DOI QR코드

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간호사와 의사 간의 윤리적 딜레마 사례개발과 간호사의 의사결정 양상

Case Development on Nurses' Ethical Dilemmas with Physicians' and Nurses' Decision Making

  • 투고 : 2013.10.26
  • 심사 : 2013.12.14
  • 발행 : 2013.12.31

초록

Purpose: This study was done to develop a realistic clinical case and investigate nurses' decision-making about nurses' ethical dilemmas with physicians in the fields of nursing practice. Methods: Case development and a hypothetical case study were used. Participants were 52 nurses. Data were collected in 2012 and 2013 using an open-ended questionnaire and interviews and analyzed using content analysis and descriptive statistics. Results: Various dilemma situations between nurses and physicians, such as violence, deathbed, medication prescription, and physicians' incapacity unfairness, were suggested. A clinical dilemma case about medication prescription was developed based on nurses' experiences. Nurses' responses to the developed case situation and responses were classified into five types. Various reasons were given for making the decisions and about 56% of the nurses decided to notify their supervisor without deleting nursing records. Conclusion: In this study, a realistic clinical dilemma case was developed, and nurses' ethical decision making was identified. These findings can be used in developing effective strategies for nurses to solve ethical dilemmas and to improve ethical decision-making abilities.

키워드

참고문헌

  1. Ahn, S. (2009). Quantitative analysis of ethics research within the Korean nursing community. Korean Journal of Medical Ethics, 12, 262-274.
  2. Ahn, S., Kim, Y., Cho, K, C., Um, Y. R., & Lee, S. H. (2004). Nurses' experiences of ethical issues and needs of ethical guidelines. Retrieved July 15, 2013, from http://webzine. koreanurse.or.kr/Webzine/read_article.php?webzine_id= 12&sub_cat_id=129&is_sub_no=234&article_id=401
  3. Buiting, H. M., van der Heide, A., Onwuteaka-Philipsen, B. D., Rurup, M. L., Rietjens, J. A. C., Borsboom, G., et al. (2010). Physicians' labelling of end-of-life practices: A hypothetical case study. Journal of Medical Ethics, 36 (1), 24-29. http:// dx.doi.org/10.1136/jme.2009.030155
  4. Cameron, M. E., Schaffer, M., & Park, H. (2001). Nursing students' experience of ethical problems and use of ethical decisionmaking models. Nursing ethics. 8, 432-447. http://dx.doi. org/10.1177/096973300100800507
  5. Cho, N. O., Hong, Q. S., & Kim, H. S. (2001). Study of nurses's interpersonal conflict and communication. The Journal of Korean Academic Society of Nursing Education, 7, 369-378.
  6. Choi, J. (2004). A study on the problem design principle for problem- based learning through the case analysis. Journal of Educational Technology, 20, 37-61.
  7. Dekeyser Ganz, F., & Berkovitz, K. (2011). Surgical nurses' perceptions of ethical dilemmas, moral distress and quality of care. Journal of Advanced Nursing, 68, 1516-1525. http:// dx.doi.org/10.1111/j.1365-2648.2011.05897.x
  8. Dierckx de Casterle, B., Izumi, S., Godferey, N. S., & Denhaerynck, K. (2008). Nurses' responses to ethical dilemmas in nursing practice: Meta-analysis. Journal of Advanced Nursing, 63, 540-549. http://dx.doi.org/10.1111/j.1365-2648.2008. 04702.x
  9. Downe-Wamboldt, B. (1992). Content analysis: Method, applications, and issues. Health Care for Women International, 13 (3), 313-321. https://doi.org/10.1080/07399339209516006
  10. Han, S. S. (1992). The nature of ethical dilemmas and decision making in hospital nursing practice. Unpublished doctoral dissertation, Seoul National University, Seoul, Korea.
  11. Han, S. S., & Ahn, S. (1992). Concept analysis of nursing ethical dilemma. The Korean Central of Medicine, 57, 55-68.
  12. Harrison, R., Birks, Y., Hall, J., Bosanquet, K., Harden, M., & Iedema, R. (in press). The contribution of nurses to incident disclosure: A narrative review. International Journal of Nursing Studies. http://dx.doi.org/10.1016/j.ijnurstu.2013. 07.001
  13. Jang, K. S., Lee, M. H., Kim, I. S., Hong, Y. M., Ha, N. S., Kong, B. H., et al. (2011). Ethics & profession of nursing. Seoul: Hyunmoonsa.
  14. Jo, K. (2010). Nurses' conflict experience toward end-of-life medical decision-making. Korean Journal of Adult Nursing, 22, 488-498.
  15. Kim, H. G. (2003). Analysis of decision-making in ethical dilemma cases among clinical nurses. Journal of Korean Academy of Nursing Administration, 9, 450-480.
  16. Kim, J. H., Ahn, S. Y., Kim, J. Y., Chung, J. H., Kim, J. M., Choi, S. H., et al. (1995). A study on attitude ethical dilemmas in clinical nurses. Journal of Korean Academy of Nursing, 25, 496-509.
  17. Kim, K. K. (2011). Development of a web-based diagnostic evaluation program for the prevention of nurses' malpractice liability. Journal of Korean Academy of Nursing Administration, 17, 33-43. https://doi.org/10.11111/jkana.2011.17.1.33
  18. Kim, K. K., Song, M. S., Rhee, K. S., & Hur, H. K. (2006). Study on factors affecting nurses' experience of non-reporting incidents. Journal of Korean Academy of Nursing Administration, 12, 454-463.
  19. Kim, S. D. (2002). A study on an ethical relationship between nurse and physician. Korean Journal of Medical Ethics, 5, 55-69.
  20. Kim, Y. M., You, M. S., Cho, Y. H., Park, S. H., Nam, S. N., Park, M. O., et al. (2010). Development and evaluation of patient safety-focused inservice education program for surgical nurses. Journal of Korean Academy of Nursing Administration, 16, 152-161. https://doi.org/10.11111/jkana.2010.16.2.152
  21. Kim, Y., Park, J., Yoo, M., Hyun, M., & Kim, G. (1999). Nurses' moral judgement on ethical dilemmas. Korean Journal of Medical Ethics, 2, 159-176.
  22. Lee, K. J., & Yoo, S. Y. (2011). Relationships between nurses' ethical dilemma, coping types, job satisfaction and turnover intention in Korea. Journal of Korean Clinical Nursing Research, 17, 1-15.
  23. Lee, Y., Lee, Y, H., Lee, M. J., Park, J., Lim, K., Choi, C., et al. (2010). Residents's perspectives on ethical conflicts and professional boundaries: A vignette-based survey. Korean Journal of Medical Ethics, 13, 153-174.
  24. McCarthy, J., & Deady, R. (2008). Moral distress reconsidered. Nursing Ethics, 15, 254-262. http://dx.doi.org/10.1177/09 69733007086023
  25. National Health Personnel Licensing Examination Board. (2013). Workshop for improving item development ability in nurse licensing examination. Seoul: Author.
  26. Park, H. (2009). Ethical dilemma of nurses. Journal of Korean Academy of Nursing Administration, 15 , 128-135.
  27. Park, H. J., & Kim, M. Y. (2004). Ethical dilemma and coping types in nurses. The Journal of Korean Academic Society of Nursing Education, 10, 75-83.
  28. Park, M., Jeon, S. H., Hong, H. J., & Cho, S. (2013, May). Ethical issues in nursing practice: Comparisons of nursing units . Paper presented at the spring meeting of the Korean Academy of Nursing Administration, Gwangju, Korea.
  29. Pavlish, C., Brown-Saltzman, K., Hersh, M., Shirk, M., & Nudelman, O. (2011). Early indicators and risk factors for ethical issues in clinical practice. Journal of Nursing Scholarship, 43, 13-21. http://dx.doi.org/10.1111/j.1547-5069.2010.01380.x
  30. Perrin, K. O., & McGhee, J. (2008). Quick look nursing: Ethics and conflict (2nd ed.). Sudbury, MA: Jones and Bartlett Publishers.
  31. Redman, B., & Fry, S. T. (2000). Nurses' ethical conflicts: What is really known about them? Nursing Ethics, 7, 360-366. http:// dx.doi.org/10.1177/096973300000700409
  32. Ulrich, C. M., Taylor, C., Soeken, K., O'Donnell, P., Farrar, A., Danis, M., et al. (2010). Everyday ethics: Ethical issues and stress in nursing practice. Journal of Advanced Nursing, 66 , 2510-2519. http://dx.doi.org/10.1111/j.1365-2648.2010.054 25.x
  33. Um, Y, R., Kang, S. Y., & Noh, W. J. (2012). Changing to positive ethics in hospital nurses through 'theatre of situations'. Journal of Korean Clinical Nursing Research, 18 (1), 1-12.
  34. Westbrook, J. I., Li, L., Georgiou, A., Paoloni, R., & Cullen, J. (2013). Impact of an electronic medication management system on hospital doctors' and nurses' work: A controlled pre-post, time and motion study. Journal of the American Medical Informatics Association, 20, 1150-1158. http://dx. doi.org/10.1136/amiajnl-2012-001414
  35. Winland-Brown, J., & Dobrin, A. (2009). Medical repatriation: Physicians' and nurses' responses to a dilemma. Southern Online Journal Of Nursing Research, 9 (4). Retrieved December 7, 2013, from http://www.resourcenter.net/images/ SNRS/Files/SOJNR_articles2/Vol09Num04Art01.html

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