精神衛生醫護人員之倫理困境及其處置

劉美珍

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精神衛生醫護人員之倫理困境及其處置

Ethical Dilemma and Treatment :A Study of Psychiatric Mental Health Physicians and Nurses.

劉美珍 , Masters　　Advisor：劉仲冬博士　　

繁體中文

精神衛生醫護人員；倫理；倫理困境；倫理決策；處置； Psychiatric mental health physicians and nurses ； Ethics ； Ethical dilemma ； Ethical decision making ； Treatment

Abstract │ Reference (68) │ Times Cited (3) │ Altmetrics

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The psychiatric physicians and nurses had encountered ethical dilemma of clinical practice. There were many studies related to ethical dilemma that could not only induced negative feelings and psychological disequilibrium, but also influenced multidisciplinary team practices and the quality of patient care. The purpose of the study was to explore the contextual process of ethical dilemma issues，factors，effects and treatment and provide suggested solutions for physicians and nurses. It could concern patients’ autonomy and value of life in the same time. The samples came from the physicians and nurses of acute ward in a psychiatric hospital in Taiwan. The study, applying qualitative research method, used participant observation and in depth interviewing to generate;constant comparative method of qualitative analysis. The findings of this study contained three portions of ethical dilemma. First，value and professional role of physicians and nurses. Second，legal and institutional difficulty whcih included health insurance of government，legal，security，resources in society and institutional policies，management in hospital. Furthermore, physicians（nurses）-patients relationship and rights and obligations of patients.；that included physicians —nurses conflict and rapport. Then，there were involuntary admissions ，diagnosis document ， medical problems including order sheet and drug effects and related adverse reactions, ECT（electroconvulsive treatment）, AAD（against advice discharge）, seclusion and restraint, and long term hospitalization were the issues of ethical dilemma .Then, the major ethical dilemmas of physicians and nurses in hospital that lacked of persons ,training system and support. Limitation of cure in psychiatric treatment of physician. And lacked of rational analysis for judged ability of decision making and managed problematic patient behaviors. The family was as decision-maker in psychiatric treatment of patients. So that the patients’ autonomy had neglect of physicians, nurses and family. According to these findings，our suggestions were： 1.Dimension of medical and nursing education；To plan the systems in curriculums of ethical issues and human subjects. And to emphasize the match of education and practice. 2.Dimension of the clinical practice：To enhance the working training of dilemmas. Administrators should be aware that physicians and nurses those whom must be supported and helped to cope with moral distress in actual situations. And to established『the ethical rounds』at ward. 3. Dimension of the administration in hospital ：To established『the ethical committees』.And to enhance the ability of profession and ethical decision making so that to highlight the quality of patient care. Key words ：Psychiatric mental health physicians and nurses；Ethics； Ethical dilemma； Ethical decision making；Treatment.

Reference ( 68 ) 〈TOP〉

毛家舲．張玨(民85)．倫理困境與護理決策過程．護理雜誌，43(1)，40-45。
連結：
尹萍譯約翰奈思比著(民88)．高科技．高思維．台北:時報。朱建民(民85)．專業倫理教育的理論與實踐．通識教育季刊，3(2)，33-56。
連結：
李亦園(民88)．田野圖像:我的人類學生涯．台北:立緒文化。李明濱(民86)．病人自主與知情同意．醫學教育，1(4)，377-387。
連結：
林春香(民84)．護理人員對末期病患自動出院過程之護理．倫理與民俗考量．護理雜誌，42(3)，78-83。
連結：
林志明譯 Michel． Foucault 著(民87)．古典時代瘋狂史．台北:時報。邱泰源(民87)．緩和醫療癌末照顧之倫理困境．應用倫理研究通訊， 8，26-30。
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