Abstract
This study focuses on the conditions relating to the four ethical principles ("Be Autonomous," "Be Harmless," "Do Beneficent" and "Be Just") out of the free-writing comments in the questionnaire on medical practices in home care services, which was made about the visit nurses of 300 randomly sampled institutions across the nation, and aims to clarify ethical issues visit nurses confront in respect to medical practice at home care scenes. 314 free-writing remarks were obtained from 228 persons. The free descriptions were compared with the four ethical principles and those that related to the principles were extraced and classified. As a result, nine types of problematic situations were extracted. They are "Situations where medical treatment is given based on the doctor's intention rather than a patient's request or will," "Situations where medical treatment is given based on the family's intention rather than a patient's request or will," "Situations where a visit nurse cannot help taking an action at her own discretion upon changes of a patient's disease conditions," "Situations where a doctor's direction is considered necessary or not the best, but a visit nurse cannot help obeying it without discussion with the doctor about it," "Situations where a visit nurse feels difficulty in grasping a patient's disease conditions due to lack of information," "Situations where a visit nurse cannot help leaving observation and post-treatment to a patient's family," "Situations where a visit nurse feels the family's care is not appropriate to a patient, but it is difficult to intervene in the matter," "Situations where shortage of facilities behind the line threatens the quality and continuity of care" and "Situations where a the best medical treatment cannot be offered due to the limited supply of medicenes and medical care products." The principles of "Be Harmless" and "Do Beneficent" are concerned to every problematic situation. Also, there were the situations that relate to the principles of "Be Autonomous" and "Be Just." The above-mentioned results suggest the need for close information exchange and consultation between doctors and visit nurses for home care medicine, the responsibility of nurses to protect patients' rights and the need to change the awareness of not only patients but also doctors and nurses to realize patient-first medicine.
