Faculty of Health Sciences, University of Lethbridge, 4401 University Drive West, Lethbridge, Alberta, Canada.
Int J Nurs Stud. 2010 Jun;47(6):723-31. doi: 10.1016/j.ijnurstu.2009.11.010. Epub 2009 Dec 9.
The phenomenon of moral distress among nurses has been described in a variety of high-income countries and practice settings. Defined as the biopsychosocial, cognitive, and behavioural effects experienced by clinicians when their values are compromised by internal or external constraints, it results from the inability to provide the desired care to patients. No research has been reported that addresses moral distress in severely resource-challenged regions such as sub-Saharan Africa.
To describe the manifestation and impact of moral distress as it was experienced by Ugandan nurses who provided care to HIV-infected or -affected people.
A critical ethnography was conducted with 24 acute care and public health nurses at a large referral centre in Uganda. Data were collected through interviews, observation, and focus group discussions.
Participants described their passion for nursing and commitment to patients. They experienced moral distress when a lack of resources put patients' wellbeing at risk. The trauma imposed by systemic challenges on the nursing profession was acknowledged, as was the perception that the public blamed nurses for poor patient outcomes. However, participants were determined to serve to the best of their abilities and to take satisfaction from any contributions they were able to make. They cited the importance of education in the development of their capacity to provide care with a positive attitude, and demonstrated a collective resilience as they discussed strategies for addressing issues that affected them and their colleagues.
The experience of moral distress among nurses in Uganda differed somewhat from the experience of nurses in high-income countries. Constraints imposed by the inability to implement skills and knowledge to their fullest extent, as well as a lack of resources and infrastructure may result in the omission of care for patients. Moral distress appears to manifest within a relational and contextual environment and participants focussed on the impact for patients, communities, and the nursing profession as a whole, rather than on their own personal suffering. The opportunity for continuing education led to strategies to transform personal attitudes and practice as well as to enhance the presentation of the profession to the public.
护士的道德困境现象在许多高收入国家和实践环境中都有描述。道德困境被定义为临床医生的生物心理社会、认知和行为影响，当他们的价值观受到内部或外部限制时，就会产生这种影响，这是由于无法为患者提供所需的护理造成的。没有研究报告表明在资源严重匮乏的地区，如撒哈拉以南非洲，存在道德困境。
描述在为艾滋病毒感染者或受影响者提供护理的乌干达护士中经历的道德困境的表现和影响。
在乌干达的一个大型转诊中心，对 24 名急症护理和公共卫生护士进行了关键民族志研究。通过访谈、观察和焦点小组讨论收集数据。
参与者描述了他们对护理的热情和对患者的承诺。当资源匮乏使患者的健康受到威胁时，他们就会感到道德困境。他们认识到系统挑战给护理行业带来的创伤，以及公众将患者不良结局归咎于护士的看法。然而，参与者决心尽自己最大的能力服务，并从他们能够做出的任何贡献中获得满足感。他们提到了教育在培养他们积极提供护理的能力方面的重要性，并展示了集体的适应力，因为他们讨论了应对影响他们和同事的问题的策略。
乌干达护士的道德困境经历与高收入国家的护士略有不同。无法充分实施技能和知识的能力限制，以及资源和基础设施的缺乏，可能导致对患者的护理缺失。道德困境似乎在关系和背景环境中表现出来，参与者关注的是对患者、社区和整个护理行业的影响，而不是自己的个人痛苦。继续教育的机会导致了改变个人态度和实践的策略，以及增强了向公众展示该职业的机会。
