Pavlish Carol, Brown-Saltzman Katherine, Fine Alyssa, Jakel Patricia
School of Nursing, University of California, Los Angeles.
UCLA Health System Ethics Center, Los Angeles, CA.
Clin J Oncol Nurs. 2015 Apr;19(2):159-65. doi: 10.1188/15.CJON.19-02AP.
Healthcare providers experience many ethical challenges while caring for and making treatment decisions with patients and their families.
The purpose of this ethnographic study was to examine the challenges and circumstances that surround ethically difficult situations in oncology practice.
The authors conducted six focus groups with 30 oncology nurses in the United States and interviewed 12 key informants, such as clinical ethicists, oncologists, and nurse administrators.
The authors found that many healthcare providers remain silent about ethical concerns until a precipitating crisis occurs and ethical questions can no longer be avoided. Patients, families, nurses, and physicians tended to delay or defer conversations about prognosis and end-of-life treatment options. Individual, interactional, and system-level factors perpetuated the culture of avoidance. These included the intellectual and emotional toll of addressing ethics, differences in moral perspectives, fear of harming relationships, lack of continuity in care, emphasis on efficiency, and lack of shared decision making. This information is critical for any proactive and system-level effort aimed at mitigating ethical conflicts and their frequent companions-moral distress and burnout.
医疗服务提供者在照顾患者及其家属并做出治疗决策时面临许多伦理挑战。
这项人种学研究的目的是调查肿瘤学实践中围绕伦理困境的挑战和情况。
作者在美国与30名肿瘤学护士进行了6次焦点小组讨论，并采访了12名关键信息提供者，如临床伦理学家、肿瘤学家和护士管理人员。
作者发现，许多医疗服务提供者在引发危机发生且伦理问题无法再回避之前，对伦理问题保持沉默。患者、家属、护士和医生往往会推迟或拖延关于预后和临终治疗选择的谈话。个人、互动和系统层面的因素使回避文化长期存在。这些因素包括处理伦理问题的智力和情感负担、道德观念的差异、害怕损害关系、护理缺乏连续性、强调效率以及缺乏共同决策。这些信息对于任何旨在减轻伦理冲突及其常见伴随问题——道德困扰和职业倦怠的积极主动的系统层面努力至关重要。
