Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
Nurs Ethics. 2024 Aug;31(5):875-895. doi: 10.1177/09697330231209294. Epub 2023 Oct 27.
Public health nursing is grounded in public health ideologies and fundamental nursing values. Researchers have argued that ethical responsibility from the perspective of the nurse is an understudied phenomenon. This meta-ethnography provides in-depth knowledge of how public health nurses (PHNs) experience ethical responsibility when working to prevent injury and disease, and promote health and well-being in children, young people and their families. There are reciprocal findings across the 10 included studies. The findings reveal that these nurses often feel alone, have worries and uncertainties and are afraid of doing wrong. They describe unclear boundaries in their work, creating a heightened sense of responsibility. PHNs fight lonely battles. Yet they show courage and commitment and are ready to stand up and fight for children and families who do not receive adequate care. A line of argument is developed and the metaphorical phrase Chivalrous knights in moral armour is used to express the authors' overall interpretations of the findings. Reflection on the findings shows how the different dimensions of ethical responsibility are interconnected. The nurses' ethical sensitivity enables them to feel compassion for others and they show indignation when vulnerable others are not treated with dignity and respect. Indignation and compassion are interrelated, and when human life and dignity are threatened, the ethical demand to respond emerges. Indignation is a precursor to moral courage, and the nurses' moral sensitivity and respect for their clients emboldens them to stand up for vulnerable others. The findings also illustrate the paradoxical nature of freedom. Freedom of choice due to unclear boundaries heightens the nurses' sense of responsibility. This research is an important step in theory development and has implications for further research, education and practice.
公共卫生护理以公共卫生理念和基本护理价值观为基础。研究人员认为，从护士的角度来看，道德责任是一个研究不足的现象。这项元民族志深入了解了公共卫生护士（PHN）在努力预防伤害和疾病、促进儿童、青少年及其家庭的健康和福祉时如何体验道德责任。这 10 项纳入研究中有相互呼应的发现。研究结果表明，这些护士常常感到孤独，有担忧和不确定感，并且害怕做错事。他们描述了工作中的界限不明确，从而产生了更高的责任感。PHN 单打独斗。然而，他们表现出勇气和承诺，随时准备为得不到充分照顾的儿童和家庭挺身而出。研究提出了一种论点，并使用了“道德盔甲下的侠义骑士”这一隐喻短语来表达作者对研究结果的总体解释。对研究结果的反思表明，道德责任的不同维度是如何相互关联的。护士的道德敏感性使他们能够同情他人，当弱势群体得不到尊重和尊严时，他们会感到愤慨。愤慨和同情是相互关联的，当人的生命和尊严受到威胁时，就会出现回应的道德要求。愤慨是道德勇气的前兆，护士对客户的道德敏感性和尊重使他们敢于为弱势群体挺身而出。研究结果还说明了自由的矛盾性质。由于界限不明确而导致的选择自由增强了护士的责任感。这项研究是理论发展的重要一步，对进一步的研究、教育和实践具有启示意义。
