探討護理人員臨床醫學倫理困境之解決-----以某醫學中心為例

To Explore the Nurses Problem-Solving of Clinical Medical Ethic Dilemma---A Case of Medical Center

江宜珊(Yi-Shan Chiang)

指導教授 ： 林秋芬

臺北醫學大學/護理學院/護理學研究所/碩士(2011年)

https://doi.org/10.6831/TMU.2011.00108

摘要

本研究旨在了解護理人員臨床醫學倫理困境的感受與解決情形，並分析其相關性，以及基本屬性對護理人員在臨床工作中面對醫學倫理困境的感受與解決情形的相關性探討。採橫斷式研究設計，以某醫學中心為例，針對臨床執業滿六個月以上的護理人員，採單位隨機抽樣方式選取收案對象，經過該院IRB審核通過，並取得院方護理部同意後，自民國100年6月20日起至6月30日止，進行資料收集。此期間共發出500份問卷，回收問卷431份，回收率86.2％；總計有效樣本共402份，有效回收率為80.4％。研究工具採自擬「醫學倫理困境量表」，本量表經過信效度檢定，效度採專家效度CVI值 > .80，信度採內在一致性檢定，感受情形之Cronbach’s α值為 .94，解決情形為 .95。
本研究結果：1.護理人員對臨床醫學倫理困境感受情形的平均值為1.83（SD= .50），介於1.23~3.37之間，其中感受情形類別中最高的是「行善助人」（M=2.00，SD= .71），顯示臨床上護理人員對臨床醫學倫理困境普遍地感受性低。2. 護理人員對臨床醫學倫理困境解決情形的平均值為2.48（SD= 1.13），介於2.15~3.06之間，其中解決情形類別中最好的是「病人權利」（M=2.60，SD= 1.16），顯示臨床上護理人員對臨床醫學倫理困境普遍地解決能力介於中等以下。3.護理人員臨床醫學倫理困境的感受情形與解決情形呈現正相關，且達統計學上顯著差異；顯示若感受情形高則其解決的能力亦相對較好。4.重症加護單位的護理人員對於臨床醫學倫理困境的感受情形較高，而開刀房的感受情形較低，但在解決情形方面，科別屬性並未達統計學上顯著差異，顯示護理人員對臨床醫學倫理困境的解決能力並不受單位科別的影響；薪資低者較薪資高者對醫學倫理困境的感受情形較高，而薪資高者對倫理困境的解決情形較好；無子女數、無婚姻、無宗教信仰者在醫學倫理困境方面的感受情形較高，且達統計學上之顯著差異。
護理人員對臨床醫學倫理困境的感受情形及解決情形皆偏低，同時護理人員的感受情形高時其問題解決情形較佳，顯示目前護理人員面對臨床醫學倫理困境時，問題解決的情形屬於中等以下，有可能是因為對醫學倫理困境的感受度低所影響，其中影響因素很多，可能是醫療機構的政策與制度、臨床業務忙碌、判斷醫學倫理困境的能力不足等，因此值得未來進一步探討。未來應思考如何提升臨床護理人員對醫學倫理困境的判斷能力及敏感度，藉由提升臨床醫學倫理困境的感受情形，提升對問題解決的能力，以增進護理人員對職場環境的滿意度，進而增加留任率，以及提升護理的照護品質。

關鍵字

護理人員；醫學倫理困境；感受情形；解決情形

並列摘要

Objective: This study aimed to understand the nurses’ experience and problem-solving of clinical medical ethic dilemmas, and analyze their relevance, and the basic properties of the nurses working in clinical medical ethics dilemma in the face of experience and to solve the relevance of the case.
Methods: Using a cross-sectional study design, a case of medical center, for example, more than six months for the clinical practice of nursing, and using random sample method for selecting case. This design passed the audit through the Medical Center IRB, and also Hospital Nursing department to obtain consent for data collection, from June 20~30, 2011. This total of 500 questionnaires sent, 431 questionnaires were returned, the return rate of 86.2%; total effective sample of 402, the effective rate of 80.4%. Collected from research tools to be “Medical Ethics Dilemma Scale”, reliability and validity of this scale through the test. Validity uses expert validity CVI > .80. Reliability uses internal consistency. The experience of Cronbach’s α is .94, and the solving of Cronbach’s α is .95.
Results: 1. Nurses experience clinical medical ethic dilemmas of the average 1.83 (SD = .50), ranging between 1.23 ~ 3.37, the highest category of cases in which experience is "doing good to help others" (M = 2.00, SD = .71), shows the clinical nurses on clinical ethical dilemmas generally low sensitivity. 2. Nurses to resolve ethical dilemmas for the clinical situation of the average 2.48 (SD = 1.13), ranging between 2.15 to 3.06, which category best to solving is "patient rights" (M = 2.60, SD = 1.16), indicating that the clinical nurses on the clinical ability to solve ethical dilemmas generally below the middle range. 3. Nurses experience of medical ethic dilemmas and solving showed a positive correlation, and reach a statistically significant difference; display case, if experience of ability is high and solving of ability is relatively good. 4. The experience of medical ethic dilemmas, nurses of intensive care unit is higher, and nurses of operating room is low; but in solving of medical ethic dilemmas, the division of property is not statistically significant difference, showing nurses solving ability of medical ethic dilemmas are not affected by the unit divisions; those who pay lower wages experience medical ethic dilemmas higher than pay higher wages; and pay higher solving of ethical dilemmas better; no children, unmarried, no religion, experience medical ethic dilemma high, and reach the statistically significant difference.
Conclusions: Nurses experience clinical medical ethic dilemmas and solving ability are low, while the case of nurses experience is high and their problem-solving id high better, shows the current clinical medical ethic dilemmas facing nurses when moderate problem-solving situations the following, it may be difficult because of the experiences of the medical ethics of the low impact of many factors which may be the policy of medical institutions and systems, busy clinical operations, to determine the ability of medical ethics dilemma inadequate, so the future is worth further exploration. Future thinking about how to improve the plight of clinical nursing staff on medical ethics and the ability to determine the sensitivity of clinical ethical dilemmas by enhancing the experience of the situation, enhance the problem-solving skills to improve nursing satisfaction with the workplace environment, thus increasing retention rates and improve care quality of care.

並列關鍵字

nurses；medical ethic dilemmas； experience；solving

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