Johns Hopkins School of Nursing, Baltimore, MD, USA.
University of Technology Sydney, Australia.
J Clin Nurs. 2018 Mar;27(5-6):e1233-e1241. doi: 10.1111/jocn.14158. Epub 2018 Feb 21.
To develop a framework to enable discussion, debate and the formulation of interventions to address ethical issues in nursing practice.
Social, cultural, political and economic drivers are rapidly changing the landscape of health care in our local environments but also in a global context. Increasingly, nurses are faced with a range of ethical dilemmas in their work. This requires investigation into the culture of healthcare systems and organisations to identify the root causes and address the barriers and enablers of ethical practice. The increased medicalisation of health care; pressures for systemisation; efficiency and cost reduction; and an ageing population contribute to this complexity. Often, ethical issues in nursing are considered within the abstract and philosophical realm until a dilemma is encountered. Such an approach limits the capacity to tangibly embrace ethical values and frameworks as pathways to equitable, accessible, safe and quality health care and as a foundation for strengthening a supportive and enabling workplace for nurses and other healthcare workers.
Conceptual framework development.
A comprehensive literature review was undertaken using the social-ecological framework as an organising construct.
This framework views ethical practice as the outcome of interaction among a range of factors at eight levels: individual factors (patients and families); individual factors (nurses); relationships between healthcare professionals; relationships between patients and nurses; organisational healthcare context; professional and education regulation and standards; community; and social, political and economic.
Considering these elements as discrete, yet interactive and intertwined forces can be useful in developing interventions to promote ethical practice. We consider this framework to have utility in policy, practice, education and research.
Nurses face ethical challenges on a daily basis, considering these within a social-ecological framework can assist in developing strategies and resolutions.
制定一个框架，以促进讨论、辩论和制定干预措施，解决护理实践中的伦理问题。
社会、文化、政治和经济因素正在迅速改变我们当地环境中的医疗保健格局，但也在全球范围内改变。护士在工作中越来越多地面临一系列伦理困境。这需要对医疗保健系统和组织的文化进行调查，以确定根本原因，并解决伦理实践的障碍和促成因素。医疗保健的日益医学化；系统的压力；效率和成本降低；以及人口老龄化导致了这种复杂性。通常，护理中的伦理问题被认为是抽象的和哲学的范畴，直到遇到困境。这种方法限制了切实接受伦理价值观和框架的能力，将其作为公平、可及、安全和高质量医疗保健的途径，以及加强护士和其他医疗保健工作者支持和有利环境的基础。
概念框架的发展。
使用社会生态框架作为组织结构，进行了全面的文献综述。
该框架将道德实践视为一系列因素在八个层面相互作用的结果：个人因素（患者和家庭）；个人因素（护士）；医护人员之间的关系；患者与护士之间的关系；医疗保健组织背景；专业和教育法规和标准；社区；以及社会、政治和经济。
将这些因素视为离散的、但相互作用和交织的力量，有助于制定促进道德实践的干预措施。我们认为该框架在政策、实践、教育和研究方面具有实用性。
护士每天都面临伦理挑战，从社会生态框架的角度考虑这些问题，可以帮助制定策略和解决方案。
