Catholic University College Ghent, Department of Nursing, Hospitaalstraat 23, 9100 Sint-Niklaas, Belgium.
Int J Nurs Stud. 2010 May;47(5):635-50. doi: 10.1016/j.ijnurstu.2009.12.010. Epub 2010 Jan 21.
Today's healthcare system requires that nurses have strong medical-technical competences and the ability to focus on the ethical dimension of care. For nurses, coping with the ethical dimension of care in practise is very difficult. Often nurses cannot act according to their own personal values and norms. This generates internal moral distress, which has a negative impact on both nurses and patients.
The objective of this review is a thorough analysis of the literature about nurses' ethical practise particularly with regard to their processes of ethical reasoning and decision making and implementation of those decisions in practise.
We conducted an extensive search of the electronic databases Medline, Embase, Cinahl, and PsycInfo for papers published between January 1988 and September 2008. A broad range of search keywords was used. The 39 selected articles had a quantitative, qualitative, or mixed-method design.
Despite the conceptual difficulties that the literature on the ethical practise of nurses suffers, in this review we understand nurses' ethical practise a complex process of reasoning, decision making, and implementation of the decision in practise. The process of decision making is more than a pure cognitive process; it is influenced by personal and contextual factors. The difficulties nurses encounter in their ethical conduct are linked to their difficult work environment. As a result, nurses often capitulate to the decisions made by others, which results in a conformist way of acting and less individually adapted care.
This review provides us with a more nuanced understanding of the way nurses reason and act in ethically difficult situations than emerged previously. If we want to support nurses in their ethical care and if we want to help them to change their conformist practises, more research is needed. Especially needed are in-depth qualitative studies that explore the experiences of nurses. Such studies could help us better understand not only how nurses reason and behave in practise but also the relationship between these two processes.
当今的医疗体系要求护士具备强大的医学技术能力，并关注护理的伦理维度。对于护士来说，在实践中应对护理的伦理维度非常困难。护士常常无法根据自己的个人价值观和规范行事。这会导致内在的道德困境，对护士和患者都产生负面影响。
本综述的目的是对护士伦理实践的文献进行全面分析，特别是关于他们的伦理推理和决策过程，以及在实践中实施这些决策的情况。
我们对 Medline、Embase、Cinahl 和 PsycInfo 电子数据库进行了广泛搜索，以查找 1988 年 1 月至 2008 年 9 月期间发表的文献。使用了广泛的搜索关键词。39 篇选定的文章采用了定量、定性或混合方法设计。
尽管文献中关于护士伦理实践存在概念上的困难，但在本次综述中，我们将护士的伦理实践理解为一个复杂的推理、决策和实践中实施决策的过程。决策过程不仅仅是一个纯粹的认知过程，它受到个人和环境因素的影响。护士在道德行为中遇到的困难与他们艰难的工作环境有关。因此，护士常常屈从于他人的决定，导致他们采取从众的行为方式，提供的护理也缺乏个性化。
本次综述使我们对护士在伦理困境中推理和行动的方式有了更细致的理解，这比之前的研究更加深入。如果我们想在伦理护理方面支持护士，并帮助他们改变从众的行为方式，那么需要进行更多的研究。特别是需要深入的定性研究，以探索护士的经验。这些研究可以帮助我们更好地理解护士在实践中的推理和行为方式，以及这两个过程之间的关系。
