護理人員臨床工作中所面臨之倫理議題

The Ethical Issues Confronted by Nurses in Clinical Practice

辛幸珍(Hsin Hsin-Chen) ； 江秀娟(Chiang Hsiu-Jiuan) ； 戴正德(Michael Cheng-tek Tai)

《Journal of Medical Education》 6卷3期 (2002/09) Pp. 314-323

https://doi.org/10.6145/jme.200209_6(3).0006

摘要

為因應醫療科技發展所帶來之衝擊以及醫療社會中各種關係日益複雜的現象，國內醫界目前正積極推動醫學倫理教育。落實醫學倫理教學，必須作多方面之革新，其中以收集本土化臨床倫理難題並納入教學內容為最首要的工作。本研究以從事臨床工作並正修習生命倫理課程之護理人員為對象，藉由期末報告及焦點座談收集其臨床工作中所經歷之倫理困擾，經過內容分析，結果顯示，護理人員在臨床工作中常面臨之倫理困擾可歸類為：難以維護病患的權利、行善助人受限、協助專業利益帶來衝突、礙難遵循公平原則、醫師關係存在著隔閡、人道立場不明、醫護認知不同等共七項。研究結果顯現出以護理角度所見本土醫療體系中日常照顧之倫理難題，可作為目前醫學倫理教學課程內容變革的重點。除此，在倫理教學方面，透過護理人員對倫理困擾之敘述，間接促成其對臨床工作之深度自省。雖然，護理人員所提供之資料中在在顯現出代言、履行責任、合作並關懷四項實踐護理倫理之概念，並且也能以醫學倫理四原則：尊重自主、利益行善、不傷害及公平正義原則檢視醫療照護活動之適切性，護理教育者還得繼續突破藩籬，加強專業倫理之實踐能力才能確立倫理教學的成效。

關鍵字

臨床倫理難題 ； 醫學倫理教學 ； 護理倫理

並列摘要

The impact of advanced medical technology on society has forced medical educators to initiate teaching that responds to the needs of the time. Innovative medical ethics curriculums should start by investigating utmost problems faced by medical professionals. Thus, cultural considerations should be a priority to promote bioethics teaching.
This study involved post-junior college nursing students to invited their inputs and evaluate the effectiveness of their nursing ethics course. Qualitative data were collected from them in their class reports upon completion of a course in Biomedical Ethics. Seven core themes were identified from participants' descriptions of their ethical dilemmas during clinical work, namely:difficulties to protect patient's right, limits of beneficence to patients, conflict in gathering professional interests, difficulties in following the principle of justice, barriers in the patient-health care professional relationship, ambiguous attitude of humanism, different recognition between nurse and doctor.
The result of this study can help in the reconfiguration of the nursing ethics course content. It also motivates self-examination of nurses to reflect the four ethical concepts of nurses to reflect the four ethical concepts of nursing practice, namely:advocacy, accountability, collaboration and caring. To reflect on these outcomes, some discussions analyzed the effectiveness of nursing, as a mean of fin-ding a way to bridge the gap between classroom teaching and the practical applications of the nursing ethics course.

並列關鍵字

Clinical Ethical Problems ； Medical Ethics Curriculum Nursing Ethics

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