护士在跨专业合作中伦理冲突的范围综述

doi:10.3761/j.issn.0254-1769.2024.09.017

摘要/Abstract

摘要：

目的对护士在跨专业合作中伦理冲突的相关研究进行范围审查，归纳和总结跨专业合作中导致伦理冲突的障碍因素及应对策略，为提高护士的跨专业合作水平提供参考。方法依据范围综述的研究框架展开研究，系统检索Cochrane Library、CINAHL、Embase、PubMed、Web of Science、中国知网、维普数据库、万方数据库、中国生物医学文献服务系统中的相关研究，检索时限为建库至2023年3月。对纳入文献进行汇总和分析。结果共纳入13篇文献，发表时间为1991年—2022年。护士在跨专业合作中导致伦理冲突的障碍因素分为个人因素（专业知识储备不足、专业价值观的差异等）、专业间因素（专业间权力不平衡、合作者间缺乏尊重及协作能力等）和环境因素（资源和人员配备不足、高强度的工作内容和高压的工作环境等）3个方面，同时针对该3个方面提出提升专业知识储备、加强跨专业教育、改善各病室医疗工作者间的理解与合作、为医疗工作者提供符合道德的及有利于跨专业合作和公开对话的工作环境等应对策略。结论跨专业合作对提供高质量的医疗护理服务至关重要，未来需要更多研究聚焦护士的跨专业合作培训教育及跨专业合作核心能力框架构建，同时关注外部组织环境，不断提高护士的跨专业合作能力。

关键词: 跨专业合作, 伦理冲突, 范围综述, 护理管理研究

Abstract:

Objective The scope of related research on ethical conflicts in the interprofessional collaboration in nursing was reviewed，so as to summarize the obstacles and coping strategies that lead to ethical conflicts in interprofessional collaboration and provide references for promoting nurse engagement in interprofessional collaboration. Methods Based on the methodological framework of the scope review，we systematically searched domestic and foreign databases including the Cochrane Library，CINAHL，Embase，PubMed，Web of Science，CNKI，VIP，Wanfang and SinoMed. The time limit for database retrieval was from the establishment of each database to March 2023. The selected studies were summarized and analyzed. Results Totally 13 articles published between 1991 and 2022 were included. The obstacle factors that lead to ethical conflicts in nurse engagement of interprofessional collaboration can be divided into 3 categories，including personal factors（insufficient professional knowledge，differences in professional values），interprofessional factors（imbalanced power between professions，lack of respect and collaboration between cooperators） and environmental factors（insufficient resources and staffing，high-intensity workload，and high-pressure work environment）. At the same time, in view of these 3 aspects, it puts forward some countermeasures, such as enhancing professional knowledge，strengthening interprofessional education，improving understanding and cooperation among medical workers in different wards，providing medical practitioners with a team-based，ethical work environment that facilitates interprofessional collaborations and open dialogues. Conclusion It is of great significance for nurses to get involved in interprofessional collaborations，in order to ensure high-quality nursing services. Further studies are needed for the development of education and the core competency framework construction for interprofessional collaborations in nursing. More attention should be paid to develop the organizational atmosphere at the same time，so as to continuously improve nurse’ capabilities in interprofessional collaborations.

Key words: Interprofessional Collaboration, Ethical Conflicts, Scoping Review, Nursing Administration Research

刘梦媛, 田凌云, 蒋敬, 冯心语, 李卫娟, 罗慧, 李映兰. 护士在跨专业合作中伦理冲突的范围综述[J]. 中华护理杂志, 2024, 59(9): 1138-1144.

LIU Mengyuan, TIAN Lingyun, JIANG Jing, FENG Xinyu, LI Weijuan, LUO Hui, LI Yinglan. Ethical conflicts in interprofessional collaboration among nurses：a scoping review[J]. Chinese Journal of Nursing, 2024, 59(9): 1138-1144.

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参考文献 40

[1]	Bainbridge L, Nasmith L, Orchard C, et al. Competencies for in-terprofessional collaboration[J]. J Phys Ther Educ, 2010, 24(1):6-11. DOI URL
[2]	Sullivan M, Kiovsky RD, J Mason D, et al. Interprofessional collaboration and education[J]. Am J Nurs, 2015, 115(3):47-54. DOI PMID
[3]	Cox M, Cuff P, Brandt B, et al. Measuring the impact of interprofessional education on collaborative practice and patient outcomes[J]. J Interprof Care, 2016, 30(1):1-3. DOI PMID
[4]	Gilbert JHV, Yan J, Hoffman SJ. A WHO report:framework for action on interprofessional education and collaborative practice[J]. J Allied Health, 2010, 39(Suppl 1):196-197.
[5]	Usberg G, Uibu E, Urban R, et al. Ethical conflicts in nursing:an interview study[J]. Nurs Ethics, 2021, 28(2):230-241. DOI URL
[6]	Clark PG, Cott C, Drinka TJ. Theory and practice in interprofessional ethics:a framework for understanding ethical issues in health care teams[J]. J Interprof Care, 2007, 21(6):591-603. DOI URL
[7]	Reeves S, Pelone F, Harrison R, et al. Interprofessional collaboration to improve professional practice and healthcare outcomes[J]. Cochrane Database Syst Rev, 2017, 6(6):CD000072.
[8]	王喜益, 叶志弘, 汤磊雯. 范围综述在护理领域的应用进展[J]. 中华护理杂志, 2019, 54(8):1259-1263. DOI
	Wang XY, Ye ZH, Tang LW. Application progress of scope review in nursing field[J]. Chin J Nurs, 2019, 54(8):1259-1263.
[9]	Lockwood C, dos Santos KB, Pap R. Practical guidance for knowledge synthesis:scoping review methods[J]. Asian Nurs Res(Korean Soc Nurs Sci), 2019, 13(5):287-294.
[10]	Melia KM. Ethical issues and the importance of consensus for the intensive care team[J]. Soc Sci Med, 2001, 53(6):707-719. PMID
[11]	Sabone M, Mazonde P, Cainelli F, et al. Everyday ethical cha-llenges of nurse-physician collaboration[J]. Nurs Ethics, 2020, 27(1):206-220. DOI URL
[12]	Vincent H, Jones DJ, Engebretson J. Moral distress perspecti-ves among interprofessional intensive care unit team members[J]. Nurs Ethics, 2020, 27(6):1450-1460. DOI URL
[13]	Pike AW. Moral outrage and moral discourse in nurse-physician collaboration[J]. J Prof Nurs, 1991, 7(6):351-363. PMID
[14]	Pavlish C, Brown-Saltzman K, Jakel P, et al. Nurses’ responses to ethical challenges in oncology practice:an ethnographic study[J]. Clin J Oncol Nurs, 2012, 16(6):592-600. DOI PMID
[15]	Hancock J, Witter T, Comber S, et al. Understanding burnout and moral distress to build resilience:a qualitative study of an interprofessional intensive care unit team[J]. J Can D’anesthesie, 2020, 67(11):1541-1548.
[16]	Oerlemans AJ, van Sluisveld N, van Leeuwen ES, et al. Ethical problems in intensive care unit admission and discharge decisions:a qualitative study among physicians and nurses in the Netherlands[J]. BMC Med Ethics, 2015, 16:9. DOI PMID
[17]	Rasoal D, Kihlgren A, James I, et al. What healthcare teams find ethically difficult[J]. Nurs Ethics, 2016, 23(8):825-837. DOI PMID
[18]	Bartholdson C, Lützén K, Blomgren K, et al. Experiences of ethical issues when caring for children with cancer[J]. Cancer Nurs, 2015, 38(2):125-132. DOI PMID
[19]	Svantesson M, Löfmark R, Thorsén H, et al. Learning a way through ethical problems:Swedish nurses’ and doctors’ experiences from one model of ethics rounds[J]. J Med Ethics, 2008, 34(5):399-406. DOI PMID
[20]	Gágyor I, Heßling A, Heim S, et al. Ethical challenges in primary care:a focus group study with general practitioners,nurses and informal caregivers[J]. Fam Pract, 2019, 36(2):225-230. DOI URL
[21]	Gagnon M, Kunyk D. Beyond technology,drips,and machines:moral distress in PICU nurses caring for end-of-life patients[J]. Nurs Inq, 2022, 29(2):e12437. DOI URL
[22]	Jensen HI, Ammentorp J, Johannessen H, et al. Challenges in end-of-life decisions in the intensive care unit:an ethical perspective[J]. J Bioeth Inq, 2013, 10(1):93-101. DOI URL
[23]	崔锦, 陈香萍, 隋伟静, 等. ICU护士跨专业合作核心能力指标体系的构建[J]. 中国护理管理, 2021, 21(6):839-844.
	Cui J, Chen XP, Sui WJ, et al. Construction of the index system of interprofessional collaboration core competence for ICU nurses[J]. Chin Nurs Manag, 2021, 21(6):839-844.
[24]	傅文瑶, 庄一渝. ICU护士跨专业合作的影响因素及干预研究进展[J]. 中华急危重症护理杂志, 2022, 3(2):168-172.
	Fu WY, Zhuang YY. Research on influencing factors and intervention of nurses’ interprofessional collaboration in ICU[J]. Chin J Emerg Crit Care Nurs, 2022, 3(2):168-172.
[25]	田雨同, 张艳, 赵敬, 等. 本科护理实习生跨专业合作学习准备度及影响因素分析[J]. 中华护理教育, 2020, 17(9):794-798.
	Tian YT, Zhang Y, Zhao J, et al. Investigation on the current situation of interprofessional cooperative learning readiness among undergraduate nursing interns[J]. Chin J Nurs Educ, 2020, 17(9):794-798.
[26]	孙柳, 王艳玲, 肖倩, 等. 北京市三级甲等医院临床护士跨专业合作学习准备度和感知度的调查分析[J]. 中华护理杂志, 2019, 54(3):417-421. DOI
	Sun L, Wang YL, Xiao Q, et al. Investigation on readiness and perception of interprofessional learning for nurses from tertiary hospitals in Beijing[J]. Chin J Nurs, 2019, 54(3):417-421. DOI
[27]	Engel J, Prentice D. The ethics of interprofessional collaboration[J]. Nurs Ethics, 2013, 20(4):426-435. DOI PMID
[28]	邱娴, 朱唯一, 方琼, 等. 建立护理专业价值观评价指标体系[J]. 中华护理杂志, 2011, 46(9):919-921.
	Qiu X, Zhu WY, Fang Q, et al. Establishing the evaluation index system of nursing professional values[J]. Chin J Nurs, 2011, 46(9):919-921.
[29]	Kenny G. The importance of nursing values in interprofessional collaboration[J]. Br J Nurs, 2002, 11(1):65-68. PMID
[30]	Tsou P, Shih J, Ho MJ. A comparative study of professional and interprofessional values between health professional associations[J]. J Interprofessional Care, 2015, 29(6):628-633. DOI URL
[31]	Skei K. Collaboration at risk:registered nurses’ experiences on orthopaedic wards[J]. J Clin Nurs, 2008, 17(14):1907-1914. DOI URL
[32]	Pakkanen P, Häggman-Laitila A, Kangasniemi M. Ethical issues identified in nurses’ interprofessional collaboration in clinical practice:a meta-synthesis[J]. J Interprof Care, 2022, 36(5):725-734. DOI URL
[33]	Molina-Mula J, Gallo-Estrada J, Perelló-Campaner C. Impact of interprofessional relationships from nurses’ perspective on the decision-making capacity of patients in a clinical setting[J]. Int J Environ Res Public Health, 2017, 15(1):49. DOI URL
[34]	Gordon F, Walsh C, Marshall M, et al. Developing interprofessional capability in students of health and social care-the role of practice-based learning[J]. J Integr Care, 2004, 12(4):12-18.
[35]	崔锦. ICU护士跨专业合作核心能力评价指标体系的构建[D]. 杭州: 浙江大学, 2020.
	Cui J. Construction of evaluation index system of ICU nurses’ cross-disciplinary cooperation core competence[D]. Hangzhou: Zhejiang University, 2020.
[36]	Bruce CR, Miller SM, Zimmerman JL. A qualitative study ex-ploring moral distress in the ICU team[J]. Crit Care Med, 2015, 43(4):823-831. DOI URL
[37]	C Fradelos E, Alexandropoulou CA, Kontopoulou L, et al. The effect of hospital ethical climate on nurses’ work-related quality of life:a cross-sectional study[J]. Nurs Forum, 2022, 57(2):244-251. DOI URL
[38]	范波, 钟清玲, 鄢鸿雁, 等. 跨专业教育在护理硕士专业学位研究生培养中的态势分析[J]. 中华护理教育, 2022, 19(7):604-608.
	Fan B, Zhong QL, Yan HY, et al. SWOT analysis of the interprofessional education for master of nursing specialist[J]. Chin J Nurs Educ, 2022, 19(7):604-608.
[39]	Kangasniemi M, Arala K, Becker E, et al. The development of ethical guidelines for nurses’ collegiality using the Delphi method[J]. Nurs Ethics, 2017, 24(5):538-555. DOI PMID
[40]	刘苑菲, 徐语同, 马亚君, 等. 三级综合医院成人ICU护士伦理冲突现状及影响因素研究[J]. 中华护理杂志, 2023, 58(8):915-921. DOI
	Liu YF, Xu YT, Ma YJ, et al. Investigation and influencing factors of ethical conflict among ICU nurses in tertiary general hospitals in China[J]. Chin J Nurs, 2023, 58(8):915-921. DOI