ICU护士道德困境体验质性研究的Meta整合

doi:10.3761/j.issn.2096-7446.2023.11.007

摘要/Abstract

摘要： 目的系统评价ICU护士道德困境体验,为制订基于证据的道德困境干预措施提供参考依据。方法计算机检索相关数据库中关于ICU护士道德困境体验的质性研究,检索时限为建库至2023年7月。采用2016年澳大利亚乔安娜布里格斯研究所（Joanna Briggs Institute,JBI）循证卫生保健中心质性研究质量评价工具对纳入的文献进行质量评价,采用Meta整合方法对结果进行整合。结果共纳入16篇文献,提炼54个研究结果,归纳8个类别,形成3个整合结果：ICU护士负性的生理、心理和认知行为体验;ICU护士道德困境的根源;ICU护士道德困境的应对方式。结论护理管理者应重视道德困境给ICU护士带来的不适体验,采用多种干预方式积极应对道德困境,从而降低ICU护士道德困境水平,提高护理服务质量。

关键词: 重症监护病房, 护士, 道德困境, 体验, Meta整合

Abstract: Objective To systematically evaluate ICU nurses' experiences of moral dilemmas to inform the development of evidence-based interventions for moral dilemmas. Methods Computerized search of relevant databases for qualitative studies on ICU nurses' experiences of ethical dilemmas was conducted with a time frame of construction to July 2023. The quality of the included literature was evaluated using the 2016 Australian Joanna Briggs Institute（JBI）Center for Evidence-Based Health Care qualitative research quality assessment tool,and the results were integrated using meta-integration methods. Results A total of 16 papers were included,54 findings were distilled,and 8 categories were grouped to form 3 integrated findings：negative physical,psychological,and cognitive behavioral experiences of ICU nurses;root causes of ethical dilemmas of ICU nurses;and ways of coping with ethical dilemmas of ICU nurses. Conclusion Nursing managers should pay attention to the physical and psychological discomfort experience brought by moral dilemmas to ICU nurses,and should use a variety of interventions to actively respond to moral dilemmas,so as to reduce the level of ICU nurses' moral dilemmas and improve the quality of nursing services.

Key words: Intensive Care Units, Nurses, Ethical Dilemma, Experience, Meta Integration

于冉, 甘青文, 连泽荣, 孙晓萱, 凌华. ICU护士道德困境体验质性研究的Meta整合[J]. 中华急危重症护理杂志, 2023, 4(11): 1000-1005.

YU Ran, GAN Qingwen, LIAN Zerong, SUN Xiaoxuan, LING Hua. Meta-integration of a qualitative study on the experience of ethical dilemmas of ICU nurses[J]. Chinese Journal of Emergency and Critical Care Nursing, 2023, 4(11): 1000-1005.

参考文献

[1] 周军,王莎莎,武丹丹,等. 重症医学科护士道德困境研究进展[J]. 医学与哲学,2020,41(16):36-40.
Zhou J,Wang SS,Wu DD,et al.Research progress on moral dilemma of nurses in intensive medicine department[J]. Med Philos,2020,41(16):36-40.
[2] 郑硕,张卫青,吴雅萱,等. ICU护士道德韧性状况及影响因素分析[J]. 护理学杂志,2023,38(9):95-98.
Zheng S,Zhang WQ,Wu YX,et al.Moral resilience and its influencing factors among ICU nurses[J]. J Nurs Sci,2023,38(9):95-98.
[3] Ashida K,Kawashima T,Kawakami A,et al.Moral distress among critical care nurses:a cross-cultural comparison[J]. Nurs Ethics,2022,29(6):1341-1352.
[4] 朱佳楠,张欣,林敏,等. 新生儿重症监护室护士经历道德困扰体验的现象学研究[J]. 护理学杂志,2019,34(15):14-17.
Zhu JN,Zhang X,Lin M,et al.A phenomenological study on moral distress exprience of nurses working in neonatal intensive care unit[J]. J Nurs Sci,2019,34(15),14-17.
[5] Guttormson JL,Calkins K,McAndrew N,et al. Critical care nurse burnout,moral distress,and mental health during the COVID-19 pandemic:a United States survey[J]. Heart Lung,2022,55:127-133.
[6] 乔红梅,李葆华,李薇,等. 重症监护与普通病房护士焦虑抑郁症状及职业倦怠比较[J]. 中国心理卫生杂志,2020,34(3):191-195.
Qiao HM,Li BH,Li W,et al.Comparison of anxiety and depression symptoms and job burnout in intensive care and general ward nurses[J]. Chin J Mental Health,2020,34(3):191-195.
[7] Joanna Briggs Institute. JBI critical appraisal checklist for qualitative research[EB/OL]. (2016-08-03)[2023-03-03].http://joanna briggs.org/assets/docs/critical0appraisal0tools.html.
[8] 胡雁. 如何开展质性研究的系统评价和Meta整合[J]. 上海护理,2020,20(7):1-5.
Hu Y.How to conduct systematic review and meta-integration of qualitative studies[J]. Shanghai Nurs,2020,20(7):1-5.
[9] Atashzadeh Shorideh F,Ashktorab T,Yaghmaei F.Iranian intensive care unit nurses' moral distress:a content analysis[J]. Nurs Ethics,2012,19(4):464-478.
[10] Choe K,Kang Y,Park Y.Moral distress in critical care nurses:a phenomenological study[J]. J Adv Nurs,2015,71(7):1684-1693.
[11] Henrich NJ,Dodek PM,Alden L,et al.Causes of moral distress in the intensive care unit:a qualitative study[J]. J Crit Care,2016,35:57-62.
[12] Park M,Yun H.Nurse's experience dealing with ethical dilemma in intensive care unit[J]. Asia Pac J Multimed Serv Convergent Art Humanit Sociol,2016:81-93.
[13] Forozeiya D,Vanderspank-Wright B,Bourbonnais FF,et al.Coping with moral distress-The experiences of intensive care nurses:an interpretive descriptive study[J]. Intensive Crit Care Nurs,2019,53:23-29.
[14] Asadi N,Royani Z,Maazallahi M,et al.Being torn by inevitable moral dilemma:experiences of ICU nurses[J]. BMC Med Ethics,2021,22(1):159.
[15] Kang J,Choi EK,Seo M,et al.Care for critically and terminally ill patients and moral distress of physicians and nurses in tertiary hospitals in South Korea:a qualitative study[J]. PLoS One,2021,16(12):e0260343.
[16] Afoko V,Hewison A,Neilson S,et al.Moral distress experienced by neonatal intensive and paediatric care nurses in Northern Ghana:a qualitative study[J]. J Res Nurs,2022,27(6):519-529.
[17] Rosa D,Bonetti L,Villa G,et al.Moral distress of intensive care nurses:a phenomenological qualitative study two years after the first wave of the COVID-19 pandemic[J]. Int J Environ Res Public Health,2022,19(22):15057.
[18] 吕露露,张雪静,杨娜. 重症监护室护士道德困境真实体验的质性研究[J]. 医学与哲学,2022,43(18):32-37.
Lü LL,Zhang XJ,Yang N.Qualitative study on the experiences of moral distress among intensive care unit nurses[J]. Med Philos,2022,43(18):32-37.
[19] 张习娟,周琴,徐君芬,等. 神经外科ICU护士经历道德困扰的质性研究[J]. 浙江医学教育,2022,21(2):90-93.
Zhang XJ,Zhou Q,Xu JF,et al.Qualitative study of nurses experiencing moral distress in neurosurgical ICU[J]. Zhejiang Med Educ,2022,21(2):90-93.
[20] 周军,魏小丽,张小红,等. 重症医学科护士道德困境体验的质性研究[J]. 中国医学伦理学,2022,35(7):790-795.
Zhou J,Wei XL,Zhang XH,et al.The experience of nurses' moral dilemma in intensive care unit:a qualitative study[J]. Chin Med Ethics,2022,35(7):790-795.
[21] Falcó-Pegueroles A,Bosch-Alcaraz A,Terzoni S,et al.COVID-19 pandemic experiences,ethical conflict and decision-making process in critical care professionals(Quali-Ethics-COVID-19 research part 1):an international qualitative study[J]. J Clin Nurs,2023,32(15/16):5185-5200.
[22] Han S,Min H,Kim S.NICU nurses' moral distress surrounding the deaths of infants[J]. Nurs Ethics,2023,30(2):276-287.
[23] 郑迎,沈丽佳,裘妃,等. 儿科专科护士道德困境影响因素及应对方式的质性研究[J]. 中华急危重症护理杂志,2023,4(7):594-600.
Zheng Y,Shen LJ,Qiu F,et al.A qualitative study on the influencing factors of moral distress and coping experience among pediatric specialist nurses[J]. Chin J Emerg Crit Care Nurs,2023,4(7):594-600.
[24] Helmers A,Palmer KD,Greenberg RA.Moral distress:developing strategies from experience[J]. Nurs Ethics,2020,27(4):1147-1156.
[25] 叶贤,陈俊庆,徐红贞. 儿科ICU护士道德困境测量工具的研究进展[J]. 中华急危重症护理杂志,2022,3(6):562-565.
Ye X,Chen JQ,Xu HZ.Research progress of moral distress measurement tools for pediatric ICU nurses[J]. Chin J Emerg Crit Care Nurs,2022,3(6):562-565.
[26] 邹振亚,茅金宝,周晓阳,等. 急危重症护士道德困境应对策略研究进展[J]. 护理研究,2022,36(6):1064-1067.
Zou ZY,Mao JB,Zhou XY,et al.Research progress on coping strategies of moral distress in emergency and critical care nurses[J]. Chin Nurs Res,2022,36(6):1064-1067.