Ethical Issues for Emergency Nurses during Resuscitation of Injured Patients

描述（申请人提供）：在创伤中心急诊科和急诊科工作的护士作为创伤小组成员参与重伤员的初步复苏。关于这些复苏的决定是在高压力环境下做出的，由于伤害的高频率和对社会的高昂成本，不可避免地充斥着道德问题。在伦理原则、社会规范和期望以及法律授权的覆盖下，这些决定是在对患者进行快速生理状态评估的复杂过程中做出的，对患者的背景知识知之甚少。研究表明，护士在许多护理专业中都面临着各种各样的道德问题，导致诸如工作不满和道德困境等后果，这些后果会降低护理质量。然而，急诊科护士在严重受伤患者复苏过程中遇到的具体伦理问题，在这些情况下做出伦理决策的因素，以及护士如何参与这些决策，在很大程度上仍然未知。摘要本研究旨在探讨急诊科护士在重伤员复苏过程中对伦理问题的认知及决策。采用半结构化面对面访谈的定性描述设计，对参与重伤员初步复苏的急诊科护士进行访谈，以回答以下四个研究问题：在重伤员的初步复苏过程中会出现哪些伦理问题？2)。急诊科护士在对严重受伤病人进行初步复苏时，道德问题对他们有何影响？3)。在对严重受伤患者进行初步复苏时，哪些因素会影响伦理决策？4.)护士如何参与重伤员复苏过程中的决策？本研究将开启一个实证生物伦理学研究的轨迹，探讨创伤及其对医疗保健提供者的影响所涉及的伦理学。这将最终导致改善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。由于损伤发生率高，护理质量下降和患者预后差可能对公共卫生产生破坏性影响。解决急诊科护士遇到的道德问题可以导致策略和干预措施，以帮助应对这些问题和决定。这不仅将改善公共卫生，而且还将实现国家护士研究所的使命宣言和战略目标，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.