评估在ICU的道德案例审议期间使用案例学:多重定性案例研究
Niek Kok1, Cornelia Hoedemaekers2, Malaika Fuchs3
1Radboud University Medical Center, Department of IQ Health, Kapittelweg 54, 6525, EP, Nijmegen, Netherlands.
Social science & medicine (1982)
|February 16, 2024
概括
重症监护室 (ICU) 专业人员经常使用案例比较或病理学来做出伦理决策,经常结合医疗和伦理因素. 需要培训来帮助他们有效地识别和评估这些基于案例的论点.
科学领域:
- 医学伦理 医学伦理
- 临床推理 临床推理
- 定性研究是指质量研究.
背景情况:
- 重症监护室 (ICU) 专业人员在压力下面临着复杂的伦理决策.
- 案例学,或基于案例的推理,通过将当前的案例与过去的经验进行比较,为道德决策提供了一种方法.
- 基于证据的医学是主导的框架,但病理学在实践中发挥着重要作用.
研究的目的:
- 评估ICU专业人员在道德案例审议 (MCD) 中使用案例推理的使用情况.
- 了解案例比较如何影响ICU中的伦理判断和道德困扰.
- 识别在识别和评估案例论证时的促进者和挑战.
主要方法:
- 在荷兰的两家医院采用多个案例研究设计.
- 通过话语分析记录和分析了25个道德案例的审议.
- 通过主题分析,对ICU专业人员进行了47次采访并进行了分析.
主要成果:
- 专业人员广泛使用案例比较 (案例学) 来决定是否继续,停止或限制治疗.
- 类比被用来证明或复杂的道德判断和解决道德困境.
- 随机推理整合了医学,伦理和上下文元素,往往偏离了首选的基于原则的推理.
结论:
- 案例学是ICU伦理决策中的普遍,综合的方法,通常被掩盖为基于证据的推理.
- 调解者在道德案例审议期间仔细审查案例论证方面发挥着关键作用.
- 教育举措应侧重于培训临床医生和辅导员,以有效地识别和评估案例论证.
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