Horntvedt May-Elin T, Romøren Maria, Solvoll Betty-Ann
Buskerud and Vestfold University College, Norway
University of Oslo and Vestfold Hospital Trust, Norway.
Nurs Ethics. 2014 Dec;21(8):890-901. doi: 10.1177/0969733014521093. Epub 2014 Mar 18.
Intravenous fluids and/or antibiotics are applied to only a limited extent in Norwegian nursing homes, and the patients are often sent to hospital in these situations. A transfer and a stay in hospital may be unnecessary strains for frail older patients. Given this background, a collaborative research project was initiated in a Norwegian county in 2009. A teaching programme was developed, which aimed to strengthen the awareness of ethics, assessments and practical procedures related to intravenous fluid and/or antibiotics among healthcare professionals.
This qualitative study aimed to increase our knowledge of the ethical problems experienced by nursing home nurses in situations related to the administration of intravenous fluids and/or antibiotics.
An exploratory design was used, and five focus group interviews were conducted with 26 registered nurses. A hermeneutic analytic approach was applied.
This study was reported to the Norwegian Social Science Data Services in May 2010. The Regional Committee for Medical and Health Research Ethics approved the collaborative research project.
The analysis showed that the nurses experienced difficult decision-making situations, which were interpreted as external pressure and internal pressure. External pressure emerged in interactions with patients and relatives. Organizational factors were also interpreted as external pressure. Internal pressure was interpreted as the nurses' experience of feeling inadequate in situations where it was difficult to protect the dignity of patients.
These findings correspond with international studies, which show that ethical problems often arise during decision-making situations.
In agreement with the definition of an ethical problem, we found that the nurses experienced uncertainty and disagreements about how situations should be managed. External and internal pressures related to intravenous fluids and/or antibiotics in nursing homes have not been reported in previous studies. Thus, these findings merit further exploration.
在挪威的养老院中，静脉输液和/或抗生素的使用程度有限，在这些情况下患者常被送往医院。对于体弱的老年患者而言，转院和住院可能是不必要的负担。鉴于此背景，2009年在挪威的一个郡启动了一项合作研究项目。制定了一个教学计划，旨在增强医护人员对与静脉输液和/或抗生素相关的伦理、评估及实际操作程序的认识。
这项定性研究旨在增进我们对养老院护士在静脉输液和/或抗生素给药相关情况中所经历的伦理问题的了解。
采用探索性设计，对26名注册护士进行了五次焦点小组访谈。应用了解释学分析方法。
本研究于2010年5月报给了挪威社会科学数据服务机构。医学与健康研究伦理区域委员会批准了该合作研究项目。
分析表明，护士们经历了艰难的决策情境，这些情境被解读为外部压力和内部压力。外部压力出现在与患者及亲属的互动中。组织因素也被视为外部压力。内部压力被解读为护士在难以维护患者尊严的情况下感到自身能力不足的体验。
这些研究结果与国际研究一致，表明伦理问题常在决策情境中出现。
与伦理问题的定义相符，我们发现护士们在如何处理这些情况方面存在不确定性和分歧。此前的研究尚未报道过养老院中与静脉输液和/或抗生素相关的外部和内部压力。因此，这些研究结果值得进一步探究。
