The meaning of being a nurse in mobile pre-hospital care from the Franklian perspectiveABSTRACT
Objective: to understand the meaning of being a mobile pre-hospital care nurse.
Method: a qualitative study with a comprehensive approach, based on the theoretical analysis of Viktor Frankl, conducted by phenomenological interview with 11 nurses working in Decentralized Bases of an Emergency Mobile Service (Serviço de Atendimento Móvel de Urgência - SAMU) of the Northeast Microregion, in Bahia, from February to June 2024. To understand the phenomenon, Vieta’s Humanistic analysis was used, called triadic configuration (humanist-existential-personalist).
Results: four thematic categories emerged: Being a nurse in SAMU is to experience the decision-making process and suffering in care relationships; Being a nurse in SAMU is to achieve the realization of Franklian values; Being a nurse in the SAMU enables the realization of life purposes and discovering the meaning of life. The facets of the phenomenon allowed professionals to face feelings of anguish, fear, suffering and transcendence motivated by pleasure and gratitude in caring for the user in the mobile pre-hospital setting.
Conclusion: the meaning of being a nurse in SAMU is driven by a new sense of life that aligns with the responsibility of providing human, comprehensive, and, above all, ethical care.
Descriptors:
Existentialism; Nurses; Qualitative research; Emergency medical services
RESUMO
Objetivo: compreender o sentido de ser enfermeira do atendimento pré-hospitalar móvel.
Método: estudo de natureza qualitativa com abordagem compreensiva, fundamentado na análise teórica de Victor Frankl, realizado mediante entrevista fenomenológica com 11 enfermeiras atuantes em Bases Descentralizadas de um Serviço de Atendimento Móvel de Urgência (SAMU) da Microrregião Nordeste, na Bahia, no período de fevereiro a junho de 2024. Para a apreensão do fenômeno foi utilizada a análise Humanística de Vieta, denominada configuração triádica (humanista-existencial-personalista).
Resultados: quatro categorias temáticas emergiram: ser enfermeira no SAMU é vivenciar o processo decisório e sofrimento nas relações de cuidado; ser enfermeira no SAMU é concretizar a realização de valores Franklianos; e ser enfermeira no SAMU possibilita a realização de propósitos de vida e de encontro de sentido da vida. As facetas do fenômeno possibilitaram um encontro das profissionais com sentimentos de angústia, medo, sofrimento e um transcender motivado pelo prazer e gratidão ao cuidar do usuário no cenário do pré-hospitalar móvel.
Conclusão: o sentido de ser enfermeira no SAMU é motivado por um novo sentido de vida que vai ao encontro da responsabilidade de um cuidado humano, integral e, sobretudo, ético.
Descritores:
Existencialismo; Enfermeiros; Pesquisa Qualitativa; Serviços Médico de Emergência
RESUMEN
Objetivo: comprender el significado de ser Enfermera de Atención Prehospitalaria Móvil.
Método: estudio cualitativo con enfoque comprensivo, basado en el análisis teórico de Viktor Frankl. Se realizó a través de una entrevista fenomenológica con 11 enfermeros que actúan en Bases Descentralizadas del Servicio de Atención Móvil de Urgencia (Serviço de Atendimento Móvel de Urgência - SAMU) de la Microrregión Nordeste, en Bahía, no período de fiebre a junio de 2024. Para comprender el fenómeno se utilizó el análisis humanista de Vieta, llamado configuración triádica (humanista-existencial-personalista).
Resultados: surgieron cuatro categorías temáticas: Ser Enfermero en el SAMU significa vivenciar el proceso de toma de decisiones y el sufrimiento en las relaciones de cuidado; Ser enfermera en SAMU significa cumplir con la realización de los valores Franklinianos; Ser enfermera en SAMU permite alcanzar metas de vida y encontrarle sentido a la vida. Las facetas del fenómeno permitieron a los profesionales encontrarse con sentimientos de angustia, miedo, sufrimiento y trascendencia motivados por el placer y la gratitud al atender a los usuarios en el ámbito prehospitalario móvil.
Conclusión: el sentido de ser enfermera en el SAMU está motivado por un nuevo sentido de vida que va en contra de la responsabilidad del cuidado humano, integral y sobre todo ético.
Descriptores:
Existencialismo; Enfermeros; Investigación Cualitativa; Servicios médicos de emergencia
INTRODUCTION
SAMU 192 is part of the Emergency Care Network in Brazil, corresponding to Mobile Pre-Hospital Care (MPHC) and constitutes the first response to various acute conditions, which occur in different settings and requires from professionals to develop knowledge, skills, and agile behaviors to manage emergency situations1.
Situations experienced by MPHC nurses, such as exposure in a public place, lack of community support during care, and work-related stressors, such as working in an unhealthy environment, can arouse feelings of fear and anguish that contrast with the feelings of pleasure and gratitude expressed during the practice of care2.
In this context, the nurse’s role in MPHC can lead to professional exhaustion in unpredictable and tense situations. Even when prepared to act safely during emergency response, the phenomenon of suffering may emerge due to feelings of loss, helplessness, and frustration during care delivery3,4.
Given that daily decisions are made under these circumstances, it is imperative that nurses be prepared to deal with diverse situations that can generate conflict. It is also necessary to seek meaning in human actions, which, for Viktor Frankl, is part of the encounter with life experiences in a unique way. This can foster the meaning of caring for others, with the proposal of self-transcendence as a characteristic of an individual capable of going beyond their limits, expanding their identity and having the capacity to change reality5.
According to Viktor Frankl, creative, experiential, and attitudinal values are drivers for the encounter with the senses. Creative values manifest themselves through activities specific to work. Experiential values arise in the act of receiving, whether affection, love, or the contemplation of nature. Attitudinal values, correspond to the attitude taken in the face of inevitable suffering (pain, guilt, and death)6.
A phenomenological study also unveiled the existence of indirect relationships in the lifeworld of MPHC that foster a distancing of “I-You” and “I-We” relationships and the maintenance of a space with little dialogue, a breakdown in cooperation and professional creativity7.
By understanding that Viktor Frankl presents congruent questions related to the search for meaning in life and that the individual's engagement with the world through meaningful purposes and values can reveal answers to deal with the challenges and existential emptiness experienced in MPHC daily life, this research becomes purposeful and contemporary in reframing the care provided by nurses to users in urgent and emergency situations.
Considering the need for further development on this topic, it is important to deepen the discussion on the existential issues involved in care relationships and the challenges faced in the MPHC setting, as well as to expand nursing research in the area, promoting a more qualified, sensitive, humane, and responsible practice.
Given these considerations, the objective of this study is to understand the meaning of being a Mobile Pre-Hospital Care nurse.
METHOD
This is a qualitative study with a comprehensive approach based on Viktor Frankl's theoretical analysis. The study complied with the recommendations of the Consolidated Criteria for Reporting Qualitative Research (COREQ)8 in structuring and organizing the research. However, the writing was aligned with the theoretical-methodological procedure of triadic analysis9, which guided the description of the participants. This study is part of a master’s dissertation entitled “The Meaning of Being a Nurse in the Mobile Emergency Care Service,” linked to the Graduate Program in Nursing and Health at the Universidade Federal da Bahia.
Existential Analysis or Logotherapy, proposed by Viktor Frankl, is a therapy centered on the meaning of life and is based on the search for meaning through the individual’s interaction with the environment in which their experiences take place5. It addresses “self-transcendence correlated with a will to meaning, which enables individuals to recognize themselves10”.
A total of eleven nurses participated in the study, selected by convenience. They work at SAMU 192 in Decentralized Bases in the Northeast Microregion of Bahia, that operates 24 hours a day, ensuring the population’s access to medical care linked to an Urgency Regulation Center (URC). Inclusion criteria were: being a nurse involved in direct care at SAMU for at least one year. Exclusion criteria included: holding administrative positions or being on leave for any reason.
Potential participants were approached through previous contact with the Technical Managers of the Decentralized Bases via telephone call and an on-site visit conducted by the lead researcher, a nurse and master’s student. During the visits, the objectives and relevance of the research were presented, and interviews were scheduled based on the professionals’ availability. Out of 25 eligible professionals, 14 expressed interest in participating, and three did not participate due to being on vacation.
Data collection took place from February to June 2024 through a phenomenological interview with open dialogue that allows someone who experiences, to understand the phenomenon, providing an empathetic encounter in a private setting and at a time defined by the participants. Interviews were conducted by the lead researcher and first author of this article, with an average duration of one hour.
An interview guide was used, developed by the principal researcher, including questions related to participants’ characteristics (sex, age, length of service in MPHC, weekly workload, and number of employment contracts), an introductory question for approach was: For you, what does it mean to be a SAMU nurse? and two guiding questions: For you, what does it mean to be a nurse working in the Mobile Emergency Care Service? and How do you experience situations that generate suffering in mobile pre-hospital emergency care?
The instrument was previously tested with a nurse with expertise in the MPHC field who had worked for over ten years in one of the services, defined as the research site, and who is currently working in management and direct care. Data saturation was used as a criterion to conclude the data collection process11.
Vieta's Humanistic Analysis9, called the triadic configuration (humanistic-existential-personalistic), was used to unveil the phenomenon under study. This analysis consists of the following steps: 1) Careful reading of the full content to grasp its overall meaning; 2) Rereading the text to identify meaning units; 3) Identification and classification of aspects with converging content for the grouping of meaning units; 4) Grouping of expressions or their meanings into categories; 5) Presentation of these groupings in representative tables summarizing the results; and 6) Comprehensive data analysis with content interpretation grounded in the theoretical framework.
To this end, the data were organized in tables using Microsoft Word 2010 and Excel. From the careful reading and selection of the material, data analysis was carried out through understanding, interpretation, and articulation of the thematic content obtained in light of Viktor Frankl’s philosophical theoretical framework12.
The study considered ethical aspects in accordance with Resolution 466/2012. The project was approved by the Research Ethics Committee of the School of Nursing of the Universidade Federal da Bahia under Opinion No. 6,563,096 (Certificate of Presentation of Ethical Appraisal: 76199023,6,0000,5531). All participants signed the Informed Consent Form (ICF). To ensure confidentiality and anonymity regarding the data collected, the interviewees were identified with flower code names: Carnation, Lily, Rose, Violet, Lotus Flower, Sunflower, Jasmine, Poppy, Magnolia, Tulip, and Mayflower, expressing the meanings and feelings of their experience as nurses in SAMU 192.
RESULTS
Of the 11 participants, nine (73.7%) were female and two (26.3%) were male. Their ages ranged from 22 to 55 years old, with one to 19 years of professional experience and one to 11 years of experience in MPHC. Among the participants, eight participants (65%) reported having more than one employment relationship, most working 36 hours per week. Given the predominance of female participants, the feminine form “nurse” was used throughout the text to refer to study participants.
From the Franklian analysis, interpretation, and understanding of the data, it was possible to unveil the meaning of being a nurse in Mobile Pre-hospital Care, giving rise to three thematic categories: Being a nurse in SAMU means experiencing the decision-making process and suffering in care relationships; Being a nurse in SAMU means realizing Franklian values; Being a nurse in SAMU enables the fulfillment of life purposes and the discovery of meaning in life.
Being a nurse in SAMU means experiencing the decision-making process and suffering in care relationships
In this category, the nurses expressed that immediate decision-making is fundamental to ensuring timely emergency care. They also revealed that they rely on institutional protocols as a foundation to support more assertive decision-making in the face of the reality encountered.
There are situations that really make me [...], but I take a deep breath because that victim needs me, and I have little time to act! (Rose)
So, I already have a family member there in despair, I already have other people expecting a lot from us, because when the family sees SAMU arriving, they say: “Thank God” SAMU is here! (Rose)
What I have [...] is to follow the protocols so there can be a good prognosis, avoid sequelae, and achieve a response [...], but I try, you know? Sometimes I put myself in that person’s place and keep my professionalism, and I also try to offer comfort, because often they are mothers who are alone in premature birth. (Rose)
Extreme and stressful situations trigger feelings of suffering and anguish that permeate the care practice, as they are tied to the professional responsibility to provide conditions for the maintenance of life even in situations in which these professionals are unable to intervene.
So, when we talk about suffering, there are many kinds, right? There’s the suffering of family members when we go on a call and [...] right? When we arrive at a scene and can’t really achieve the expected outcome of leaving there, right? Not all calls end positively, right? Especially trauma cases where we get there and the patient is already deceased, or due to some maneuvers that were unsuccessful, so, for me, that's the greatest suffering [...]. (Lily)
Yes. I think it’s not just with me, right? It’s with most people, professionals who work at SAMU. Experiencing a situation involving one of our own family members, right? And we [...] it feels like it’s happening to us. We get very shaken, right? A situation that, most of the time, relates to public health, right? We suffer too, we do. (Lotus Flower)
Oh, I suffer when it comes to [...], the elderly part! It's (thinking) we get really down. (Magnolia)
Because usually, when there's a situation of suffering, there's a very desperate atmosphere, an environment that, if we get involved with it, we get confused in the procedure. I travel a lot, I go through existential crises, and then, people's suffering also affects me. (Mayflower)
Being a nurse in SAMU means realizing Franklian values
The participants express attitudinal values, demonstrating the ability to transform a critical health situation into relief, aid, assistance, and attentiveness.
And knowing that you managed to somehow alleviate someone's suffering, that you helped save a life, right? I mean it in the sense that it's a team, it's the joint work of a team, [...] together, right? Yes, this [...] this opportunity that the service gives us, for us to give our best. Combining efforts and working to save a life [there's] no amount of money that can pay for that. It’s very rewarding. (Rosa)
First of all, I really like this field, and I really see that, [...] SAMU, it brings us, can bring us, situations where we can truly help others, right? It [...] can bring us a positive, satisfactory result in someone's survival. So, for me, that's truly priceless. (Poppy)
It's not just about being technical, about knowing the procedures; it's about taking action, about taking a stand. So, right? (Lotus Flower)
They also unveil experiential values in their daily practice, stemming from their experience with others, which addresses suffering and translates what they can receive and feel in the care relationship in emergency situations, as observed in the statements.
Yes, but it also brings us great comfort, knowing that many of our procedures are [...] brought to us. (Poppy)
I try to seek my religiosity. To be more aligned with my values. And I look for leisure. Being with my family helped me unwind a bit about what pre-hospital care is like. (Tulip)
And there were some situations that made me feel extremely emotional because [...] especially when it involves children, vulnerability. (Rose)
Creative values were expressed through their actions and efforts in their daily work, which contribute to their performance as part of the SAMU 192 team.
[...] because I have to think logically, I have to be quick, I have to be precise. I have to try to stabilize that patient as much as possible, as soon as I can, and take them to a support unit that meets their needs [...] And I have to know, imagine, try to understand the causes and symptoms, the patient's condition, and how I will treat the patient. (Rose)
I’m proud to be part of the service! […] Initially, I wasn’t planning to go into emergency care, but [...] I had the opportunity to start working first in the emergency area, and shortly after that, I joined the SAMU service. (Carnation)
For me, being a SAMU nurse [...] is about doing my best, welcoming the victims, and having the sensitivity to understand that we're not just facing a victim, but a human being with all the complexities of human experience. (Tulip)
Being a nurse in SAMU enables the fulfillment of life purposes and the discovery of meaning in life
The discovery of a new meaning was expressed in the participants' statements, redefining the role they play in the SAMU setting.
I find in SAMU all the aspects I was looking for when I chose my profession. So, we have to give our all [...] I give my best, I lay my head on the pillow and rest in peace, because I do my best. (Rose)
Oh! Yes [...] I've been working at SAMU for four years now. It's a life experience, right? I was already part of the service in another role, as a nursing technician, and working as a nurse today is a dream come true, right? I can develop my work, and I can, it's [...] fulfill the life expectations I have, right? That I had. That I have. And that I build every day. (Sunflower)
I've always worked in healthcare, right? I've always identified with emergency services and thought SAMU would be like that, just like a hospital, right? Pretty similar, even. But when I started working there, I saw that it's completely different, right? I think [...], it fulfills me. Being at SAMU is fulfilling for me. (Lotus Flower)
DISCUSSIONS
In light of Viktor Frankl’s existential analysis, it is evident that nurses reflect the suffering experienced by others, the need to be present and take responsibility, self-repair in stressful situations, the search for principles and values, and personal fulfillment.
The SAMU 192 nurses face workplace conflicts, often related to relationships with other professionals, managers, and the families of those under their care, which hinder decision-making and lead to negative feelings of pain and sadness13.
When there is no prudent resolution that respects the values, duties, and responsibilities inherent in the decision-making process, an existential vacuum can occur through feelings of suffering, expressed as frustration, as seen in the statements.
A study conducted in Iran on the management of psychological distress in professionals working in mobile prehospital care indicates that responsibility, with a focus on saving lives, is consistent with a commitment to duty, altruism, and the exercise of ethical principles during professional practice14.
Aware that working in MPHC can amplify stressful situations due to diverse scenarios, which may interfere with safe care, it must be considered that empirical knowledge, technical-scientific expertise, lived experiences, moral sensitivity, and dynamism, when facing conflicts in care practice, contribute to more assertive decision-making, redefining care practices15.
For Existential Analysis, the person has within themselves a vocation for freedom and, as a conscious being, can make their own decisions, but assuming responsibility for their consequences12. The nurses, in choosing freely to work at SAMU, decide to actively engage in the struggle for the person being rescued, thus giving meaning to suffering and being led back to their own wholeness as active beings and producers of care.
Nurses also reveal that their care practice is associated with recognizing the person in a holistic way. Thus, even in critical situations, it is important to ensure individualized care that is attentive to the patient’s needs. However, unsafe situations hinder adequate therapy and lead to reflection on their professional competencies, values, and duties7,16.
From this perspective, professionals, when experiencing conflicting situations without identifying the ethical and moral issues that permeate their care practice, may encounter challenging contexts that increase the risk of moral distress, as an erroneous decision-making process can affect the quality of care13. However, because they are motivated by humanized care that transcends technical performance, the nurses in this study understand that their actions must be beneficial to the individual.
In a challenging space of care, restricted and dominated by technically invasive procedures for life maintenance, there is a need for a practice based on respect that recognizes the being in urgent and emergency situations, to provide qualified care consistent with the moral obligation to do the best for the person being cared for17.
Thus, establishing horizontal relationships, sharing knowledge, and working collaboratively is necessary to enable ethical decision-making18. Human beings, in their existence with others, experience the motivation of responsibility and commitment in the face of life events19.
The search for meaning in life is intrinsic to the human being. However, the commitment to turn toward something or someone is unique to each person and is not necessarily linked to the pursuit of pleasure. Since the meaning of life, as unconditional, can also generate suffering, Logotherapy, as proposed by Frankl, holds that going through challenging situations can lead to the discovery of new meaning in life20.
Nurses working at SAMU reveal feelings of personal and professional fulfillment through their service, even though they report that there are several circumstances that limit their caregiving. From a Franklian perspective, suffering provokes a change in self when it makes sense to those experiencing an inexorable situation6.
Experiences are part of the search for meaning in life, and this meaning is not associated with having, but with being as a person. Therefore, the search for meaning is the reason that instinctively drives people in their daily actions. Through the singularity of the search for meaning in life, the accomplishment or achievement of something considered important to the person is what provides satisfaction characterized by the desire for meaning12.
The nurses’ experiences reveal a connection in the pursuit of Franklian values, which allow them to overcome adverse conditions and foster meanings, including creative, experiential, and attitudinal values. Experiential values are related to finding meaning through lived experience20 and the nurses in the study state that in situations that generate suffering they try to provide care in the best possible way, without causing harm to the person, re-signifying their practice in the occurrences, experienced through help expressed as a sensitive and supportive attitude.
For creative values, expressed in the ability to produce something for the world6, the moment when professionals report that, as they feel fulfilled, they conduct themselves based on legal ethical precepts and scientific technical foundations, they develop strategies for their work, revealing their ability to contribute during their existence at SAMU.
However, upon the need to make decisions for the person being cared for, they also exercise attitudinal values in the world of SAMU 192, as these are related to the individual's full realization, transforming adverse situations into personal fulfillment21. These values express feelings of professional fulfillment through their work, contributing to alleviating the person's suffering during care.
Nurses understand their responsibility in the care process and experience an awakening of consciousness that enables a new meaning in life. The world of care at SAMU allows them to understand the condition of responsibility and commitment when making decisions22.
Thus, the daily life of a nurse working at SAMU 192 is marked by the transcendence of responsible care, which converges into a practice that must be grounded in technical-scientific knowledge and humanistic attitudes2. As they are transformed by their experiences at SAMU, their statements reflect a renewed sense of self as professionals, unveiling personal satisfaction and appreciation for the world of work.
As a limitation, it is noted that this study was conducted with a specific group that presents similar characteristics of professional practice, which may contrast with other care realities. Additionally, there is a scarcity of studies on the phenomenon, which may require comparison to broaden the findings.
FINAL CONSIDERATIONS
In each meeting with the study participants, it was possible to unveil the experiences of being a nurse in an adverse world that produces care and relationships that intensify values, feelings, and meanings.
The nurses reveal that SAMU 192 is a complex service marked by factors that evoke feelings of anguish, sadness, and suffering, which create limitations for their caregiving practice. However, even in the face of these circumstances, they express having found new meaning in their professional practice and experience satisfaction and gratitude while performing their work.
It is evident that the participants in this study embody Franklian values, as they experience adverse situations in their caregiving practice, assume decision-making processes based on ethical principles, and act with an understanding of meeting the needs of the person as a holistic being. The results of this study unveil the need for further research on this topic to promote reflections on new nursing care practices, driven by respect for life, humanization, and quality of care in the SAMU setting.
REFERENCES
-
1. O’Dwyer G, Konder MT, Reciputti LP, Macedo C, Lopes MGM. O processo de implantação do Serviço de Atendimento Móvel de Urgência no Brasil: estratégias de ação e dimensões estruturais. Cad Saúde Pública. 2017;33(7):e00043716. https://doi.org/10.1590/0102-311X00043716
» https://doi.org/10.1590/0102-311X00043716 -
2. Oliveira SS, Pitzer CMT, Ferraz MOA, Lírio LKS, Santa Rosa DOS, Freitas KS, et al. Ethical problems in the clinical practice of mobile pre-hospital care nurses: a scoping review. Online Braz J Nurs. 2022;21:e20226644. https://doi.org/10.17665/1676-4285.20236650
» https://doi.org/10.17665/1676-4285.20236650 -
3. Carvalho AEL, Frazão IS, Silva DMR, Andrade MS, Vasconcelos SC, Aquino JM. Stress of nursing professionals working in pre-hospital care. Rev Bras Enferm. 2020;73(2):e20180660. https://doi.org/10.1590/0034-7167-2018-0660
» https://doi.org/10.1590/0034-7167-2018-0660 -
4. Bijani M, Abedi S, Karimi S, Tehranineshat B. Major challenges and barriers in clinical decision-making as perceived by emergency medical services personnel: a qualitative content analysis. BMC Emerg Med. 2021;21(1):11. https://doi.org/10.1186/s12873-021-00408-4
» https://doi.org/10.1186/s12873-021-00408-4 - 5. Frankl VE. Em busca de sentido: um psicólogo no campo de concentração. 46 ed. São Leopoldo: Sinodal; Petrópolis: Vozes. 2019.
- 6. Frankl VE. Psicoterapia e o sentido da vida. 6ed. São Paulo: Quadrante. 2015.
-
7. Oliveira SS, Lima AB, Santa-Rosa DO, Freitas GF, Ferraz MOA. Experiences of the moral deliberation of nurses in mobile pre-hospital care. Rev Baiana Enferm. 2021;35:1-9. https://doi.org/10.18471/rbe.v35.38733
» https://doi.org/10.18471/rbe.v35.38733 -
8. Souza VR, Marziale MH, Silva GT, Nascimento PL. Translation and validation into Brazilian Portuguese and assessment of the COREQ checklist. Acta Paul Enferm. 2021;34:eAPE02631. https://doi.org/10.37689/actaape/2021AO02631
» https://doi.org/10.37689/actaape/2021AO02631 -
9. Vietta EP. The triad, humanist-existencial-personalism: a theoretical approach-research methodology in psychiatric nursing and mental health. Rev Latino-Am Enferm. 1995;3(1):31-43. https://doi.org/10.1590/S0104-11691995000100004
» https://doi.org/10.1590/S0104-11691995000100004 - 10. Frankl VE. Psicoterapia e sentido da vida: fundamentos da logoterapia e analise existencial. Quadrante. 2016.
-
11. Fontanella BJB, Ricas J, Turato ER. Amostragem por saturação em pesquisas qualitativas em saúde: contribuições teóricas. Cad Saúde Pública [Internet]. 2008[cited 2025 Jan 5];24(1) Available from: https://www.scielosp.org/article/csp/2008.v24n1/17-27/
» https://www.scielosp.org/article/csp/2008.v24n1/17-27/ - 12. Frankl VE. Sede de Sentido. São Paulo: Quadrante; 1989.
-
13. Jesus IS, Ferraz MOS, Farias MTD, Azevedo GN, Santa Rosa DO. Enfrentamento de problemas éticos por enfermeiros do Serviço de Atendimento Móvel de Urgência. Rev Iberoam Bioét. 2024;25. https://doi.org/10.14422/rib.i25.y2024.010
» https://doi.org/10.14422/rib.i25.y2024.010 -
14. Azizi M, Bidaki R, Ebadi A, Ostadtaghizadeh A, Tafti AD, Hajebi A, et al. Psychological distress management in Iranian emergency prehospital providers: a qualitative study. J Educ Health Promot. 2021;10:442. https://doi.org/10.4103/jehp.jehp_351_21
» https://doi.org/10.4103/jehp.jehp_351_21 -
15. Yasin JCM, Barlem ELD, Ruivo EDG, Andrade GB, Silveira RS, Bremer LCF. Ethical issues experienced by nurses during COVID-19: relationship with moral. Texto Contexto Enferm. 2023;32: e20230072. https://doi.org/10.1590/1980-265X-TCE-2023-0072pt
» https://doi.org/10.1590/1980-265X-TCE-2023-0072pt -
16. Lopes PF, Toledo VP. Sentimentos do enfermeiro ao acolher paciente psiquiátrico agitado e agressivo. Revista Enferm UFPE. 2020;14:e244485. https://doi.org/10.5205/1981- 8963.2020.244485
» https://doi.org/10.5205/1981- 8963.2020.244485 -
17. Jafari M, Ebadi A, Khankeh HR, Maddah SSB, Hosseini MA. Development and validation of moral distress scale in pre-hospital emergency servisse providers. Int J Emerg Serv. 2022;11(2):263-76. https://doi.org/10.1108/IJES-05-2021-0028
» https://doi.org/10.1108/IJES-05-2021-0028 -
18. Oliveira SS, Ferraz MOA, Rosa DOS. Desafios para a autonomia de enfermeiras no atendimento pré-hospitalar móvel [Internet]. BlogRev@Enf; 2021 [cited 2025 Feb 8]. Available from: https://blog.revenf.org/2021/07/02/desafios-para-a-autonomia-de-enfermeiras-no-atendimento-pre-hospitalar-movel/
» https://blog.revenf.org/2021/07/02/desafios-para-a-autonomia-de-enfermeiras-no-atendimento-pre-hospitalar-movel/ -
19. Rocha RCNP, Pereira ER, Silva RMCRA. A dimensão espiritual e sentido da vida na prática do cuidado de Enfermagem: enfoque fenomenológico. REME Rev Min Enferm. 2018;22:e-1151. https://doi.org/10.5935/1415-2762.20180082
» https://doi.org/10.5935/1415-2762.20180082 - 20. Frankl VE. A vontade de sentido: fundamentos e aplicação da logoterapia. São Paulo. 2011.
-
21. Barros LO, Moreira TC, Oliveira DA, Noronha APP. Relação entre sentido de vida e satisfação com a vida. Inter Psicol. 2021;25(3). https://doi.org/10.5380/riep.v25i3.68813318
» https://doi.org/10.5380/riep.v25i3.68813318 -
22. Oliveira SS, Ferraz MOA, Barata RS, Pitzer CMT, Anjos KF, Rosa DOS, et al. Problemas éticos vivenciados por enfermeiras no atendimento pré-hospitalar móvel. REME Rev Min Enferm. 2025;29:e-1572. https://doi.org/10.35699/2316-9389.2025.41921
» https://doi.org/10.35699/2316-9389.2025.41921
Access to the dataset is available upon request from the corresponding author.
