Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Via Tesserete 48, 6900 Lugano, Switzerland.
Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Via Gallino, 12, 6500 Bellinzona, Switzerland.
Int J Environ Res Public Health. 2021 Nov 16;18(22):12012. doi: 10.3390/ijerph182212012.
During the Covid-19 pandemic, nurses experienced increased pressure. Consequently, ethical concerns and psychological distress emerged. This study aimed to assess nurses' ethical conflict, resilience and psychological impact, and compare these variables between nurses who worked in Covid-19 wards and nurses who did not.
Design-Multicentre online survey. Setting-Multi-site public hospital; all nursing staff were invited to participate. The survey included validated tools and a novel instrument to assess ethical conflict. Spearman's rho coefficient was used to assess correlations between ethical conflict and psychological distress, logistic regressions to evaluate relationships between nurses' characteristics and outcome variables, and the Mann-Whitney/t-test to compare groups.
548 questionnaires out of 2039 were returned (275 = Covid-19; 273 = non-Covid-19). We found a low-moderate level of ethical conflict (median = 111.5 [76-152]), which emerged mostly for seeing patients dying alone. A moderate and significant positive correlation emerged between ethical conflict and psychological distress (546) = 0.453, < 0.001. Nurses working in Covid-19-ICUs (OR = 7.18; 95%CI = 3.96-13.01; < 0.001) and Covid-19 wards (OR = 5.85; 95%CI = 3.56-9.6; < 0.001) showed higher ethical conflict. Resilience was a protective factor for ethical conflict.
Ethical conflict was significantly linked to psychological distress, while a higher level of resilience was found to be a protective factor. These results can be informative for nursing management in future similar crises.
在新冠疫情期间，护士面临着更大的压力，随之而来的是伦理问题和心理困扰。本研究旨在评估护士的伦理冲突、韧性和心理影响，并比较在新冠病房工作和不在新冠病房工作的护士之间的这些变量。
设计-多中心在线调查。地点-多地点公立医院；邀请所有护理人员参与。该调查包括经过验证的工具和一种新的评估伦理冲突的工具。使用 Spearman rho 系数评估伦理冲突与心理困扰之间的相关性，使用逻辑回归评估护士特征与结果变量之间的关系，使用 Mann-Whitney/t 检验比较组间差异。
在 2039 份问卷中，有 548 份（275 份=新冠病房；273 份=非新冠病房）被回收。我们发现伦理冲突处于低中度水平（中位数=111.5 [76-152]），主要是因为看到患者独自死亡。伦理冲突与心理困扰之间存在中度显著正相关（546）=0.453， < 0.001）。在新冠 ICU 工作的护士（OR=7.18；95%CI=3.96-13.01； < 0.001）和新冠病房工作的护士（OR=5.85；95%CI=3.56-9.6； < 0.001）的伦理冲突更高。韧性是伦理冲突的保护因素。
伦理冲突与心理困扰显著相关，而较高的韧性水平被认为是一种保护因素。这些结果可为未来类似危机中的护理管理提供信息。
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