ICU护士死亡态度在道德困境与安宁疗护核心能力间的中介效应

Mediating role of death attitude on moral distress and core competence in hospice care among ICU nurses

目的调查ICU护士道德困境与安宁疗护核心能力现状,探讨死亡态度在两者间的中介效应。方法选取4所三甲医院的429名ICU护士为研究对象,采用一般资料调查问卷、中文版护士道德困境量表、中文版死亡态度描绘量表(修订版)及安宁疗护护士核心能力问卷进行调查。结果ICU护士道德困境、负向死亡态度、正向死亡态度与安宁疗护核心能力评分分别为(78.19±32.84)分、(40.21±9.02)分、(66.07±9.89)分、(70.21±20.88)分;道德困境与负向死亡态度呈正相关(r=0.500,P<0.05),与正向死亡态度呈负相关(r=-0.496,P<0.05),与安宁疗护核心能力呈负相关(r=-0.690,P<0.05);死亡态度在道德困境与安宁疗护核心能力间有部分中介作用(β=-0.332,P<0.05),中介效应占总效应的42.78%。结论护理管理者需提高对ICU护士道德困境的关注,采取多样举措普及安宁疗护理念及死亡继续教育,着力改善道德环境,促使护理人员树立科学的死亡态度,提升安宁疗护服务能力。

Objective To investigate the moral distress and core competence in hospice care of ICU nurses,and to explore the mediating role of death attitude in their relationship.Methods A total of 429 ICU nurses from 4 Grade A tertiary hospitals were selected,then they were investigated by utilizing a general information questionnaire,the Chinese version of the Moral Distress Scale(MDS),the Death Attitude Profile-Revised(DAP-R)and the Core Competence Questionnaire for Hospice Nurses.Results The participants′score of moral distress,negative death attitude,positive death attitude,and core competency in hospice care were(78.19±32.84)points、(40.21±9.02)points、(66.07±9.89)points、(70.21±20.88)points.ICU nurses′moral distress was positively correlated with negative death attitude(r=0.500,P<0.05),negatively correlated with positive death attitude(r=-0.496,P<0.05)and core competence in hospice care(r=-0.690,P<0.05).Death attitude was a partial mediator between moral distress and core competence in hospice care(β=-0.332,P<0.05),the mediating effect accounted for 42.78%of the total effect.Conclusion Nursing managers should pay more attention to moral distress of ICU nurses,take various measures to popularize the concept of hospice care and death continuing education,improve the moral environment,promote nurses to establish a scientific death attitude,so as to improve their competence in hospice care.