Development of the nursing ethical educational program in psychiatry nursing

目的：明确精神科护士的伦理观念，制定精神科护理伦理教育方案，以获得精神科护理实践中的伦理能力。方法：2003年对精神科护士进行伦理困境听证，编制调查问卷，对精神科护理实践中的伦理观进行调查。利用该问卷，2004年进行了全国范围的调查。从2005年精神科护理伦理教育项目开发的结果来看，实施了该项目，并进行了有效的验证。结果与结论：就精神科护士的伦理现状而言，(1)精神科护士的伦理敏感性存在较低的趋势。(2)精神科护士在身体约束问题上倾向于“我们应该约束”，而在身体约束问题上倾向于“我们应该补救”，当采取与患者的意愿相反的补救措施时，存在一种思想倾向；(3)精神科护士的价值意识提取如下：(1)当患者自身判断能力下降时，应由医务人员代替患者进行决策，最大限度地考虑患者的利益；(2)医务人员最应保护患者的身体安全；(3)患者本人应尊重决策；(4)精神科护士应站在患者的立场上思考；(5)应尊重患者家属的意愿。当病人自身的判断能力下降时，征得与情况有关的人的同意是很重要的。实施精神科护理伦理教育方案。本项目旨在提高从尊重和保护人权的角度解决问题的护理伦理实践能力，并组织了护理伦理讲座和伦理困境小组工作。结果，参与者在伦理困境中从伦理角度进行分析的能力得到了提高。但对他们来说，从尊重和保护人权的角度提高解决问题的能力是不可能的，因为他们很难意识到自我的价值。结果表明，在精神科护理伦理教育中，有必要引入提高自我价值意识的敏感性课程。少

Aim : To clarify psychiatric nurses' ethical view and develop the psychiatric nursing ethical educational program which aims toward the acquisition of the ethical competence in psychiatry nursing practice.Methods : In 2003 hearing concerning ethical dilemma was executed in the psychiatric nurses, the questionnaire which invests the ethical view in psychiatry nursing practice was developed. Making use of that questionnaire nationwide investigation was executed in 2004. In 2005 from the findings the psychiatric nursing ethical educational program developed, executed it, the effective verification did.Results and Conclusion : Concerning the ethical actual condition of the psychiatry nurses, that (1)as for ethical sensitivity of the psychiatry nurses there is a low tendency. (2)concerning body restraint the psychiatric nurses have tendency to have an idea "we should restrain," and as for them "we should remedy,", that there is a tendency which is thought when the remedy which opposes to th … More e intention of the patient is done, (3)the psychiatric nurses' senses of value extracted as following : (1)when judgment ability of the patient himself has decreased, the medical person should decision making in place of the patient, considering the profit of the patient in the maximum, (2)the medical person most should protect that body safety of the patient, (3)the patient himself should respect decision making, (4)the psychiatric nurses should think being in the standpoint of the patient, (5)the people intention of the family should be respected, when judgment ability of the patient himself has decreased, (6)it is important the people who relate to circumstance to agree, to agree upon.The psychiatric nursing ethical educational program was executed. This program had the aim to improve ethical nursing practice ability toward the problem solving from standpoint of human rights respect and protection, and organized the lecture about nursing ethics and group work of the ethical dilemma. As a result, the participants' ability to analyze from the point of ethical view in ethical dilemma improved. But for them it was not possible to improve problem solving ability from standpoint of human rights respect and protection, because it was difficult for them to become aware in sense of value of the self.As a conclusion, we obtained suggestion that it is necessary to introduce the program which enhances the level of sensitivity which becomes aware in sense of value of oneself during the psychiatric nursing ethical educational program. Less