Kaohsiung Medical University, Taiwan.
Nurs Ethics. 2019 Aug;26(5):1484-1493. doi: 10.1177/0969733018766579. Epub 2018 Apr 15.
Most previous studies on moral distress focused on the factors that cause moral distress, paying inadequate attention to the moral conflict of nurses' values, the physician-nurse power hierarchy, and the influence of the culture.
To analyze the main causes for moral distress with interpretive interactionism.
A qualitative study was adopted.
Through purposeful sampling, 32 nurses from 12 different departments were chosen as the samples.
Approval from the Institutional Review Board of the Kaohsiung Medical University Hospital.
Moral distress is likely to occur in the following clinical situations: patients have no idea about their diseases; the medical decisions fail to meet the optimum benefit of patients; and patients with terminal cancers are not given a proper death. The reason why nurses become trapped in moral distress is that they fail to achieve moral goodness. Inadequate confidence, the physician-nurse power hierarchy, and the Oriental culture affect nurses' goodness-based intention for patients, which deteriorates moral distress.
The main cause for moral distress is the moral goodness of nurses. If nurses' goodness-based intention for patients is inconsistent with the moral objective of achieving optimum benefit for patients, it leads to moral distress. Culture is an essential background factor of care for patients. In the Oriental culture, family members influence patients' right to know about their diseases, the choice of treatment, and patients' autonomy of not receiving cardio-pulmonary resuscitation. This results in moral distress in medical care.
The occurrence of moral distress demonstrates that nurses have moral characteristics such as goodness and caring. It is suggested that appropriate educational strategies can be adopted to weaken the power hierarchy between physicians and nurses and enhance nurses' confidence and cultural sensitivity, so as to reduce the moral distress of nurses.
大多数关于道德困境的既往研究都集中在导致道德困境的因素上，而对护士价值观的道德冲突、医患权力等级以及文化的影响关注不足。
运用阐释互动主义分析道德困境的主要原因。
定性研究。
通过目的性抽样，选取来自 12 个不同科室的 32 名护士作为研究对象。
高雄医学大学附设中和纪念医院伦理审查委员会批准。
在以下临床情况下可能发生道德困境：患者对自身疾病不知情；医疗决策未使患者获益最大化；临终癌症患者未得到妥善死亡。护士陷入道德困境的原因是他们未能实现道德善良。信心不足、医患权力等级以及东方文化影响护士对患者的善良意图，从而加剧道德困境。
道德困境的主要原因是护士的道德善良。如果护士对患者的善良意图与为患者实现最佳利益的道德目标不一致，就会导致道德困境。文化是关怀患者的重要背景因素。在东方文化中，家属会影响患者了解自身疾病、治疗选择以及是否接受心肺复苏的自主权。这导致医疗护理中的道德困境。
道德困境的发生表明护士具有善良和关怀等道德特征。建议采取适当的教育策略，削弱医患权力等级，增强护士的信心和文化敏感性，从而减少护士的道德困境。
