道德困境对急诊科护士患者导向亲社会行为的影响与作用机制研究

Exploring the influence of moral distress on emergency nurses′patient-oriented prosocial behavior and its mechanism

目的探讨道德困境对急诊科护士患者导向亲社会行为的影响,以及内部动机和自我效能感在其中的作用,为急诊科护士心理健康研究提供理论参考.方法采用一般资料调查表、中文版护士道德困境量表、内部动机量表、自我效能感量表及患者导向亲社会行为量表对四川省4家公立医院的194名急诊科护士进行问卷调查,采用多元线性分层回归、简单斜率分析及Bootstrap检验进行分析.结果急诊科护士道德困境得分为(78.11±19.78)分,患者导向亲社会行为得分为(23.04±4.37)分,道德困境与内部动机、患者导向亲社会行为均呈负相关(r=-0.336,P<0.001;r=-0.209,P=0.003),内部动机与患者导向亲社会行为呈正相关(r=0.494,P<0.001).内部动机在道德困境与患者导向亲社会行为之间起完全中介效应,中介效应值为-0.152,占总效应的72.38%.护士自我效能感对中介效应的前半段路径存在调节效应(β=-0.116,P=0.003).结论急诊科护士道德困境处于中等水平,其患者导向的亲社会行为处于中等偏上水平.内部动机在道德困境与患者导向亲社会行为之间起完全中介作用,自我效能感在道德困境与患者导向亲社会行为之间起调节作用.

Objective To explore the effect of moral distress on emergency nurses′patient-oriented prosocial behavior,and the effect of intrinsic motivation and self-efficacy between them,so as to provide theoretical reference for the study of mental health of nurses in emergency department.Methods Totally 194 emergency department nurses from 4 public hospitals in Sichuan province were surveyed using a general data questionnaire,the Chinese version of moral dilemma scale,the intrinsic motivation scale,the self-efficacy scale and the patient-oriented prosocial behavior scale.Multiple linear hierarchical regression,simple slope analysis and Bootstrap test were used for analysis.Results The Chinese version moral dilemma score and patient-oriented prosocial behavior item score were 78.11±19.78 and 23.04±4.37 respectively.The Chinese version of moral dilemma was negatively correlated with internal motivation and patient-oriented prosocial behavior(r=-0.336,P<0.001;r=-0.209,P=0.003),while internal motivation was positively correlated with patient-oriented prosocial behavior(r=0.494,P<0.001).Internal motivation played a completely mediating role in the relationship between moral dilemma and patient-oriented prosocial behavior,and the mediating effect was-0.152,accounting for 72.38%of the total effect.Nurses′self-efficacy had an effect on the first half(β=-0.116,P=0.003).Conclusion The moral dilemma of nurses in the emergency department is in the middle level,and the patient-oriented prosocial behavior was above the middle level.Internal motivation plays a completely mediating role between moral dilemmas and prosocial behavior,while self-efficacy just plays a moderating role between them.