急性醫療機構護理人員臨床倫理困境之探討

The purposes of this study are to understand how nurses cope with ethical dilemmas and compare the differences between different accreditation levels of acute health care institutions. The research methods include literature review, case analyses, and questionnaires. Based on the case reports from nurses and literature review, the nursing ethical dilemma questionnaire was drafted with a 5 point Likert scale. Research subjects came from nursing staff members of the Nursing Association of Private Health Care Institutions. Through random sampling, one medical center, four regional hospitals, and four district hospitals were included in this study. Questionnaires were distributed to all day shift nurses, 824 in total, of the participating hospitals. 738 copies were collected with a valid response rate of 88%. The result of this study indicated that the chances of nurses encountering ethical dilemma are between sometimes and occasionally. The top five dilemmas in terms of frequency in descending order are: withholding information; there is no hope of recovery, but the family request not to give up and the patient suffers; the health care team consults with the family members to avoid potential malpractice law suites even when the patient is able to make the decision; the choice between quality of life and prolonging life; only the family are informed of the progress and cannot decide whether to inform the patient when he or she has questions regarding his or her condition. The most frequent situation is that families request withholding information from patients. The differences in distribution are related to job title, seniority, and work unit. There are statistically significant differences in the intensive care units and emergency departments. In terms of hospital accreditation levels, the frequency is the highest in the medical center, followed by the regional hospital with the district hospital lowest. Health care institutions should promulgate guidelines and standard operation procedures for the frequently encountered ethical dilemmas. Continuing education should also focus on these aspects to increase the ability of nurses in solving ethical dilemmas.