目的 探讨医院伦理氛围在伦理支持体系与急诊分诊护士道德勇气之间的中介作用,并为临床实践提供依据,以提升急诊分诊护士的伦理标准和决策能力。方法 于2023年10月—12月,通过便利抽样方法,在湖北省十堰市3所三级甲等综合医院中选取396名急诊分诊护士作为研究对象。基于社会支持理论,假设医院伦理氛围在伦理支持体系对急诊分诊护士道德勇气的影响中起中介作用。采用一般资料调查表、急诊分诊护士伦理支持体系感受调查问卷、医院伦理氛围量表及护士道德勇气量表进行数据收集,并使用结构方程模型进行数据分析和假设验证。结果 描述性分析显示,急诊分诊护士的伦理支持体系感受、医院伦理氛围及道德勇气的评分分别为（83.35±10.01）分、（100.64±13.49）分、（81.52±10.56）分。相关性分析表示,伦理支持体系得分与医院伦理氛围得分（r=0.833,P<0.01）及道德勇气得分（r=0.820,P<0.01）之间均呈强正相关,医院伦理氛围得分与道德勇气得分（r=0.887,P<0.01）也显示出强正相关性。结构方程模型分析表明,各项拟合指标优良,医院伦理氛围在伦理支持体系感受与道德勇气之间具有显著的中介作用,间接效应值为0.492,95%CI为0.489~0.685,相对效应值为51.52%。结论 医院伦理氛围显著地中介了伦理支持体系与急诊分诊护士道德勇气之间的关系,强调了医院伦理氛围在提升护理职业道德标准中的关键作用。
Objective To explore the mediating role of hospital ethical climate in the relationship between ethical support system and the moral courage of emergency triage nurses,and to provide practical insights for clinical practice to enhance the ethical standards and decision-making abilities of emergency triage nurses. Methods From October to December 2023,396 emergency triage nurses were selected from three tertiary hospitals in Shiyan City through convenience sampling. Based on the theory of social support,it was hypothesized that the hospital ethical climate mediated the impact of ethical support systems on the moral courage of emergency triage nurses. Data were collected using a general information questionnaire,Emergency Triage Nurses‘ Ethical Support System Perception Questionnaire,Hospital Ethical Climate Scale,and Moral Courage Scale for Nurses. Structural Equation Modeling（SEM） was utilized for data analysis and hypothesis testing. Results Descriptive analysis indicated that the scores for emergency triage nurses‘ perceptions of the ethical support system,hospital ethical climate,and moral courage were （83.35±10.01）,（100.64±13.49）,and （81.52±10.56）,respectively. Correlation analysis showed strong positive correlations between scores of the ethical support system and hospital ethical climate（r=0.833,P<0.01）,and moral courage（r=0.820,P<0.01）. The hospital ethical climate also had a strong positive correlation with moral courage scores（r=0.887,P<0.01）. SEM analysis indicated excellent fit indices,the hospital ethical climate significantly mediated the relationship between perceptions of the ethical support system and moral courage,with an indirect effect value of 0.492,95%CI of 0.489-0.685,and a relative effect of 51.52%. Conclusion The hospital ethical climate significantly mediates the relationship between ethical support system and the moral courage of emergency triage nurses,underscoring the critical role of the hospital ethical climate in enhancing professional ethical standards in nursing.
[1] 曹英华,江萍,付迪,等. 急诊科护士突发公共卫生事件心理弹性培训方案的构建与初步应用研究[J]. 军事护理,2024,41(1):56-60.
Cao YH,Jiang P,Fu D,et al.Construction and preliminary application of psychological resilience training program for emergency nurses in public health emergencies[J]. Mil Nurs,2024,41(1):56-60.
[2] 王田田,苏晴晴,张瑶瑶,等. 急诊科护士道德勇气现状及影响因素研究[J]. 中华急危重症护理杂志,2023,4(10):930-935.
Wang TT,Su QQ,Zhang YY,et al.Study on moral courage and its influencing factors of emergency nurses[J]. Chin J Emerg Crit Care Nurs,2023,4(10):930-935.
[3] 金静芬,陈玉国,朱华栋,等. 急诊预检分诊标准(成人部分)[J]. 中华急危重症护理杂志,2020,1(1):45-48.
Jin JF,Chen YG,Zhu HD,et al.Emergency Triage Scale(Adult part)[J]. Chin J Emerg Crit Care Nurs,2020,1(1):45-48.
[4] Bailoor K,Adams MA.Medical ethics in endoscopy[J]. Am J Gastroenterol,2020,115(2):158-159.
[5] De Bie FR,Flake AW,Feudtner C.Life support system for the fetonate and the ethics of speculation[J]. JAMA Pediatr,2023,177(6):557-558.
[6] Pajakoski E,Rannikko S,Leino-Kilpi H,et al.Moral courage in nursing:an integrative literature review[J]. Nurs Health Sci,2021,23(3):570-585.
[7] 王丝瑶,姜文彬,刘翠,等. 护士道德勇气及其影响因素研究[J]. 中华护理教育,2022,19(8):732-736.
Wang SY,Jiang WB,Liu C,et al.The current status and influence factors of nurses‘ moral courage[J]. Chin J Nurs Educ,2022,19(8):732-736.
[8] Rathert C,May DR,Chung HS.Nurse moral distress:a survey identifying predictors and potential interventions[J]. Int J Nurs Stud,2016,53:39-49.
[9] 王丝瑶,魏丽丽,张艳,等. 护士道德勇气量表的汉化及信效度检验[J]. 护理学杂志,2019,34(21):92-95.
Wang SY,Wei LL,Zhang Y,et al.The reliability and validity of the Chinese version Nurses‘ Moral Courage Scale[J]. J Nurs Sci,2019,34(21):92-95.
[10] 王璐. 医院伦理氛围量表的汉化及其应用研究[D]. 郑州:郑州大学,2018.
Wang L.Reliability and validity of Chinese version of the Hospital Ethical Climate Survey Assessment and the application in nurses[D]. Zhengzhou:Zhengzhou University,2018.
[11] Numminen O,Katajisto J,Leino-Kilpi H.Development and validation of Nurses‘ Moral Courage Scale[J]. Nurs Ethics,2019,26(7/8):2438-2455.
[12] 张海洪,赵伟立,丛亚丽. 世界医学会《国际医学伦理准则》2022年版修订述评[J]. 医学与哲学,2022,43(20):1-4.
Zhang HH,Zhao WL,Cong YL.Review of the 2022 revision of international code of medical ethics of world medical association[J]. Med Philos,2022,43(20):1-4.
[13] 王晶,董杰昌,程金莲. 医学伦理查房在构建和谐医患关系中的实践与思考[J]. 中国医学伦理学,2023,36(9):1041-1045.
Wang J,Dong JC,Cheng JL.Practice and thinking of medical ethics ward rounds in constructing a harmonious doctor-patient relationship[J]. Chin Med Ethics,2023,36(9):1041-1045.
[14] Traner CB,Tolchin DW,Tolchin B.Medical ethics education for neurology residents:where do we go from here?[J]. Semin Neurol,2018,38(5):497-504.
[15] 陈梅男,吴晓雯,胡怡然,等. 三级甲等综合性医院伦理审查体系建设的实践分析[J]. 中国社会医学杂志,2022,39(5):491-495.
Chen MN,Wu XW,Hu YR,et al.Practice and analysis on the construction of ethical review system in A-level public hospital[J]. Chin J Soc Med,2022,39(5):491-495.
[16] 谢卓君,龚学德. 我国医院伦理委员会组织结构中存在的问题及其对策研究[J]. 医学与社会,2021,34(11):125-129,134.
Xie ZJ,Gong XD.Research on the problems and its countermeasures in the organizational structure of hospital ethics committee in China[J]. Med Soc,2021,34(11):125-129,134.
[17] Kangasniemi M,Pakkanen P,Korhonen A.Professional ethics in nursing:an integrative review[J]. J Adv Nurs,2015,71(8):1744-1757.
[18] Hthelee LHH,Sadooghiasl A,Kermanshahi SM.Moral distress and moral courage among Iraqi nurses during the COVID-19 pandemic:a cross-sectional study[J]. J Med Ethics Hist Med,2023,16:19.
[19] Kälvemark S,Höglund AT,Hansson MG,et al.Living with conflicts-ethical dilemmas and moral distress in the health care system[J]. Soc Sci Med,2004,58(6):1075-1084.
[20] Liu YF,Zhang YP,Jin JF.The relationships of ethical climate,physician-nurse collaboration and psychological empowerment with critical care nurses‘ ethical conflict in China:a structural equation model[J]. J Nurs Manag,2022,30(7):2434-2441.
