University of Huddersfield, UK.
Nurs Ethics. 2018 Mar;25(2):230-242. doi: 10.1177/0969733017703700. Epub 2017 May 3.
Complex and expensive treatment options have increased the frequency and emphasis of ethical decision-making in healthcare. In order to meet these challenges effectively, we need to identify how nurses contribute the resolution of these dilemmas.
To identify the values, beliefs and contextual influences that inform decision-making. To identify the contribution made by nurses in achieving the resolution of ethical dilemmas in practice.
An interpretive exploratory study was undertaken, 11 registered acute care nurses working in a district general hospital in England were interviewed, using semi-structured interviews. In-depth content analysis of the data was undertaken via NVivo coding and thematic identification. Participants and context: Participants were interviewed about their contribution to the resolution of ethical dilemmas within the context of working in an acute hospital ward. Participants were recruited from all settings working with patients of any age and any diagnosis. Ethical considerations: Ethical approval was obtained from the local National Research Ethics Committee.
Four major themes emerged: 'best for the patient', 'accountability', 'collaboration and conflict' and 'concern for others'. Moral distress was also evident in the literature and findings, with moral dissonance recognised and articulated by more experienced nurses. The relatively small, single-site sample may not account for the effects of organisational culture on the results; the findings suggested that professional relationships were key to resolving ethical dilemmas.
Nurses use their moral reasoning based on their beliefs and values when faced with ethical dilemmas. Subsequent actions are mediated though ethical decision-making frames of reference including deontology, consequentialism, the ethics of care and virtue ethics. Nurses use these in contributing to the resolution of these dilemmas. Nurses require the skills to develop and maintain professional relationships for addressing ethical dilemmas and to engage with political and organisational macro- and micro-decision-making.
Nurses' professional relationships are central to nurses' contributions to the resolution of ethical dilemmas.
复杂且昂贵的治疗方案增加了医疗保健中伦理决策的频率和重要性。为了有效应对这些挑战，我们需要确定护士如何为解决这些困境做出贡献。
确定影响决策的价值观、信念和背景因素。确定护士在实践中解决伦理困境方面所做的贡献。
进行了一项解释性探索性研究，对英格兰一家地区综合医院的 11 名注册急性护理护士进行了访谈，使用半结构化访谈。通过 NVivo 编码和主题识别对数据进行深入的内容分析。
参与者被问及他们在急性病房工作背景下对解决伦理困境的贡献。参与者是从所有年龄段和各种诊断的患者中招募的。
已从当地国家伦理委员会获得伦理批准。
出现了四个主要主题：“对患者最好”、“问责制”、“协作和冲突”以及“关心他人”。道德困境在文献和研究结果中也很明显，经验丰富的护士认识到并表达了道德不和谐。相对较小的单一地点样本可能无法说明组织文化对结果的影响；研究结果表明，专业关系是解决伦理困境的关键。
护士在面对伦理困境时，会根据自己的信仰和价值观运用他们的道德推理。随后的行动通过道德决策参考框架来调解，包括义务论、后果主义、关怀伦理和美德伦理。护士利用这些框架为解决这些困境做出贡献。护士需要具备发展和维护专业关系的技能，以解决伦理困境，并参与政治和组织的宏观和微观决策。
护士的专业关系是护士为解决伦理困境做出贡献的核心。
