加護病房護理人員道德困擾及其相關因素之探討

研究目的以探討加護病房護理人員道德困擾及其相關因素，採橫斷式描述相關性研究設計，立意方式取樣，針對中部某醫學中心5個加護病房之護理人員，採問卷調查方式，收案131人(n=131)，問卷回收率89%。研究工具:分別以Wocial & Weaver(2009)所發展的道德困擾溫度計，測量最近2週工作內所經歷的道德困擾的程度；採用Severinsson & Kamaker (1999)修訂的道德敏感性問卷（MSQ），測量護理人員的道德敏感性； Goldman 和Tabak (2010)所修訂之「倫理氣候問卷」（Ethical Climate Questionnaire，簡稱ECQ），測量護理人員在醫療環境中對於倫理氣候的感受。研究方法:採描述性統計平均數、標準差與推論性統計使用t-test、單因子變異數分析(one-way ANOVA)，以皮爾森積分相差（Pearson Correlation），分析道德困擾與道德敏感度以及道德困擾與倫理氣候之間的關係，以多元回歸(multiple regression)分析道德困擾的預測情形。研究結果: (1)道德困擾溫度計(MDT)問卷測量結果，道德困擾的平均得分為3.56 (MD=3.56，SD=2.18)，顯示有2/3的加護病房護理人員(61.8%)都承受著道德困擾，其中約有1/3護理人員(32.8%)MDT得分超過5分承受著嚴重的道德困擾。(2)參加倫理課程的在職教育護理人員整體之道德困擾有顯著上的影響(t=4.613, p<.001)。(3)道德困擾與道德敏感性的分量表中的「衝突」呈低度正相關(r=.212,p<.05)。(4)道德困擾與倫理氣候分量表(關懷導向、功利導向、服務導向、法律導向)呈現低度相關，而道德困擾僅與倫理氣候分量表「獨立導向」無相關。(5)「功利導向」與「接受倫理課程在職教育」等兩個變項，可聯合解釋「道德困擾」變異量20.9%，有統計上的顯著(R2=0.209, p<.001)，顯示出「接受倫理課程在職教育」與「功利導向」兩個變項對道德困擾的預測力。研究討論:在倫理課程在職教育的推動時，會提高道德困擾的發生，所以須著重於道德困擾的預防，及針對道德困擾的因應與處理。

Objective: The purpose of the study was to determine the associated factors of moral distress among ICU nurses. Purposive sampling method was conducted to recruit nurses from five ICU of a medical center in central Taiwan. A Sample of 131 nurses was recruited. Research Methods: This was a cross-sectional correlation survey use the moral distress thermometer, moral Sensitivity questionnaire (MSQ), and the ethical climate questionnaire (ECQ) was used. Statistical methods: Descriptive data were analyzed by mean, standard deviation and rank, inferential statistics using the t-test, one-way ANOVA. Pearson correlation was conducted to analyze the association between factors and moral distress.Multiple regression analysis was conducted to explore the predication of factors on moral distress. Results：(1) Two-third ICU nurses experience moral distress. (2) " Ethical education receiving" was found to be significantly with moral distress (t=4.613, p<.001). (3) "Conflict" the subscale of moral sensitivity was found to be significantly low correlated with moral distress. (4)Ethical climate (caring, instrumental, service, law & code) was found to be significantly low correlated with moral distress. (5)Total 20.9% of variance of moral distress can be explained by instrumental ethical climate and ethical education receiving.