Abstract
Objective To explore the ethical dilemmas encountered and coping experiences of nursing staff during the continuity of care for patients undergoing multiple biliary surgeries, in order to provide references for enhancing nurses' ethical decision-making capacity and optimizing continuity of care services. Methods A purposive sampling method was used to select 15 nursing staff from the Biliary Surgery Department of a tertiary hospital in Shanghai as research subjects. Semi-structured in-depth interviews were conducted, and thematic analysis was employed to analyze the data. Results Three themes were extracted: ethical challenges (conflict between patient autonomy and best interests, dilemma between information disclosure and hope maintenance, resource constraints and care equity, balance between professional boundaries and emotional involvement); coping experiences (moral distress and emotional exhaustion, professional commitment and responsibility persistence, fluctuation of self-efficacy); and coping strategies (strengthening communication and coordination skills, seeking professional and social support, enhancing ethical literacy and decision-making capacity, personal reflection and emotional adjustment). Conclusion Nursing staff encountered multiple ethical dilemmas in the continuity of care for patients undergoing multiple biliary surgeries, and there is an urgent need to enhance their coping strategies, strengthen physician-patient communication and shared decision-making, promote multidisciplinary teamwork and ethical support, improve their own ethical decision-making and professional competence, and refine the service model of continuity of care. (目的 探索护理人员在多次胆道手术患者延续性护理工作过程中遇到的伦理困境和应对体验, 以期为提升护理人员的伦理决策能力和优化延续性护理服务提供参考。方法 采用目的抽样法选取上海市某三甲医院胆道外科15名护理人员为研究对象, 进行半结构式深度访谈, 运用主题分析法分析资料。结果 共提取出3个主题: 伦理挑战(患者自主与最佳利益的冲突, 信息披露与希望维系的困境, 资源限制与照护公平性, 专业界限与情感投入的平衡); 应对体验(道德困扰与情感耗竭, 职业承诺与责任坚守, 自我效能感的波动); 应对方法(强化沟通与协调能力, 寻求专业与社会支持, 提升伦理素养与决策能力, 个人反思与情绪调适)。结论 护理人员在多次胆道手术患者延续性护理中遇到了多重伦理困境, 亟待提升护理人员的应对策略; 加强医患沟通与共享决策, 促进多学科团队协作与伦理支持, 提升自身伦理决策与专业素养, 完善延续性护理的服务模式。)