Charles Warren Fairbanks Center for Medical Ethics, Indiana University Health, Indianapolis, IN 46202, USA.
Cancer Nurs. 2013 Mar-Apr;36(2):114-21. doi: 10.1097/NCC.0b013e31825f4dc8.
Oncology nurses routinely encounter ethical dilemmas when caring for advanced cancer patients, particularly concerning prognosis-related communications. Nurses experience uncertainty and barriers to providing quality end-of-life care; thus, more information is needed about recognizing and managing these dilemmas and to clarify their role in these situations.
The purposes of this study were to (1) describe the frequency and types of ethical dilemmas experienced by oncology nurses caring for advanced cancer patients and (2) to summarize their written comments about prognosis-related communications.
This was a content analysis of narrative comments provided by 137 oncology nurses who completed a mailed national survey of members of the Oncology Nursing Society.
The most frequently reported ethical dilemmas encompassed uncertainties and barriers to truth telling, familial and cultural conflict, and futility. Physician-nurse teams were considered optimal for delivering prognosis-related information. Nurses offered strategies for facilitating these communications. They also expressed the need for more education about how to engage in prognosis-related discussions and for better methods for relaying this information among team members to avoid "working in the dark."
Oncology nurses routinely experience ethical dilemmas, and there is a need for clarification of their role in these circumstances. Healthcare providers would benefit from interdisciplinary education about prognosis-related discussions. Attention to managing familial conflict and understanding cultural variations associated with illness, death, and dying is also needed.
Findings reveal new information about ethical dilemmas encountered by nurses and strategies for improving end-of-life communications with advanced cancer patients.
肿瘤护士在护理晚期癌症患者时经常会遇到伦理困境，尤其是在涉及预后相关沟通时。护士在提供优质临终关怀方面感到不确定和存在障碍；因此，需要更多关于识别和管理这些困境的信息，并阐明他们在这些情况下的角色。
本研究的目的是：(1)描述护理晚期癌症患者的肿瘤护士所经历的伦理困境的频率和类型；(2)总结他们关于预后相关沟通的书面意见。
这是对完成肿瘤护理学会成员邮寄全国调查的 137 名肿瘤护士的叙事性意见进行的内容分析。
报告的最常见伦理困境包括告知真相的不确定性和障碍、家庭和文化冲突以及无效。医生-护士团队被认为是提供预后相关信息的最佳选择。护士提出了促进这些沟通的策略。他们还表示需要更多关于如何进行预后相关讨论的教育，以及更好的方法在团队成员之间传递这些信息，以避免“在黑暗中工作”。
肿瘤护士经常遇到伦理困境，需要澄清他们在这些情况下的角色。医疗保健提供者将受益于关于预后相关讨论的跨学科教育。还需要注意管理家庭冲突和理解与疾病、死亡和临终相关的文化差异。
研究结果揭示了护士在遇到的伦理困境方面的新信息，以及改善与晚期癌症患者进行临终沟通的策略。
