School of Nursing, Fujian University of Traditional Chinese Medicine, Fujian, China.
Department of Nursing, The Third People's Hospital of Fujian Province, Fujian, China.
Int Nurs Rev. 2023 Dec;70(4):518-526. doi: 10.1111/inr.12871. Epub 2023 Aug 16.
The purpose of this study was to explore whether clinical ethical climate mediates the relationship between resilience and moral courage in a population of clinical nurses during COVID-19, and if moral distress faced by nurses is a moderating factor.
Resilience can help nurses maintain their personal health during COVID-19 when they face great physical and psychological shock and are prone to health problems. Moral courage, as an ethical competency, helps nursing staff in adhering to the principles and values of professional ethics. There is a strong correlation between resilience and moral courage, but the mechanism by which resilience contributes to moral courage is unclear.
A cross-sectional study research is designed. Three hundred thirty clinical nurses from six hospitals in Beijing, Sichuan, and Fujian of China were included between August 2021 and March 2022. The survey instruments include the Nurses' Moral Courage Scale (NMCS), Connor-Davidson Resilience Scale (CD-RISC), Moral Distress Scale-Revised (MDS-R), and Hospital Ethical Climate Scale (HECS).
Ethical climate mediates 15% of the relationship between resilience and moral courage. The association between resilience and ethical climate, as well as the indirect relationship between resilience and moral courage, was modified by moral distress.
This study investigated the mechanisms by which resilience affects moral courage in clinical nurses in the context of COVID-19, suggesting that moral courage can be increased by alleviating moral distress and increasing ethical climate.
This study confirms the mediating effect of moral climate on the relationship between resilience and moral courage, as well as the moderating effect of moral distress. Hospital policymakers should value nurses' psychological resilience and moral courage, develop effective policies to prevent and manage stressors, build social support systems, and create a positive ethical climate.
本研究旨在探讨在 COVID-19 期间，临床护士群体的韧性是否通过临床伦理氛围来调节韧性与道德勇气之间的关系，以及护士所面临的道德困境是否是一个调节因素。
在 COVID-19 期间，护士面临巨大的身心冲击，容易出现健康问题，韧性可以帮助护士保持个人健康。道德勇气作为一种伦理能力，有助于护理人员坚持职业道德的原则和价值观。韧性与道德勇气之间存在很强的相关性，但韧性对道德勇气的贡献机制尚不清楚。
采用横断面研究设计。2021 年 8 月至 2022 年 3 月，共纳入来自中国北京、四川和福建的 6 家医院的 330 名临床护士。调查工具包括护士道德勇气量表（NMCS）、Connor-Davidson 韧性量表（CD-RISC）、修订版道德困境量表（MDS-R）和医院伦理氛围量表（HECS）。
伦理氛围对韧性和道德勇气之间 15%的关系起中介作用。韧性与伦理氛围之间的关系以及韧性与道德勇气之间的间接关系都受到道德困境的调节。
本研究调查了在 COVID-19 背景下韧性对临床护士道德勇气的影响机制，表明通过减轻道德困境和增加伦理氛围可以提高道德勇气。
对护理和卫生政策的启示：本研究证实了道德氛围对韧性和道德勇气之间关系的中介作用，以及道德困境的调节作用。医院政策制定者应重视护士的心理韧性和道德勇气，制定有效的政策来预防和管理压力源，建立社会支持系统，并营造积极的伦理氛围。
