Ramathuba Dorah U, Ndou Hulisani
Department of Advanced Nursing Science, University of Venda, Thohoyandou, South Africa.
Health SA. 2020 Apr 16;25:1183. doi: 10.4102/hsag.v25i0.1183. eCollection 2020.
Conflicts arise when healthcare providers disagree about providing optimal care to critically ill patients where resources and services are constrained.
This study investigated ethical conflicts experienced by intensive care unit (ICU) healthcare professionals working in a regional hospital, Limpopo province of South Africa.
The study was conducted at a rural public regional hospital in Vhembe district, Limpopo Province. Communities served by the hospital are poor and medically uninsured.
This study adopted a qualitative, exploratory and descriptive design. The target population comprised Health care professionals working in an ICU of the regional hospital. Purposive sample was selected and 17 unstructured interviews were conducted. Tesch's method of data analysis was used. Ethical considerations were adhered to.
Patients' care needs were compromised because of the unavailability of beds and high-technology equipment, such as well-functioning ventilators. Doctors were not having the necessary skills required in the ICU as the majority were on community service/internship and nurses acted beyond their scope of practice because of a lack of adequately trained intensive care specialists. Infection control practices were overlooked and 'use once' pieces of equipment were reused. Conflicting values between nurses, patients and family of patients exist.
Lack of resources compromises provision of optimal and intensive care. Patients were prone to infections and their safety might have been compromised.
当医疗服务提供者在资源和服务受限的情况下,对于为重症患者提供最佳护理存在分歧时,就会产生冲突。
本研究调查了在南非林波波省一家地区医院工作的重症监护病房(ICU)医护人员所经历的伦理冲突。
该研究在林波波省韦姆贝区的一家农村公立地区医院进行。该医院服务的社区贫困且没有医疗保险。
本研究采用定性、探索性和描述性设计。目标人群包括在该地区医院ICU工作的医护人员。采用目的抽样法,进行了17次非结构化访谈。使用了泰施的数据分析方法。遵循了伦理考量。
由于床位和高科技设备(如功能良好的呼吸机)短缺,患者的护理需求受到影响。由于大多数医生处于社区服务/实习阶段,他们不具备ICU所需的必要技能,并且由于缺乏训练有素的重症监护专家,护士的行为超出了其执业范围。感染控制措施被忽视,“一次性使用”的设备被重复使用。护士、患者及其家属之间存在价值冲突。
资源短缺影响了最佳和重症护理的提供。患者容易感染,其安全可能受到影响。