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医学和护理专业学生的伦理学教学与道德能力培养。

The Teaching of Ethics and the Moral Competence of Medical and Nursing Students.

机构信息

Centre for Research in Health Technologies and Information Systems (CINTESIS), University of Porto, R. Dr. Plácido da Costa, 4200-450, Porto, Portugal.

Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.

出版信息

Health Care Anal. 2021 Jun;29(2):113-126. doi: 10.1007/s10728-020-00401-1. Epub 2020 Sep 17.

Abstract

In a time marked by the development of innovative treatments in healthcare and the need for health professionals to deal with resulting ethical dilemmas in clinical practice, this study was developed to determine the influence of the bioethics teaching on the moral competence of medical and nursing students. The authors conduct a longitudinal study using the Moral Competence Test extended version before and after attending the ethics curricular unit, in three nursing schools and three medical schools of Portugal. In this questionnaire the participant is confronted with three ethical dilemmas (related to theft, euthanasia and the torture of a terrorist) and asked to evaluate arguments for and against the attitude of the main character (Worker, doctor and judge). For both nursing and medical students, C-score was lower after the attendance of the ethics curricular units, with a statistically significant decrease in the total score (from 21 to 19.5 on average; p = 0.046) for nursing students and a decrease not statistically significant for medical students (from 23.2 to 22 on average; p = 0.358). A multivariate analysis did not find any association between this decrease and gender, course, or age. The phenomenon of moral segmentation was observed, with better performance in the worker and judge dilemma, than in the doctor dilemma. These results highlight the need to reflect on the curricular strategies that can be implemented for health professionals to better develop moral competence and decision-making, allowing for the provision of humanized health care.

摘要

在医疗保健领域创新治疗方法不断发展的时代,以及医疗专业人员在临床实践中需要应对由此产生的伦理困境的时代,本研究旨在确定生物伦理学教学对医学和护理学生道德能力的影响。作者在葡萄牙的三所护理学校和三所医学院进行了一项纵向研究,在参加伦理课程单元前后使用扩展版道德能力测试进行。在这个问卷中,参与者面临三个伦理困境(与盗窃、安乐死和折磨恐怖分子有关),并被要求评估主要角色(工人、医生和法官)的态度的正反论据。对于护理和医学专业的学生来说,参加伦理课程单元后 C 分数较低,总分数有统计学意义的下降(护理学生平均从 21 分下降到 19.5 分;p=0.046),而医学学生的下降没有统计学意义(平均从 23.2 分下降到 22 分;p=0.358)。多变量分析没有发现这种下降与性别、课程或年龄之间存在任何关联。观察到道德分割现象,工人和法官困境的表现优于医生困境。这些结果强调需要反思可以为卫生专业人员实施的课程策略,以更好地发展道德能力和决策能力,从而提供人性化的医疗保健。

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