Centre for Health Ethics, Law and History, Institute of Health Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Department of Nursing, Institute of Health Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
J Nurs Manag. 2022 Oct;30(7):2301-2307. doi: 10.1111/jonm.13842. Epub 2022 Oct 17.
This article explores moral disagreements between nurses and physicians; specifically, we aim to analyse professional nurses' practice in navigating these conflicts.
Nurses face morally challenging situations while caring for patients when their views on treatments and care may contradict those of physicians. It is important that nurses represent patients' perspectives and are partners in the care decision-making process.
A narrative review was conducted by including peer-reviewed articles in English. A literature search was conducted using the Web of Science database and Google Scholar search engine from 1 December 2021 to 10 February 2022.
A total of 27 articles published between 2009 and 2021 were included in the analysis. The following themes were explored in this article: areas in which moral disagreements occur and how these disagreements shape physician-nurse relationships, differences in the status of professional autonomy in nursing in the Baltic states and Nordic countries, and potential directions for nurses' involvement in the decision-making process regarding moral disagreements in nursing practice.
Moral disagreements between nurses and physicians most often occur in situations related to treatment and/or care strategies as well as end-of-life decisions. Nurses' participation in the decision-making process and physicians' willingness to consider nurses' perspectives play a fundamental role in navigating moral conflicts because nurses possess a body of knowledge about their patients that differs from that of physicians. This knowledge is just as worthy as physician knowledge. Considering the level of professional autonomy in specific regions, nurses' involvement in decision-making regarding particular patients' care in the Baltic states seems to be relatively low compared to that in the Scandinavian countries, where nurses have a much wider space for independent decision-making.
Complex moral situations that require the input of both physicians and nurses must be examined and addressed. Several processes may assist in fostering nurses' contributions to decision-making, among which training to effectively deal with morally complex situations and creating an atmosphere conducive to collaboration between physicians and nurses are particularly important.
本文探讨了护士和医生之间的道德分歧；具体来说，我们旨在分析专业护士在应对这些冲突时的实践。
护士在照顾患者时会面临道德挑战，因为他们对治疗和护理的看法可能与医生的观点相矛盾。护士代表患者的观点并成为护理决策过程中的合作伙伴非常重要。
通过纳入英语同行评审文章进行叙述性综述。使用 Web of Science 数据库和 Google Scholar 搜索引擎，从 2021 年 12 月 1 日至 2022 年 2 月 10 日进行文献检索。
共纳入了 2009 年至 2021 年期间发表的 27 篇文章。本文探讨了以下主题：道德分歧发生的领域以及这些分歧如何塑造医生与护士之间的关系、波罗的海国家和北欧国家护理专业自主地位的差异，以及护士在护理实践中道德分歧决策过程中的潜在方向。
护士和医生之间的道德分歧最常发生在与治疗和/或护理策略以及临终决策相关的情况下。护士参与决策过程和医生愿意考虑护士的观点在解决道德冲突方面起着至关重要的作用，因为护士对患者的了解与医生不同，而这种知识与医生的知识一样有价值。考虑到特定地区的专业自主权水平，与北欧国家相比，波罗的海国家的护士在参与特定患者护理决策方面的参与度似乎相对较低，在北欧国家，护士有更广泛的独立决策空间。
必须检查和处理需要医生和护士共同参与的复杂道德情况。有几个过程可以帮助促进护士对决策的贡献，其中培训以有效应对道德复杂情况和创造有利于医生和护士合作的氛围尤为重要。
