📋 护理管理 · 第4课，共7课 · 6 min
考试会点名的六项伦理原则
Six Ethical Principles the Exam Names by Name
⚖️ 一位患者请你不要告诉家属他得了绝症。家属请你不要告诉患者。考试会问你正在遵循哪项原则，而答案有一个特定的名称。
⚖️ A client asks you not to tell the family about a terminal diagnosis. The family asks you not to tell the client. The exam will ask which principle you are honoring, and the answer has a specific name.
💡 核心要点
自主、有益、无害、公正、忠诚、诚实。当它们发生冲突时，应澄清价值观，告知患者，并支持他们的选择，而不是替他们做决定；只有当团队无法解决冲突时，才升级到伦理委员会。
Autonomy, beneficence, nonmaleficence, justice, fidelity, veracity. When they collide, clarify values, inform the client, and support their choice rather than deciding for them; escalate to the ethics committee only if the team cannot resolve the conflict.
🧠 为什么重要
自主（AUTONOMY）：患者做出自己决定的权利，即使是你不同意的决定也是如此。有益（BENEFICENCE）：采取行动使患者受益。无害（NONMALEFICENCE）：不造成伤害，包括不因疏忽而造成可避免的伤害。公正（JUSTICE）：在护理和资源的分配上做到公平。忠诚（FIDELITY）：信守承诺，忠于约定。诚实（VERACITY）：说真话。当原则之间发生冲突时，就会出现伦理困境，例如当患者拒绝一项有益的治疗时，自主与有益之间的冲突。护士的职责是澄清价值观，提供信息，支持患者知情后的选择，并在团队无法解决冲突时借助伦理委员会。在开头的情景中，当一位有行为能力的患者要求不要告诉家属时，自主和保密（HIPAA）起主导作用，护士不会与家属分享诊断。当家属要求不要告诉患者时，他们的要求与诚实以及患者的自主发生了冲突。护士不会对患者撒谎或欺骗患者，会探讨家属的担忧，并通知医疗服务提供者，以维护患者知情的权利。护士可以出于良心反对参与某些操作，但必须提前通知主管，以便安排另一位护士，而且绝不能抛弃患者。
AUTONOMY: the client's right to make their own decisions, even ones you disagree with. BENEFICENCE: acting to benefit the client. NONMALEFICENCE: doing no harm, including not causing avoidable harm through omission. JUSTICE: fairness in the distribution of care and resources. FIDELITY: keeping promises and being faithful to commitments. VERACITY: telling the truth. An ETHICAL DILEMMA arises when principles conflict, such as autonomy versus beneficence when a client refuses a beneficial treatment. The nurse's role is to clarify values, provide information, support the client's informed choice, and use the ethics committee when the team cannot resolve the conflict. In the hook's scenario, when a competent client asks that the family not be told, autonomy and confidentiality (HIPAA) govern, and the nurse does not share the diagnosis with the family. When the family asks that the client not be told, their request conflicts with veracity and the client's autonomy. The nurse does not lie to or deceive the client, explores the family's concerns, and notifies the provider so the client's right to know is honored. Nurses may conscientiously object to participating in certain procedures but must notify the supervisor in advance so another nurse can be assigned, and must not abandon the client.
🏥 真实场景
🚭 一位肺癌患者继续吸烟。护士的有益原则说要干预；患者的自主原则说这是他自己的选择。护士不带评判地提供戒烟信息，记录所做的宣教和患者的决定，并以同样的尊重继续护理他。尊重自主并不等于认同。
🚭 A client with lung cancer continues to smoke. The nurse's beneficence says intervene; the client's autonomy says it is his choice. The nurse provides cessation information without judgment, documents the teaching and the client's decision, and keeps caring for him with the same respect. Honoring autonomy is not the same as agreeing.
📌 要点总结
- 自主意味着患者知情后的选择有效Autonomy means the client's informed choice stands
- 忠诚是信守承诺；诚实是说真话Fidelity is keeping promises; veracity is telling the truth
- 先澄清价值观并告知患者；团队无法解决的困境交给伦理委员会；良心反对绝不意味着抛弃患者Clarify values and inform the client first; dilemmas the team cannot resolve go to the ethics committee; conscientious objection never means abandonment
✅ 自我测试
一位有行为能力且患有可治疗感染的患者出于宗教原因拒绝抗生素。哪项原则支持护士尊重这一拒绝？A competent client with a treatable infection refuses antibiotics for religious reasons. Which principle supports the nurse honoring the refusal?
- 公正Justice
- 自主Autonomy
- 无害Nonmaleficence
- 有益Beneficence
答案: B · 自主
自主是患者自我决定的权利，包括拒绝有益治疗的权利。有益会推动护士为了患者的好处而给予抗生素，而这正是拒绝所推翻的价值取向。
Autonomy is the client's right to self-determination, including refusing beneficial treatment. Beneficence would push the nurse to give the antibiotics for the client's good, which is exactly the value the refusal overrides.
一位护士答应患者10分钟后回来帮忙翻身，尽管很忙还是做到了。这是哪项原则？A nurse promises a client to return in 10 minutes to help with repositioning and does so despite being busy. Which principle is this?
- 诚实Veracity
- 公正Justice
- 自主Autonomy
- 忠诚Fidelity
答案: D · 忠诚
忠诚是对承诺和约定的忠实。诚实意味着说真话；这里的护士是在履行一个约定，而不是在披露信息。
Fidelity is faithfulness to promises and commitments. Veracity means telling the truth; the nurse here is keeping a commitment, not disclosing information.
一位护士出于道德原因反对协助一项合法操作。恰当的做法是什么？A nurse objects on moral grounds to assisting with a legal procedure. What is the appropriate action?
- 提前通知主管，以便重新分派护理工作Notify the supervisor in advance so care can be reassigned
- 默默参与，在下一次员工会议上提出担忧Participate silently and raise the concern at the next staff meeting
- 告诉患者这个操作在道德上是错误的，应该取消Tell the client the procedure is morally wrong and should be cancelled
- 拒绝并让患者在班次结束前无人护理Refuse and leave the client without care until the shift ends
答案: A · 提前通知主管，以便重新分派护理工作
允许良心反对，但不允许抛弃患者。护士提前通知主管，以便将护理工作重新分派给另一位护士。
Conscientious objection is allowed, but client abandonment is not. The nurse notifies the supervisor in advance so care can be reassigned to another nurse.
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