Palmryd Lena, Rejnö Åsa, Godskesen Tove E
Perioperative Medicine and Intensive Care Function, Karolinska University Hospital, 171 76, SolnaStockholm, Sweden.
Palliative Research Centre, Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Box 11189, 100 61, Stockholm, Sweden.
Ann Intensive Care. 2021 Feb 5;11(1):23. doi: 10.1186/s13613-021-00802-y.
Integrity is a core value for delivering ethical health care. However, there is a lack of precision in defining what integrity is and how nurses understand it. In the setting of nurses caring for critically ill and dying patients in intensive care units (ICUs), integrity has not received much attention. Therefore, the aim of this study was to explore how nurses perceive and maintain the integrity of patients during end-of-life care in the ICU setting.
This study had a qualitative descriptive design. Data were collected using individual semi-structured interviews with 16 intensive care nurses working at ICUs in four Swedish hospitals. The data were analysed by applying qualitative content analysis.
Five overall categories were explored: seeing the unique individual; sensitive to patient vulnerability; observant of patients' physical and mental sphere; perceptive of patients' religion and culture; and being respectful during patient encounters. Many nurses found it difficult to define integrity and to explain what respecting integrity entails in the daily care of dying patients. They often used notions associated with respect and patient-centred attitudes, such as listening and being sensitive or by trying to describe good care. Integrity was nonetheless seen as a central value for their clinical work and a precondition for ethical nursing practice. Some nurses were concerned about patient integrity, which is at risk of being "wiped out" due to the patient's illness/injury, unfamiliarity with the ICU environment and utter dependence on others for care. Protecting patients from harm and reducing patient vulnerability were also seen as important and a way to maintain the integrity of patients.
The study results show that even though integrity is a fundamental ethical concept and a core value in nursing, ethical codes and guidelines are not always helpful in clinical situations in the end-of-life care of ICU patients. Hence, opportunities must regularly be made available for ICU nurses to reflect on and discuss ethical issues in terms of their decision-making and behaviour.
诚信是提供符合伦理道德的医疗服务的核心价值观。然而，在定义诚信是什么以及护士如何理解诚信方面缺乏精确性。在重症监护病房（ICU）中，护士照顾重症和临终患者的情况下，诚信并未受到太多关注。因此，本研究的目的是探讨在ICU环境下的临终护理中，护士如何看待并维护患者的诚信。
本研究采用定性描述性设计。通过对瑞典四家医院ICU工作的16名重症监护护士进行个人半结构式访谈收集数据。运用定性内容分析法对数据进行分析。
探讨了五个总体类别：看到独特的个体；对患者的脆弱性敏感；关注患者的身心领域；感知患者的宗教和文化；以及在与患者接触时保持尊重。许多护士发现很难定义诚信，也难以解释在临终患者的日常护理中尊重诚信意味着什么。他们经常使用与尊重和以患者为中心的态度相关的概念，如倾听、敏感或试图描述优质护理。尽管如此，诚信仍被视为他们临床工作的核心价值观以及符合伦理道德的护理实践的前提条件。一些护士担心患者的诚信，由于患者的疾病/损伤、对ICU环境不熟悉以及完全依赖他人护理，患者的诚信有被“抹去”的风险。保护患者免受伤害并降低患者的脆弱性也被视为重要的，并且是维护患者诚信的一种方式。
研究结果表明，尽管诚信是护理中的一个基本伦理概念和核心价值观，但伦理规范和指南在ICU患者临终护理的临床情况中并不总是有帮助的。因此，必须定期为ICU护士提供机会，让他们就决策和行为方面的伦理问题进行反思和讨论。
