护理管理中的伦理问题 - 解决问题的横断面调查。
Ethical problems in nursing management - a cross-sectional survey about solving problems.
机构信息
Department of Nursing Science, University of Turku, FI-20014, Turku, Finland.
Welfare Division, Turku University Hospital and City of Turku, Turku, Finland.
出版信息
BMC Health Serv Res. 2019 Jun 24;19(1):417. doi: 10.1186/s12913-019-4245-4.
BACKGROUND
Nurse managers encounter a wide range of ethical problems related to patients, staff, the organisation and themselves. However, little is known about the methods they use to try to solve these problems. In this study, our goal is to fill this knowledge gap by investigating the ethical problems encountered by nurse managers, the frequency of use and usefulness of different methods to solve these problems, and the background factors associated with the use of the methods.
METHODS
A cross-sectional survey study was conducted in November 2014-May 2015 in Finland. The data were collected from nurse managers in strategic, middle and ward management (n = 214) using a questionnaire developed for this study. The questionnaire consisted of four parts: socio-demographic background factors, frequency and difficulty of ethical problems in nursing management, frequency of use and usefulness of the methods in solving ethical problems, and work-related background factors.
RESULTS
Discussions with nurses was the most frequently used method, used by 94% of the nurse managers either often or always in the case of ethical problems, followed by the use of personal values (74%) and discussions with manager colleagues (70%). However, almost all methods in the different groups - discussion and deliberation, use of outside experts, written instructions and ethical principles, acts and degrees as well as work arrangements - were considered somewhat or very useful by more than half of the respondents. The use of outside experts was the least used and the least useful method.
CONCLUSIONS
When solving ethical problems, nurse managers use most frequently the same methods as a few decades ago. A more diverse range of methods would be helpful in ethical problem-solving. The use of outside experts, ethics literature and codes of ethics should be combined with ethical reasoning and decision-making to get new dimensions and outside knowledge.
背景
护士长会遇到与患者、员工、组织和自身相关的各种伦理问题。然而，人们对他们尝试解决这些问题所采用的方法知之甚少。在这项研究中，我们的目标是通过调查护士长遇到的伦理问题、解决这些问题的不同方法的使用频率和有用性，以及与方法使用相关的背景因素，来填补这一知识空白。
方法
2014 年 11 月至 2015 年 5 月，在芬兰进行了一项横断面调查研究。使用为该研究专门设计的问卷，从战略、中层和病房管理中的护士长（n=214）收集数据。问卷包括四个部分：社会人口统计学背景因素、护理管理中的伦理问题的频率和难度、解决伦理问题的方法的使用频率和有用性，以及与工作相关的背景因素。
结果
与护士讨论是最常使用的方法，94%的护士长在遇到伦理问题时经常或总是使用这种方法，其次是使用个人价值观（74%）和与经理同事讨论（70%）。然而，在不同群体中，几乎所有的方法——讨论和审议、使用外部专家、书面指示和道德原则、行为和程度以及工作安排——都被超过一半的受访者认为有些或非常有用。使用外部专家是使用最少和最无用的方法。
结论
在解决伦理问题时，护士长最常使用的方法与几十年前相同。更广泛的方法范围将有助于解决伦理问题。应将外部专家的使用、伦理文献和道德规范与伦理推理和决策相结合，以获得新的维度和外部知识。
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