Seo Mi Hwa, Kim Eun A, Kim Hae Ran
Department of Nursing, Chonnam National University Hwasun Hospital, Gwangju, Republic of Korea.
Department of Nursing, Honam University, Gwangju, Republic of Korea.
PLoS One. 2025 Jan 3;20(1):e0316654. doi: 10.1371/journal.pone.0316654. eCollection 2025.
Person-centered care focuses on individualized care that respects patients' values, preferences, and autonomy. To enhance the quality of critical care nursing, institutions need to identify the factors influencing ICU nurses' ability to provide person-centered care. This study explored the relationship between clinical judgment ability and person-centered care among intensive care unit (ICU) nurses, emphasizing how the ICU nursing work environment moderates this relation.
A cross-sectional survey was conducted between September 4 and September 18, 2023, with 192 ICU nurses recruited from four general hospitals with a convenience sample (valid response rate = 97.4%). Participants completed online self-report structured questionnaires. The collected data were analyzed using hierarchical multiple regression and PROCESS macro Model 1, with a 95% bias-corrected bootstrap confidence interval to verify moderating effects.
Clinical judgment ability (β = .24, p < .001) and ICU nursing work environment (β = .50 p < .001) were found to be significant predictors of person-centered care. These two predictors explained the 47.0% of person-centered care in the final hierarchical regression model. Additionally, Clinical judgment (B = 0.28, p < .001, Boot. 95%CI = 0.130.42) and the ICU nursing work environment (B = 0.41, p < .001, Boot. 95%CI = 0.300.52) positively affected person-centered care, and the interaction term of clinical judgment and ICU nursing work environment (B = 0.16, p = .026, Boot. 95%CI = 0.02~0.30) also positively affected person-centered care. The moderating effect was particularly significant when the ICU nursing work environment score was 2.90 points (below 14.6%, above 85.4%) or higher on a scale of 1-5 and As the ICU nursing work environment score increased, the positive moderating effect also increased.
The ICU nurses' clinical judgment ability positively affected person-centered care, and the nursing work environment moderated the relationship between clinical judgment ability and person-centered care. Therefore, strategies for enhancing person-centered care among ICU nurses should focus on developing educational programs to improve clinical judgment ability and implementing comprehensive efforts to effectively improve and manage the nursing work environment.
以患者为中心的护理注重个性化护理，尊重患者的价值观、偏好和自主权。为提高重症护理质量，医疗机构需要确定影响重症监护病房（ICU）护士提供以患者为中心护理能力的因素。本研究探讨了重症监护病房护士的临床判断能力与以患者为中心的护理之间的关系，重点关注ICU护理工作环境如何调节这种关系。
于2023年9月4日至9月18日进行了一项横断面调查，从四家综合医院招募了192名ICU护士，采用便利抽样（有效回复率 = 97.4%）。参与者完成了在线自我报告结构化问卷。使用分层多元回归和PROCESS宏模型1对收集的数据进行分析，采用95%偏差校正的自助置信区间来验证调节效应。
发现临床判断能力（β = 0.24，p < 0.001）和ICU护理工作环境（β = 0.50，p < 0.001）是以人为本护理的重要预测因素。在最终的分层回归模型中，这两个预测因素解释了47.0%的以患者为中心的护理。此外，临床判断（B = 0.28，p < 0.001，Boot. 95%CI = 0.130.42）和ICU护理工作环境（B = 0.41，p < 0.001，Boot. 95%CI = 0.300.52）对以患者为中心的护理有积极影响，临床判断与ICU护理工作环境的交互项（B = 0.16，p = 0.026，Boot. 95%CI = 0.02~0.30）也对以患者为中心的护理有积极影响。当ICU护理工作环境得分在1-5分的量表上为2.90分（低于14.6%，高于85.4%）或更高时，调节效应尤为显著，并且随着ICU护理工作环境得分的增加，正向调节效应也增加。
ICU护士的临床判断能力对以患者为中心的护理有积极影响，护理工作环境调节了临床判断能力与以患者为中心的护理之间的关系。因此，提高ICU护士以患者为中心护理的策略应侧重于制定教育计划以提高临床判断能力，并实施全面努力以有效改善和管理护理工作环境。
