Porr Caroline, Gaudine Alice, Smith-Young Joanne
Faculty of Nursing, Memorial University of Newfoundland.
Nurs Ethics. 2024 Jun;31(4):541-552. doi: 10.1177/09697330231200563. Epub 2023 Oct 5.
Despite news reports of morally distressing situations resulting from complex and demanding community-care delivery in Canada, there has been little research on the topic of ethical conflicts experienced by community-based health care professionals.
To identify ethical conflicts experienced by community nurses.
Data were collected using semi-structured interviews and then relevant text was extracted and condensed using qualitative content analysis. This research was part of a larger grounded theory project examining how community nurses manage ethical conflict.
Community nurses, including 13 public health nurses and 11 home care nurses from two Canadian provinces, were interviewed.
Study approval was granted by the Health Research Ethics Authority of Newfoundland and Labrador and by provincial health authorities.
Seven ethical conflicts were identified and assigned to one of two groups. In the grouping categorized as challenges with obligations or risks, the ethical conflicts were: (1) screening for child developmental issues knowing there is a lack of timely early intervention services; (2) encountering inequities in the health care system; (3) not fulfilling principles, goals, and initiatives of primary and secondary prevention; and (4) feeling powerless to advocate for clients. The remaining ethical conflicts were categorized as challenges with process, risks, and consequences, and were: (5) jeopardizing therapeutic relationships while reporting signs of a child at risk; (6) managing confidentiality when neighbors are clients; and (7) supporting client autonomy and decision-making but uncertain of the consequences.
Research investigation will continue to be important to raise awareness and mobilize ethics supports as health care services are steadily shifted from institutional to community settings. Moreover, with heightened potential for communicable disease outbreaks across international borders from global warming, community nurses around the world will continue to be required to address ethically-difficult care situations with competence and compassion.
尽管有新闻报道称，加拿大复杂且要求苛刻的社区护理服务引发了道德困境，但关于社区医疗保健专业人员所经历的伦理冲突这一主题的研究却很少。
确定社区护士所经历的伦理冲突。
通过半结构化访谈收集数据，然后使用定性内容分析法提取并浓缩相关文本。本研究是一个更大的扎根理论项目的一部分，该项目旨在研究社区护士如何处理伦理冲突。
对来自加拿大两个省份的社区护士进行了访谈，其中包括13名公共卫生护士和11名家庭护理护士。
该研究获得了纽芬兰和拉布拉多省卫生研究伦理委员会以及省级卫生当局的批准。
确定了七起伦理冲突，并将其分为两组。在被归类为义务或风险挑战的组中，伦理冲突包括：（1）在明知缺乏及时的早期干预服务的情况下筛查儿童发育问题；（2）在医疗保健系统中遇到不平等现象；（3）未实现一级和二级预防的原则、目标和倡议；（4）感到无力为客户争取权益。其余的伦理冲突被归类为过程、风险和后果挑战，包括：（5）在报告儿童处于危险中的迹象时危及治疗关系；（6）当邻居是客户时管理保密问题；（7）支持客户的自主权和决策，但对后果不确定。
随着医疗保健服务稳步从机构环境转向社区环境，研究调查对于提高认识和调动伦理支持仍然至关重要。此外，由于全球变暖导致跨国界传染病爆发的可能性增加，世界各地的社区护士将继续被要求以专业能力和同情心应对道德困境。
