临床实践中道德困扰的研究进展

Research Progress of Moral Distress among Clinical Practice

医学作为一门科学与艺术相结合的学科,其核心价值始终基于为患者谋福利。在临床实践中,医务人员在与患者及其家属接触的过程中,经常面临需要进行医疗决策的复杂情境。但有时由于内部或外部各种因素的限制,个体无法施行符合自身价值和信念的措施时,便会产生道德困扰,给医务人员带来一系列消极的生理或心理反应。长此以往,甚至会导致医务人员出现职业倦怠和离职意愿,从而影响患者安全,造成医护人才队伍的损失。从道德困扰的概念、产生原因、造成的影响和干预措施这四个方面进行梳理和综述,进一步探究道德困扰的产生机制,并形成减轻或消除道德困扰的干预措施。

As a subject combining science and art,the core value of medicine is always based on the welfare of patients.Among clinical practice,medical staff often face complex situations involving medical decision-making in the process of interacting with patients and their families.However,sometimes due to the limitations of internal or external factors,individuals cannot implement measures in line with their own values and beliefs,which will cause moral distress and bring a series of negative physiological or psychological reactions to medical staff.In the long run,it may even lead to job burnout and turnover intention of medical staff,thus affecting patient safety and causing the loss of medical talent team.In this paper,the concept,causes,effects and intervention measures of moral distress will be sorted out and summarized in order to further explore the mechanism of moral distress and form the intervention measures to alleviate or eliminate moral distress.