护士道德困境对护理的影响及应对策略研究进展
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摘要
道德困境对护理工作满意度、职业倦怠、认同感、同情心疲乏、人员流动、健康等方面均有影响,建议采取有效的措施来缓解护士的道德困境,如通过加强伦理道德教育,提高伦理决策能力;改善沟通协作,提供更多支持;提供伦理咨询和评估,发展伦理委员会;进行自我反省,提高个人应对水平。
Moral dilemmas can produce an impact on nursing job satisfaction, job burnout, identity, compassion fatigue,mobility, health, etc. It is recommended that effective measures should be taken to alleviate the moral dilemmas faced by nurses.For example, ethics education should be strengthened to improve ethical decision-making ability. Communication and cooperation should be enhanced and more support should be provided. Ethical consultation and evaluation should be supplied. Ethics committee should be set up. Every nurse should examine their own errors and promote individual response.
Moral dilemmas can produce an impact on nursing job satisfaction, job burnout, identity, compassion fatigue,mobility, health, etc. It is recommended that effective measures should be taken to alleviate the moral dilemmas faced by nurses.For example, ethics education should be strengthened to improve ethical decision-making ability. Communication and cooperation should be enhanced and more support should be provided. Ethical consultation and evaluation should be supplied. Ethics committee should be set up. Every nurse should examine their own errors and promote individual response.
引文
[1]孙霞,曹枫林,宋萌萌.护士道德困境的研究进展[J].社区医学杂志,2011,9(17):12-14.
[2]沈志莹,钟竹青,丁四清,等.长沙市三级甲等综合医院护士道德困境现状及其影响因素分析[J].中国护理管理,2017,17(1):50-54.
[3] PAULY BM,VARCOE C,STORCH J. Framing the issues:moral distress in health care[J].HEC Forum,2012,24(1):1-11.
[4]CORLEY MC,MINICK P,ELSWICK RK,et al. Nurse moral distress and ethical work environment[J]. Nurs Ethics,2005,12(4):381-390.
[5] BORHANI F, ABBASZADEH A, MOHAMAHI E, et al. Moral sensitivity and moral distress in Iranian critical care nurses[J]. Nurs Ethics,2015,24(4):474-482.
[6]高峰,刘芬,刘珊珊,等.护士道德困境与工作满意度相关性分析[J].护理学杂志,2014,29(6):49-51.
[7]胡校云,李再云.肿瘤科护士道德困境与工作满意度相关性研究[J].当代护士,2016,16(5):16-18.
[8]LAWRENCE LA. Work engagement,moral distress,education level,and critical reflective practice in intensive care nurses[J]. Nurs Forum,2011,46(4):256-268.
[9]HWANG J, BAE J. Influence of Mental Health Nurses'Moral Distress and Job Satisfaction on Turnover Intention[J].J Korean Acad Psychiatr Ment Health Nurs,2017,26(4):325-332.
[10]NEGRISOLO A,BRUGNARO L. Moral disress in nursing care[J].Prof Inferm,2012,65(3):163-170.
[11]CHAE Y,YU S,LEE EJ,et al. The Relation Among Moral Distress,Physical Symptoms and Burnout of Hospital Nurses[J]. J Korean Acad Society Nursi Educa,2017,23(4):430-440.
[12]章志伟,王霞,王建宁,等.重症监护室护士道德困境与职业倦怠的相关性研究[J].上海交通大学学报(医学版),2014,34(7):1073-1077.
[13]谭开宇,林霞.肿瘤科护士道德困境对职业倦怠的影响[J].护理研究,2017,31(34):4344-4348.
[14]林丽艳,李贤连,陈洁,等. ICU护士道德困境对其职业认同感的影响[J].中国护理管理,2016,16(6):772-776.
[15]沈琰.护士道德困境与同情心疲乏的相关性研究[J].护理管理杂志,2016,16(6):398-399,434.
[16]JAMETON A.What Moral Distress in Nursing History Could Suggest about the Future of Health Care[J]. Ama J Ethics,2017,19(6):617-628.
[17]MASON VM,LESLIE G,LYONS P,et al. Compassion Fatigue,Moral Distress,and Work Engagement in Surgical Intensive Care Unit Trauma Nurses[J].Dimens Crit Care Nurs. 2014,33(4):215-225.
[18]DYO M,KALOWES P,DEVRIES J. Moral distress and intention to leave:A comparison of adult and paediatric nurses by hospital setting[J].Intensive And Critical Care Nursing,2016(36):42-48.[2018-07-01].https://www.sciencedirect.com. DOI:10.1016/j.iccn.2016. 04. 003.
[19]ATASHZADEH-SHOORIDEH F,ASHKTORAB T,YAGHMAEI F,et al. Relationship between ICU nurses'moral distress with burnout and anticipated turnover[J]. Nurs Ethics,2015,22(1):64-76.
[20]WOODS M,RODGERS V,TOWERS A,et al. Researching moral distress among New Zealand nurses:A national survey[J]. Nurs Ethics,2015,22(1):117-130.
[21] NAN CH, MINJEONG A, SOOK SH. Differences of Turnover Intention by Moral Distress of Nurses[J]. J Korea Cont Associa,2015,15(5):403-413.
[22]LAZZARIN M,BIONDI A,MAURO SD. Moral distress in nurses in oncology and haematology units[J]. Nurs Ethics,2012,19(2):183-195.
[23]HENRICH NJ,DODEK PM,GLADSTONE E,et al.Consequences of moral disress in the intensive care unit:a qualitative study[J]. Am J Crit Care,2017,26(4):e48-e58.
[24]PRESTIA AS,SHERMAN RO. Chief Nursing Officers Experiences With Moral Distress[J]. J Nursi Adm,2017,47(2):101-107.
[25]HART SH. Hospital ethical climates and registered nurse's turnover intentions[J].Image J Nurs Sch,2005,37(2):173-177.
[26]CHOE K,KANG Y,PARK Y. Moral distress in critical care nurses:a phenomenological study[J]. J Adv Nursi,2015,71(7):1684-1693.
[27] BEUMER CM. Innovative solutions:the effect of a workshop on reducing the experience of moral distress in an intensive care unit setting[J]. Dimens Crit Care Nurs,2008,27(6):263-267.
[28]MALLOY DC,HADJISTAVROPOULOS T,MCCARTHY EF,et al.Culture and organizational climate:nurses'insights into their relationship with physicians[J]. Nurs Ethics,2009,16(6):719-733.
[29]国家卫生和计划生育委员会.全国护理事业发展规划纲要(2016-2020年)[EB/OL].(2016-11-64)[2017-01-11].http://www.nhfpc.gov.cn/yzygj/s3593/201611/92b2e8f8cc644a899e9d0fd572aefef3.shtml.
[30]RUSHTON CH,SCHOONOVER-SHOFFNER K,KENNEDY MS.A Collaborative State of the Science Initiative:Transforming Moral Distress into Moral Resilience in Nursing[J]. Am J Nurs,2017,117(2):2-6.
[31]GUTIERREZ KM. Critical care nurses'perceptions of and responses to moral distress[J]. Dimens Crit Care Nurs,2005,24(5):229-241.
[32]KARAGOZOGLU S,YILDIRIM G,OZDEN D,et al. Moral distress in Turkish intensive care nurses[J]. Nurs Ethics,2015,24(2):1-16.
[33]DEADY R,MCCARTHY J. A study of the situations,features,and coping mechanisms experienced by Irish psychiatric nurses experiencing moral distress[J]. Perspect Psychiatr C,2010,46(3):209-220.
[34] BURSTON AS, TUCKETT AG. Moral distress in nursing:contributing factors,outcomes and interventions[J]. Nurs Ethics,2013,20(3):312-324.
[35]NORDAM A,TORJUUL K,SORLIE V. Ethical challenges in the care of older people and risk of being burned out among male nurses[J].J Clin Nurs,2005,14(10):1248-1256.
[36]KAREN M. Critical care nurses'perceptions of and responses to moral distress[J]. Dimens Crit Care Nurs,2005,24(5):229-241.
[37]A NN B,ELIZABETH G. A health system-wid e moral distress consultation service:development and evaluation[J]. HEC Forum,2017,29(2):127-143.
[38]ROSENTHAL MS,CLAY M. Initiatives for Responding to Medical Trainees'Moral Distress about End-of-Life Cases[J]. Ama J Ethics,2017,19(6):585-594.
[39]RAINES M. Ethical decision making in nurses[J]. J Bus Ethics,2000,2(1):29-41.
[40]ZUZELO PR. Employing the moral distress of registered nurses[J].Nurs Ethics,2007,14(3):344-359.
[41] HANNA DR. The lived experience of moral distress:nurses who assisted with elective abortions[J]. Res Theory Nurs Pract,2005,19(1):95-124.
[42] MUSTO LC, RODNEY PA, VANDERHEIDE R. Toward interventions to address moral distress:navigating structureand agency[J]. Nurs Ethics,2015,22(1):91-102.
[43]ROBINSON EM,LEE SM,ZOLLFRANK A,et al. Enhancing Moral Agency:Clinical Ethics Residency for Nurses[J]. Hastings Cent Rep,2014,44(5):12-20.
[2]沈志莹,钟竹青,丁四清,等.长沙市三级甲等综合医院护士道德困境现状及其影响因素分析[J].中国护理管理,2017,17(1):50-54.
[3] PAULY BM,VARCOE C,STORCH J. Framing the issues:moral distress in health care[J].HEC Forum,2012,24(1):1-11.
[4]CORLEY MC,MINICK P,ELSWICK RK,et al. Nurse moral distress and ethical work environment[J]. Nurs Ethics,2005,12(4):381-390.
[5] BORHANI F, ABBASZADEH A, MOHAMAHI E, et al. Moral sensitivity and moral distress in Iranian critical care nurses[J]. Nurs Ethics,2015,24(4):474-482.
[6]高峰,刘芬,刘珊珊,等.护士道德困境与工作满意度相关性分析[J].护理学杂志,2014,29(6):49-51.
[7]胡校云,李再云.肿瘤科护士道德困境与工作满意度相关性研究[J].当代护士,2016,16(5):16-18.
[8]LAWRENCE LA. Work engagement,moral distress,education level,and critical reflective practice in intensive care nurses[J]. Nurs Forum,2011,46(4):256-268.
[9]HWANG J, BAE J. Influence of Mental Health Nurses'Moral Distress and Job Satisfaction on Turnover Intention[J].J Korean Acad Psychiatr Ment Health Nurs,2017,26(4):325-332.
[10]NEGRISOLO A,BRUGNARO L. Moral disress in nursing care[J].Prof Inferm,2012,65(3):163-170.
[11]CHAE Y,YU S,LEE EJ,et al. The Relation Among Moral Distress,Physical Symptoms and Burnout of Hospital Nurses[J]. J Korean Acad Society Nursi Educa,2017,23(4):430-440.
[12]章志伟,王霞,王建宁,等.重症监护室护士道德困境与职业倦怠的相关性研究[J].上海交通大学学报(医学版),2014,34(7):1073-1077.
[13]谭开宇,林霞.肿瘤科护士道德困境对职业倦怠的影响[J].护理研究,2017,31(34):4344-4348.
[14]林丽艳,李贤连,陈洁,等. ICU护士道德困境对其职业认同感的影响[J].中国护理管理,2016,16(6):772-776.
[15]沈琰.护士道德困境与同情心疲乏的相关性研究[J].护理管理杂志,2016,16(6):398-399,434.
[16]JAMETON A.What Moral Distress in Nursing History Could Suggest about the Future of Health Care[J]. Ama J Ethics,2017,19(6):617-628.
[17]MASON VM,LESLIE G,LYONS P,et al. Compassion Fatigue,Moral Distress,and Work Engagement in Surgical Intensive Care Unit Trauma Nurses[J].Dimens Crit Care Nurs. 2014,33(4):215-225.
[18]DYO M,KALOWES P,DEVRIES J. Moral distress and intention to leave:A comparison of adult and paediatric nurses by hospital setting[J].Intensive And Critical Care Nursing,2016(36):42-48.[2018-07-01].https://www.sciencedirect.com. DOI:10.1016/j.iccn.2016. 04. 003.
[19]ATASHZADEH-SHOORIDEH F,ASHKTORAB T,YAGHMAEI F,et al. Relationship between ICU nurses'moral distress with burnout and anticipated turnover[J]. Nurs Ethics,2015,22(1):64-76.
[20]WOODS M,RODGERS V,TOWERS A,et al. Researching moral distress among New Zealand nurses:A national survey[J]. Nurs Ethics,2015,22(1):117-130.
[21] NAN CH, MINJEONG A, SOOK SH. Differences of Turnover Intention by Moral Distress of Nurses[J]. J Korea Cont Associa,2015,15(5):403-413.
[22]LAZZARIN M,BIONDI A,MAURO SD. Moral distress in nurses in oncology and haematology units[J]. Nurs Ethics,2012,19(2):183-195.
[23]HENRICH NJ,DODEK PM,GLADSTONE E,et al.Consequences of moral disress in the intensive care unit:a qualitative study[J]. Am J Crit Care,2017,26(4):e48-e58.
[24]PRESTIA AS,SHERMAN RO. Chief Nursing Officers Experiences With Moral Distress[J]. J Nursi Adm,2017,47(2):101-107.
[25]HART SH. Hospital ethical climates and registered nurse's turnover intentions[J].Image J Nurs Sch,2005,37(2):173-177.
[26]CHOE K,KANG Y,PARK Y. Moral distress in critical care nurses:a phenomenological study[J]. J Adv Nursi,2015,71(7):1684-1693.
[27] BEUMER CM. Innovative solutions:the effect of a workshop on reducing the experience of moral distress in an intensive care unit setting[J]. Dimens Crit Care Nurs,2008,27(6):263-267.
[28]MALLOY DC,HADJISTAVROPOULOS T,MCCARTHY EF,et al.Culture and organizational climate:nurses'insights into their relationship with physicians[J]. Nurs Ethics,2009,16(6):719-733.
[29]国家卫生和计划生育委员会.全国护理事业发展规划纲要(2016-2020年)[EB/OL].(2016-11-64)[2017-01-11].http://www.nhfpc.gov.cn/yzygj/s3593/201611/92b2e8f8cc644a899e9d0fd572aefef3.shtml.
[30]RUSHTON CH,SCHOONOVER-SHOFFNER K,KENNEDY MS.A Collaborative State of the Science Initiative:Transforming Moral Distress into Moral Resilience in Nursing[J]. Am J Nurs,2017,117(2):2-6.
[31]GUTIERREZ KM. Critical care nurses'perceptions of and responses to moral distress[J]. Dimens Crit Care Nurs,2005,24(5):229-241.
[32]KARAGOZOGLU S,YILDIRIM G,OZDEN D,et al. Moral distress in Turkish intensive care nurses[J]. Nurs Ethics,2015,24(2):1-16.
[33]DEADY R,MCCARTHY J. A study of the situations,features,and coping mechanisms experienced by Irish psychiatric nurses experiencing moral distress[J]. Perspect Psychiatr C,2010,46(3):209-220.
[34] BURSTON AS, TUCKETT AG. Moral distress in nursing:contributing factors,outcomes and interventions[J]. Nurs Ethics,2013,20(3):312-324.
[35]NORDAM A,TORJUUL K,SORLIE V. Ethical challenges in the care of older people and risk of being burned out among male nurses[J].J Clin Nurs,2005,14(10):1248-1256.
[36]KAREN M. Critical care nurses'perceptions of and responses to moral distress[J]. Dimens Crit Care Nurs,2005,24(5):229-241.
[37]A NN B,ELIZABETH G. A health system-wid e moral distress consultation service:development and evaluation[J]. HEC Forum,2017,29(2):127-143.
[38]ROSENTHAL MS,CLAY M. Initiatives for Responding to Medical Trainees'Moral Distress about End-of-Life Cases[J]. Ama J Ethics,2017,19(6):585-594.
[39]RAINES M. Ethical decision making in nurses[J]. J Bus Ethics,2000,2(1):29-41.
[40]ZUZELO PR. Employing the moral distress of registered nurses[J].Nurs Ethics,2007,14(3):344-359.
[41] HANNA DR. The lived experience of moral distress:nurses who assisted with elective abortions[J]. Res Theory Nurs Pract,2005,19(1):95-124.
[42] MUSTO LC, RODNEY PA, VANDERHEIDE R. Toward interventions to address moral distress:navigating structureand agency[J]. Nurs Ethics,2015,22(1):91-102.
[43]ROBINSON EM,LEE SM,ZOLLFRANK A,et al. Enhancing Moral Agency:Clinical Ethics Residency for Nurses[J]. Hastings Cent Rep,2014,44(5):12-20.