Living with conflicts-ethical dilemmas and moral distress in the health care system
Living with conflicts-ethical dilemmas and moral distress in the health care system
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DOI：
10.1016/s0277-9536(03)00279-x
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发表时间：
2004-03-01
影响因子：
5.4
通讯作者：
Arnetz, B
中科院分区：
文献类型：
--
作者：
Kälvemark, S;Höglund, AT;Arnetz, B
在过去的十年中，瑞典的医疗保健系统发生了根本性的变化。这些变化使医疗保健变得更加复杂，道德越来越成为临床实践的必要组成部分。考虑到这一点，许多卫生保健专业人员患有与压力有关的疾病也就不足为奇了。由于道德困境而产生的压力通常被称为“道德困扰”。本文章来自安德鲁Jameton的道德困境的概念的发展，并提出了一项研究的结果，使用焦点小组的方法，确定不同类别的医疗保健提供者之间的道德困境和道德困境的情况。这项研究包括医院诊所和药房。结果表明，所有类别的工作人员接受采访表达的道德困扰的经验，以前的研究主要集中在护士经历的道德困扰。第二，它明确指出，道德困境并不仅仅是由于体制限制，防止医疗保健提供者采取行动，他/她的道德考虑，这是道德困境的传统定义的结果。在有些情况下，工作人员确实遵循了他们的道德决定，但这样做与法律的条例等相抵触。在这些情况下，道德上的痛苦也会发生。关于道德困扰的历史研究主要集中在个体医疗服务提供者及其主观道德信念上。我们的研究结果表明，道德苦恼的研究必须更多地关注道德困境的情境。最后，本研究的结论是，工作组织必须提供更好的支持资源和结构，以减少道德苦恼。结果指出，需要进一步的道德教育和论坛讨论道德上令人不安的情况下，在日常护理实践中的医院和药房工作人员。(C)2003 Elsevier Ltd.保留所有权利。
During the last decade, the Swedish health care system has undergone fundamental changes. The changes have made health care more complex and ethics has increasingly become a required component of clinical practice. Considering this, it is not surprising that many health care professionals suffer from stress-related disorders. Stress due to ethical dilemmas is usually referred to as "moral distress". The present article derives from Andrew Jameton's development of the concept of moral distress and presents the results of a study that, using focus group method, identifies situations of ethical dilemmas and moral distress among health care providers of different categories. The study includes both hospital clinics and pharmacies.The results show that all categories of staff interviewed express experiences of moral distress; prior research has mostly focused on moral distress experienced by nurses. Second, it was made clear that moral distress does not occur only as a consequence of institutional constraints preventing the health care giver from acting on his/her moral considerations, which is the traditional definition of moral distress. There are situations when the staff members do follow their moral decisions, but in doing so they clash with, e.g. legal regulations. In these cases too, moral distress occurs. Hitherto research on moral distress has focused on the individual health care provider and her subjective moral convictions. Our results show that the study of moral distress must focus more on the context of the ethical dilemmas.Finally, the conclusion of the study is that the work organization must provide better support resources and structures to decrease moral distress. The results point to the need for further education in ethics and a forum for discussing ethically troubling situations experienced in the daily care practice for both hospital and pharmacy staff. (C) 2003 Elsevier Ltd. All rights reserved.