知行合一——談護理執業上的道德勇氣

Unity of Knowing and Action- Exploring Moral Courage in Nursing Practice

倫理（ethics）為護理專業的核心價值，護理人員的執業行為，無一不是為了回應善的、對的並合乎社會大眾對「好護士」的期待，因此在護理人員培育過程的初始，即被灌輸以病人為中心的思考模式，並以此過程回應倫理與護病關係的專業意義。但進入臨床工作後，現實情境趨向複雜，相對於病人權利的醫療決策受到各種不同因素的牽引與影響，因而導致倫理困境（ethical dilemma）與道德困擾（moral distress）的產生。護理人員在臨床執業的過程中若能秉持自己的良知，面對倫理困境激發個人的道德勇氣，必能為病人與自己的權利發聲，以維護個人心目中好護士的角色並符合社會上對護理人員高道德標準的要求。本文即從個人的道德與良知出發，闡述何謂道德勇氣以及發揮道德勇氣的條件、適當的解決方法與倫理行動，以及可能的訓練方法，期許臨床工作中的護理同仁能發揮道德勇氣，共創正向的倫理工作環境。

Ethics is a core value of nursing, and hospital nurses will try, as much as possible, to be “good” in terms of established nursing ethics and values. Nurses learn the value of providing “patient centered care” in school and try to establish relationships of trust with their patients in clinical settings. However, the realities of working in the hospital teaches nurses that actual situations are complex to the point of inducing “ethical dilemmas” and “moral distress” because of the many factors that affect medical decisions regarding individual patients. If nurses could follow their conscience in managing difficult ethical situations with moral courage, they would promote the value of “good nurse” which is innate in both nurses and society. This article defines the parameters of conscience and moral courage, the conditions such should exhibit, strategies nurses should consider, and appropriate nursing training methods. The authors hope to help foster the development of moral courage and create positive practice environments for nursing staff.