Characteristics of moral distress from nurses’perspectives:An integrative review

Objective:This integrative review aimed to identify the common characteristics of moral distress in nursing and distinguish it from other types of distress by examining nurses’perspectives in the literature.These insights will help update existing tools and create new ones to capture moral distress better,guiding the development and implementation of strategies to support nurses in addressing this challenge.Methods:Whittemore and Knafl’s integrative review method was employed to guide a systematic search for literature in three databases(EBSCO Medline,CINAHL,and PubMed).Additionally,two journals,Bioethics and Nursing Ethics,were manually searched to reduce search bias.The included studies were primary resources published in English between 2018 and 2023,utilizing quantitative,qualitative,or mixed methods to examine moral distress’s characteristics,components,and definitions.All of identified studies were screened,extracted,and analyzed independently by two researchers.Results:Nineteen studies were included.The results were grouped into five themes shaping the main characteristics of moral distress:1)experiencing a moral situation,with five ethically conflicted situations identified,including treatment plans,professional and personal moral values,team dynamics,complex contexts,clinical practices,and patient-centered care;2)making a moral judgment,where nurses experience moral distress when they cannot act consistently with their values,ethical principles,and moral duties;3)the presence of constraints,categorized at three levels:individual factors related to the nurse,patient,and patient’s family;team factors related to the team or unit involved;and system factors,including institutional and policy elements;4)moral wrongdoing,which occurs when nurses are unable to perform the right moral action;and 5)moral suffering,with studies showing that moral distress impacts physical,emotional,and psychological well-being.Conclusion:The findings enhance the understanding of moral distress characteristics among nursing staff,highlighting the concept of the crescendo effect,which underscores the cumulative and escalating nature of unresolved moral distress,emphasizing the need to address moral conflicts proactively to prevent the erosion of moral integrity and professional satisfaction.

The concept and characteristics of clinical practice ability in Master Degree of Nursing (specialty)

The concepts of ability, practice ability, and professional practice ability were analyzed using a theoretical research method. Based on the results of the analysis, the concept of clinical practice ability for Master Degree of Nursing（specialty） students was de？ned, and the characteristics were interpreted to provide references for future in-depth studies.

Mediating effect of work engagement between job characteristics and nursing performance among general hospital nurses

Objective:This study aimed to determine the effects of job characteristics and work engagement on the nursing performance of nurses working in general hospitals.Methods:Data were collected from 169 nurses who are working in a general hospital in South Korea by using a cross-sectional descriptive survey design.Results:Nurses’job characteristics and work engagement showed positive effects on nursing performance.This effect was magnified when work engagement was used as a mediating variable.Conclusions:The findings elucidate the factors influencing job performance and provide managers with important information for developing programs to improve the job skills and work engagement of nurses.

Application of "Internet+" question-based teaching mode in theteaching of characteristic nursing of Dai medicine

Objective: To explore the application effect of "Internet+" combined with question teaching method in the teachingof characteristic nursing of Dai medicine. Methods:In this paper, 103 students majoring in medical science in ourschool were selected as the research objects, and the teaching mode of "Internet+" combined with questions wasimplemented. After the course, the theory and skills of the students were assessed, and the evaluation of theteaching mode was conducted by questionnaire survey. Results: "Internet+" combined with question-basedteaching mode can improve the initiative and enthusiasm of students in learning and enhance their awareness andunderstanding of the characteristic nursing of Dai medicine. 93.2% of the students are satisfied with this teachingmethod. Conclusion:The characteristic nursing of Dai medicine belongs to one of the four traditional nationalmedicine in China. This teaching method can lay a foundation for inheriting the traditional culture and cultivatinghigh-level applied nursing talents of national medicine in the future. It is worth popularizing and applying innursing teaching.

Job characteristics and staying engaged in work of nurses: Empirical evidence from Malaysia

Objective: The purpose of this study is to examine the relationship between job characteristics (job autonomy,job feedback,skill variety,task identity,task significance) and work engagement of nurses in Malaysia.Methods: A survey using self-administered questionnaires was used to collect data from a sample of 856 staff nurses working in eight public hospitals in Malaysia.A shortened nine-item version of the Utrecht Work Engagement Scale(UWES-9) was used to measure work engagement.The UWES-9 comprises three dimensions,which was measured with three items each: vigor,dedication,and absorption.Job characteristics (job autonomy,job feedback,skill variety,task identity,task significance) were measured with the corresponding subscales of the Job Diagnostic Survey.Each subscale consisted of three items.Hypotheses were tested using hierarchical regression analysis.Results: Findings indicated that all the five demographic variables (age,marital status,education,organizational tenure,job tenure) were unrelated to work engagement.The results further revealed that job autonomy (β=0.19,P < 0.01),job feedback (β=0.10,P < 0.01),task identity (β=0.13,P < 0.01),and task significance (β=0.08,P< 0.05) were positively related to work engagement.Skill variety (β=0.03,P> 0.05),however,did not affect work engagement.Conclusion: Job autonomy,job feedback,task identity,and task significance are important factors in predicting work engagement.The findings of this study highlighted the need to incorporate these core dimensions in nursing management to foster work engagement.

Consensus of the Characteristics of Clinical Judgement Utilised by Nurses’ in Their Practice: Results of a Survey

Clinical judgement is an important component of safe and effective nursing care. Clinical judgement remains a challenging cognitive process to articulate and assess. An integrative review of the literature conducted in 2016 identified 13 characteristics of clinical judgement. This paper reports the results of a 2-phase survey to obtain consensus whether these characteristics identified accurately represented nurses’ perception of clinical judgement. The 2-phase survey was administered via an online survey software tool. The survey in phase 1 sought Yes/No answers for nurse academics with recruitment via a hyperlink in an email to individuals identified from University websites, Google and published articles. In phase 2, the survey was modified to a Likert scale and recruitment occurred via online networks and was open to all nurses. The results identified that the characteristics accurately represented the nurse’s perception of clinical judgement. By articulating the characteristics, it allows clinical judgement to be easily described and can therefore be applied to both nursing research and education.

Psychosocial Characteristics of Fathers Who Have Abused Their Children as Seen by Public Health Nurses

This study aims to identify details of the psychosocial characteristics of fathers who have abused children as they appear to public health nurses (PHNs). In this study a qualitative descriptive design was applied to the data analysis. Interviewees were 10 public health nurses (PHNs), in charge of maternal and child health services for 5 or more years at public health centers. The study analyzed 13 cases reported in the PHNs interviews. The characteristics of the fathers who had abused children as seen by the PHNs were the psycho-social characteristics of ‘weak suppression and control of impulsiveness’, ‘cognitive dissonance in the fatherhood role’, ‘poor social sensitivity’, ‘unbalanced relationship with other members of the family’ and ‘weak relationships with people around the father’. The father’s impulsiveness and cognitive dissonances in the fatherhood role are associated with weaknesses in the family relationships and social adaptation. Conversely, the weakness in the strength of family relationships and social adaptation affects the father’s ability to control impulsiveness and give rise to the cognitive dissonance in the fatherhood role. These in turn interact to create a negative downward spiral, a steadily worsening situation. The findings of this study suggest the necessity for PHNs to focus on the background to the cognitive dissonance in the fatherhood role and to work to educate and guide the fathers.

Public health nurse observations of behavioral characteristics of fathers who contribute to the emotional instability of mothers, as presented in cases of infant abuse

The objective of this study is to look at the understanding and perceptions of public health nurses (PHNs) related to behavioral characteristics of fathers that contribute to emotional instability in mothers by reviewing abuse cases involving infants and very young children. A qualitative descriptive design was applied to the data analysis, based on a semi-structured interview administered to three experienced PHNs who had been in charge of maternal and child health services for at least five years at a public health department or health center;with the data obtained in the interview narratives analyzed. In the observations of the experienced PHNs, the behavioral characteristics of fathers who are instigators of child abuse can be classified into five categories, fathers who are: “Talking to others about marital problems without attempting to solve these by themselves”, “Working on learning about childcare seeking to correct childcare methods”, “Taking the initiative in childcare at cross purposes with mothers”, “Stressing the effort they (the fathers) put into childcare”, and “Failing to notice the own family situation and problems”. The findings of the study suggest the necessity for PHNs to understand fathers, to be aware of the difficulty of building a supportive relationship with fathers, and to improve skills enabling the PHNs to help fathers form good relationships with other family members.

The Importance of Mentoring in Nursing Academia

Mentoring in academia promotes the retention of students and future faculty. Presently, it is general knowledge that we have a shortage of nurses in our profession. However, we also have a shortage of experientially qualified educators and mentors. In general, the problem is there is a lack of mentors in healthcare as a whole that have the ability or willingness to mentor future generations of faculty. Mentors are needed to pass on knowledge and promote retention of students and faculty in academia. The example we present to the students in healthcare professions will also impact the retention of healthcare faculty as a whole. It is logical to think that if we retain our students in academia, we also retain future experientially qualified faculty in academia. How we mentor one another as a novice and seasoned faculty can impact what students see and learn as well from us. A literature review of 46 articles was completed and 19 of the articles were used as references in this article, along with a few more relevant references. The articles from the literature review showed evidence of positive mentoring experiences lead to the retention of students, future mentees, and mentors in nursing academia.

Evaluation of clinical competence and its related factors among ICU nurses in Kermanshah-Iran: A cross-sectional study

Objectives:The present study was conducted to evaluate the clinical competence and its related demographic factors among critical care nurses in Kermanshah,Iran.Methods:In this cross-sectional study,155 Iranian nurses were selected by stratified random sampling.The data collection tools included a personal information form and the"Nurse Competence Scale".Data were analyzed using descriptive and analytical statistics.Results:The mean score of nurses'clinical competence was equal to 76.14±1.59 out of 100,which was at a"very good level".The mean score of using clinical competence in practice was equal to 70.38±15.25 out of 100,which was at a"good level".Among the subscales of clinical competence,the highest mean score was related to"managing situation".The mean score of"using clinical competence in practice"was related to the subscale of"therapeutic interventions".There was no statistically significant difference among the score of clinical competence of nurses varying with different gender,age,academic degree,and work experience.Conclusions:The clinical competence of critical care nurses in Kermanshah was at a"very good"level,and the use of clinical competence in practice was at a"good level."Given the importance of clinical competencies in practice,nurses'clinical competence should be evaluated objectively and positive measures should be taken to promote the application of their clinical competence.

围绝经期女性心理特点及心理护理干预进展

围绝经期为女性生命周期中的重要转折时期,该时期女性普遍伴随着情绪不稳定、焦虑、抑郁、易怒/烦躁等心理波动。对出现上述症状女性群体,若不及时进行心理干预,可导致人际关系紧张、心理健康问题加剧,严重影响其生活质量。故研究围绝经期女性心理特点不仅有利于临床观察及识别特殊时期女性的心理健康问题,还有利于后续制定有效心理护理干预策略。本文概述了围绝经期女性的心理特点,并综述了相应的心理护理干预方法,旨在为临床实践中的干预措施提供理论支持与实践参考。

中医特色护理在痛风性关节炎中的应用研讨

目的针对痛风性关节炎(GA)患者在常规护理基础上联合中医特色护理,观察其对患者日常生活活动能力、生活质量的影响。方法收集2021年7月至2023年1月我院GA患者(n=60)进行前瞻性研究,采用随机数字表法将患者分为两组。对照组采用常规护理,内容包括生活起居、饮食、运动、心理、疼痛指导、穴位贴敷,观察组在此基础上联合耳部全息铜砭刮痧。比较两组护理前后Barthel评分、关节肿胀与疼痛程度(VAS量表),采用问卷调查患者满意度并进行比较。结果护理前组间Barthel、关节肿胀及疼痛评分比较结果为P>0.05;经过不同方案的护理之后,观察组Barthel评分高于对照组与护理前,关节肿胀、疼痛评分低于对照组与护理前,差异显著(P<0.05);观察组护理满意度为93.33%与对照组的73.33%比较,差异明显(P<0.05)。结论中医特色护理有利于改善GA患者临床症状,减轻关节肿胀及疼痛程度,提高患者日常生活活动能力,患者满意度高。

康复训练结合中医特色护理在缺血性脑卒中后肩手综合征患者中的应用效果

目的探讨康复训练结合中医特色护理在缺血性脑卒中后肩手综合征患者中的应用效果。方法回顾性选择2022年3月至2023年3月华中科技大学同济医学院附属同济医院收治的90例缺血性脑卒中后肩手综合征患者资料进行分析。根据护理方法的不同分为对照组与观察组,每组45例。其中对照组采用常规护理,观察组实施康复训练结合中医特色护理。比较2组患者的日常生活能力、上肢运动功能、手肿胀程度、手功能、疼痛程度及有效率。结果护理7 d及护理1个月后,观察组的改良Barthel指数、简氏Fugl-Meyer评定量表(FMA)上肢功能评分、简单手功能检查(STEF)得分均明显高于对照组,肿胀程度均轻于对照组(P均<0.05),且2组均优于护理前(P均<0.05)。护理1个月后,观察组屈曲、外展、外旋及内旋的疼痛视觉模拟量表(VAS)评分均低于对照组(P均<0.05),且2组均较护理前降低(P均<0.05)。观察组的总有效率高于对照组(P<0.05)。结论康复训练结合中医特色护理应用于缺血性脑卒中后肩手综合征患者的临床护理中,能够有效改善患者的上肢运动功能、手功能,减轻手肿胀程度和疼痛,提高其日常生活能力及有效率。

耳穴压豆结合情志护理在剖宫产术后加速康复外科的应用

目的分析耳穴压豆结合情志护理在剖宫产术后加速康复外科(ERAS)的应用效果。方法随机将2022年4月—2023年8月在江西省妇幼保健院行剖宫产术的110例产妇分为两组,各55例。对照组实施常规护理干预;干预组在常规护理基础上给予ERAS护理,并结合开展中医特色护理,包括耳穴压豆、情志护理。比较两组产妇心理状况、产后下床时间、住院时间、产后并发症、护理满意度。结果两组干预后焦虑自评量表(SAS)、抑郁自评量表(SDS)评分降低,且干预组低于对照组(P<0.05);干预组产后下床时间、住院时间较对照组短(P<0.05);干预组产后并发症发生率为3.64%(2/55),低于对照组的14.55%(8/55)(P<0.05);干预组护理满意度为98.18%(54/55),高于对照组的85.45%(47/55)(P<0.05)。结论耳穴压豆结合情志护理在剖宫产术后ERAS的应用可改善产妇负性情绪,使产妇尽快下床,降低并发症发生率,促进术后康复进程,缩短住院时间,且利于临床护理满意度的提升。

社区嵌入式中医药特色医养结合服务绩效评价指标体系构建研究

背景面对日益严峻的人口老龄化趋势和非传染性慢性病的威胁,我国积极引导和促进社区嵌入式中医药特色医养结合的发展,然而已有文献中鲜见关于该领域绩效评价的研究,构建一套科学、有效的社区嵌入式中医药特色医养结合服务绩效评价指标体系,具有重要的理论意义和实践价值。目的构建社区嵌入式中医药特色医养结合服务绩效评价指标体系,并确定各层次指标权重,为相关政策的制定及开展社区嵌入式中医药特色医养结合服务绩效评价提供借鉴和参考。方法于2022年9—10月,通过文献研究法,依据嵌入性理论和结构-过程-结果理论模型,建立社区嵌入式中医药特色医养结合“嵌入-绩效”二维理论框架;于2022年10—11月,根据“嵌入-绩效”二维理论框架,采用文献研究法、德尔菲法、实地调查法构建形成指标体系;于2022年12月,应用层次分析法确定各级指标权重系数并检验各级指标逻辑一致性。结果构建了包含嵌入性和嵌入绩效2个维度、6项一级指标、19项二级指标、45项三级指标的社区嵌入式中医药特色医养结合服务绩效评价体系;一级指标中权重最大的分别是A5(服务过程)和A6(服务结果),二级、三级指标中组合权重最大的分别是B17(服务产出)和B19(服务满意度)、C44(老年人满意度);判断矩阵均通过一致性检验,随机性一致性比值(CR)<0.1。结论所建立的社区嵌入式中医药特色医养结合“嵌入-绩效”二维理论框架具有较强的适用性和可行性,根据该理论框架构建的指标体系专家意见集中度较高,具有较强的科学性、合理性、系统性、层次性和应用价值,能够为政府部门制定相关政策提供借鉴和参考,是开展社区嵌入式中医药特色医养结合服务绩效评价的有效工具。

院前急救护士替代性创伤现状及其影响因素研究

目的了解院前急救护士替代性创伤现状,并分析其影响因素,为制订院前急救护士替代性创伤恢复方案提供参考。方法采用一般资料问卷、灾难救助者替代性创伤问卷、中文版Jefferson同理心量表、中文版护士道德困境量表、中国大五人格调查问卷简版及中文版医院磁性要素量表对长沙市197名院前急救护士进行调查。结果院前急救护士灾难救助者替代性创伤问卷总分为(89.79±22.06)分。多元线性回归分析结果显示,是否经历过患者死亡、工作时长、是否接受过创伤相关培训及同理心、道德困境、人格特征、工作环境是影响院前急救护士替代性创伤发生的因素(P<0.05)。结论院前急救护士替代性创伤发生率较高,患者死亡经历、工作时长、创伤相关培训及同理心、道德困境、人格特征、工作环境是影响院前急救护士替代性创伤发生的因素,管理者需针对其影响因素制订干预措施。

中医特色护理技术在桥本甲状腺炎延续护理中的应用

目的探讨中医特色护理技术在桥本甲状腺炎延续护理中的应用效果。方法选取2020年5月至2023年3月于河南中医药大学第一附属医院就诊的114例桥本甲状腺炎患者作为研究对象,按随机数表法分为研究组和常规组各57例。常规组患者给予常规延续护理,研究组患者在常规组的基础上采用中医特色护理技术护理,两组患者均连续干预2个月。比较两组患者干预前后的甲状腺激素水平[游离甲状腺激素(FT4)、促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)]、生活质量[诺丁汉健康调查表(NHP)]和负性情绪[抑郁自评量表(SDS)、焦虑自评量表(SAS)],同时比较两组患者对护理的满意度。结果干预后,研究组患者的FT4、FT3分别为(12.21±0.66)pmol/L、(3.97±0.36)pmol/L,明显高于常规组的(11.64±0.85)pmol/L、(3.62±0.31)pmol/L,TSH为(7.81±1.03)mIU/L,明显低于常规组的(9.36±1.22)mIU/L,差异均有统计学意义(P<0.05);干预后,研究组患者NHP量表中的睡眠、躯体活动、社会隔离、精力水平评分及总分分别为(27.51±5.29)分、(16.36±2.14)分、(10.25±2.14)分、(15.66±3.38)分、(69.78±7.64)分,明显低于常规组的(34.11±6.11)分、(21.28±2.86)分、(14.47±2.50)分、(19.74±3.44)分、(89.60±9.17)分,SAS、SDS评分分别为(38.15±3.17)分、(35.14±4.16)分,明显低于常规组的(43.67±4.23)分、(41.33±5.09)分,差异均有统计学意义(P<0.05);研究组患者的护理满意度为94.74%,明显高于常规组的82.46%,差异有统计学意义(P<0.05)。结论中医特色护理技术在桥本甲状腺炎延续护理中的应用可调节患者的甲状腺激素水平,减轻负性情绪,提升生活质量,从而提高患者对护理的满意度。

ICU护士隐性缺勤类别特征的潜在剖面分析

目的探讨ICU护士隐性缺勤的潜在类别特征,并分析其影响因素。方法采用便利抽样的方法,2023年5月选取浙江省4所三级甲等综合医院420名ICU护士作为研究对象,采用一般资料调查表、隐性缺勤量表和职业倦怠量表进行调查。运用R语言进行潜在剖面分析,并采用单因素分析、Logistic回归分析ICU护士隐性缺勤类别特征的影响因素。结果391名ICU护士完成调查,其隐性缺勤得分为(16.10±4.64)分,处于中等水平,分为4个潜在类别:分别命名为低工作受限-低工作精力型(n=51,13.04%)、高工作受限-中等工作精力型(n=96,24.55%)、低工作受限-高工作精力型(n=19,4.86%)、中等工作受限-中等工作精力型(n=225,57.55%),其影响因素包括平均月薪、职业倦怠中的情感衰竭与个人成就感维度(均P<0.05)。结论ICU护士隐性缺勤具有明显的分类特征。护理管理者可根据其影响因素对不同类别特征护士进行干预,以降低护士隐性缺勤水平,进而提高护理服务质量。

中医特色护理临床路径在骨质疏松性胸腰椎压缩骨折患者经皮穿刺椎体后凸成形术围手术期的临床应用

目的 探讨中医特色护理临床路径在骨质疏松性胸腰椎压缩骨折(OVCF)患者经皮穿刺椎体后凸成形术(PKP)围手术期的应用效果。方法 选取浙江中医药大学附属温州市中医院2020年6月至2021年12月收治的老年OVCF患者96例,采用随机数字表法分为两组,每组48例。对照组实施骨折术后常规护理,观察组在对照组基础上实施中医特色护理临床路径干预。比较两组视觉模拟评分法(VAS)、功能障碍指数(ODI)评分及并发症、护理满意度情况。结果 术后1周,两组VAS、ODI评分均低于入院时,且观察组低于对照组(P<0.05)。观察组并发症总发生率低于对照组,护理满意度高于对照组(P<0.05)。结论 中医特色护理临床路径用于OVCF患者PKP围手术期,可获得显著效果。

中医特色护理结合康复训练改善宫颈癌根治术后患者膀胱功能与生活质量的分析

目的 分析中医特色护理结合康复训练改善宫颈癌根治术后患者的膀胱功能及生活质量的影响。方法 择取我院在2020年8月至2021年8月期间收治的64例宫颈癌患者进行观察,以摸球法分为两组,所有患者均给予宫颈癌根治术治疗,对照组(n=32)给予康复训练,观察组(n=32)给予中医特色护理结合康复训练,对比两组护理效果。结果 观察组尿潴留率、再置管率低于对照组,自解小便率高于对照组,残余尿量少于对照组(P<0.05)。护理后,观察组患者自理能力、生活质量更高(P<0.05)。结论 将中医特色护理结合康复训练用于宫颈癌根治术术后,可有效改善患者膀胱功能,提升自理能力,其生活质量有所提升,适宜在临床进行推广。