探討台灣護理人員臨床常見倫理困境議題: 臨床倫理困境

Nurse’s unresolved ethical dilemmas can lead them to conceive the idea of leaving their profession. Also, it will affect the patient safety and the care quality. This qualitative study was conducted via individual interviews with nurses guided by a semi-structured questionnaire. The interviews were transcribed verbatim and analyzed using content analysis. The subjects were 66 nurses from six hospitals in the northern region of Taiwan. In each hospital, 11 nurses which include three medical nurses, three surgical nurses, three critical care nurses, one mental health nurse and one OR nurse were randomly selected. Nurses were interviewed after agreeing to participate in the study. The study findings are shown as follows: 1. The most challenging medical ethical dilemma in current clinical practice consists of “keeping patient informed”. 2. The reason it is the most troublesome issue is that it requires” contact with the patient on a daily basis,” ”not wanting to lie to the patient,” “the physician did first not explain the patient’s disease condition or treatments,” and “feeling afraid of not being able to keep a promise to the patient’s family members” 3. Ways of dealing with the dilemma included communicating with patience, reminding the physicians and family members that the patients has the right of informed consent. 4. The main difficulty in dealing with this issue is the “challenge of communication”. 5. To break through this dilemma often requires continuous efforts to communicate with the physician, asking for the head nurse’s help or initiating case discussion across disciplinary. 6. Nurses need to improve their professional competence, communication skills and tolerate frustration. 7. These competencies can be improved by lectures, unified case discussion, cooperative care, case study method, discussion of relevant films, experience sharing, visiting, reading, advanced study or participation in personal growth groups. This study suggests that nurses’ competence in managing ethical dilemmas should be developed to improve their job satisfaction, patient safety and the quality of patient care.