia/abordagem: é feita uma revisão bibliométrica na qual foram identificados, de maneira sistemática, artigos de revisão, estudos transversais, metanálise e estudos qualitativos de todo o mundo. Uma vez aplicados os filtros de seleção, foram analisados os resultados com o método deliberativo de Diego Gracia. Resultados: foram identificados quatro subtemas principais: incidência do burnout durante a pandemia da covid-19, estressores éticos que favorecem a síndrome de burnout, consequências dessa síndrome e estratégias para preveni-lo e combatê-lo. Cada subtema é descrito a partir dos âmbitos individuais, institucionais e sociais. Discussão/conclusões: é argumentada com a teoria de Diego Gracia e é apresentada uma hierarquização de princípios éticos implicados no burnout; existem fatores que favorecem o surgimento dessa doença profissional com um profundo silêncio bioético, no qual subjazem problemas de reconhecimento moral e econômico, equidade, segurança profissional, dever de cuidar, boa prática médica e bem-estar do paciente, da família e da sociedade em geral. Além disso, as consequências da síndrome têm repercussões nos âmbitos sociais, institucionais e individuais, razão pela qual as intervenções para sua prevenção e atenção devem de igual forma ter uma abordagem pluralista e diverso a partir do macro, meso e micro. Nesse sentido, é necessário fortalecer as estratégias de pesquisa e educação, para compreender, explicar e abordar o fenômeno de uma forma integral.

Reflections of Moral Suffering, Resilience, and Wisdom of Pediatric Oncology Social Workers during the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic has significantly altered the lives of pediatric oncology social workers. Challenges include difficulty building rapport with the use of telephone/computers, lack of clarity around who is designated as "essential", structural challenges, isolation, and witnessing distress. This study aimed to describe the ways that the pandemic has personally impacted pediatric oncology social workers. METHODS: Participants were recruited through the Association of Pediatric Oncology Social Workers (APOSW) listserv. In total, 101 participants from 31 states and the District of Columbia completed an online survey containing quantitative and open-ended questions. Qualitative data analysis included thematic analysis of participants' optional survey responses to three open-ended questions. RESULTS: Fifty-seven of the participants provided responses that revealed 3 first level codes and 11 second level codes. First level codes were developed a priori from the questions: Experiences that stay with you, Wisdom gained and Impact on your work. Pandemic-related challenges caused moral suffering and professional challenges for participants but also created opportunities to find meaning in their work. CONCLUSION: Data illuminated moral suffering, unrecognized resilience, new ways of maintaining self-and family care, and creative approaches to care of children with cancer and their families at diagnosis, during treatments and at the end of life.

Critical Care Providers' Moral Distress: Frequency, Burden, and Potential Resources.

BACKGROUND: Critical Care Providers (CCPs) experience situations that challenge their ethics and professional standards and may entail moral distress (MD). AIM: To analyze MD perceived by CCPs in intensive care units (ICUs) or emergency departments (EDs) and further clarify whether CCPs who rely on spiritual resources differ in their perception of MD from those who do not utilize these resources. METHODS: A cross-sectional anonymous survey was administered using a modified version of the German language version of the Moral Distress Scale (MDS) with 2 × 12 items to assess the frequency and the respective perceived burden of specific situations by applying a 5-point Likert scale. Explorative factor analysis was performed and the sub-constructs of the respective items regarding MD frequency and burden were identified. Job burden and professional satisfaction were measured using visual analogue scales (VAS) and a four-point Likert scale, respectively. The 15-item SpREUK questionnaire was applied to measure spiritual attitudes and behaviours and to differentiate between religious and spiritual persons. Data from 385 German-speaking CCPs were included (55% physicians, 45% nurses). RESULTS: Conflict situations are similar for physicians and nurses although they are perceived as more burdensome by nurses. Among physicians, the MDS factor Looking away/Resignation scores highest for assistant physician residents, whereas distress caused by looking away is more often perceived by specialist physicians without a managerial position. Work satisfaction is inversely associated with MD and emotional exhaustion is positively associated with it. Participants' spirituality is marginally associated with MD. The best predictors of both MD frequency and burden are emotional exhaustion with further influences of work satisfaction, being a nurse, and being a non-believer on the frequency of MD perception. Being a nurse, participants' experience in ICU/ED, and being of the male gender are further predictors of MD burden. CONCLUSIONS: MD is experienced differently by different groups of CCPs depending on their place in the hierarchy of responsibility. As MD perception is best predicted by emotional exhaustion, these situations should be avoided. Although some CCPs may rely on spiritual resources, all need individual and team support to cope with MD.

Atravessamentos políticos: a cultura organizacional e o sofrimento moral no serviço público / Political crossing: organizational culture and moral suffering in public service / Gestiones políticas: la cultura organizacional y el sufrimiento moral en el servicio público

A atividade profissional e a organização do trabalho possuem lugar fundamental na relação entre os processos de saúde e doença mental. Esta pesquisa busca compreender a relação entre as práticas de gestão nas instituições públicas e a saúde mental de servidores públicos municipais da região do Vale do Sinos, Rio Grande do Sul, através de um delineamento exploratório-descritivo, seguindo metodologia qualitativa. Participaram da pesquisa seis servidores públicos. Foi utilizado um questionário e uma entrevista semiestruturada, cujo material foi submetido à análise de conteúdo, resultando duas categorias: Práticas de gestão, cultura e trabalho; efeitos das práticas de gestão e cultura na saúde do trabalhador. Verificou-se a existência de uma cultura organizacional pautada em valores políticos e clientelistas, servindo a máquina pública de meio para a manutenção do poder político. Este cenário provoca falta de reconhecimento, sofrimento moral e desinvestimento subjetivo, propiciando um quadro de risco para a saúde mental dos trabalhadores.

Professional activity and work organization have a fundamental place in the relationship between the mental health and illness processes. This research aims to understand the relationship between management practices in public institutions and the mental health of municipal public servants in the region of Vale do Sinos, Rio Grande do Sul, through an exploratory-descriptive design, following a qualitative methodology. Six municipal public servants participated in the research. A questionnaire and a semi-structured interview were used. The material collected was submitted to content analysis, resulting in two categories: Management practices, culture, and work; effects of management practices and culture on worker health. The existence of an organizational culture based on political and clientelist values was verified, where the public machine is used as a means for maintaining political power. This scenario leads to lack of recognition, moral suffering, and subjective disinvestment, promoting a scenario of risk to workers' mental health.

La actividad profesional y la organización del trabajo poseen lugar fundamental en la relación entre los procesos de salud y enfermedad mental. Esta investigación busca comprender la relación entre las prácticas de gestión en las instituciones públicas y la salud mental de los funcionarios municipales de la región de Vale do Sinos, Rio Grande do Sul. Se trata de un estudio con delineamiento exploratorio-descriptivo de metodología cualitativa. Participaron de esta investigación seis empleados públicos. Fueron utilizados un cuestionario y una entrevista semiestructurada, cuyo material fue sometido al análisis de contenido, resultando en dos categorías: Prácticas de gestión, cultura y trabajo; efectos de las prácticas de gestión y cultura en la salud del trabajador. Se verificó la existencia de una cultura organizacional pautada en valores políticos y clientelistas, donde la maquinaria pública sirve para mantener el poder político. Este escenario conlleva falta de reconocimiento, sufrimiento moral y desinversión subjetiva, lo que trae riesgo para la salud mental de los trabajadores.

Freud's psychoanalysis: a moral cure.

That psychoanalytical treatment in its classical Freudian sense is primarily a moral or ethical cure is not a very controversial claim. However, it is far from obvious how we are to understand precisely the moral character of psychoanalysis. It has frequently been proposed that this designation is valid because psychoanalysis strives neither to cure psychological symptoms pharmaceutically, nor to superficially modify the behaviour of the analysand, but to lead the analysand through an interpretive process during which he gradually gains knowledge of the unconscious motives that determine his behaviour, a process that might ideally liberate him to obtain, in relation to his inner desires, the status of a moral agent. There resides something appealing in these claims. But it is the author's belief that there is an even deeper moral dimension applying to psychoanalytical theory and praxis. Freudian psychoanalysis is a moral cure due to its way of thematizing psychological suffering as moral suffering. And this means that the moral subject - the being that can experience moral suffering - is not primarily something that the psychoanalytical treatment strives to realize, but rather the presupposition for the way in which psychoanalysis theorizes psychological problems as such.