Goethals Sabine, Dierckx de Casterlé Bernadette, Gastmans Chris
KAHO St-Lieven, Sint-Niklaas, Belgium,
Med Health Care Philos. 2013 Nov;16(4):983-91. doi: 10.1007/s11019-012-9455-z.
In their practice, nurses make daily decisions that are ethically informed. An ethical decision is the result of a complex reasoning process based on knowledge and experience and driven by ethical values. Especially in acute elderly care and more specifically decisions concerning the use of physical restraint require a thoughtful deliberation of the different values at stake. Qualitative evidence concerning nurses' decision-making in cases of physical restraint provided important insights in the complexity of decision-making as a trajectory. However a nuanced and refined understanding of the reasoning process in terms of ethical values is still lacking. A qualitative interview design, inspired by the Grounded Theory approach, was carried out to explore nurses' reasoning process in terms of ethical values. We interviewed 21 acute geriatric nurses from 12 hospitals in different regions in Flanders, Belgium in the period October 2009-April 2011. The Qualitative Analysis Guide of Leuven was used to analyse interview data. Nurses' decision-making is characterized as an ethical deliberation process where different values are identified and where the process of balancing these values forms the essence of ethical deliberation. Ethical decision-making in cases of physical restraint implies that nurses have to choose which values receive priority in the process, which entails that not all values can be respected to the same degree. As a result, decision making can be experienced as difficult, even as a dilemma. Driven by the overwhelming goal of protecting physical integrity, nurses took into account the values of dignity and justice more implicitly and less dominantly.
在日常工作中，护士们每天都会做出基于伦理考量的决策。伦理决策是一个基于知识和经验、由伦理价值观驱动的复杂推理过程的结果。尤其是在老年急症护理中，更具体地说，在涉及使用身体约束的决策方面，需要对不同的关键价值观进行深思熟虑。关于护士在身体约束案例中的决策的定性证据，为决策过程的复杂性提供了重要见解。然而，在伦理价值观方面，对推理过程仍缺乏细致入微和精确的理解。受扎根理论方法启发，我们采用了定性访谈设计，以探究护士在伦理价值观方面的推理过程。2009年10月至2011年4月期间，我们对比利时弗拉芒不同地区12家医院的21名老年急症科护士进行了访谈。采用鲁汶定性分析指南对访谈数据进行分析。护士的决策被描述为一个伦理审议过程，在这个过程中，不同的价值观被识别出来，而平衡这些价值观的过程构成了伦理审议的核心。在身体约束案例中的伦理决策意味着护士必须选择在这个过程中哪些价值观具有优先权，这就意味着并非所有价值观都能得到同等程度的尊重。因此，决策可能会被体验为困难，甚至是一种两难境地。在保护身体完整性这一压倒性目标的驱动下，护士们更多地隐含而非主导性地考虑了尊严和正义的价值观。
