Deliberação moral da enfermeira no atendimento pré-hospitalar móvel na pandemia da Covid-19

Abstract

Moral deliberation is a procedure aimed at systematizing decision-making, consisting of four stages: deliberation on facts, deliberation on values, deliberation on duties, and deliberation on responsibility. This study aims to: Analyze elements of the moral deliberation of SAMU nurses during the pandemic. Diego Gracia's clinical bioethics was used as a theoretical-methodological framework. This is qualitative research with data collection carried out between the months of October and November 2022 after the opinion of the Research Ethics Committee of the School of Nursing of the Federal University of Bahia and the release of the research field by the responsible administrative body . As instruments, a characterization form of the participants and an open interview script were used, along with a clinical case vignette experienced by the author during the pandemic context and three questions, one approximation question and two guiding questions. Six nurses participated in the intervention of the Mobile Emergency Care Service. Based on the thematic content analysis, three categories were defined: nurses' perception of the ethical problem, choice of essential values, and courses of action in deliberating on duties, the latter based on the analysis of Diego Gracia's deliberative bioethics. In the results, it was observed that the nurses recognize an ethical problem from the use of a vignette and bring that the values involved are the autonomy of the patient or family and professional responsibility and direct the courses of action towards intermediate and optimal outputs, bringing legality and the consequences as a way of evaluating the way out of the problem. With the COVID-19 pandemic, ethical problems emerged involving the absence of companions, causing suffering for family members and patients, and the lack of clarity in the information provided after hospitalizations. Thus, moral deliberation aims to find the most prudent path, that is, the way out that generates less damage to conflicting values.