重大传染病疫情防控护士伦理困境的研究进展

伦理困境在重大传染病疫情防控期间普遍存在于护士中，会影响护士身心健康和护理质量。从重大传染病疫情防控护士伦理困境相关概念、现状、评估工具、影响因素四个方面进行综述，旨在提高护士、护理管理者、卫生管理机构对重大传染病疫情防控护士伦理困境的关注，为进一步制定策略提供理论参考。在重大传染病疫情防控期间护士伦理困境研究方面，国内外研究多采用量表和质性访谈进行调查。研究发现该时期护士伦理困境包括探视限制的伦理困境、稀缺资源公正分配的伦理困境和护士权利与义务的伦理困境。影响因素主要有人口学因素、心理因素、风险感知和社会支持等。建议今后从伦理学的角度开发适宜的评估工具，及时掌握重大传染病疫情防控时期护士伦理困境现况，深入挖掘影响因素。     

人类辅助生殖技术应用中护士伦理素养提升研究

梳理护士在人类辅助生殖技术应用中的角色作用,针对可能的伦理困境,分析护理实践中应对困境的制约因素：提出构建护理伦理素养体系,建议完善伦理规则与教育体系,强化案例教育,增强风险防范能力,培育健康伦理文化,以有效提升护士伦理素养。     

临床护理工作中的伦理问题案例分析两则

临床护理工作中常常会遇见各种伦理问题,只有正确分析和认识造成护理伦理困境的原因,才能帮助护士走出伦理困境,做出合乎伦理的决策现状。     

应用团体伦理决策培养急诊科护士的伦理决策能力

目的提高急诊科护士的伦理决策能力。方法通过伦理决策过程,由护理团体对以往在急诊救治中的护理困境作出最佳伦理决策。结果使护士知晓伦理相关的理论,掌握应对护理实践中的护理伦理困惑的方法,提高护理伦理决策能力。结论通过应用团体伦理决策法,培养和提高急诊科护士的伦理决策能力,有效地减少了护患医疗纠纷。     

NICU护士道德困境、医院伦理氛围与工作满意度的现状及相关性研究

目的:调查新生儿重症监护病房(NICU)护士道德困境、医院伦理氛围、工作满意度现状,探讨三者之间的关系。方法:便利抽样法选取郑州市4家三级甲等医院NICU护士248例为研究对象,采用一般资料调查表、护士道德困境量表、医院伦理氛围量表、工作满意度量表进行问卷调查。结果:NICU护士道德困境得分为(92.40±50.65)分,医院伦理氛围得分为(100.31±18.28)分,工作满意度得分为(49.60±14.36)分;一般人口学特征中是否为独生子女或不同学历、职称、人事关系、工作压力、与病人家属沟通能力及对护理专业有不同看法的NICU护士其工作满意度得分差异有统计学意义(P<0.05);道德困境与工作满意度呈负相关,医院伦理氛围与工作满意度呈正相关,差异均有统计学意义(P<0.01);医院伦理氛围总分、道德困境总分是NICU护士工作满意度的主要预测变量(R2=0.534)。结论:NICU护士的道德困境处于较高水平、医院伦理氛围处于中等水平、工作满意度处于较低水平,减少NICU护士的道德困境,改善医院伦理氛围可有效提高NICU护士的工作满意度。     

精神科临床护理工作中的伦理问题及对策

就目前精神科护理工作中存在的伦理困境和道德问题,提出了相应的对策：加强伦理道德教育,培养护士良好职业素质;重视业务技能培训,提高护士的专业技术;规范医院的各项制度,确保护理服务顺利进行;加大精神卫生知识宣教。     

临床护士护理伦理再教育现状调查与分析

通过对江西省赣州市某三级甲等医院的临床护士护理伦理再教育情况的问卷调查,指出大部分临床护士在校期间曾接受过护理伦理教育,但在医院内接受专业伦理培训的不多;不同学历的护士对护理伦理知识的认知存在一定的差异;几乎所有的护士都认为在医院开展护理伦理再教育对临床工作具有积极的指导作用.我国护理伦理再教育现状不容乐观,其原因主要为我国临床护士队伍数量不足,负荷重;医院对护士进行护理伦理再教育认识不足;护士缺乏伦理意识和需求.呼吁只有加强对临床护士实施护理伦理再教育才能满足社会发展的需要.     

一例慢性伤口不愈合患者拒绝住院治疗的伦理剖析

介绍专科护士在为慢性伤口不愈合患者制定治疗护理计划中出现有利原则与尊重原则伦理冲突的个案,运用广州医科大学附属第三医院设计的《临床护理伦理结构化分析表格》进行伦理分析和伦理决策,并解决复杂护理病例的临床护理伦理难题。实践表明,护士在为患者制定护理治疗计划出现伦理冲突的境遇下,运用临床护理结构化伦理分析有助于提升护士的伦理决策能力,强化伦理思维。建议在临床护理中强化护士的伦理思维,不断提升护士伦理决策能力,并培育科学与人文相融的核心护理技术,提升护理价值。     

临床护士护理伦理决策能力现状及影响因素研究

目的本文分析的是临床护士护理伦理决策能力现状及影响因素。方法本文选择我院的80名临床护士,通过2007版护理伦理决策问卷对临床护士护理伦理决策能力现状及影响因素进行调查,并总结了平均护理伦理决策问卷得分。结果本次实验临床护士的平均护理伦理决策问卷得分为(271.14±18.23)分,临床护士护理伦理决策能力影响因素主要有专业知识获取方式多少、学历、是否接受过护理决策培训,P0.05,认为差异具有统计学意义。结论现阶段影响临床护士护理伦理决策能力的因素较多,为此,医院需要从多方面来提高临床护士护理伦理决策能力。     

安宁疗护病房护士的护理伦理敏感性现状及其影响因素

目的 了解安宁疗护病房护士的护理伦理敏感性现状及其影响因素.方法 采用一般资料问卷、护士职业状态认知问卷、护理伦理敏感性问卷调查184名安宁疗护病房护士一般情况、职业状态认知情况和护理伦理敏感性,分析安宁疗护病房护士的护理伦理敏感性现状及其影响因素.结果 184名安宁疗护病房护士的护理伦理敏感性得分为(37.21±5....     

器官移植科护士在临床工作中的伦理困惑及对策

针对器官移植科护士在临床工作中遭遇的伦理困惑,即对“移植术前家属要求不告知患者病情”、“照顾临终患者”及“实习护士带教”的困惑.提出以下解决对策:确定患者的根本利益所在,思考并灵活运用适当的伦理原则,采取有效的沟通方式及负责任的伦理行为,关怀照顾患者的身体和情绪反应,维护患者的根本利益,尊重及保障患者的权益.通过长期、循序渐进的临床护理伦理决策训练,提高伦理决策能力,在解决临床伦理问题的同时,又兼顾患者的最大利益,为其提供高品质的护理服务.     

优质护理服务下临床护士伦理认知模式构建

护士伦理认知是指护士对道德关系和道德规范的认识,包括印象获取、概念的形成以及思维能力的发展．最终形成较高的伦理素养。全国范围内广泛开展优质护理服务以来,护理中不断地注人人文关怀,临床护士的伦理道德水平的高低显得尤为重要。本文在分析当前优质护理服务和护理人员伦理认知及教育现状的基础上．对新形势下临床护士伦理认知模式构建提出建议和思考。     

Enhancing humanistic skills: an experiential approach to learning about ethical issues in health care.

An outstanding feature of the study of nursing ethics is that it raises questions concerning moral virtue, conscience, consistency and character. A considerable section of the literature is devoted to ideas of how best to teach ethics to health professionals. It has been shown that when faced with ethical dilemmas nurses tended to rely on intuition and instinct to resolve them, with little systematic analysis to help the process. Nurses who have been in practice for a number of years may experience particular difficulties in resolving ethical dilemmas, for although they may be able easily to identify ethical problems they may feel powerless to behave appropriately through lack of theoretical background and/or confidence in participating in informed debate. An educational programme was designed to meet the needs of mature registered nurses who were undertaking a post-qualification part-time honours degree in nursing studies. A variety of teaching methods were employed in teaching the nurses. These included discussion, student-led seminars, structured debate and role play. A session which dealt with sudden death and organ donation is described in some detail. Because the topic involved communication between professionals and patients and/or relatives and was linked with ethics, role play was used to explore the dynamics in these areas. The participants were invited to act out the situation as they felt it might occur. Role play highlighted the stress and shock attached to such an experience. Before working through the dynamics of a situation the nurses were conscious of being part of decision-making 'in the cold' and 'in isolation'. As a result of the experiential learning they felt more able to reflect analytically and to participate in discussions in an informed and articulate way.     

ICU护理伦理要求与继续教育对策

探讨ICU护理工作的伦理要求与继续教育对策,旨在结合ICU护理岗位特点,有针对性地加强ICU护士伦理道德教育,提高临床伦理决策能力,有效提升急危重症患者护理服务的质量。     

护士面部表情识别能力对防范骨科护理风险的伦理探究

目的 了解骨科护士面部表情识别能力和骨科护理风险事件发生现状,探讨面部表情识别能力对护理风险防范的伦理意义.方法 对骨科护士进行面部表情识别能力测试和护理风险事件发生状况调查并探究其相关性,采用SPSS17.0对数据结果进行统计学分析.结果 骨科护士总体面部表情识别能力不高,面部表情识别能力与护理风险防范存在相关关系,且OR值=0.684,面部表情识别是防范护理风险的重要方面.结论 面部表情识别能力对护理风险防范具有重要伦理意义,可以通过提高面部表情识别能力来营造充满人文关怀的伦理环境,降低护理风险发生率。     

Partial and impartial ethical reasoning in health care professionals.

OBJECTIVES: To determine the relationship between ethical reasoning and gender and occupation among a group of male and female nurses and doctors. DESIGN: Partialist and impartialist forms of ethical reasoning were defined and singled out as being central to the difference between what is known as the "care" moral orientation (Gilligan) and the "justice" orientation (Kohlberg). A structured questionnaire based on four hypothetical moral dilemmas involving combinations of (health care) professional, non-professional, life-threatening and non-life-threatening situations, was piloted and then mailed to a randomly selected sample of doctors and nurses. SETTING: 400 doctors from Victoria, and 200 doctors and 400 nurses from New South Wales. RESULTS: 178 doctors and 122 nurses returned completed questionnaires. 115 doctors were male, 61 female; 50 nurses were male and 72 were female. It was hypothesised that there would be an association between feminine subjects and partialist reasoning and masculine subjects and impartialist reasoning. It was also hypothesised that nurses would adopt a partialist approach to reasoning and doctors an impartialist approach. No relationship between any of these variables was observed.     

Ethical dilemmas in palliative care: a study in Taiwan

OBJECTIVES: To investigate the incidence and solution of ethical dilemmas in a palliative care unit. DESIGN: Health care workers recorded daily all dilemmas in caring for each patient. SETTING: Palliative care unit of National Taiwan University Hospital in Taiwan. PATIENTS: Two hundred and forty-six consecutive patients with terminal cancer during 1997-8. MAIN MEASUREMENT: Ethical dilemmas in the questionnaire were categorised as follows: telling the truth; place of care; therapeutic strategy; hydration and nutrition; blood transfusion; alternative treatment; terminal sedation; use of medication, and others. RESULTS: The type and frequency of ethical dilemmas encountered were: place of care (33.3%); truth-telling (32.1%); hydration and nutrition (25.2%); therapeutic strategy (24.8%), and use of medication (19.1%). Ethical problems relating to the place of care and to therapeutic strategy were unlikely to be solved with increased hospital stay and some ethical dilemmas remained unsolved even in the final week in hospital, including place of care (23.2%), truth-telling (17.1%) and therapeutic strategy (11.4%). Problems of truth-telling occurred in nearly half (42.6%) of patients over sixty-five-years-old. Conflicts about blood transfusion were experienced in all patients below 18-years-old, and the dilemmas concerning the place of care occurred most frequently with head and neck cancer patients (43.8%). CONCLUSIONS: The solution of ethical dilemmas required refocusing by medical professionals on the importance of continuing communication. Improved ethical training for professionals would contribute to solving the moral dilemmas of palliative care.     

风湿内科护理常见的伦理问题及对策研究

目的探究风湿内科护理常见的伦理问题与解决对策,提高风湿内科临床护理质量。方法收集所有病例资料,以及护理内容,统计护理伦理问题的类型,以我院自制调查问卷的形式,选取近些年我院风湿内科临床护理时遇到的伦理问题,对其进行总结分析,从而提出针对性的解决对策。结果在风湿内科20例发生护理伦理问题的个例中,其中13例是由于对患者隐私部位护理引起的,4例由于患者合并感染性疾病引起的,3例是由于人文关怀程度不够引起的。而对40名护理人员进行调查显示,其中19例护理人员对基础伦理护理知识掌握不到位,占47.5%,13例护理人员面对伦理问题时做出错误选择,占32.5%。结论风湿内科同其他科室一样,同样存在伦理护理问题,通过伦理护理宣教、临床带教等模式可以有效提高护理人员伦理护理技能,并且减少伦理护理问题的产生,对提高风湿内科护理质量有显著价值,值得推广。