Pavlish Carol L, Hellyer Joan Henriksen, Brown-Saltzman Katherine, Miers Anne G, Squire Karina
Carol L. Pavlish is an associate professor at University of California Los Angeles (UCLA), School of Nursing, Los Angeles, California. Joan Henriksen Hellyer is coordinator of ethics consultation services at the Mayo Clinic, Rochester, Minnesota. Katherine Brown-Saltzman is co-director of the ethics center at UCLA Health System, Los Angeles, California. Anne G. Miers is a clinical nurse specialist at the Mayo Clinic and adjunct faculty at Winona State University Graduate School of Nursing, Rochester, Minnesota. Karina Squire is a staff nurse in critical care at the Mayo Clinic.
Am J Crit Care. 2015 May;24(3):248-56. doi: 10.4037/ajcc2015418.
Ethical conflicts, often leading to poor teamwork and moral distress, are very challenging to patients, patients' families, and health care providers. A proactive approach to ethical conflicts may improve patient care outcomes.
To examine acceptability and feasibility of an ethics screening and early intervention tool for use by nurses caring for critically ill patients.
Twenty-eight nurses in 2 medical centers applied the ethics screening tool to 55 patient situations. Nurses assessed situations for risk factors and early indicators of ethical conflicts and analyzed level of risk. At study completion, nurses participated in focus group discussions about the tool's benefits and challenges. Frequency counts were performed on risk factors and early indicators of ethical conflicts. Content analysis was used on written explanations regarding high-, medium-, and low-risk situations and on focus group data.
Older patients with multiple comorbid conditions and aggressive treatments were frequently assessed to be at risk for ethical conflicts. Nurses who witnessed patients' suffering and deterioration were likely to initiate the screening process. The most prominent family risk factors included unrealistic expectations and adamancy about treatment. The most prominent early indicators were signs of patients' suffering, unrealistic expectations, and providers' own moral distress. High-risk situations averaged a greater number of risk factors and early indicators than did medium- and low-risk situations. Certain risk factors featured prominently in high-risk situations.
A phenomenon of shared suffering emerged from the study and signifies the importance of relational strategies such as routine family conferences and ethics consultation.
伦理冲突常常导致团队协作不佳和道德困扰，这对患者、患者家属及医疗服务提供者而言极具挑战性。对伦理冲突采取积极主动的应对方法可能会改善患者护理结果。
探讨一种伦理筛查与早期干预工具供护理重症患者的护士使用的可接受性和可行性。
2个医疗中心的28名护士将伦理筛查工具应用于55个患者案例。护士评估案例中的风险因素和伦理冲突的早期指标，并分析风险水平。在研究结束时，护士参与了关于该工具的益处和挑战的焦点小组讨论。对伦理冲突的风险因素和早期指标进行了频数统计。对关于高、中、低风险案例的书面解释以及焦点小组数据进行了内容分析。
患有多种合并症且接受积极治疗的老年患者经常被评估为存在伦理冲突风险。目睹患者痛苦和病情恶化的护士更有可能启动筛查流程。最突出的家庭风险因素包括不切实际的期望和对治疗的固执态度。最突出的早期指标是患者痛苦的迹象、不切实际的期望以及医护人员自身的道德困扰。与中、低风险案例相比，高风险案例平均有更多的风险因素和早期指标。某些风险因素在高风险案例中尤为突出。
该研究中出现了共同痛苦的现象，这表明了诸如定期家庭会议和伦理咨询等关系策略的重要性。
