护士道德勇气研究进展

当护士拥有道德勇气时能履行对病人的道德责任等多种作用。本文对国内外护士道德勇气的研究进行梳理,列举了中西方学者对于道德勇气概念的定义,并且从质性和量性研究两方面分析护士道德勇气的研究现况,总结了人口学因素、组织伦理氛围、道德困境、道德敏感性与道德韧性等影响护士道德勇气的相关因素。本文有助于更全面的理解这一护士美德,未来可通过结合中国国情进一步探索并构建干预方案以提高护士的道德勇气,保障患者享受高质量护理。

     

ICU护士伦理气氛认知与道德困境的相关性研究

采用量性研究方法对ICU护士进行调查分析,了解ICU护士道德困境和伦理气氛认知的现状,并探讨两者之间的相关性。结果显示,ICU护士道德困境总分为43.00分(24.00, 67.00),伦理气氛认知得分为(3.44±0.38)分。相关性分析结果显示：道德困境总分与关怀型伦理气氛呈负相关(r=-0.131,P＜0.05),与功利型伦理气氛呈正相关(r=0.297,P＜0.01)。护理管理者在临床工作中可采取积极有效的措施塑造关怀型伦理气氛,避免或削弱功利型伦理气氛的形成, 从而降低道德困境的发生。

     

新生儿ICU护士道德困境研究进展

新生儿ICU护士由于工作环境与护理对象的特殊性,极易产生道德困境。目前有多种道德困境评估工具用以评估新生儿ICU护士道德困境,大多数新生儿ICU护士对道德困境认知清晰,道德困境水平较高;护士的权限、治疗和护理措施对患儿预后的影响、团队合作等情景是新生儿ICU护士道德困境的来源。道德困境使新生儿ICU护士产生了负面心理,降低了护士的工作积极性,不利于临床工作的开展,应重视新生儿ICU护士道德困境问题,采取措施以改善新生儿ICU护士道德困境,降低道德困境对新生儿ICU护士的负面影响。

     

朱熹浩然之气、道德认知与道德勇气述论

浩然之气是儒家道德哲学的重要伦理命题。朱熹在其理学构架内重新对“浩然之气”进行诠释,在他看来,“知言”是养成浩然之气的关键,亦即要通过道德认知的方式涵养出道德勇气,将血气转化为浩气。如此养成的浩气,可以推动道德实践的落实,使人以一种无所疑虑、恐惧的状态去实践。浩气具有道德实践能力,即在朱熹的思想当中,气不是纯然消极的,气可以有积极的面向,这也是“浩然之气”道德性的重要展现。“浩然之气”作为“道德勇气”其时代价值也就能更充分地展现出来,即今天依旧需要具有道德实践力、能抗风险、坚守价值的道德主体,此种道德主体必定是一身浩气。     

监护病房与普通病房倒班护士工作负载的比较

应用高效液相色谱法测定尿内儿茶酚胺排出量,对36名监护病房和普通病房倒班护士工作负载作了比较。结果表明:监护病房护士日班和大夜班的工作负载较普通病房护士重些,且监护病房护士以心理负荷为主,普通病房护士以体力负荷为主;而两组被试小夜班工作负载的情形相类似。此外,还以被试对工作负载、心境变化和睡眠情况的自我评定作为参考。     

试析社区护士角色道德

角色道德是由角色产生、发展而形成的一种心理结构。社区护士的角色道德问题表现为角色不清、缺乏角色转换的心理准备,原因在于社区护士的形象模糊、制度建设不完善以及缺乏提升自我素质和境界的环境。建议以道德文化为切入点推进角色道德建设,以角色道德价值观教育为核心,构建适合社区护士的角色道德规范。     

道德困境的博弈分析

在无法避免的道德困境面前,各种伦理学理论和道德选择技术似乎都显得无能为力.博弈分析方法以及"自存一存人"道德哲学构想的引入,在一定程度上为理解和摆脱各种道德困境提供了一种可操作性的行为选择技术和较为合理的理论设想.     

论世俗道德的特点及其困境

世俗道德的产生是社会生活世俗化的必然结果,是经济发展的内在逻辑.它具有现实性、人本性和平凡性等特征.世俗道德不可避免地陷入利益主义、享乐主义和庸俗化等困境.只有"回到人本身",才能走出困境.     

高校学生道德困境研究:日常德性的视角

以45位本科生和硕士研究生为对象, 采用日常德性的视角, 考察高校学生在日常生活中亲历的道德困境, 重点探讨个人日常道德困境的内容, 以及他们对个人日常道德困境的解读和处理。结果表明(1)个人日常道德困境多数不同于假设性的公正取向的道德困境。人们对各类个人日常道德困境的解读和阐释存在个体差异。道德内容主要取决于人们所强调的问题。(2)人们所主张的有助于处理日常道德困境的策略与他们在生活中实际采用的策略是有差异的。在真实的道德选择和决定中, 会有更多利己和实用的考虑。此外, 人们对道德行为的判断多倚重对行为后果(特别是伤害性后果)的考虑。     

社会转型期道德困境的理论表现及其启示意义

道德困境是道德发展的常规现象,这在我国理论界多有表现.如理论界对道德冲突、道德矛盾、道德建设的路径选择以及个体道德的培养等方面展开过深入而激烈的讨论,这对于探索道德发展的规律、推动学科研究的深化乃至促进道德文明建设都具有重要的意义.理论是现实的反映,现实道德困境的形成和解决需要一个长期的过程,道德困境理论的研究可以为解决这一问题提供有益启示.     

Moral Courage and Facing Others

Abstract

Moral courage involves acting in the service of one’s convictions, in spite of the risk of retaliation or punishment. I suggest that moral courage also involves a capacity to face others as moral agents, and thus in a manner that does not objectify them. A moral stand can only be taken toward another moral agent. Often, we find ourselves unable to face others in this way, because to do so is frightening, or because we are consumed by blinding anger. But without facing others as moral subjects, we risk moral cowardice on the one hand and moral fanaticism on the other.     

With Hope and Imagination: Imaginative Moral Decision-Making in Neonatal Intensive Care Units

Although the role of imagination in moral reasoning is often neglected, recent literature, mostly of pragmatist signature, points to imagination as one of its central elements. In this article we develop some of their arguments by looking at the moral role of imagination in practice, in particular the practice of neonatal intensive care. Drawing on empirical research, we analyze a decision-making process in various stages: delivery, staff meeting, and reflection afterwards. We show how imagination aids medical practitioners demarcating moral categories, tuning their actions, and exploring long-range consequences of decisions. We argue that imagination helps to bring about at least four kinds of integration in the moral decision-making process: personal integration by creating a moral self-image in moments of reflection; social integration by aiding the conciliation of the diverging perspectives of the people involved; temporal integration by facilitating the parties to transcend the present moment and connect past, present, and future; and epistemological integration by helping to combine the various forms of knowledge and experience needed to make moral decisions. Furthermore, we argue that the role of imagination in these moral decision-processes is limited in several significant ways. Rather than being a solution itself, it is merely an aid and cannot replace the decision itself. Finally, there are also limits to the practical relevance of this theoretical reflection. In the end, it is up to care professionals as reflective practitioners to re-imagine the practice of intensive care and make the right decisions with hope and imagination.

The Definition of Moral Dilemmas: A Logical Confusion and a Clarification

This discussion note deals with Jurriaan de Haan's paper The Definition of Moral Dilemmas: A Logical Problem (Ethical Theory and Moral Practice 4(3), 2001, pp. 267–284). In the first, critical part I will point out a confusion in the logical analysis of the paper in question. In the second, constructive part I will indicate how the analysis of moral dilemmas should proceed within the framework of a possible world semantics.     

道德困境之困境—— 情与理的辩争

道德判断是人类日常生活中必不可少的评价性活动之一, 但道德判断中情与理的作用争执不休。从休谟和康德的哲学论争到发展心理学家对道德推理的关注, 直至现代社会心理学家对情绪的重新审视, 道德判断的决策机制已经演变为多种模型相互竞争的局面。在回顾和分析道德判断各种理论的基础上, 阐述了情绪和推理在道德判断中的作用, 认为今后应当更多地关注道德推理的实际作用, 并当运用更为先进的操纵手段, 同时注重情境的影响来考察道德判断中情与理的问题。     

Tragic Dilemmas and the Priority of the Moral

My purpose in this paper is to argue that we are not vulnerableto inescapable wrongdoing occasioned by tragic dilemmas. I directmy argument to those who are most inclined to accept tragicdilemmas: those of broadly Nietzschean inclination who reject``modern moral philosophy' in favor of the ethical ideas of theclassical Greeks. Two important features of their project are todeny the usefulness of the ``moral/nonmoral distinction,' and todeny that what are usually classified as moral reasons always oreven characteristically ``trump' nonmoral reasons in anadmirable agent's deliberations.I show critics of modern moral philosophy such as BernardWilliams that their acceptance of tragic dilemmas underminestheir project of denying the moral/nonmoral distinction and thepriority of moral reasons. The possibility of tragic dilemmasrequires an account of practical deliberation in which moralreasons appear as already in-force obligations, with blame andguilt ready to be invoked, while nonmoral reasons appear as merereasons. This makes moral reasons importantly different fromnonmoral reasons in how they achieve their deliberative weight,and also makes them characteristically weightier. Thus,accommodating tragic dilemmas reinforces the moral/nonmoraldistinction and the priority of moral reasons, the very thingsthese critics want to deny. By accepting the possibility oftragic dilemmas, these critics are undermining their own project.The standard normative theories are dead set against tragicdilemmas, and the critics of modern moral philosophy shouldreject tragic dilemmas for the good of their project. Thus we allshould reject tragic dilemmas.     

Blended courage: Moral and psychological courage elements in mental health treatment seeking by active duty military personnel

We propose that seeking mental health care in an environment with heightened stigma may combine elements of both psychological and moral courage. Interviews of 32 active duty US Army personnel about their process of seeking current mental health care were analyzed for themes of voluntary action, personal risk, and noble or worthwhile goals (benefits). Risks and benefits were divided into internal risks and benefits, characteristic of psychological courage; and external risks and benefits, characteristic of moral courage. Concerns about external risks were themes in all narratives, while concerns about internal risks were themes in only about half of narratives. Both internal and external benefits of treatment were themes in approximately three-quarters of the narratives, whereas doubts about internal (but not external) benefits were also expressed at a similar rate. Thus, participants described an act of blended courage, with social risks of moral courage taken for wellness goals of psychological courage.     

安宁疗护实践中伦理困境的探讨

在对临终患者的照护中,医务人员常会面对较多的伦理困惑。对安宁疗护实践的四个方面及其存在的伦理困境和对策进行了探讨,包括预立医疗照护计划、心肺复苏术的使用、营养支持治疗及尊严死。要减少伦理冲突的发生,除了政府需健全相关法律法规及推进预立医疗照护计划外,医务人员应具有伦理敏感性,能把安宁疗护实践中的伦理问题与患者和家属进行深入的讨论。医务人员应了解和尊重患者的需要、偏好和价值观,使患者和家属深入了解生命维持治疗的利弊,同时,鼓励家属多从对患者有益的角度做出医疗决策。