伦理问题

介绍

Ethical issues are of concern to all nurses. Rehabilitation nurses, 特别是, 在他们执业的环境中遇到具有挑战性的道德状况. Nurses provide care to promote the health and well-being of individuals; this implies interactions among people, 它暗示着对善的追求以及对健康和福利的追求. “伦理”是一个正式的决策过程,用来确定行为的正确性. “道德”指的是正确行为的规则和原则(Blais,等.). 护理职业的道德标准是建立在 Code of Ethics for Nurses with Interpretive Statements (American Nurses Association, 2001).

当必须在艰难的选择或重要的原则冲突之间做出选择时,伦理困境就产生了. 从事康复护理专业的护士面临着无数的伦理困境. 皇冠6686官网(皇冠6686会员登录)的成员已经确定了一些与那些从事康复护理的人有关的伦理问题, including the following: 

  1. Patients’ rights, including the rights of minors. (未成年人能够理解父母以他们的名义做出的决定. 如果未成年人没有参与决策过程,不同意父母的决定, the minor may have no recourse regarding that decision, which leads to an ethical and legal conflict.)
  2. The use of restraints
  3. Do-not-resuscitate orders
  4. Advance directives, 这意味着在生前遗嘱和持久委托书方面的护理干预和责任
  5. 管理有自我毁灭倾向或自杀倾向的客户
  6. 与医疗改革以及分配和提供医疗服务方式的变化有关的问题,包括, but not limited to:
    • access to health care and rehabilitation
    • cost containment
    • determining length of stay
    • defining who meets the criteria for rehabilitation
    • 处理病人不遵守治疗和康复
    • 病人和家庭教学为出院回家或另一个水平的护理做准备
    • Transition to care level with appropriate skills for patients’ needs
  7. Confidentiality, security, and privacy related to patient care
  8. Substance abuse
  9. Abused patients
  10. The nurse/client relationship, e.g., when does it become too intimate, and when is intimacy between the nurse and the client appropriate?

因为康复护士非常关心伦理问题, 皇冠6686官网制定了这一立场声明.

Position Statement

皇冠6686官网支持美国医院协会2001年《皇冠6686会员登录》和《皇冠6686会员登录》(2003年)作为道德决策的重要指南. 皇冠6686会员登录 makes the following additional statements:

  1. The rehabilitation nurse acts as a patient advocate.
  2. 康复护士认识到患者参与决策过程的重要性,并认识到一些患者不像康复专业人员那样重视独立和健康.
  3. 康复护士关心的是康复病人所定义的生活质量, if technological advances in healthcare are compromising it. 先进的医疗技术可以延长生命,但不能提高生活质量.
  4. 康复护士负责提供信息或协助收集和解释信息,这些信息是解决重大道德困境所必需的,并协助患者做出决策.
  5. 康复护士了解可能影响康复患者的伦理问题,并了解自己的价值观和态度.
  6. The rehabilitation nurse, practices with compassion and respect for the dignity, worth of every individual, in a nonjudgmental and nondiscriminatory manner.
  7. 康复护士的决定是基于自主的伦理原则, 善行, justice and nonmaleficence.
  8. 康复护士参与研究,并认识到研究和人体实验的好处对人权构成某种威胁. To protect these rights when participating in research, the nurse considers the issues of informed consent, criteria for inclusion and retention of subjects, training of researchers, research dissemination, ethical supervision and accountability, 并规定受试者的隐私和结果和发现的机密性.
  9. 康复护士参与病人使用或为病人分配资源的决策.

Regarding the rights of patients, 皇冠6686官网持有以下信念:

  1. 所有人,不论年龄大小,都有权接受康复服务, 比赛, 性别, 种族, 宗教, or economic status.
  2. All patients have the right to receive full resuscitation, request do not resuscitate orders, request the discontinuation of life support measures, or refuse recommended treatment, as long as they fully understand what they are requesting.
  3. 所有用于提高患者参与康复能力的药物治疗都将伴随着一个有目标结果的明确的护理计划.
  4. 所有的病人都有权利期望改变他们的环境以提高他们的安全. If environmental modifications prove unsuccessful, 患者有权利期望使用最少的限制装置来防止伤害风险. 在使用环境修改和/或限制措施时,应同时制定针对限制减少结果的明确护理计划.
  5. 所有患者都有权期望患者教育过程包括适用于患者护理需求的健康信息和指导,以及做出出院计划决定所需的信息. 这些决定可能包括出院回家或其他水平的护理资源.

参考文献

American Nurses Association. (2001). Code of Ethics for Nurses with Interpretive Statements. 从检索 http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf.

American Hospital Association. (2003). The 病人护理 Partnership. 从检索 http://www.aha.org/advocacy-issues/communicatingpts/pt-care-partnership.shtml.

Blais, KK, Hayes, JS, Kozier, B., Erb, G, (2010). Professional Nursing Practice: Concepts and Perspectives (第六版). Upper Saddle River, NJ: Prentice Hall.

Jacelon, CS (Ed.). (2011). The Specialty Practice of Rehabilitation Nursing: A Core Curriculum (第六版). Glenview, IL: Author.

Oermann, M.H. (1997). Professional Nursing Practice. Stamford, CT: Appleton & 兰格.

Approved by the 皇冠6686会员登录 Board of Directors September 1994; revised October 2003; revised April 2014.

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