Indiana State University, Terre Haute, Indiana, USA.
Nurs Ethics. 2010 May;17(3):353-62. doi: 10.1177/0969733010361442.
In the context of health care system complexity, nurses need responsive leadership and organizational support to maintain intrinsic motivation, moral sensitivity and a caring stance in the delivery of patient care. The current complexity of nurses' work environment promotes decreases in work motivation and moral satisfaction, thus creating motivational and ethical dissonance in practice. These and other work-related factors increase emotional stress and burnout for nurses, prompting both new and seasoned nurse professionals to leave their current position, or even the profession. This article presents a theoretical conceptual model for professional nurses to review and make sense of the ethical reasoning skills needed to maintain a caring stance in relation to the competing values that must coexist among nurses, health care administrators, patients and families in the context of the complex health care work environments in which nurses are expected to practice. A model, Nurses' Ethical Reasoning Skills, is presented as a framework for nurses' thinking through and problem solving ethical issues in clinical practice in the context of complexity in health care.
在医疗保健系统的复杂性背景下，护士需要有响应式的领导力和组织支持，以保持内在动机、道德敏感性和关爱立场，为患者提供护理。目前，护士工作环境的复杂性导致工作动机和道德满意度下降，从而在实践中产生了动机和道德上的不和谐。这些以及其他与工作相关的因素增加了护士的情绪压力和倦怠感，促使新老护士专业人员离开当前岗位，甚至离开这个职业。本文提出了一个理论概念模型，供专业护士审查和理解在复杂的医疗保健工作环境中，护士必须保持关爱立场所需的伦理推理技能，在这种环境中，护士、医疗保健管理人员、患者和家庭之间的竞争价值观必须共存。提出了一个模型，即护士的伦理推理技能，作为护士在护理复杂性背景下通过思考和解决临床实践中的伦理问题的框架。
