Cyprus University of Technology, Department of Nursing, Siakolas Centre for Health Studies, Nicosia, Cyprus.
Am J Crit Care. 2012 Mar;21(2):e41-52. doi: 10.4037/ajcc2012205.
Discretionary autonomy is a key factor in enhanced patient outcomes and nurses' work satisfaction. Among nurses, insufficient autonomy can result in moral distress.
To explore levels of autonomy among European critical care nurses and potential associations of autonomy with nurse-physician collaboration, moral distress, and nurses' characteristics.
Descriptive correlational study of a convenience sample of 255 delegates attending a major European critical care conference in 2009. Respondents completed a self-administered questionnaire with validated scales for nurses' autonomy, nurse-physician collaboration, and moral distress.
The mean autonomy score (84.26; SD, 11.7; range, 18-108) and the mean composite (frequency and intensity) moral distress score (73.67; SD, 39.19; range, 0-336) were both moderate. The mean collaboration score was 47.85 (SD, 11.63; range, 7-70). Italian and Greek nurses reported significantly lower nurse-physician collaboration than did other nurses (P < .001). Greek and German nurses reported significantly higher moral distress (P < .001). Autonomy scores were associated with nurse-physician collaboration scores (P < .001) and with a higher frequency of moral distress (P = .04). Associations were noted between autonomy and work satisfaction (P = .001). Frequency of moral distress was associated inversely with collaboration (ρ = -0.339; P < .001) and autonomy (ρ = -0.210; P = .01) and positively with intention to quit (ρ = 0.257; P = .004).
In this sample of European intensive care nurses, lower autonomy was associated with increased frequency and intensity of moral distress and lower levels of nurse-physician collaboration.
自主决策是提高患者治疗效果和护士工作满意度的关键因素。在护士群体中，自主权不足可能导致道德困境。
探讨欧洲重症监护病房护士的自主决策水平，以及自主决策与护士-医师合作、道德困境和护士特征之间的潜在关联。
对 2009 年参加欧洲重症监护会议的 255 名代表进行便利抽样的描述性相关性研究。调查对象填写了一份自我管理问卷，问卷采用了经过验证的护士自主决策、护士-医师合作和道德困境的量表。
平均自主决策评分（84.26；标准差，11.7；范围，18-108）和平均综合（频率和强度）道德困境评分（73.67；标准差，39.19；范围，0-336）均为中等水平。平均合作评分（47.85；标准差，11.63；范围，7-70）。意大利和希腊的护士报告的护士-医师合作显著低于其他国家的护士（P <.001）。希腊和德国的护士报告的道德困境明显更高（P <.001）。自主决策评分与护士-医师合作评分相关（P <.001），与道德困境的频率增加相关（P =.04）。自主决策评分与工作满意度呈正相关（P =.001）。道德困境的频率与合作呈负相关（ρ = -0.339；P <.001），与自主决策呈负相关（ρ = -0.210；P =.01），与离职意向呈正相关（ρ = 0.257；P =.004）。
在该样本的欧洲重症监护病房护士中，较低的自主决策水平与道德困境的频率和强度增加以及护士-医师合作水平降低有关。
