随着医院变得越来越复杂,他们所面对的伦理问题也相应地变得复杂起来。因此,许多医院都制定了医疗保健道德计划(HCEP),其中不仅包括道德咨询服务。然而,缺乏对这些项目的系统研究。
基于一个国家,对600家美国医院的分层样本进行横断面调查,我们报告了患病率,范围,活动,人员配备,工作量,经济补偿,以及HCEP面临的最大挑战。
在372家医院中,线人回应了一项在线调查,97%的医院有HCEP。他们的范围包括几乎所有医院的临床伦理职能,但在更少的医院中包括其他职能:道德领导(35.7%),监管合规(29.0%),商业道德(26.2%),和研究伦理(12.6%)。HCEP负责向包括所有员工在内的各种目标受众提供持续的道德教育(77.0%),护士(59.9%),职员医生(49.0%),医院领导(44.2%),医疗居民(20.3%)和社区/公众(18.4%)。HCEP工作人员通常通过审查现有政策来参与政策工作,但很少参与新政策的制定。在80.5%的医院中,HCEP在行政领导中拥有道德代表,在其他医院委员会中有40.7%的代表,积极从事社区外展活动的占22.6%,并以17.7%的比例引领大规模道德质量改进举措。总的来说,主要教学医院和城市医院拥有最高度整合的道德计划,范围最广,活动数量最多。大型医院,学术附属医院,和城市医院有更多的个人从事HCEP工作,并且有更多的个人获得专门用于该工作的经济补偿。总的来说,HCEP面临的最常见的最大挑战是资源短缺,然而,对于床位少于100张的医院来说,利用不足是最常见的最大挑战。受访者应对挑战的策略包括员工培训和额外资金。
虽然这项研究由于其局限性必须谨慎解释,研究结果可能有助于了解美国医院HCEP的特征以及与这些特征相关的因素.这些信息可能有助于探索加强HCEP的方法。
As hospitals have grown more complex, the ethical concerns they confront have grown correspondingly complicated. Many hospitals have consequently developed health care ethics programs (HCEPs) that include far more than ethics consultation services alone. Yet systematic research on these programs is lacking.
Based on a national, cross-sectional survey of a stratified sample of 600 US hospitals, we report on the prevalence, scope, activities, staffing, workload, financial compensation, and greatest challenges facing HCEPs.
Among 372 hospitals whose informants responded to an online survey, 97% of hospitals have HCEPs. Their scope includes clinical ethics functions in virtually all hospitals, but includes other functions in far fewer hospitals: ethical leadership (35.7%), regulatory compliance (29.0%), business ethics (26.2%), and research ethics (12.6%). HCEPs are responsible for providing ongoing ethics education to various target audiences including all staff (77.0%), nurses (59.9%), staff physicians (49.0%), hospital leadership (44.2%), medical residents (20.3%) and the community/general public (18.4%). HCEPs staff are most commonly involved in policy work through review of existing policies but are less often involved in development of new policies. HCEPs have an ethics representative in executive leadership in 80.5% of hospitals, have representation on other hospital committees in 40.7%, are actively engaged in community outreach in 22.6%, and lead large-scale ethics quality improvement initiatives in 17.7%. In general, major teaching hospitals and urban hospitals have the most highly integrated ethics programs with the broadest scope and greatest number of activities. Larger hospitals, academically affiliated hospitals, and urban hospitals have significantly more individuals performing HCEP work and significantly more individuals receiving financial compensation specifically for that work. Overall, the most common greatest challenge facing HCEPs is resource shortages, whereas underutilization is the most common greatest challenge for hospitals with fewer than 100 beds. Respondents\' strategies for managing challenges include staff training and additional funds.
While this study must be cautiously interpreted due to its limitations, the findings may be useful for understanding the characteristics of HCEPs in US hospitals and the factors associated with these characteristics. This information may contribute to exploring ways to strengthen HCEPs.