Linnaeus University, Sweden; Region Kalmar County, Sweden; University of Borås, Sweden.
Linnaeus University, Sweden; Uppsala University, Sweden; Region Sörmland, Sweden.
Nurs Ethics. 2020 Jun;27(4):946-959. doi: 10.1177/0969733020911077. Epub 2020 Apr 7.
Working as an ambulance nurse involves facing ethically problematic situations with multi-dimensional suffering, requiring the ability to create a trustful relationship. This entails a need to be clinically trained in order to identify ethical conflicts.
To describe ethical conflicts in patient relationships as experienced by ambulance nursing students during clinical studies.
An exploratory and interpretative design was used to inductively analyse textual data from examinations in clinical placement courses.
The 69 participants attended a 1-year educational programme for ambulance nurses at a Swedish university.
The research was conducted in accordance with the Declaration of Helsinki. Participants gave voluntary informed consent for this study.
The students encountered ethical conflicts in patient relationships when they had inadequate access to the patient's narrative. Doubts regarding patient autonomy were due to uncertainty regarding the patient's decision-making ability, which forced students to handle patient autonomy. Conflicting assessments of the patient's best interest added to the conflicts and also meant a disruption in patient focus. The absence of trustful relationships reinforced the ethical conflicts, together with an inadequacy in meeting different needs, which limited the possibility of providing proper care.
Contextual circumstances add complexity to ethical conflicts regarding patient autonomy, dependency and the patient's best interest. Students felt they were fluctuating between paternalism and letting the patient choose, and were challenged by considerations regarding the patient's communication and decision-making ability, the views of third parties, and the need for prioritisation.
The essence of the patient relationship is a struggle to preserve autonomy while focusing on the patient's best interest. Hence, there is a need for education and training that promotes ethical knowledge and ethical reflection focusing on the core nursing and caring values of trust and autonomy, particularly in situations that affect the patient's decision-making ability.
从事救护车护士工作需要面对具有多维痛苦的伦理问题，这需要有建立信任关系的能力。这需要在临床方面进行培训，以识别伦理冲突。
描述救护车护理学生在临床学习中体验到的患者关系中的伦理冲突。
采用探索性和解释性设计，对临床实习课程考试中的文本数据进行归纳分析。
69 名参与者参加了瑞典一所大学为期 1 年的救护车护士教育计划。
本研究符合《赫尔辛基宣言》的规定。参与者自愿对此项研究表示同意。
当学生无法充分了解患者的叙述时，他们在患者关系中遇到了伦理冲突。对患者自主权的怀疑是由于对患者决策能力的不确定性，这迫使学生处理患者自主权。对患者最佳利益的评估不一致加剧了冲突，并意味着对患者的关注被打乱。缺乏信任关系也加剧了伦理冲突，以及对满足不同需求的不足，这限制了提供适当护理的可能性。
背景情况使涉及患者自主权、依赖性和患者最佳利益的伦理冲突变得更加复杂。学生们感到他们在家长式作风和让患者选择之间摇摆不定，并受到患者沟通和决策能力、第三方观点以及需要优先排序的考虑的挑战。
患者关系的本质是在关注患者最佳利益的同时努力维护自主权。因此，需要教育和培训，以促进关注信任和自主权等核心护理和关怀价值观的伦理知识和伦理反思，特别是在影响患者决策能力的情况下。
