重新审视护理工作中道德困扰与道德代理之间的关系。

IF 2.6 3区 医学 Q1 NURSING
Nursing Philosophy Pub Date : 2024-01-01 Epub Date: 2023-02-07 DOI:10.1111/nup.12419
Georgina Morley, Lauren R Sankary
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引用次数: 0

摘要

近年来,人们对道德困境现象进行了批判性的研究,这是有道理的。人们提出了许多不同的定义,有些定义声称与最初的定义一致,但实际上指的是不同的认识论状态。在本文中,我们通过探讨道德困扰与道德代理的关系来重新审视道德困扰。我们对道德代理的三种概念进行了批判性研究,并认为其中两种概念有可能将护士的价值观置于道德行动的中心,而病人的价值观才是护士应尽的义务。我们建议,艾梅-米利肯(Aimee Milliken)提出的道德代理概念应在护理领域得到更广泛的接受,该概念将患者的价值观重新置于中心位置。我们利用一个案例来说明病人父母(代理人)的价值观有理由限制护士的道德代理权,从而造成道德困扰的情况。通过研究该案例中对护士代理权的限制,我们说明了 "狭隘 "道德困扰的问题性质以及重新考虑道德困扰的价值。 最后,我们提出了一个以行动为导向的建议,确定了一些我们认为对护士(和其他医疗保健专业人员)有用的调解步骤,以在狭隘的道德困扰体验和行使道德代理权之间进行调解。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Re-examining the relationship between moral distress and moral agency in nursing.

In recent years, the phenomenon of moral distress has been critically examined-and for a good reason. There have been a number of different definitions suggested, some that claimed to be consistent with the original definition but in fact referred to different epistemological states. In this paper, we re-examine moral distress by exploring its relationship with moral agency. We critically examine three conceptions of moral agency and argue that two of these conceptions risk placing nurses' values at the center of moral action when it ought to be the patient's values that shape nurses' obligations. We propose that the conception of moral agency advanced by Aimee Milliken which re-centers patient values, should be more broadly accepted within nursing. We utilize a case example to demonstrate a situation in which the values of a patient's parents (surrogates) justifiably constrained nurses' moral agency, creating moral distress. Through an examination of constraints on nurse agency in this case, we illustrate the problematic nature of 'narrow' moral distress and the value of re-considering moral distress.  Finally, we provide an action-oriented proposal identifying mediating steps that we argue have utility for nurses (and other healthcare professionals) to mediate between experiences of narrow moral distress and the exercise of moral agency.

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来源期刊
CiteScore
4.80
自引率
9.10%
发文量
39
审稿时长
>12 weeks
期刊介绍: Nursing Philosophy provides a forum for discussion of philosophical issues in nursing. These focus on questions relating to the nature of nursing and to the phenomena of key relevance to it. For example, any understanding of what nursing is presupposes some conception of just what nurses are trying to do when they nurse. But what are the ends of nursing? Are they to promote health, prevent disease, promote well-being, enhance autonomy, relieve suffering, or some combination of these? How are these ends are to be met? What kind of knowledge is needed in order to nurse? Practical, theoretical, aesthetic, moral, political, ''intuitive'' or some other? Papers that explore other aspects of philosophical enquiry and analysis of relevance to nursing (and any other healthcare or social care activity) are also welcome and might include, but not be limited to, critical discussions of the work of nurse theorists who have advanced philosophical claims (e.g., Benner, Benner and Wrubel, Carper, Schrok, Watson, Parse and so on) as well as critical engagement with philosophers (e.g., Heidegger, Husserl, Kuhn, Polanyi, Taylor, MacIntyre and so on) whose work informs health care in general and nursing in particular.
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