Zeng Jing, Guo Sheng-Bin, Zheng Qing-Xiang, Liu Xiu-Wu, Lin Hui-Ming, Hu An-Fen, Yang Yan, Wei Bi-Rong
Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou City, Fujian Province, China.
Fujian Obstetrics and Gynecology Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou City, Fujian Province, China.
BMC Nurs. 2023 Apr 12;22(1):116. doi: 10.1186/s12912-023-01282-0.
Clinical decision-making is considered an essential behaviour in clinical practice. However, no research has been done to examine the associations among midwives' clinical decision-making, work environment and psychological empowerment. Thus, this study aimed to determine the influence of work environment on midwives' clinical decision-making and confirm the mediating role of psychological empowerment.
This study was designed as a multicentre cross-sectional study, and included 602 registered midwives from 25 public hospitals in China. A sociodemographic questionnaire, Work Environment Scale, Psychological Empowerment Scale and Clinical decision-making Scale were applied. A structural equation model was conducted to estimate the hypothesis model of the clinical decision-making among midwives and explore the potential mediating mechanism of midwives' clinical decision-making. This model was employed maximum likelihood estimation method and bootstrapping to examine the statistical significance.
The mean score of clinical decision-making among midwives was 143.03 ± 14.22, at an intermediate level. The data of this hypothesis model fitted well, and the results showed that work environment positively affected psychological empowerment, which in turn positively affected clinical decision-making; psychological empowerment partly mediated the relationship between work environment and clinical decision-making among midwives.
Midwives' clinical decision-making could be promoted directly or indirectly by providing a healthy work environment and improving psychological empowerment. It is essential for hospital managers to pay attention to the assessment of the midwives' work environment and actively improve it, such as establishing a supportive, fair and just workplace, and maintaining effective communication with midwives. Furthermore, managers can also promote midwives' clinical decision-making behaviour by enhancing their psychological empowerment via enhancing job autonomy.
临床决策被认为是临床实践中的一项基本行为。然而，尚未有研究探讨助产士的临床决策、工作环境和心理授权之间的关联。因此，本研究旨在确定工作环境对助产士临床决策的影响，并确认心理授权的中介作用。
本研究设计为多中心横断面研究，纳入了来自中国25家公立医院的602名注册助产士。应用了社会人口学问卷、工作环境量表、心理授权量表和临床决策量表。采用结构方程模型来估计助产士临床决策的假设模型，并探索助产士临床决策的潜在中介机制。该模型采用最大似然估计法和自抽样法来检验统计显著性。
助产士临床决策的平均得分为143.03±14.22，处于中等水平。该假设模型的数据拟合良好，结果表明工作环境对心理授权有正向影响，心理授权又对临床决策有正向影响；心理授权在工作环境与助产士临床决策之间起到部分中介作用。
通过提供健康的工作环境和提高心理授权，可以直接或间接地促进助产士的临床决策。医院管理者必须重视对助产士工作环境的评估并积极加以改善，例如建立一个支持性、公平公正的工作场所，并与助产士保持有效的沟通。此外，管理者还可以通过增强工作自主性来提高助产士的心理授权，从而促进其临床决策行为。
