Agazio Janice, Goodman Petra
School of Nursing, The Catholic University of America, Washington, DC.
School of Nursing, The Catholic University of America, Washington, DC.
Nurs Outlook. 2017 Sep-Oct;65(5S):S92-S99. doi: 10.1016/j.outlook.2017.06.010. Epub 2017 Jun 30.
Codes of ethics set forth standards of ethical conduct for nurses. However, nurses involved in wartime operations, or disasters, may often have their moral compass challenged by the patient care decisions necessary under adverse conditions. Reverse triage, resource allocation, and promotion of patient autonomy present multiple challenges to meeting commonly applied ethical principles.
The purpose of this study was to use the International Council of Nursing code of ethics as a framework to organize the ethical issues emerging from wartime nursing.
This article represents a secondary analysis of two studies using thematic analysis to identify ethical issues encountered by military nurses during the recent conflicts in Iraq and Afghanistan. Data were collected from nurses deployed from 2002 to 2015 and from 111 military nurses during focused interviews.
Across both studies, issues such as resource allocation, patient triage, cultural differences, and equitable treatment for all emerged as challenges within the wartime environment. Nurses were at a loss at times as to how best to manage the situations and recommended that more education is needed in ethical decision making before, during, and after deployment as a debriefing strategy. Similar issues have been documented in military and disaster literature indicating that such challenges are not limited to the recent conflicts but cross time and location.
By better understanding how nurses define, assess, and manage the ethical situations they encounter in wartime nursing practice, military nurses can better prepare for future conflicts, provide mentorship and targeted education to hopefully reducing any feelings of moral distress, and promote ethical decision making that will best promote outcomes in accordance with nursing's ethical codes.
道德准则规定了护士的道德行为标准。然而，参与战时行动或灾难救援的护士，其道德准则常常会受到在恶劣条件下进行患者护理决策的挑战。逆向分诊、资源分配以及促进患者自主权，在遵循普遍适用的道德原则方面带来了多重挑战。
本研究旨在以国际护士理事会道德准则为框架，梳理战时护理中出现的道德问题。
本文是对两项研究的二次分析，采用主题分析法来识别军事护士在近期伊拉克和阿富汗冲突期间遇到的道德问题。数据收集自2002年至2015年部署的护士以及111名军事护士的重点访谈。
在这两项研究中，资源分配、患者分诊、文化差异以及对所有人的公平治疗等问题，在战时环境中均成为挑战。护士们有时对于如何最好地应对这些情况感到困惑，并建议在部署前、部署期间和部署后，作为一种汇报策略，需要进行更多的道德决策教育。军事和灾难相关文献中也记录了类似问题，表明此类挑战并非仅限于近期冲突，而是跨越时间和地点。
通过更好地理解护士如何界定、评估和管理他们在战时护理实践中遇到的道德情况，军事护士可以更好地为未来冲突做好准备，提供指导和针对性教育，有望减少任何道德困扰感，并促进符合护理道德准则的道德决策，从而最好地促进护理结果。
