ﭼﺎﻟﺶ ﻫﺎي اﺧﻼﻗﯽ ﻣﺮاﻗﺒﺖ و درﻣﺎن ﺑﯿﻤﺎران ﮐﻮوﯾﺪ 19 در ﺑﯿﻤﺎرﺳﺘﺎن از ﻣﻨﻈﺮ اراﺋﻪ دﻫﻨﺪﮔﺎن ﺧﺪﻣﺖ

Ethical Challenges of Care and Treatment for Patients with COVID-19 in a Hospital from the Perspective of Service Providers

ﮔﺴﺘﺮش ﺳﺮﯾﻊ ﮐﻮوﯾﺪ 19، ﻧﺒﻮد درﻣﺎن اﺳﺘﺎﻧﺪارد، ﻣﺤﺪودﯾﺖ زﻣﺎﻧﯽ و ﮐﻤﺒــﻮد ﻣﻨــﺎﺑﻊ از ﭼﺎﻟﺶﻫﺎي ﺟﺪي در ﺳﺮاﺳﺮ دﻧﯿﺎﺳﺖ. ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﻫﻤﯿﺖ اﺧﻼق در اراﺋﻪي ﻣﺮاﻗﺒﺖ ﺑــﻪ ﺑﯿﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﺑﯿﻤﺎريﻫﺎي ﻧﻮﭘﺪﯾﺪ، اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺎ ﻫﺪف ﺗﺒﯿﯿﻦ ﭼﺎﻟﺶﻫﺎي اﺧﻼﻗﯽ در ﻣﺮاﻗﺒﺖ از ﺑﯿﻤﺎران ﮐﻮوﯾﺪ 19 و درﻣﺎن آﻧﺎن اﻧﺠﺎم ﺷﺪ. ﭘﮋوﻫﺶ ﺣﺎﺿﺮ ﺑﻪ روش ﺗﺤﻠﯿﻞ ﻣﺤﺘــﻮاي ﮐ ﯿﻔــﯽ در ﺳــﺎل 1399 اﻧﺠــﺎم ﺷــﺪ. ﻣﺸــﺎرﮐﺖ ﮐﻨﻨﺪﮔﺎن 22 ﻧﻔــﺮ از ﭘﺰﺷــﮑﺎن ﻣﺘﺨﺼﺺ ﻋﻔﻮﻧﯽ و ﭘﺮﺳﺘﺎران ﺑﺨﺶﻫﺎي ﻣﺮاﻗﺒﺖ ﺑﯿﻤﺎران ﮐﻮوﯾــ ﺪ 19 ﺑــﺎ ﺣــﺪاﻗﻞ ﭘــﻨﺞ ﺳﺎل ﺳﺎﺑﻘﻪي ﮐﺎر در ﺑﯿﻤﺎرﺳﺘﺎنﻫﺎي اﺳﺘﺎن ﻣﺎزﻧﺪران ﺑﻮدﻧﺪ. دادهﻫﺎ از ﻃﺮﯾﻖ ﻣﺼﺎﺣﺒﻪي ﻧﯿﻤﻪﺳﺎﺧﺘﺎرﯾﺎﻓﺘﻪي ﻣﺒﺘﻨﯽ ﺑﺮ ﻫــﺪف و روش ﮔﻠﻮﻟــﻪي ﺑﺮﻓــﯽ، ﭘــﺲ از ﮐﺴــﺐ رﺿــﺎﯾﺖ آﮔﺎﻫﺎﻧﻪ از ﺷــﺮﮐﺖ ﮐﻨﻨﺪﮔﺎن ﺟﻤــﻊآوري ﺷــﺪ و ﺗــﺎ اﺷــﺒﺎع دادهﻫــﺎ اداﻣــﻪ ﯾﺎﻓــﺖ. ﺗﺤﻠﯿﻞ دادهﻫــﺎي ﻣﻄﺎﻟﻌﻪ ﺑﺎ اﺳﺘﻔﺎده از روش ﮔــﺮاﻧﻬﯿﻢ ﻟﻮﻧــﺪﻣﻦ اﻧﺠــﺎم ﺷــﺪ. ﺑــﺮاي ﺻــﺤﺖ و اﺳﺘﺤﮑﺎم ﻣﻄﺎﻟﻌﻪ از ﻣﻌﯿﺎرﻫﺎي ﭘﯿﺸﻨﻬﺎدي ﮔﻮﺑﺎ و ﻟﯿﻨﮑﻠﻦ اﺳﺘﻔﺎده ﺷﺪ.از ﺗﺤﻠﯿﻞ ﺗﺠﺮﺑﯿﺎت ﻣﺸﺎرﮐﺖ ﮐﻨﻨﺪﮔﺎن، ﭼﻬﺎر درونﻣﺎﯾﻪي اﺻﻠﯽ و ﺳﯿﺰده درونﻣﺎﯾــﻪي ﻓﺮﻋــﯽ درﺧﺼــﻮص ﭼﺎﻟﺶ ﻫ ﺎي اﺧﻼ ﻗﯽ در ﻣﺮاﻗﺒﺖ از ﺑﯿﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﮐﻮو ﯾﺪ 19 اﺳﺘﺨﺮاج ﺷــ ﺪ. رﻋ ﺎﯾــﺖ ﺣﻘــﻮق ﺑﯿﻤﺎران ، اﻧﮓ و ﺗﺒﻌــ ﯿﺾ اﺟﺘﻤــﺎﻋ ﯽ ، وﻇ ﯿﻔــﻪ ي ﻣﺮاﻗﺒــﺖ از ﺑﯿﻤــﺎران و ﺣﻤ ﺎﯾــﺖ و ﭘﺎﺳــﺦ ﮔﻮ ﯾﯽ ﻣﺴﺌﻮﻻ ن از ﭼﺎﻟﺶ ﻫ ﺎي اﺻ ﻠﯽ اﺧﻼ ﻗﯽ در ﻣﺮاﻗﺒﺖ از ﺑﯿﻤﺎران در دوران ﮐﺮوﻧﺎ ﺑود . ﺑﺎ ﺗﻮﺟــﻪ ﺑــﻪ ﯾﺎﻓﺘﻪ ﻫ ﺎي ﻣﻄﺎﻟﻌﻪ، ﺣﻤ ﺎ ﯾﺖ از ﺣﻘﻮق ﺑ ﯿﻤﺎران و اراﺋــﻪ ي ﻣﺮاﻗﺒــﺖ ﺑــ ﺎ ﮐ ﯿﻔ ﯿــ ﺖ ﺧــﻮب از ﻃﺮ ﯾــ ﻖ ﺗﺼﻤ ﯿﻢ ﮔ ﯿﺮ ي آﮔﺎﻫﺎﻧﻪ و اﺧﻼ ﻗﯽ ﺑﺮاي اﻓﺰ ا ﯾﺶ رﺿــ ﺎ ﯾ ﺘﻤﻨﺪ ي ﺑ ﯿﻤــﺎران و ارﺗﻘــ ﺎء ﺳــﻼﻣﺖ آﻧــﺎن ، ﺑﻪ ﻋﻨﻮان راﻫﮑﺎرﻫﺎي رﻓﻊ ﭼﺎﻟﺶ ﻫﺎي اﺧﻼﻗﯽ، ﺗﻮﺻ ﯿﻪ ﻣﯽ ﺷﻮ د .

The rapid spread of COVID-19, lack of standard treatment, time constraints, and lack of resources are challenges around the world. Considering the importance of ethics in providing care to patients with emerging diseases, this study was conducted to explain the ethical challenges in care and treatment for patients with COVID-19. The present study was conducted by qualitative content analysis during 2019. Participants were 22 infectious disease physicians and nurses of COVID- 19 care wards with at least five years of experience in hospitals of Mazandaran province. Data were collected through semi-structured interviews based on the purpose and method of snowball after obtaining informed consent from participants and continued until data saturation. Data analysis was performed using Granheim Lundman method. Guba and Lincoln proposed criteria were used for the accuracy and robustness of the study. In the present study, five main themes and 18 sub-themes were extracted. Respect for patients' rights, maintaining patient independence, preventing the effects of stigma and discrimination against patients, lack of comprehensive support, and lack of support and accountability of the authorities were the main ethical challenges in caring for patients during the admission period. According to the findings of the study, solutions to address ethical challenges, protect patients' rights and provide quality care through informed and ethical decision-making to increase patient satisfaction and improve their health are recommended.