Laabs Carolyn A
J Am Acad Nurse Pract. 2005 Feb;17(2):76-84. doi: 10.1111/j.1041-2972.2005.00014.x.
To identify the ethical issues nurse practitioners (NPs) encounter in primary care, examine the types of moral problems that arise related to those issues, and determine the level of distress NPs experience.
Self-reported responses to an investigator-designed, anonymous, mailed survey on a convenience sample of 71 NPs practicing in primary care in one midwestern metropolitan area.
This preliminary descriptive study identified a number and variety of ethical issues NPs encounter in primary care. The issue encountered with the greatest frequency was patient refusal of appropriate treatment. Distress was reported most often over problems of moral dilemma, followed by moral distress, and least often, moral uncertainty and moral outrage. Another type of moral problem, possibly related to conflict between patient autonomy and NP beneficence, occurred almost as often as moral dilemma. Not as many NPs reported encountering ethical issues or being distressed as the literature suggests. The reason for this is unclear but may be related to NPs' sense of moral responsibility or their ability to discern subtle ethical issues in the complex primary care environment. Regardless of moral problem, NPs felt frustrated and powerless. As a result, some changed jobs and contemplated leaving advanced practice.
More research is needed to clearly understand ethical issues and moral problems for NPs in primary care, how NPs identify and manage problems, and the effects on NPs and patients.
识别执业护士（NP）在初级保健中遇到的伦理问题，研究与这些问题相关的道德问题类型，并确定NP所经历的苦恼程度。
对在中西部一个大都市地区从事初级保健工作的71名NP的便利样本进行调查，这些调查是由研究者设计的、匿名的、邮寄的自我报告式问卷。
这项初步描述性研究识别出了NP在初级保健中遇到的一系列伦理问题。最常遇到的问题是患者拒绝接受适当治疗。报告苦恼最多的是道德困境问题，其次是道德苦恼，而道德不确定性和道德义愤最少。另一种道德问题，可能与患者自主权和NP的善行之间的冲突有关，其出现频率几乎与道德困境相同。报告遇到伦理问题或感到苦恼的NP不像文献所表明的那么多。原因尚不清楚，但可能与NP的道德责任感或他们在复杂的初级保健环境中辨别细微伦理问题的能力有关。无论遇到何种道德问题，NP都感到沮丧和无力。因此，一些人换了工作，并考虑离开高级实践岗位。
需要更多研究来清楚地了解NP在初级保健中的伦理问题和道德问题、NP如何识别和管理这些问题，以及对NP和患者的影响。
