应答者：COVID-19 大流行期间重症监护护士所面临的伦理问题的定性研究。
RESPONDER: A qualitative study of ethical issues faced by critical care nurses during the COVID-19 pandemic.
机构信息
Center for Bioethics, Stanley S. Zielony Institute for Nursing Excellence, Cleveland Clinic, Cleveland, Ohio, USA.
Stanley S. Zielony Institute for Nursing Excellence, Cleveland Clinic Marymount Hospital, Garfield Heights, Ohio, USA.
出版信息
J Nurs Manag. 2022 Oct;30(7):2403-2415. doi: 10.1111/jonm.13792. Epub 2022 Sep 30.
AIMS
To identify and understand ethical challenges arising during COVID-19 in intensive care and nurses' perceptions of how they made "good" decisions and provided "good" care when faced with ethical challenges and use of moral resilience.
BACKGROUND
Little is known about the ethical challenges that nurses faced during the COVID-19 pandemic and ways they responded.
DESIGN
Qualitative, descriptive free-text surveys and semi-structured interviews, underpinned by appreciative inquiry.
METHODS
Nurses working in intensive care in one academic quaternary care centre and three community hospitals in Midwest United States were invited to participate. In total, 49 participants completed free-text surveys, and seven participants completed interviews. Data were analysed using content analysis.
RESULTS
Five themes captured ethical challenges: implementation of the visitation policy; patients dying alone; surrogate decision-making; diminished safety and quality of care; and imbalance and injustice between professionals. Four themes captured nurses' responses: personal strength and values, problem-solving, teamwork and peer support and resources.
CONCLUSIONS
Ethical challenges were not novel but were amplified due to repeated occurrence and duration. Some nurses' demonstrated capacities for moral resilience, but none described drawing on all four capacities.
IMPLICATIONS FOR NURSING MANAGEMENT
Nurse managers would benefit from greater ethics training to support their nursing teams.
目的
识别和理解在 COVID-19 期间重症监护中出现的伦理挑战，以及护士在面对伦理挑战和使用道德韧性时，如何做出“好”的决策并提供“好”的护理的看法。
背景
对于护士在 COVID-19 大流行期间面临的伦理挑战以及他们的应对方式，知之甚少。
设计
基于欣赏式探究的定性、描述性自由文本调查和半结构化访谈。
方法
邀请在美国中西部一家学术四级保健中心和三家社区医院工作的重症监护护士参与。共有 49 名参与者完成了自由文本调查，7 名参与者完成了访谈。使用内容分析法分析数据。
结果
五个主题捕捉到了伦理挑战：探视政策的实施；患者孤独死亡；代理人决策；护理安全和质量下降；以及专业人员之间的不平衡和不公正。四个主题捕捉到了护士的反应：个人的力量和价值观、解决问题、团队合作和同伴支持以及资源。
结论
伦理挑战并不新鲜，但由于反复发生和持续时间而加剧。一些护士表现出道德韧性的能力，但没有人描述利用所有四种能力。
对护理管理的影响
护士长将受益于更多的伦理培训，以支持他们的护理团队。
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