Ethical Issues for Emergency Nurses during Resuscitation of Injured Patients

描述(申请人提供)：在创伤中心急诊科工作的护士作为创伤团队的成员参与严重受伤患者的初始复苏。关于这些复苏的决定是在高度紧张的环境中做出的，由于伤害的频率高及其对社会的高昂成本，因此不可避免地充斥着伦理问题。这些决定是在快速评估生理状态的复杂过程中做出的，几乎没有关于患者的背景知识，这一过程覆盖了伦理原则、社会规范和期望以及法律规定。研究表明，在许多护理专业中，护士都面临着各种各样的伦理问题，导致工作不满和精神痛苦等后果，从而降低护理质量。然而，急诊护士在重伤患者复苏过程中遇到的具体道德问题，在这些情况下做出道德决定的因素，以及护士如何参与这些决定，在很大程度上仍不清楚。这项研究的目的是阐明急诊护士对严重创伤患者复苏过程中的伦理问题和决定的看法。本研究采用定性描述性设计，以半结构式面对面访谈方式，对参与重伤病人初期复苏的急诊护士进行访谈，以回答以下四个研究问题：1)在重伤患者的最初复苏过程中会出现哪些伦理问题？急诊护士在对严重受伤的病人进行初步复苏时会出现道德问题，这对急诊护士有何影响？在严重受伤患者的最初复苏过程中，哪些因素会导致做出伦理决定？在重伤患者的复苏过程中，护士是如何参与决策的？这项研究将开启一条经验性生命伦理学研究的轨迹，考察创伤所涉及的伦理及其对医疗保健提供者的影响。这最终将导致改进医疗保健提供者关于创伤患者和情况的道德决策的方法，从而改善创伤患者接受的护理。伦理问题的负面影响可能导致护理质量下降和患者预后不良。由于伤害的发生率很高，护理质量下降和患者预后不良可能会对公共卫生产生毁灭性的影响。解决急诊护士遇到的道德问题可以导致战略和干预措施，以帮助处理这些问题和决定。这不仅将改善公共健康，还将满足NINR的使命声明和战略目标，改善护理工作环境、护理质量，并可能留住护士。

DESCRIPTION (provided by applicant): Nurses working in emergency departments ED of trauma centers participate as members of the trauma team in the initial resuscitation of severely injured patients. Decisions regarding these resuscitations are made in high stress environments and are inevitably rife with ethical issues due to the high frequency of injury and its exorbitant costs to society. These decisions are made with little background knowledge about the patients during a complex process of rapid assessment of physiological status overlaid by ethical principles, societal norms and expectations, and legal mandates. Research shows that nurses are confronted with various ethical issues throughout many nursing specialties, leading to consequences such as job dissatisfaction and moral distress which can decrease quality of care. However, the specific ethical issues ED nurses experience during the resuscitation of severely injured patients, the factors contributing to the ethical decisions made during the these situations, and how nurses are involved in these decisions remain largely unknown. The purpose of this study is to explicate ED nurses' perceptions of ethical issues and decisions during resuscitation of severely injured patients. A qualitative descriptive design using semi- structured face-to-face interviews of ED nurses participating in the initial resuscitation of severely injured patients will be used to answer the following four research questions: 1.) What ethical issues arise during the initial resuscitation of severely injured patients?, 2.) How are ED nurses affected by the ethical issues that arise during initial resuscitation of severely injured patients?, 3.) What factors contribute to the ethical decisions made during the initial resuscitation of severely injured patients?, and 4.) How are nurses involved in making decisions during resuscitation of severely injured patients? This study will initiate a trajectory of empirical bioethics research examining the ethics involved in trauma and the effects they have on health care providers. This will ultimately lead to methods of improving health care provider ethical decision making in regards to trauma patients and situations thereby improving the care trauma patients receive. The negative effects of ethical issues can lead to decreased quality of care and poor patient outcomes. With the high occurrence of injury, decreased quality of care and poor patient outcomes can have devastating effects on public health. Addressing the ethical issues encountered by the ED nurses can lead to strategies and interventions to assist in coping with these issues and decisions. This will not only improve public health, but also address NINR's mission statement and strategic goals improving the nursing work environment, quality of care, and possibly retention of nurses.