Hemşirelikte etik uygulama, bakım alan ve bakım veren arasındaki kişilerarası ilişkinin hassasiyeti nedeni ile oldukça önemlidir. Etik bakımı sağlayabilmek ve etik ikilemleri yönetebilmek için hemşireler vicdanlarına başvurmaktadır. Vicdani ret, hemşirelerin vicdan ile ilgili kişisel ve etik çatışmaları ele alma stratejisidir. Ancak vicdani reddin hemşirelik alanında nasıl yaşandığı sorusunun kesin bir yanıtı bulunmamaktadır. Vicdan, vicdan stresi ve vicdani ret kavramlarının incelenmesi; bu kavramların hemşirelik etiğinin uygulaması, araştırması ve eğitimi üzerine etkilerinin anlaşılmasını sağlayacaktır. Bu çalışmanın amacı, hemşirelikte vicdan, vicdan stresi ve vicdani ret kavramlarının irdelenmesi ve bakım etiğine yansımalarının değerlendirilmesidir. Yapılan araştırmalar sonucunda, vicdani ret ile ilgili hemşirelerin yeterince bilgi sahibi olmadığı, çevre ve kendi vicdanları arasında sıkışarak vicdani stres deneyimledikleri, vicdan çatışması sonucunda bireysel ve ahlaki inançları nedeni ile vicdani redde yöneldikleri anlaşılmaktadır. Ancak çalışmalarda vicdani reddin bakım sonuçlarına etkileri açıklanmamıştır. Ülkemizde hemşirelik bilimini ilerletmek adına bakımda vicdan stresi ve vicdani redde yönelik çalışmalara ihtiyaç duyulmaktadır. Ayrıca hemşirelikte tartışmalı bir konu olan vicdani reddin eğitim, araştırma, yönetim ve uygulama açısından taraflarla tartışılması ve ülkemiz hemşireleri için ilke birliği oluşturulması önerilebilir.
Anahtar Kelimeler: Hemşirelik bakımı; vicdan; vicdan stresi; vicdani ret
Ethical practice in nursing is very important because of the sensitivity of interpersonal relationships between care giver and care taken. Nurses use their conscience to provide ethical care and manage ethical dilemmas. Conscientious objection is the strategy of nurses to deal with personal and ethical conflicts about conscience. However, there is no definitive answer to the question of how conscientious objection is experienced in the field of nursing. The investigation of the conscience, conscience stress and conscientious objection concepts will help to understand the effects of these concepts on the practice, research and education of nursing ethics. The aim of this review is to evaluate the concepts of conscience, conscience stress and conscientious objection in nursing and to evaluate their reflections on care ethics. The studies revealed that the nurses concerned with conscientious objection did not have enough knowledge and experienced conscience stress in a squeeze between the environment and their own conscience, and as a result of the conflict of conscience, they are oriented towards conscientious objection because of their individual and moral beliefs. However, the effects of conscientious objection on care outcomes are not explained. In order to advance the nursing science in our country, studies on conscience and conscientious objection are needed in nursing care. In addition, it can be suggested to discuss the conscientious objection, which is a controversial issue in nursing, with the parties in terms of education, research, management and implementation and to establish a unity of principles for the nurses of our country.
Keywords: Nursing care; conscience; conscientious stress; conscientious objection
- Dinç L. [The concept of caring and its' moral component]. Hacettepe University Faculty of Health Sciences Nursing Journal. 2010;74-82.
- Sulmasy DP. What is conscience and why is respect for it so important? Theor Med Bioeth. 2008;29(3):135-49. [Crossref] [PubMed]
- Lamb C, Evans M, Babenko-Mould Y, Wong CA, Kirkwood KW. Conscience, conscientious objection, and nursing: a concept analysis. Nurs Ethics. 2019;26(1):37-49. [Crossref] [PubMed]
- Jensen A, Liddell E. The influence of conscience in nursing. Nurs Ethics. 2009;16(1): 31-42. [Crossref] [PubMed]
- Kaya A, Boz İ, The development of the Professional Values Model in nursing. Nurs Ethics. 2019;26(3):914-23. [Crossref] [PubMed]
- Yalım YN. [Conscientious objection as an expanding ethical issue in medical practice]. Turkish Journal of Bioethics. 2018;5(1):9-17. [Crossref]
- Pieper A. Etiğe Giriş. Sezer G, Atayman V, çeviri editörleri. 2. Baskı. İstanbul: Ayrıntı Yayınları; 2012.
- Erdem ve Mutluluk. In: Fromm E, ed. Yörükan A, çeviri editörü. 4. Baskı. İstanbul: Türkiye İş Bankası Kültür Yayınları; 1997. p.284.
- Fromm E. [The problems of humanist philosophy of morality]. Kendini Savunan İnsan. Arat N, çeviri editörü. 4. Baskı. İstanbul: Say Yayınları; 1998. p.142-58.
- Fromm E. [Problems of humanist morality]. Yörükan A, çeviri editörü. Erdem ve Mutluluk. 2. Baskı. İstanbul: Türkiye İş Bankası Kültür Yayınları; 1994. p.172-3.
- Kant I. Pratik Aklın Eleştirisi. Kuçuradi İ. Gökberk Ü, Akatlı F, çeviri editörleri. 2. Baskı. Ankara: Türkiye Felsefe Kurumu; 1994. p.108.
- Aral V. [Man and norm]. İstanbul Üniversitesi Hukuk Fakültesi Mecmuası. 2014;72(1):17-42.
- Jasemi M, Aazami S, Hemmati Maslak Pak M, Habibzadeh H, Zabihi RE. Factors affecting conscience-based nursing practices: a qualitative study. Nurs Ethics. 2018; doi: 10.1177/096973301.761173. [Crossref] [PubMed]
- Kadıoğlu FG, Öner Yalçın S. Nurses' and physicians' views of conscience in Turkey. Revista Romana De Bioetica. 2014;12(3):19-31.
- Davis S, Schrader V, Belcheir MJ. Influencers of ethical beliefs and the impact on moral distress and conscientious objection. Nurs Ethics. 2012;19(6):738-49. [Crossref] [PubMed]
- Fleming V, Frith L, Luyben A, Ramsayer B. Conscientious objection to participation in abortion by midwives and nurses: a systematic review of reasons. BMC Med Ethics. 2018;19(1):31. [Crossref] [PubMed] [PMC]
- Ford NJ, Austin W. Conflicts of conscience in the neonatal intensive care unit: perspectives of Alberta. Nurs Ethics. 2018;25(8):992-1003. [Crossref] [PubMed]
- Glasberg AL, Eriksson S, Dahlqvist V, Lindahl E, Strandberg G, Söderberg A, et al. Development and initial validation of the Stress of Conscience Questionnaire. Nurs Ethics. 2006;13(6):633-48. [Crossref] [PubMed]
- Juthberg C, Eriksson S, Norberg A, Sundin K. Stress of conscience and perceptions of conscience in relation to burnout among care-provides in older people. J Clin Nurs. 2007;17(14):1897-906. [Crossref] [PubMed]
- Carbone S, Rickwood D, Tanti C. Workforce shortages and their impact on Australian youth, mental health service reform. Adv Ment Health. 2011;10(1):92-7. [Crossref]
- Saarnio R, Sarvimäki A, Laukkala H, Isola A. Stress of conscience among staff caring for older persons in Finland. Nurs Ethics. 2012;19(1):104-15. [Crossref] [PubMed]
- Lamb C, Evans M, Babenko-Mould Y, Wong C, Kirkwood K. Nurses' use of conscientious objection and the implications for conscience. J Adv Nurs. 2019;75(3):594-602. [Crossref] [PubMed]
- Yang CF, Che HL, Hsieh HW, Wu SM. Concealing emotions: nurses' experiences with induced abortion care. J Clin Nurs. 2016;25(9-10):1444-54. [Crossref] [PubMed]
- Piers RD, Azoulay E, Ricou B, Dekeyser Ganz F, Decruyenaere J, Max A, et al; APPROPRICUS Study Group of the Ethics Section of the ESICM. Perceptions of appropriateness of care among European and Israeli intensive care unit nurses and physicians. JAMA. 2011;306(24):2694-703. [Crossref] [PubMed]
- Catlin A, Armigo C, Volat D, Vale E, Hadley MA, Gong W, et al. Conscientious objection: a potential neonatal nursing response to care orders that cause suffering at the end of life? Study of a concept. Neonatal Netw. 2008;27(2):101-8. [Crossref] [PubMed]
- Sørlie V, Jansson L, Norberg A. The meaning of being in ethically difficult care situations in pediatric care as narrated by female registered nurses. Scand J Caring Sci. 2003;17(3):285-92. [Crossref] [PubMed]
- Lamb C, Evans M, Babenko-Mould Y, Won CA, Kirkwood KW. Conscience, conscientious objection, and nursing: A concept analysis. Nurs Ethics. 2019; 26(1):37-49. [Crossref] [PubMed]
- Dickens BM. Legal protection and limits of conscientious objection: when conscientious objection is unethical. Med Law. 2009;28(2): 337-47. PMID: 19705646
- Orr RD. Autonomy, conscience, and professional obligation. Virtual Mentor. 2013;15(3): 244-8. [Crossref] [PubMed]
- Toro-Flores R, Bravo-Agüi P, Catalán-Gómez MV, González-Hernando M, Guijarro-Cenisergue MJ, Moreno-Vázquez M, et al. Opinions of nurses regarding conscientious objection. Nurs Ethics. 2019;26(4):1027-38. [Crossref] [PubMed]
- Lamb C, Babenko-Mould Y, Evans M, Wong CA, Kirkwood KW. Conscientious objection and nurses: results of an interpretive phenomenological study. Nurs Ethics. 2018. doi: 10.1177/0969733018763996. [Crossref] [PubMed]
- Dobrowolska B, McGonagle I, Pilewska-Kozak A, Kane R. Conscientious object in nursing: regulations and practice in two European countries. Nurs Ethics. 2019. doi: 10.1177/0969733019845136. [Crossref] [PubMed]
- Awoonor-Williams JK, Baffoe P, Ayivor PK, Fofie C, Desai S, Chavkin W. Prevalence of conscientious objection to legal abortion among clinicians in northern Ghana. Int J Gynaecol Obstet. 2018;140(1):31-6. [Crossref] [PubMed]
- Lewis-Newby M, Wicclair M, Pope T, Rushton C, Curlin F, Diekema D, et al; ATS Ethics and Conflict of Interest Committee. An official American Thoracic Society policy statement: managing conscientious objections in intensive care medicine. Am J Respir Crit Care Med. 2015;191(2):219-27. [Crossref] [PubMed]
- Shahriari M, Mohammad E, Fooladi MM, Abbaszadeh A, Bahrami M. Proposing codes of ethics for Iranian nurses a mixed methods study. Journal of Mixed Methods Research. 2016;10(4):352-66. [Crossref]
- Ancell A, Sinnott-Armstrong W. How to allow conscientious objection in medicine while protecting human rights. Camb Q Healthc Ethics. 2017;26(1):120-31. [Crossref] [PubMed]
- Schuklenk U, Smalling R. Why medical professionals have no moral claim to conscientious objection accommodation in liberal democracies. J Med Ethics. 2017;43(4):234-40. [Crossref] [PubMed]
- Türk Hemşireler Derneği. Hemşireler İçin Etik, İlke ve Sorumluluklar. Ankara: Türk Hemşireler Derneği Yayınları; 2009. p.9.
- Magelssen M. When should conscientious objection be accepted? J Med Ethics. 2012; 38(1):18-21. [Crossref] [PubMed]
- Australian Nursing & Midwifery Federation Policy-Conscientious objection. 2017. http://anmf.org.au/documents/policies/P_Conscientious_Objection.pdf.
.: İşlem Listesi