Svantesson M, Löfmark R, Thorsén H, Kallenberg K, Ahlström G
Centre for Nursing Science, Orebro University Hospital, Box 1324, SE-70113 Orebro, Sweden.
J Med Ethics. 2008 May;34(5):399-406. doi: 10.1136/jme.2006.019810.
To evaluate one ethics rounds model by describing nurses' and doctors' experiences of the rounds.
Philosopher-ethicist-led interprofessional team ethics rounds concerning dialysis patient care problems were applied at three Swedish hospitals. The philosophers were instructed to promote mutual understanding and stimulate ethical reflection, without giving any recommendations or solutions. Interviews with seven doctors and 11 nurses were conducted regarding their experiences from the rounds, which were then analysed using content analysis.
The goal of the rounds was partly fulfilled. Participants described both positive and negative experiences. Good rounds included stimulation to broadened thinking, a sense of connecting, strengthened confidence to act, insight into moral responsibility and emotional relief. Negative experiences were associated with a sense of unconcern and alienation, as well as frustration with the lack of solutions and a sense of resignation that change is not possible. The findings suggest that the ethics rounds above all met the need of a forum for crossing over professional boundaries. The philosophers seemed to play an important role in structuring and stimulating reasoned arguments. The nurses' expectation that solutions to the ethical problems would be sought despite explicit instructions to the contrary was conspicuous.
When assisting healthcare professionals to learn a way through ethical problems in patient care, a balance should be found between ethical analyses, conflict resolution and problem solving. A model based on the findings is presented.
通过描述护士和医生参与伦理查房的经历来评估一种伦理查房模式。
在瑞典的三家医院开展了由哲学家-伦理学家主导的跨专业团队伦理查房，讨论透析患者护理问题。指导哲学家促进相互理解并激发伦理反思，但不给出任何建议或解决方案。就他们在查房中的经历对7名医生和11名护士进行了访谈，随后采用内容分析法进行分析。
查房目标部分实现。参与者描述了积极和消极的经历。良好的查房包括激发拓宽思维、产生联系感、增强行动信心、洞察道德责任以及缓解情绪。消极经历与漠不关心和疏离感相关，以及对缺乏解决方案的沮丧和认为无法改变的听天由命感。研究结果表明，伦理查房首先满足了跨越专业界限的论坛需求。哲学家似乎在构建和激发理性论证方面发挥了重要作用。护士不顾明确相反指示仍期望寻求伦理问题解决方案的情况很明显。
在协助医护人员了解处理患者护理中伦理问题的方法时，应在伦理分析、冲突解决和问题解决之间找到平衡。基于研究结果提出了一个模型。
