Ethical decision-making in hospice care
Ethical decision-making in hospice care
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DOI：
10.1177/0969733014534873
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发表时间：
2015-05-01
期刊：
影响因子：
4.2
通讯作者：
Breitsameter, Christof
中科院分区：
文献类型：
--
作者：
Walker, Andreas;Breitsameter, Christof
背景资料：临终关怀是基于一个整体的方法，把病人的身体，心理，社会和精神福利的最前沿的工作。此外，他们起草自己的使命声明，他们是在努力遵循和寻求开展他们的工作，按照道德守则和标准的照顾。研究问题和设计：我们的研究是什么形式的过程和程度的纬度决策时，在实践中出现的问题的伦理和伦理相关的性质。我们采用了定性的方法。数据收集和评价基于扎根理论的方法。伦理考虑：研究报告给相关伦理委员会，在提交研究方案后，伦理委员会没有提出异议。临终关怀中心的研究得到了临终关怀中心主任和护理团队的批准。参与者的权利得到保护，通过获得知情的consent.Results：药物治疗在prefinal阶段和问题，影响提供固体和液体在生命的终结阶段有一个道德层面。在这两个领域，决定是集体作出的。护士在决策过程中的个人（和道德相关的）回旋余地仅限于护士自己的管理护理风格。护士的决策往往更大程度上取决于她的能力，使她的理想护理的概念，以适应她的工作的实际情况，而不是任何概念框架。讨论：一个适应过程是必要的，因为她需要结合临终关怀的四个支柱-即身体，心理，社会和精神护理-到她的日常工作的实践。伦理相关的决定往往是由护士调整他们的愿望水平，他们所面临的实际条件的特点。
Background: Hospices are based on a holistic approach which places the physical, psychological, social and spiritual welfare of their patients at the forefront of their work. Furthermore, they draw up their own mission statements which they are at pains to follow and seek to conduct their work in accordance with codes of ethics and standards of care.Research question and design: Our study researched what form the processes and degrees of latitude in decision-making take in practice when questions of an ethical and ethically relevant nature arise. We used a qualitative approach. Data collection and evaluation was based on the methods of grounded theory.Ethical considerations: The study was reported to the relevant Ethics Commission who had raised no objections following the submission of the study protocol. The study at the hospices was approved by the directors of the hospices and the nursing teams. The rights of the participants were protected by obtaining informed consent.Results: Medication in the prefinal phase and questions affecting the provision of solids and liquids in the end-of-life phase have an ethical dimension. In the context of these two fields, decisions are taken collectively. A nurse's individual (and ethically relevant) leeway in decision-making processes is restricted to the nurse's own style of administering care. The nurse's decision-making often depends to a far greater degree on her ability to adapt her concept of ideal care to fit the practical realities of her work than to any conceptual framework.Discussion: An adaptive process is necessary for the nurse because she is required to incorporate the four pillars of hospice care - namely, physical, psychological, social and spiritual care - into the practice of her daily work.Conclusion: Ethically relevant decisions are often characterised by nurses adjusting their aspiration levels to the practical conditions with which they are confronted.