醫護學生與醫事人員對新興傳染病反應的同理心和道德選擇比較

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题名:	醫護學生與醫事人員對新興傳染病反應的同理心和道德選擇比較 Comparison of Empathy and Moral Choice regarding emerging infectious disease response among Healthcare Students and Healthcare Professionals
作者:	張廷馥 CHANG, TING-FU
贡献者:	全球衛生暨發展碩士學位學程蔡奉真
关键词:	新興傳染疾病;同理心;道德選擇;醫學教育 Emerging Infectious Disease（EID）;Empathy;Moral Choice;Medical Education
日期:	2023-06-12
上传时间:	2023-12-07 09:42:04 (UTC+8)
摘要:	研究背景 COVID-19 等新出現的傳染病因其高傳播性和致病性而威脅著全球健康。醫療機構的資源有限，常常使醫療保健提供者陷入倫理和道德困境。本研究旨在了解醫事人員 (HCPs) 和醫護學生 (HSs) 如何看待同理心和道德選擇之間的差異，以及它們如何應用於醫療保健環境。研究設計這項橫斷面研究於2020年06月至2021年04月期間招募了382名參與者（169名醫事人員和213名醫護學生）。自我評估的線上問卷除人口統計學外，還包括三個部分：非道德倫理困境（NMD）、非個人道德倫理困境（IMD），以及個人道德倫理困境（PMD）。使用描述性統計和 t 檢定來比較醫事人員跟醫護學生的社會角色、就業和統計相關訓練經驗。 T 檢定用於比較醫事人員和醫護學生之間的道德困境選擇結果及個人感受疼痛或中性強度的結果。對於道德困境情境的問題，t檢定檢驗後P值<0.05的特殊問題，進一步使用卡方檢驗進行二次檢驗。此外，根據作為結果“高”和“低”分界點的平均分來劃分組。在控制混雜因素後，使用邏輯回歸分析來探討作為道德選擇的自變量與參與者作為 HS 和 HCP 的身份之間的關聯。研究結果大多數參與者是未婚 (82%) 女性 (66%)，年齡在 20 至 24 歲之間 (58%)。大多數醫事人員來自急診室和重症監護病房 (60%) 工作的護理師 (91%)，擁有 5-10 年經驗 (28%)。他們的平均年收入在新台幣40萬至100萬之間（83%）。大多數參與者每週工作時間小於等於 40 小時 (87%)，每週工作時間等於及超過 5 天 (93%)，每晚睡眠時間等於大於 7 小時 (67%)。大多數人（92%）曾接受過大規模備災和大規模疫情中傳染病預防的培訓，並經歷過2003年SARS（59%）和2009年H1N1流感（92%）的疫情；但仍有大多數人(85%)沒經歷過 1998 年腸道病毒 71 (EV71) 大流行。在道德困境情境中，回答問題後的總分沒有統計學意義；儘管如此，對於某些特定問題而言，它具有統計顯著性（p 值 0.05）。醫護學生和醫事人員之間三個非道德倫理問題的得分存在顯著差異：包括：“收成蘿蔔”（89% [HCP] vs 97% [HSs]）、“交通工具”（95%[HCP] vs 99% [HSs]） ]）和“參與調查”（72%[HCP] vs 87%[HS]）。醫護學生和醫事人員之間的兩個非個人道德倫理問題的得分存在顯著差異，包括：“毒氣”（76% [HCP] vs 55% [HSs]）和“疫苗政策”（78% [HCP] vs 87% [HSs]））。醫護學生和醫事人員之間的三個個人道德倫理問題的得分存在顯著差異，包括：“在 X 傳染病期間請假”（70% [HCP] vs 80% [HS]）、“Ｘ傳染病專責醫院”（70% vs 79） % [HSs]），以及“封院決定”（70% [HCP] vs 57% [HSs]）。疼痛或中性強度的感知部分分析了三個不同的問題。 (a) 感受對他人的疼痛或中性，與醫事人員（M = 23，SD = 13.158）相比，醫護學生（M = 21.96，SD = 11.17）在感受他人疼痛方面具有更高的強度。 (b) 感受對自我的疼痛或中性，在“自我的疼痛”中，與醫事人員（M = 27.01，SD = 12.295）相比，醫護學生（M = 25.32，SD = 10.062）在感受自我的疼痛情況下的強度更高；然而，在感受自我的中性方面，醫護學生和醫事人員之間沒有顯著差異。 (c) 疼痛同理心，對於他人的感知強度，與醫事人員（M = 19.05，SD = 8.935）相比，醫護學生（M = 16.46，SD = 8.51）具有更高的強度；然而，在感知自我的強度上，並沒有顯著差異。透過六種模型的檢驗，並通過二元回歸發現了不同因素之間的三種潛在相關性：疼痛同理心以及醫護學生和醫事人員的道德決策。首先，在比較非道德倫理困境（NMD）和非個人倫理困境（IMD）部分時，20 歲至 24 歲之間的人更有可能做出功利主義決策。醫護學生對感受他人疼痛強度得分較低（得分：17）及對感受自我他疼痛的得分也較低（得分：17），而男性則不太可能做出功利主義的選擇。在個人道德倫理困境（PMD）中，對於感受疼痛或中性強度的情境下，20-24 歲的參與者（醫護學生）更有可能做出功利主義決定。大多數參與者對他人的感知強度得分低（得分：17）及對自己的感知強度得分低（得分：16），尤其是男性更為顯著，更有可能做出功利主義的決定。研究結論根據研究結果，我們建議擴展目前的醫護學生(HSs)的醫學課程，以解決公共衛生困境中的道德培訓。由於醫護學生沒有臨床經驗來做出道德判斷，這些道德困境的訓練可能要考慮引入更多現實生活場景，讓醫護學生以更實際的方式考慮問題。此外，讓一線醫護人員獲得心理諮詢也至關重要，因為這可以改善他們的心理健康，不僅在創傷恢復期間，而且在日常生活中。與面臨緊迫或一般性問題相比，醫護人員，尤其是男性，在面臨不明確且對自己及其家人不利的選擇時，更有可能表現出更強烈的功利主義。今後醫療機構應提倡設立專業心理諮詢機構，當一線醫護人員就醫時，將其視為病人，與外部醫療諮詢單位合作或提供專業心理諮詢。諮商人員及其單位有保密的責任，不得向醫院相關主管部門提供患者病情。 Background Emerging infectious diseases, like COVID-19, threaten global health due to their high transmissibility and pathogenicity. Limited resources in healthcare facilities often place healthcare providers in ethical and moral dilemmas. This study aims to understand how Healthcare Professionals (HCPs) and Healthcare Students (HSs) perceive differences between empathy and moral choice and how they apply in healthcare settings. Study Design This cross-sectional study recruited 382 participants (169 HCPs and 213 HSs) from June 2020 to April 2021. The online self-reported questionnaire, aside from Demographic information, includes three sections: non-moral dilemma (NMD), impersonal (IMD), and personal moral dilemmas (PMD). Descriptive statistics and t-tests were used to compare the HS’s and HCP’s social roles, employment, and training statistics. T-tests were used for comparing the results of the Moral Dilemma and Perception of Pain or Neutral Intensity between HSs and HCPs. For the questions on Moral Dilemma situations, special questions with a P-value < 0.05 after t-test examination were further examined using a chi-square test. Further, groups were separated according to the mean score as the cut-off point for “High” and “Low” from the results. Logistic regression analysis was used to explore associations between independent variables as moral choices and participants’ identity as HSs and HCPs after controlling for confounders. Results The majority of the participants were unmarried (82%) female (66%) with ages between 20 and 24 (58%) . The majority of HCPs were Nurses (91%) worked in the emergency room and intensive care units (60%) with 5-10 years’ experience (28%). Their average annual income were between $400,000 and $1 million NTD (83%). The majority of participants worked < 40 hours/week (87%), worked more than 5 days/week (93%) and had sleep more and than 7 hours/night (67%). Most of them were ever trained in large-scale disaster preparedness and infectious disease prevention in large-scale outbreaks (92%) and experienced the SARS 2003 (59%) and H1N1 2009 (92%) outbreaks; but they didn’t * experience the 1998 Enterovirus 71 (EV71) pandemic (85%). In the Moral Dilemma Situation, the total score after answering the questions was not statistically significant; nevertheless, it was statistically significant for some specific questions (p-value 0.05). The scores of three NMD questions were significantly different between HSs and HCPs: including: “Turnip Harvesting” (89% [HCPs] vs 97% [HSs]), “Train or Bus” (95%[HCPs] vs 99% [HSs]), and “Survey” (72%[HCPs] vs 87%[HSs]). The scores of two IMD questions were significantly different between HSs and HCPs, including: “Toxic Fumes” (76% [HCPs] vs 55% [HSs]) and “Vaccine Policy” (78% [HCPs] vs 87% [HSs]). The scores of three PMD questions were significantly different between HSs and HCPs, including: “Asking for leave during X infectious disease” (70% [HCPs] vs 80% [HSs]), “Hospital for infectious disease” (70% vs 79% [HSs]), and “Decision to close hospital” (70% [HCPs] vs 57% [HSs]). The Perception of Pain or Neutral Intensity section analyzed three different questions. (a) Perception Pain or Neutral to others, compared to HCPs (M = 23, SD = 13.158), HSs (M = 21.96, SD = 11.17) had the higher intensity in regard to pain. (b) Perception Pain or Neutral with Ourselves, in the Pain with Ourselves, compared to HCPs (M = 27.01, SD = 12.295), HSs (M = 25.32, SD = 10.062) had the higher intensity in the situation of pain; however, in the neutral, there was no significant difference between HSs and HCPs. (c) Pain Empathy, for the Perception intensity to Others, compared to HCPs (M = 19.05, SD = 8.935), HSs (M = 16.46, SD = 8.51) had the higher intensity; however, in the Perception intensity with Ourselves were no significant difference. Six models were examined and three potential correlations between different factors were found via binary regression: pain empathy, and moral decision-making by HCPs and HSs. First, when comparing the NMD and the IMD sections, utilitarian decisions were more likely to be made by those between the ages of 20 and 24. HSs, had low scores (score: 17) for perception intensity for others and low scores (score: 16) for perception intensity for themselves, while Males were less likely to do so. In the PMD’s Perception of Pain or Neutral Intensity, participants ages 20-24 were more likely to make utilitarian decisions, healthcare students(HSs). Participants with low scores (scores: 17) for the intensity of their perception of others and low scores (scores: 16) for the intensity of their perception of themselves, especially Male participants. Conclusions From the study result, we recommend to expend the current medical curriculum for HSs to address ethical trainings in public health dilemmas. Since HSs do not have clinical experiences to make moral judgement, those ethical trainings might consider to bring more real-life scenarios for HSs to consider the issue in a more practical way. Additionally, it's critical to allow front-line HCPs to access psychological counseling, as it may improve their mental health - not just during the recovery from trauma, but also on a daily basis. HCPs, especially males, were more likely to display stronger utilitarianism when presented with unclear options that would be bad for themselves and their families than when faced with a pressing or general problem. Medical facilities, in the fu03ture, should promote and set up professional psychological consultations for medical consultations with front-line HCPs and treat them as patients, work with external medical consultation units, or provide professional psychological consulting. Consultants should not provide patient information or medical staff accountability to relevant departments of the hospital.
描述:	碩士指導教授:蔡奉真委員:吳君黎委員:蔡奉真委員:陳澂毅
数据类型:	thesis
显示于类别:	[全球衛生暨發展碩士學位學程] 博碩士論文

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