护士对其职业自主性如何影响养老院居民临终关怀道德维度的认知——一项定性研究
Nurses' perceptions of how their professional autonomy influences the moral dimension of end-of-life care to nursing home residents- a qualitative study.
作者信息
Gilbert Rachel, Lillekroken Daniela
机构信息
Department of Nursing and Health Promotion, Oslo Metropolitan University, PB 4, St. Olavs Plass, N-0130, Oslo, Norway.
出版信息
BMC Nurs. 2024 Mar 28;23(1):216. doi: 10.1186/s12912-024-01865-5.
BACKGROUND
Over the years, caring has been explained in various ways, thus presenting various meanings to different people. Caring is central to nursing discipline and care ethics have always had an important place in nursing ethics discussions. In the literature, Joan Tronto's theory of ethics of care is mostly discussed at the personal level, but there are still a few studies that address its influence on caring within the nursing context, especially during the provision of end-of-life care. This study aims to explore nurses' perceptions of how their professional autonomy influences the moral dimension of end-of-life care provided to nursing home residents.
METHODS
This study has a qualitative descriptive design. Data were collected by conducting five individual interviews and one focus group during a seven-month period between April 2022 and September 2022. Nine nurses employed at four Norwegian nursing homes were the participants in this study. Data were analysed by employing a qualitative deductive content analysis method.
RESULTS
The content analysis generated five categories that were labelled similar to Tronto's five phases of the care process: (i) caring about, (ii) caring for, (iii) care giving, (iv) care receiving and (v) caring with. The findings revealed that nurses' autonomy more or less influences the decision-making care process at all five phases, demonstrating that the Tronto's theory contributes to greater reflectiveness around what may constitute 'good' end-of-life care.
CONCLUSIONS
Tronto's care ethics is useful for understanding end-of-life care practice in nursing homes. Tronto's care ethics provides a framework for an in-depth analysis of the asymmetric relationships that may or may not exist between nurses and nursing home residents and their next-of-kin. This can help nurses see and understand the moral dimension of end-of-life care provided to nursing home residents during their final days. Moreover, it helps handle moral responsibility around end-of-life care issues, providing a more complex picture of what 'good' end-of-life care should be.
背景
多年来，关怀有着多种解释方式，因此对不同的人呈现出不同的含义。关怀是护理学科的核心，护理伦理在护理伦理学讨论中一直占据重要地位。在文献中，琼·特龙托的关怀伦理理论大多在个人层面进行讨论，但仍有少数研究探讨了其在护理背景下对关怀的影响，尤其是在提供临终关怀期间。本研究旨在探讨护士对其职业自主性如何影响为养老院居民提供的临终关怀道德维度的看法。
方法
本研究采用定性描述性设计。在2022年4月至2022年9月的七个月期间，通过进行五次个人访谈和一次焦点小组访谈收集数据。挪威四家养老院的九名护士参与了本研究。采用定性演绎内容分析法对数据进行分析。
结果
内容分析产生了五个类别，其标签与特龙托护理过程的五个阶段相似：（i）关心，（ii）照顾，（iii）给予关怀，（iv）接受关怀，（v）共同关怀。研究结果表明，护士的自主性或多或少会在所有五个阶段影响决策护理过程，这表明特龙托的理论有助于更深入地思考什么可能构成“良好”的临终关怀。
结论
特龙托的关怀伦理有助于理解养老院中的临终关怀实践。特龙托的关怀伦理为深入分析护士与养老院居民及其近亲之间可能存在或不存在的不对称关系提供了一个框架。这有助于护士看到并理解在养老院居民生命的最后日子里为其提供的临终关怀的道德维度。此外，它有助于处理临终关怀问题周围的道德责任，提供一幅关于“良好”临终关怀应该是什么样更复杂的图景。
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