临床护士道德困境的潜在剖面分析及其与道德敏感性的关系研究

Relationship between moral distress and moral sensitivity in clinical nurses:a latent profile analysis

目的调查临床护士道德困境现况,分析临床护士道德困境的潜在剖面及其与道德敏感性的关系并探讨不同剖面的影响因素。方法采取便利抽样法于2022年5月选取武汉市某三级甲等综合医院1022名临床护士作为调查对象。采用一般资料调查表、护士道德敏感性量表、护士道德困境量表进行调查,以护士道德困境量表的4个外显指标进行潜在剖面分析,并用单因素分析、二分类Logistic回归分析进行统计分析。结果1022名临床护士的道德困境可分为“低道德困境型”(72.7%)和“高道德困境型”(27.3%)2个潜在剖面。道德困境的影响因素包括年龄、职称、道德力量与责任、道德负担感(P<0.05)。结论临床护士道德困境水平处于轻度水平。护士道德困境可分为2个类别,护理管理者应根据不同剖面的人群特征制定针对性的干预方案,增强护士道德敏感性,降低其道德困境水平。针对“高道德困境型”护士,既要注意培养护士道德决策能力,也要充分营造良好的医院伦理氛围,合理授权,疏导其因道德困境产生的不良情绪;针对“低道德困境型”护士,要强化护士职业道德伦理再教育,提升护理道德修养,规范临床实践中的道德行为,从而改善护理质量。

Objective To investigate the current status of clinical nurses’moral distress,to analyze the latent profile of moral distress and its relationship with moral sensitivity,and to explore the influencing factors of different profiles.Methods A total of 1,022 clinical nurses from a tertiary grade-A hospital in Wuhan were selected by convenience sampling method in May 2022,and they were investigated by using the general information questionnaire,Nurses’Moral Sensitivity Scale and Nurses’Moral Distress Scale.Four explicit indicators of nurses’moral distress scale were used for latent profile analysis,and univariate analysis and binary logistic regression analysis were used for statistical analysis.Results The moral distress of 1,022 clinical nurses could be divided into"low moral distress type"(72.7%)and"high moral distress type"(27.3%).The influencing factors of moral distress included age,professional title,moral power and responsibility,and moral burden(P<0.05).Conclusion Clinical nurses have slight moral distress,which could be divided into two latent profiles.Specific interventions should be formulated according to the characteristics of different latent profiles to enhance nurses’moral sensitivity and reduce their moral distress.The cultivation of moral decision-making ability of nurses,a good moral and ethical atmosphere,reasonable authorization,and easing emotions caused by moral distress are helpful for nurses of"high moral distress type";for"low moral distress type"nurses,it is necessary to strengthen the professional ethics education of nurses,improve nursing moral cultivation,standardize moral behavior in clinical practice,so as to improve the quality of nursing.