Walker R M, Miles S H, Stocking C B, Siegler M
Department of Internal Medicine, University of South Florida College of Medicine, Tampa 33612-4799.
J Gen Intern Med. 1991 Sep-Oct;6(5):424-9. doi: 10.1007/BF02598164.
To understand the kinds of clinical situations physicians and nurses regard as "ethics problems."
The authors prospectively studied physicians' and nurses' perceptions of ethics problems using paired interviews. Individual interviews were conducted with physicians and nurses as they cared for the same patients during a six-week period. Each was asked whether any ethics problems had arisen in the care of his or her patients and, if so, to give a brief description of each problem.
Three general medical services in a 497-bed community teaching hospital.
13 physicians (mostly family medicine residents) and 42 nurses caring for 142 patients.
The physicians and nurses thought ethics problems were present in 75 of the 142 patients cases. Physicians and nurses identified ethics problems with similar frequencies; however, they often identified ethics problems in different patient cases or identified different ethics problems in the same case. Physicians and nurses described a variety of problem types. Physicians identified more problems related to quality of life, inappropriate hospital admissions, and cost of care; nurses identified more problems related to patient preferences, family wishes, pain management, implementing treatments, and discharge planning. A fourth of the ethics problems identified by physicians and nurses involved interstaff conflicts.
The physicians and nurses studied considered a broad range of clinical situations to be "ethics problems," and they perceived them to occur frequently. Systematic differences were found between physicians' and nurses' perceptions of ethics problems, and many ethics problems generated interstaff conflicts. Incorporating this kind of information into clinical ethics education programs, and into hospital policies, may represent a useful approach toward improving physician-nurse interaction.
了解医生和护士视为“伦理问题”的临床情况种类。
作者采用配对访谈对医生和护士对伦理问题的看法进行前瞻性研究。在六周期间，当医生和护士照料相同患者时，对他们进行单独访谈。询问每人在照料其患者过程中是否出现任何伦理问题，若出现，简要描述每个问题。
一家拥有497张床位的社区教学医院的三个普通医疗科室。
13名医生（大多为家庭医学住院医师）和42名护士，照料142名患者。
医生和护士认为在142例患者病例中有75例存在伦理问题。医生和护士识别伦理问题的频率相似；然而，他们常常在不同患者病例中识别出伦理问题，或在同一病例中识别出不同的伦理问题。医生和护士描述了多种问题类型。医生识别出更多与生活质量、不适当的住院收治及护理费用相关的问题；护士识别出更多与患者偏好、家属意愿、疼痛管理、实施治疗及出院计划相关的问题。医生和护士识别出的伦理问题中有四分之一涉及医护人员之间的冲突。
参与研究的医生和护士认为广泛的临床情况属于“伦理问题”，且他们认为这些问题频繁出现。发现医生和护士对伦理问题的看法存在系统性差异，且许多伦理问题引发了医护人员之间的冲突。将这类信息纳入临床伦理教育项目及医院政策中，可能是改善医护人员互动的一种有效方法。
