Artnak K E, Dimmitt J H
University of Texas Health Science Center at San Antonio, Graduate School of Biomedical Sciences, School of Nursing, USA.
Arch Psychiatr Nurs. 1996 Feb;10(1):16-23. doi: 10.1016/s0883-9417(96)80082-3.
The need for advanced practice nurses to incorporate ethical analysis into case management is becoming more apparent -- particularly for the increasingly independent practice settings of psychiatric and mental health nursing. The nursing literature contains many articles dealing with the more abstract treatment of clinical ethics, but for the practitioner there is unfortunately little information available that uses ethical principles in a practical framework, which addresses the concrete reality of daily, difficult clinical decision making. This article applies a model of reasoned analysis to an actual case study using the concepts of casuistry or case-based reasoning. This method offers an alternative to the more popular paradigm of principilism. Complicated by the existence of violence and abuse, the case examines several ethical issues including patient privacy and legitimate breaches of patient confidentiality.
高级实践护士将伦理分析纳入病例管理的需求日益明显，尤其是在精神科和心理健康护理日益独立的执业环境中。护理文献中有许多文章论述临床伦理学较为抽象的内容，但遗憾的是，对于从业者而言，在实际框架中运用伦理原则的信息很少，而这一框架能解决日常艰难临床决策的具体现实问题。本文运用决疑法或基于案例的推理概念，将一种理性分析模型应用于一个实际案例研究。这种方法为更流行的原则主义范式提供了一种替代方案。由于存在暴力和虐待情况，该案例较为复杂，探讨了几个伦理问题，包括患者隐私和对患者保密的合理违背。
