探討台灣護理人員臨床常見倫理困境議題: 臨床倫理困境

Translated title of the contribution: The study of clinical ethical dilemma issues among nurses in Taiwan: clinical ethical dilemma

林秋芬, 蔡篤堅

Research output: Contribution to journalArticle

Abstract

Nurse’s unresolved ethical dilemmas can lead them to conceive the idea of leaving their profession. Also, it will affect the patient safety and the care quality. This qualitative study was conducted via individual interviews with nurses guided by a semi-structured questionnaire. The interviews were transcribed verbatim and analyzed using content analysis. The subjects were 66 nurses from six hospitals in the northern region of Taiwan. In each hospital, 11 nurses which include three medical nurses, three surgical nurses, three critical care nurses, one mental health nurse and one OR nurse were randomly selected. Nurses were interviewed after agreeing to participate in the study. The study findings are shown as follows: 1. The most challenging medical ethical dilemma in current clinical practice consists of “keeping patient informed”. 2. The reason it is the most troublesome issue is that it requires” contact with the patient on a daily basis,” ”not wanting to lie to the patient,” “the physician did first not explain the patient’s disease condition or treatments,” and “feeling afraid of not being able to keep a promise to the patient’s family members” 3. Ways of dealing with the dilemma included communicating with patience, reminding the physicians and family members that the patients has the right of informed consent. 4. The main difficulty in dealing with this issue is the “challenge of communication”. 5. To break through this dilemma often requires continuous efforts to communicate with the physician, asking for the head nurse’s help or initiating case discussion across disciplinary. 6. Nurses need to improve their professional competence, communication skills and tolerate frustration. 7. These competencies can be improved by lectures, unified case discussion, cooperative care, case study method, discussion of relevant films, experience sharing, visiting, reading, advanced study or participation in personal growth groups. This study suggests that nurses’ competence in managing ethical dilemmas should be developed to improve their job satisfaction, patient safety and the quality of patient care.
Original languageTraditional Chinese
Pages (from-to)23-39
Number of pages17
Journal台灣生命倫理學刊
Issue number2
Publication statusPublished - 2013

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Taiwan
Ethics
Nurses
Patient Safety
Physicians
Clinical Studies
Patient Care
Communication
Supervisory Nursing
Interviews
Professional Competence
Frustration
Job Satisfaction
Quality of Health Care
Patient Rights
Critical Care
Informed Consent
Mental Competency
Reading
Mental Health

Keywords

  • clinical practice
  • medical ethical dilemma
  • nurses

Cite this

探討台灣護理人員臨床常見倫理困境議題 : 臨床倫理困境. / 林秋芬; 蔡篤堅.

In: 台灣生命倫理學刊, No. 2, 2013, p. 23-39.

Research output: Contribution to journalArticle

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abstract = "護理人員的倫理困境若未解決,會萌生離職念頭,影響病人安全和照護品質,因此本研究的目的為了解目前護理人員臨床最感困擾的醫學倫理議題、產生的原因、如何處理、處理過程所遭遇的瓶頸和突破,以及提升處理能力和培養能力的方案。運用質性研究法,透過半結構問卷指引,進行護理人員個別訪談,再以內容分析法進行訪談資料整理和分析。研究對象選取北區6家醫院之臨床護理人員,依據各醫院各單位名單,於訪談當天隨機經受訪者同意後,每家醫院選取11位,含3位內科(含腫瘤)、3位外科、3位急重症、1位精神科、1位開刀房,共訪談66位護理人員。研究發現;1. 目前臨床最感困擾的醫學倫理議題為----病人的告知說明;2. 造成困擾原因為不認同醫師的處置;3. 處理方式通常會選擇耐心溝通,提醒醫師和家屬,病人有知情同意權;4. 處理這些倫理困境的主要困難[溝通問題];5. 突破這些困難,持續與醫師溝通、請護理長出面處理或邀請跨團隊個案討論;6. 護理人員需要增加專業能力、溝通能力和挫折忍受力;7. 這些能力的培養,可以透過課室教學、聯合個案討論、共同照護、案例分析、相關電影賞析、經驗分享、參觀、閱讀、進修或參加心理成長團體等。建議未來應積極增進護理人員的倫理困境處理能力,才能增進病人安全和提升照護品質。",
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N2 - 護理人員的倫理困境若未解決,會萌生離職念頭,影響病人安全和照護品質,因此本研究的目的為了解目前護理人員臨床最感困擾的醫學倫理議題、產生的原因、如何處理、處理過程所遭遇的瓶頸和突破,以及提升處理能力和培養能力的方案。運用質性研究法,透過半結構問卷指引,進行護理人員個別訪談,再以內容分析法進行訪談資料整理和分析。研究對象選取北區6家醫院之臨床護理人員,依據各醫院各單位名單,於訪談當天隨機經受訪者同意後,每家醫院選取11位,含3位內科(含腫瘤)、3位外科、3位急重症、1位精神科、1位開刀房,共訪談66位護理人員。研究發現;1. 目前臨床最感困擾的醫學倫理議題為----病人的告知說明;2. 造成困擾原因為不認同醫師的處置;3. 處理方式通常會選擇耐心溝通,提醒醫師和家屬,病人有知情同意權;4. 處理這些倫理困境的主要困難[溝通問題];5. 突破這些困難,持續與醫師溝通、請護理長出面處理或邀請跨團隊個案討論;6. 護理人員需要增加專業能力、溝通能力和挫折忍受力;7. 這些能力的培養,可以透過課室教學、聯合個案討論、共同照護、案例分析、相關電影賞析、經驗分享、參觀、閱讀、進修或參加心理成長團體等。建議未來應積極增進護理人員的倫理困境處理能力,才能增進病人安全和提升照護品質。

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KW - medical ethical dilemma

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JO - 台灣生命倫理學刊

JF - 台灣生命倫理學刊

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