Aalesund University College, Norway.
Nurs Ethics. 2012 May;19(3):419-30. doi: 10.1177/0969733011429015. Epub 2012 Feb 8.
The aim of this study is to explore how nurses perceive patient participations of patients over 75 years old undergoing hemodialysis treatment in dialysis units, and of their next of kin. Ten nurses told stories about what happened in the dialysis units. These stories were analyzed with critical discourse analysis. Three discursive practices are found: (1) the nurses' power and control; (2) sharing power with the patient; and (3) transferring power to the next of kin. The first and the predominant discursive practice can be explained with an ideology of paternalism, in which the nurses used biomedical explanations and the ethical principle of benefice to justify their actions. The second can be explained with an ideology of participation, in which the nurses used ethical narratives as a way to let the patients participate in the treatment. The third seemed to involve autonomous decision-making and the ethical principle of autonomy for the next of kin in the difficult end-of-life decisions.
本研究旨在探讨护士如何看待接受血液透析治疗的 75 岁以上老年患者及其家属的参与情况。10 名护士讲述了透析病房中发生的故事。采用批评性话语分析对这些故事进行了分析。发现了三种话语实践：（1）护士的权力和控制；（2）与患者分享权力；（3）将权力转移给家属。第一种也是主要的话语实践可以用家长制思想来解释，护士用生物医学解释和受益原则来证明他们的行为是合理的。第二种可以用参与思想来解释，护士用伦理叙事作为让患者参与治疗的一种方式。第三种似乎涉及到在困难的临终决策中，家属的自主决策和自主权的伦理原则。
