以患者为中心：当家庭护理人员将对患者的忠诚置于系统和自身之上时。一项民族志研究。
Putting patients first: when home-based care staff prioritise loyalty to patients above the system and themselves. An ethnographic study.
机构信息
Faculty of Medicine, Institute of Health and Society, Centre for Medical Ethics, University of Oslo, Gaustadalléen 21, Oslo, 0349, Norway.
出版信息
BMC Med Ethics. 2024 Sep 11;25(1):95. doi: 10.1186/s12910-024-01094-0.
BACKGROUND
The growing number of older people worldwide poses challenges for health policy, particularly in the Global North, where policymakers increasingly expect seniors to live and receive care at home. However, healthcare professionals, particularly in home-based care, face dilemmas between adhering to care ideals and meeting external demands. Although they strive to uphold ethical care standards, they must deal with patients' needs, cooperation with colleagues and management guidelines. Home-based care is an essential part of healthcare services in Norway, but staff struggle with high patient numbers and time management. This article focuses on how staff deal with ethical challenges related to contextual and organisational constraints.
METHODS
An ethnographic fieldwork in three municipalities in South-East Norway. The first author conducted three to four months of participant observation in each municipality. In addition, she conducted in-depth interviews with key informants in two municipalities and a focus group interview with seven home-based care workers in one municipality. The data was analysed by using a reflexive thematic analysis.
RESULTS
Staff in home-based care are frequently more loyal to the patient than to the system and to their own needs. To provide good care, all informants disregarded the patient's formal decision, i.e. they provided more care than the formalised decision stipulated. To prioritise beneficence to patients, informants also disregarded some of the rules applicable in home-based care. In addition, staff accepted risks to their own safety and health to provide care in the patient's home.
CONCLUSION
The loyalty of home-based care staff to their patients can go beyond their loyalty to the rules of the system and even their own safety. This commitment might be attributed to a sense of doing meaningful work, to providing relationship-based and individualised care, and to strong moral courage. However, the staff's emphasis on flexibility and individualised care also brings challenges related to unclear boundaries related to patient care.
背景
全球老年人口数量不断增加，对卫生政策构成了挑战，尤其是在全球北方地区，政策制定者越来越期望老年人在家中生活和接受护理。然而，医疗保健专业人员，特别是在家庭护理中，面临着在坚持护理理想和满足外部需求之间的困境。尽管他们努力坚持伦理护理标准，但他们必须应对患者的需求、与同事的合作以及管理指南。家庭护理是挪威医疗保健服务的重要组成部分，但工作人员面临着患者数量多和时间管理困难的问题。本文重点探讨了工作人员如何应对与背景和组织限制相关的伦理挑战。
方法
在挪威东南部的三个市进行了一项民族志实地研究。第一作者在每个市进行了三到四个月的参与式观察。此外，她在两个市对关键信息员进行了深入访谈，并在一个市对七名家庭护理工作者进行了焦点小组访谈。数据采用反思性主题分析进行分析。
结果
家庭护理工作人员通常对患者比对系统和自己的需求更忠诚。为了提供良好的护理，所有受访者都无视患者的正式决定，即他们提供的护理超过了正式规定的决定。为了优先考虑患者的利益，受访者还无视了一些适用于家庭护理的规则。此外，工作人员为了在患者家中提供护理而接受了对自己安全和健康的风险。
结论
家庭护理工作人员对患者的忠诚可以超越他们对系统规则甚至自己安全的忠诚。这种承诺可能归因于对有意义工作的感知、提供基于关系和个性化的护理以及强烈的道德勇气。然而，工作人员对灵活性和个性化护理的强调也带来了与患者护理相关的不明确界限的挑战。
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