Faculty of Nursing, University of Manitoba, 381 Helen Glass Centre for Nursing, Winnipeg, Manitoba, Canada, R3T 2N2,
J Bioeth Inq. 2013 Oct;10(3):325-36. doi: 10.1007/s11673-013-9463-6. Epub 2013 Jun 22.
While researchers have examined the types of ethical issues that arise in long-term care, few studies have explored long-term care nurses' experiences of moral distress and fewer still have examined responses to initial moral distress. Using an interpretive description approach, 15 nurses working in long-term care settings within one city in Canada were interviewed about their responses to experiences of initial moral distress, resources or supports they identified as helpful or potentially helpful in dealing with these situations, and factors that hindered nurses in their responses. Using a thematic analysis process, three major themes were identified from the nurses' experiences: (i) the context of the situation matters; (ii) the value of coming together as a team; and (iii) looking for outside direction. The work of responding to initial moral distress was more fruitful if opportunities existed to discuss conflicts with other team members and if managers supported nurses in moving their concerns forward through meetings or conversations with the team, physician, or family. Access to objective others and opportunities for education about ethics were also identified as important for dealing with value conflicts.
虽然研究人员已经研究了长期护理中出现的各种伦理问题，但很少有研究探讨长期护理护士的道德困境体验，更少研究初始道德困境的应对措施。本研究采用解释性描述方法，对加拿大一个城市的 15 名在长期护理机构工作的护士进行了访谈，了解他们对初始道德困境的应对措施，以及他们认为有助于或可能有助于处理这些情况的资源或支持，同时还探讨了阻碍护士应对困境的因素。通过主题分析过程，从护士的经历中确定了三个主要主题：（i）情境的背景很重要；（ii）团队合作的价值；（iii）寻求外部指导。如果有机会与其他团队成员讨论冲突，如果管理人员通过会议或与团队、医生或家属的对话来支持护士推进他们的问题，那么应对初始道德困境的工作会更有成效。获得客观他人的支持以及接受伦理学教育的机会也被认为对处理价值观冲突很重要。
