從領導角色談護理實務之倫理氣候

Ethical Climate in Nursing Practice--The Leader’s Role

現今在日益複雜的醫療環境中，必須清楚地知道組織的使命、願景與價值，這是有效管理的重要關鍵。護理業務是一種道德良心的事業，且在護理照護中不斷地強調護理倫理的重要性，期望護理人員能本著護理倫理原則照護病人。然而倫理困境的產生影響護理人員的照護品質、心理壓力與留任等，同時影響護理人員對組織的承諾及阻礙組織的發展，故護理領導者應建立護理實務中倫理氣候的氛圍及策略，使護理人員能夠運用護理倫理規範於臨床照護。建立倫理氣候的策略包括：1.尊重病人及護理人員的自主性；2.提供安全的護理；3.面臨不安全護理業務的處理；4.加強護理倫理教育及運用資源。倫理氣候影響著護理人員面對倫理壓力、工作行為、組織承諾、工作滿意度及離職意向等。護理領導者必須建立倫理氣候的策略，並能實際運用於護理實務中，且應隨時檢視護理人員實務上對倫理氣候自我感受的情形，以解決護理人員於臨床照護過程所面臨的倫理問題及增加護理專業的認同感，進而願意繼續留任於護理職場。

In the increasingly complex medical environment today we must be aware of the hospital’s mission, vision, and values, which are the keys to effective management. Management of patient care is compulsorily entangled with moral conscience. The importance of nursing ethics and patient expectations is therefore continuously stressed out in line with the principles of nursing care. However, the impact of ethical dilemmas of nursing care quality, such as psychological stress in dealing with patient’s desires and goals on one side and at the other side the medical goal of curing set on the background of the institution objectives. Therefore, care directives should be established by nursing leaders to ensure a workable ethical climate where nursing practice can be established without ethical conflict. Strategic establishment of ethical climate include providing a safe care, facing the treatment of unsafe treatment, respecting the autonomy of patients and of nurses, and strengthening nursing ethical nawareness and use of resources. After establishment of ethical directives, the practical application of nursing practice should be continuously followed up and re-assessed with respect to the situation. This will provide a healthy working atmosphere for nursing staff and prevent burn-out in our profession.