Vryonides Stavros, Papastavrou Evridiki, Charalambous Andreas, Andreou Panayiota, Merkouris Anastasios
Cyprus University of Technology, Cyprus
Cyprus University of Technology, Cyprus.
Nurs Ethics. 2015 Dec;22(8):881-900. doi: 10.1177/0969733014551377. Epub 2014 Nov 3.
In the face of scarcity, nurses may inevitably delay or omit some nursing interventions and give priority to others. This increases the risk of adverse patient outcomes and threatens safety, quality, and dignity in care. However, it is not clear if there is an ethical element in nursing care rationing and how nurses experience the phenomenon in its ethical perspective.
The purpose was to synthesize studies that relate care rationing with the ethical perspectives of nursing, and find the deeper, moral meaning of this phenomenon.
A systematic review and thematic synthesis of qualitative studies was used. Searching was based on guidelines suggested by Joana Brigs Institute, while the synthesis has drawn from the methodology described. Primary studies were sought from nine electronic databases and manual searches. The explicitness of reporting was assed using consolidated criteria for reporting qualitative research. Nine studies involving 167 nurse participants were included. Synthesis resulted in 35 preliminary themes, 14 descriptive themes, and four analytical themes (professional challenges and moral dilemmas, dominating considerations, perception of a moral role, and experiences of the ethical effects of rationing). Discussion of relationships between themes revealed a new thematic framework.
Every effort has been taken, for the thoroughness in searching and retrieving the primary studies of this synthesis, and in order for them to be treated accurately, fairly and honestly and without intentional misinterpretations of their findings.
Within limitations of scarcity, nurses face moral challenges and their decisions may jeopardize professional values, leading to role conflict, feelings of guilt, distress and difficulty in fulfilling a morally acceptable role. However, more research is needed to support certain relationships.
Related literature is limited. The few studies found highlighted the essence of justice, equality in care and in values when prioritizing care-with little support to the ethical effects of rationing on nurses. Further research on ethical dimension of care rationing may illuminate other important aspects of this phenomenon.
面对资源稀缺，护士可能不可避免地会延迟或省略一些护理干预措施，而优先进行其他干预。这增加了患者出现不良后果的风险，并威胁到护理的安全性、质量和尊严。然而，目前尚不清楚护理资源分配中是否存在伦理因素，以及护士如何从伦理角度看待这一现象。
旨在综合有关护理资源分配与护理伦理视角相关的研究，探寻这一现象更深层次的道德意义。
采用定性研究的系统综述和主题综合法。检索依据乔安娜·布里格斯研究所建议的指南进行，综合过程则借鉴了所描述的方法。通过九个电子数据库和手工检索来查找原始研究。使用定性研究报告的统一标准评估报告的明确性。纳入了九项涉及167名护士参与者的研究。综合分析得出35个初步主题、14个描述性主题和四个分析性主题（专业挑战与道德困境、主导因素、道德角色认知以及资源分配伦理影响的体验）。对主题之间关系的讨论揭示了一个新的主题框架。
已尽一切努力全面搜索和检索本综合研究的原始研究，并确保对其进行准确、公正和诚实的处理，且不故意曲解其研究结果。
在资源稀缺的限制下，护士面临道德挑战，其决策可能危及专业价值观，导致角色冲突、内疚感、困扰以及难以履行道德上可接受的角色。然而，需要更多研究来支持某些关系。
相关文献有限。所发现的少数研究强调了在优先提供护理时公平、护理平等和价值观平等的本质，但对资源分配对护士的伦理影响支持较少。对护理资源分配伦理维度的进一步研究可能会阐明这一现象的其他重要方面。
