UCLA School of Nursing, Los Angeles, CA 90095–6918, USA.
J Nurs Scholarsh. 2011 Dec;43(4):385-95. doi: 10.1111/j.1547-5069.2011.01422.x. Epub 2011 Oct 18.
Nurses in all clinical settings encounter ethical issues that frequently lead to moral distress. This critical incident study explored nurses' descriptions of ethically difficult situations to identify priorities, action responses, and regrets.
Employing the critical incident technique, researchers developed a questionnaire that collected information on ethically difficult situations, nurse actions, and situational outcomes. Data on nursing priorities and actions were analyzed and categorized using a constant comparison technique.
Addressing patient autonomy and quality of life were ethical priorities in the majority of cases. In many cases, nurses analyzed ethics from a diffuse perspective and only considered one dimension of the ethics conflict. However, some nurses were specific in their ethical analysis and proactive in their action choices. Nurses also identified 12 ethics-specific nurse activities, five ways of being, three ways of knowing, and two ways of deliberating. In 21 cases, nurses chose not to pursue their concerns beyond providing standard care. Several nurses expressed significant regret in their narration; most regretted unnecessary pain and suffering, and some claimed they did not do enough for the patient.
Not enough specific, evidence-based ethics actions have been developed. Stronger and more proactive nursing voices with early ethics interventions would make valuable contributions to quality of care for patients, especially at the end of life.
Ever-expanding treatment options raise ethical issues and challenge nurses to be effective patient advocates. Evidence-based nursing interventions that promptly identify and address moral conflict will benefit patients, their families, and the entire healthcare team by mitigating potential moral distress and disengagement.
所有临床环境中的护士都会遇到经常导致道德困境的伦理问题。本关键性事件研究探讨了护士对道德困境的描述，以确定优先事项、行动反应和遗憾。
研究人员采用关键性事件技术，开发了一份问卷，收集有关道德困境、护士行为和情境结果的信息。使用恒比法对护理优先事项和行动进行了分析和分类。
在大多数情况下，患者自主权和生活质量是伦理的优先事项。在许多情况下，护士从漫不经心的角度分析伦理问题，只考虑伦理冲突的一个维度。然而，一些护士在伦理分析上非常具体，在行动选择上也非常积极主动。护士还确定了 12 项特定于伦理的护士活动、5 种行为方式、3 种认知方式和 2 种审议方式。在 21 例中，护士选择不超越提供标准护理来处理他们的关注。几位护士在叙述中表示非常遗憾；大多数人对不必要的痛苦和苦难表示遗憾，有些人声称他们对病人做得不够。
还没有制定足够具体的循证伦理学行动。更有力、更积极主动的护理声音，加上早期的伦理学干预，将对患者的护理质量做出有价值的贡献，特别是在生命的尽头。
不断扩大的治疗选择引发了伦理问题，并要求护士成为有效的患者代言人。基于证据的护理干预措施可以迅速识别和解决道德冲突，通过减轻潜在的道德困境和脱离，使患者、他们的家人和整个医疗团队受益。
