Moral distress among healthcare professionals working in intensive care units in Spain / Desasosiego moral entre los profesionales sanitarios que trabajan en unidades de cuidados intensivos en España

Objective To assess moral distress (MD) among Spanish critical care healthcare professionals (HCPs). Design Cross-sectional, prospective study. Setting ICUs in Spain. Participants HCPs currently working in Spanish ICUs. Interventions A 55-item questionnaire was electronically distributed. Main variables The questionnaire included work-related and socio-demographic characteristics, the Spanish version of the Measure of Moral Distress for Health Care Professionals (MMD-HP-SPA), and the Hospital Ethical Climate Survey (HECS). Results In total, 1065 intensive care providers completed the questionnaire. Three out of four validity hypotheses were supported. MD was significantly higher for physicians (80, IQR 40–135) than for nurses (61, IQR 35–133, p=0.026). MD was significantly higher for those clinicians considering leaving their position (78, IQR 46–163 vs. 61, IQR 32–117; p<0.001). The MMD-HP-SPA was inversely correlated with the HECS (r=−0.277, p<0.001). An exploratory factor analysis revealed a four-factor structure, evidencing the patient, team, and system levels of MD. Conclusions In the study sample, Spanish intensivists report higher MD than nurses. Strategies to improve ICU ethical climate and to correct other related factors in order to mitigate MD at a patient, team, and system level should be implemented. Both groups of HCPs manifest a relevant intention to leave their position due to MD. Further studies are needed to determine the extent to which MD influences their desire to leave the job (AU)

Objetivo Evaluar el desasosiego moral (DM) entre los profesionales sanitarios que trabajan en UCI en España. Diseño Estudio prospectivo transversal. Ámbito UCI en España. Participantes Profesionales sanitarios que actualmente trabajan en UCI españolas. Intervenciones Se distribuyó electrónicamente un cuestionario de 55 ítems. Variables principales El cuestionario incluía características sociodemográficas y laborales, la versión en español de la Medida de desasosiego moral para profesionales sanitarios (MMD-HP-SPA) y la Encuesta de clima ético hospitalario (HECS). Resultados En total 1.065 profesionales sanitarios de cuidados intensivos completaron el cuestionario. Tres de 4 hipótesis de validez fueron apoyadas. El DM fue significativamente mayor entre los médicos (80, IQR 40-135) que entre las enfermeras (61, IQR 35-133, p=0,026). El DM fue significativamente más alto para aquellos médicos que estaban considerando dejar su puesto de trabajo (78, IQR 46-163 vs. 61, IQR 32-117; p<0,001). El MMD-HP-SPA se correlacionó inversamente con el HECS (r=–0,277, p<0,001). Un análisis factorial exploratorio reveló una estructura de 4 factores, evidenciando los niveles de paciente, equipo y sistema del DM. Conclusiones En este estudio los intensivistas refirieron niveles de DM más altos que las enfermeras. Se deben implementar estrategias para mejorar el clima ético en las UCI y corregir otros factores relacionados con el fin de mitigar el DM en lo que atañe al paciente, al equipo y al sistema. Ambos grupos de profesionales manifestaron una intención relevante de abandonar su puesto de trabajo debido al DM. Se necesitan más estudios para determinar en qué medida el DM influye sobre su deseo de abandonar su puesto de trabajo (AU)

Moral distress among healthcare professionals working in intensive care units in Spain.

OBJECTIVE: To assess moral distress (MD) among Spanish critical care healthcare professionals (HCPs). DESIGN: Cross-sectional, prospective study. SETTING: ICUs in Spain. PARTICIPANTS: HCPs currently working in Spanish ICUs. INTERVENTIONS: A 55-item questionnaire was electronically distributed. MAIN VARIABLES: The questionnaire included work-related and socio-demographic characteristics, the Spanish version of the Measure of Moral Distress for Health Care Professionals (MMD-HP-SPA), and the Hospital Ethical Climate Survey (HECS). RESULTS: In total, 1065 intensive care providers completed the questionnaire. Three out of four validity hypotheses were supported. MD was significantly higher for physicians (80, IQR 40-135) than for nurses (61, IQR 35-133, p=0.026). MD was significantly higher for those clinicians considering leaving their position (78, IQR 46-163 vs. 61, IQR 32-117; p<0.001). The MMD-HP-SPA was inversely correlated with the HECS (r=-0.277, p<0.001). An exploratory factor analysis revealed a four-factor structure, evidencing the patient, team, and system levels of MD. CONCLUSIONS: In the study sample, Spanish intensivists report higher MD than nurses. Strategies to improve ICU ethical climate and to correct other related factors in order to mitigate MD at a patient, team, and system level should be implemented. Both groups of HCPs manifest a relevant intention to leave their position due to MD. Further studies are needed to determine the extent to which MD influences their desire to leave the job.

Moral distress among healthcare professionals working in intensive care units in Spain.

OBJECTIVE: To assess moral distress (MD) among Spanish critical care healthcare professionals (HCPs). DESIGN: Cross-sectional, prospective study. SETTING: ICUs in Spain. PARTICIPANTS: HCPs currently working in Spanish ICUs. INTERVENTIONS: A 55-item questionnaire was electronically distributed. MAIN VARIABLES: The questionnaire included work-related and socio-demographic characteristics, the Spanish version of the Measure of Moral Distress for Health Care Professionals (MMD-HP-SPA), and the Hospital Ethical Climate Survey (HECS). RESULTS: In total, 1065 intensive care providers completed the questionnaire. Three out of four validity hypotheses were supported. MD was significantly higher for physicians (80, IQR 40-135) than for nurses (61, IQR 35-133, p=0.026). MD was significantly higher for those clinicians considering leaving their position (78, IQR 46-163 vs. 61, IQR 32-117; p<0.001). The MMD-HP-SPA was inversely correlated with the HECS (r=-0.277, p<0.001). An exploratory factor analysis revealed a four-factor structure, evidencing the patient, team, and system levels of MD. CONCLUSIONS: In the study sample, Spanish intensivists report higher MD than nurses. Strategies to improve ICU ethical climate and to correct other related factors in order to mitigate MD at a patient, team, and system level should be implemented. Both groups of HCPs manifest a relevant intention to leave their position due to MD. Further studies are needed to determine the extent to which MD influences their desire to leave the job.

Abuso sexual infantil (ASI): comprensiones y representaciones clínicas desde las prácticas de salud mental / Sexual child abuse: understanding and representing clinical practices within mental health practices

Este artículo presenta una investigación, realizada en dos etapas, que estudia al Abuso Sexual Infantil (ASI) como fenómeno clínico, enmarcada en sus expresiones representacionales, conceptuales y culturales. Interroga a profesionales de instituciones que trabajan con abuso, trazando un itinerario analítico comprensivo de abordajes tanto clínicos, como de políticas de intervención desarrolladas. Metodológicamente realizamos un estudio observacional, analítico y longitudinal ambispectivo, con diseño cualitativo, aplicado en dos cohortes de tiempo (2005-2006 y 2011-2012), para profundizar el conocimiento de comprensiones y estrategias clínicas que profesional e institucionalmente han abordado al ASI. Sus resultados destacan: sobrejudicialización y sobrepatologización del ASI, necesidad de profundizar el trabajo interdisciplinario, dificultades del abordaje individual de reparación y prevención, desasosiego y malestar subjetivo de los profesionales, presencia social y mantención de situaciones de abuso con patrones de género predominantemente autoritarios, y devastador daño psíquico de víctimas directas e indirectas.

This study investigates Sexual Child Abuse (SCA) in its clinical context, including its representational, conceptual, and cultural expressions. Working with professionals of institutions, following an analytic yet understanding method, this study traces their approaches at the clinical level as well as intervention policies. Methodologically, the investigation is observational, analytic, and longitudinal, and qualitative design study, including two temporal cohorts (2005-2006 and 2011-2012). These methods were chosen to acquire better knowledge regarding the strategies used in clinics. Relevant results include: excessive tendencies to treat the matter as a juridical case and as pathology; the need for interdisciplinary work; the difficulty of repairing and preventing; the presence of discontent and unease in professionals related to their work; social relations in the presence of SCA of an authoritarian type; and the devastating psychic damage, both direct and indirect, in its victims.

Toxicomania e suicídio sob uma visão psicanalítica / Adicción a las drogas y el suicidio bajo una visión psicoanalítica / La toxicomanie et le suicide sous une vision psychanalytique / Drug addiction and suicide under a psychoanalytic view

Para a psicanálise, qual a relação, na contemporaneidade, entre o suicídio e a toxicomania? Esse questionamento surgiu a partir de uma experiência de escuta analítica com toxicômanos. Oportunidade essa em que foram trazidas, diversas vezes, pelos usuários abusivos, suas ideações e/ou tentativas mal sucedidas de suicídio. Dessa forma, buscou-se, com este artigo, realizar um levantamento bibliográfico de cunho psicanalítico a fim de lograr uma compreensão entre a adição às drogas e o ato suicida, e as questões que possam ser comuns a ambos os assuntos. Explorou- se a obra freudiana O Mal-estar na Civilização e levantaram-se questões a respeito do gozo, desamparo e mal-estar; explorando, ainda, autores como Joel Birman e Jesús Santiago para uma compreensão da apresentação do sujeito contemporâneo. Chegou- se ao denominador comum da precariedade simbólica dos sujeitos contemporâneos devido à falência do legislador, o que resulta na dificuldade em lidar com o excesso de dimensões traumáticas às quais estão expostos na pós-modernidade. Assim, recorrem ao uso de substâncias artificiais como forma de obter uma descarga temporária e lograr um prazer "por baixo" do simbólico; ou, ainda, fazem uso de um recurso extremo, o suicídio - um ato final e infalível na solução do problema do mal-estar.(AU)

What kind of relation exists between suicide and drug addiction for psychoanalysis in the contemporaneity? The questioning came up after an experience of analytical hearing with drug addicts in which they brought several times their suicidal ideations and unsuccessful trials. In this way, this article aims to explore, through a bibliographical research, the psychoanalytical theory in order to reach a comprehension about drug addiction and the suicidal act and their common points. We explored Freud's work Civilization and its Discontents and found important concepts for the understanding of the mentioned topics - such as pleasure, helplessness, and discomfort. In addition, we discuss works of contemporaneous psychoanalysts, such as Joel Birman and Jesús Santigo, for a comprehension about the constitution of the subject in the contemporaneity. We found, as a common denominator, the subject's symbolic precariousness due to a collapse of the legislator. This subject, lacking symbolic capability, is exposed to an excess of traumatic dimensions and has difficulties dealing with it. Therefore, they appeal to artificial substances in order to achieve a temporary discharge and even obtain a pleasure that is not mediated by the symbolic. Another possibility, more extreme, rests upon the suicide, a final and unfailing act in order to solve the discomfort.(AU)

Para el Psicoanálisis, qué clase de relación existe, en la contemporaneidad, entre elsuicidio y la drogadicción? La pregunta surgió a partir de una escucha analítica con sujetos drogadictos, quienes manifestaron en varias ocasiones sus ideas suicidas y sus procesos no exitosos. De esta manera, este artículo busca explicar la teoría psicoanalítica para alcanzar una comprensión básica sobreestos temas y sus puntos en común. Se exploró la obra de Freud, La civilización y sus descontentos, y se encontraron conceptos importantes para el entendimiento de los temas mencionados, como el placer, la impotencia y el desasosiego. Adicionalmente, se revisaron obras contemporáneas de Psicoanálisis como las de Joel Birman y Jesús Santiago para comprender la constitución del sujeto en la contemporaneidad. Se encontró, como común denominador, la precariedad simbólica del sujeto debido a la caída del legislador. Este sujeto carente de capacidad simbólica es expuesto a un exceso de dimensiones traumáticas y le dificulta lidiar con éstas. Por lo tanto, el sujeto apela a sustancias artificiales para lograr una descarga temporal y obtener un placer sin la mediación de lo simbólico. Otra posibilidad más extrema yace en el suicidio, un acto final e indefectible para terminar el desasosiego.(AU)

Quelle est la relation entre le suicide et la toxicomanie dans la psychanalyse contemporaine pour? Cette question s'est posée à partir d'une expérience analytique découte avec les toxicomanes. Cette opportunité dans laquelle ils ont été amenés à plusieurs reprises par leurs agresseurs idéations et / ou tentatives infructueuses de suicide. Ainsi, nous avons cherché à accomplir avec cet article une caractéristique de la littérature psychanalytique afin de parvenir à une compréhension de la toxicomanie et de suicide, et les questions qui sont communes aux deux sujets. Explorées pour l' de Freud - le malaise dans la civilisation - et dês questions se posent au sujet de la joie, sentiment d'impuissance et d'inconfort, voire de auteurs Joel Birmans et Jesús Santiago pour une compréhension de la présentation du sujet dontemporain. Il en est résulté un dénominateur commun symbolique de la précarité des sujets contemporains en raison de l'échec de la législature, ce qui entraine une incapacité à faire face à des dimensions supplémentaires qui sont exposés à la post-modernité traumatique, et donc recourir à l'utilisation de substances artificielle comme un moyen d'obtenir une décharge, et même d'atteindre un plaisir temporaire,''en bas'' de la symbolique, ou même faire usage d'une station, dernier suicide - un acte final et une solution infaillible pour le problème du malaise.(AU)

Toxicomania e suicídio sob uma visão psicanalítica / Adicción a las drogas y el suicidio bajo una visión psicoanalítica / La toxicomanie et le suicide sous une vision psychanalytique / Drug addiction and suicide under a psychoanalytic view

Para a psicanálise, qual a relação, na contemporaneidade, entre o suicídio e a toxicomania? Esse questionamento surgiu a partir de uma experiência de escuta analítica com toxicômanos. Oportunidade essa em que foram trazidas, diversas vezes, pelos usuários abusivos, suas ideações e/ou tentativas mal sucedidas de suicídio. Dessa forma, buscou-se, com este artigo, realizar um levantamento bibliográfico de cunho psicanalítico a fim de lograr uma compreensão entre a adição às drogas e o ato suicida, e as questões que possam ser comuns a ambos os assuntos. Explorou- se a obra freudiana O Mal-estar na Civilização e levantaram-se questões a respeito do gozo, desamparo e mal-estar; explorando, ainda, autores como Joel Birman e Jesús Santiago para uma compreensão da apresentação do sujeito contemporâneo. Chegou- se ao denominador comum da precariedade simbólica dos sujeitos contemporâneos devido à falência do legislador, o que resulta na dificuldade em lidar com o excesso de dimensões traumáticas às quais estão expostos na pós-modernidade. Assim, recorrem ao uso de substâncias artificiais como forma de obter uma descarga temporária e lograr um prazer "por baixo" do simbólico; ou, ainda, fazem uso de um recurso extremo, o suicídio - um ato final e infalível na solução do problema do mal-estar.

What kind of relation exists between suicide and drug addiction for psychoanalysis in the contemporaneity? The questioning came up after an experience of analytical hearing with drug addicts in which they brought several times their suicidal ideations and unsuccessful trials. In this way, this article aims to explore, through a bibliographical research, the psychoanalytical theory in order to reach a comprehension about drug addiction and the suicidal act and their common points. We explored Freud's work Civilization and its Discontents and found important concepts for the understanding of the mentioned topics - such as pleasure, helplessness, and discomfort. In addition, we discuss works of contemporaneous psychoanalysts, such as Joel Birman and Jesús Santigo, for a comprehension about the constitution of the subject in the contemporaneity. We found, as a common denominator, the subject's symbolic precariousness due to a collapse of the legislator. This subject, lacking symbolic capability, is exposed to an excess of traumatic dimensions and has difficulties dealing with it. Therefore, they appeal to artificial substances in order to achieve a temporary discharge and even obtain a pleasure that is not mediated by the symbolic. Another possibility, more extreme, rests upon the suicide, a final and unfailing act in order to solve the discomfort.

Para el Psicoanálisis, qué clase de relación existe, en la contemporaneidad, entre elsuicidio y la drogadicción? La pregunta surgió a partir de una escucha analítica con sujetos drogadictos, quienes manifestaron en varias ocasiones sus ideas suicidas y sus procesos no exitosos. De esta manera, este artículo busca explicar la teoría psicoanalítica para alcanzar una comprensión básica sobreestos temas y sus puntos en común. Se exploró la obra de Freud, La civilización y sus descontentos, y se encontraron conceptos importantes para el entendimiento de los temas mencionados, como el placer, la impotencia y el desasosiego. Adicionalmente, se revisaron obras contemporáneas de Psicoanálisis como las de Joel Birman y Jesús Santiago para comprender la constitución del sujeto en la contemporaneidad. Se encontró, como común denominador, la precariedad simbólica del sujeto debido a la caída del legislador. Este sujeto carente de capacidad simbólica es expuesto a un exceso de dimensiones traumáticas y le dificulta lidiar con éstas. Por lo tanto, el sujeto apela a sustancias artificiales para lograr una descarga temporal y obtener un placer sin la mediación de lo simbólico. Otra posibilidad más extrema yace en el suicidio, un acto final e indefectible para terminar el desasosiego.

Quelle est la relation entre le suicide et la toxicomanie dans la psychanalyse contemporaine pour? Cette question s'est posée à partir d'une expérience analytique découte avec les toxicomanes. Cette opportunité dans laquelle ils ont été amenés à plusieurs reprises par leurs agresseurs idéations et / ou tentatives infructueuses de suicide. Ainsi, nous avons cherché à accomplir avec cet article une caractéristique de la littérature psychanalytique afin de parvenir à une compréhension de la toxicomanie et de suicide, et les questions qui sont communes aux deux sujets. Explorées pour l' de Freud - le malaise dans la civilisation - et dês questions se posent au sujet de la joie, sentiment d'impuissance et d'inconfort, voire de auteurs Joel Birmans et Jesús Santiago pour une compréhension de la présentation du sujet dontemporain. Il en est résulté un dénominateur commun symbolique de la précarité des sujets contemporains en raison de l'échec de la législature, ce qui entraine une incapacité à faire face à des dimensions supplémentaires qui sont exposés à la post-modernité traumatique, et donc recourir à l'utilisation de substances artificielle comme un moyen d'obtenir une décharge, et même d'atteindre un plaisir temporaire,''en bas'' de la symbolique, ou même faire usage d'une station, dernier suicide - un acte final et une solution infaillible pour le problème du malaise.