He Qingyun, Huang Chunmei, Feng Zhixian, Shen Huajuan
Department of Emergency Intensive Care Unit, Tongde Hospital of Zhejiang Province Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
Hospital-Acquired Infection Control Department, Tongde Hospital of Zhejiang Province Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
J Nurs Manag. 2025 Apr 3;2025:7756343. doi: 10.1155/jonm/7756343. eCollection 2025.
Ethical conflict in nursing is a common phenomenon in intensive care units (ICUs). Nurses' ethical sensitivity forms the basis for identifying ethical conflicts. Ethical decision-making abilities are closely related to ethical conflict. However, there are currently no reports on the pathways between ethical sensitivity, decision-making ability, and conflicts among ICU nurses. Based on the cognitive-behavioral theory, a structural equation model was developed to quantitatively analyze the relationships between ICU nurses' ethical sensitivity, decision-making ability, and conflicts. A cross-sectional survey was conducted involving ICU nurses from six general hospitals in China from May to July 2024, using the General Information Questionnaire, Ethical Conflict Nursing Questionnaire-Critical Care Version (ECNQ-CCV), Chinese Moral Sensitivity Questionnaire-Revised Version (MSQ-R-CV, including the dimensions of moral responsibility and strength and sense of moral burden), and Chinese version of judgment about nursing decision (JAND-CE). Descriptive analyses were conducted with SPSS 25.0, and a structural equation model (using Amos 26.0) was performed to identify path relationships between the variables. The constructed model demonstrated a strong overall fit, and there were significant correlations between ethical sensitivity, decision-making ability, and conflicts among Chinese ICU nurses ( < 0.05). The values of path coefficients showed that moral responsibility and strength have a positive association with JAND-CE ( = 0.263, < 0.05) and negative association with ECNQ-CCV ( = -0.246, < 0.05). Moreover, sense of moral burden has a negative association with JAND-CE ( = -0.353, < 0.05) and positive association with ECNQ-CCV ( = 0.232, < 0.05). Further, JAND-CE has a negative association with ECNQ-CCV ( = -0.183, < 0.05). This study conducted mediation analysis by examining the indirect path between moral responsibility and strength, sense of moral burden, and ECNQ-CCV via JAND-CE, whereby the beta coefficients of independent mediating and mediating-dependent variables were multiplied. The indirect path between moral responsibility and strength and ECNQ-CCV through JAND-CE was significant (i.e. indirect path (0.263 × (-0.183)) = -0.048, < 0.05, LL = -0.608, UL = -0.07), and the indirect path between sense of moral burden and ECNQ-CCV through JAND-CE was significant (indirect path ((-0.353) × (-0.183)) = 0.065, < 0.05, LL = 0.082, UL = 0.758) and did not contain a zero value between lower and upper boundaries. This study reveals the dual-path mechanism of moral responsibility and strength and sense of moral burden on ethical conflicts through structural equation modeling, emphasizing the mediating pivotal role of ethical decision-making ability. The research findings provide a theoretical basis for the refinement of moral capacity cultivation systems, while also warning of the potential negative impacts of moral burden. Nursing managers should dynamically evaluate ICU nurses' ethical sensitivity and decision-making abilities to provide a reference for implementing individualized ethical conflict intervention measures.
护理中的伦理冲突是重症监护病房（ICU）的常见现象。护士的伦理敏感性是识别伦理冲突的基础。伦理决策能力与伦理冲突密切相关。然而，目前尚无关于ICU护士伦理敏感性、决策能力与冲突之间路径的报道。基于认知行为理论，构建了结构方程模型，以定量分析ICU护士伦理敏感性、决策能力与冲突之间的关系。于2024年5月至7月对中国六家综合医院的ICU护士进行了横断面调查，使用了一般信息问卷、《重症护理伦理冲突问卷》（ECNQ - CCV）、《中文版道德敏感性问卷修订版》（MSQ - R - CV，包括道德责任维度、力量感和道德负担感）以及《中文版护理决策判断问卷》（JAND - CE）。使用SPSS 25.0进行描述性分析，并采用结构方程模型（使用Amos 26.0）来确定变量之间的路径关系。构建的模型整体拟合良好，中国ICU护士的伦理敏感性、决策能力与冲突之间存在显著相关性（P < 0.05）。路径系数值表明，道德责任和力量感与JAND - CE呈正相关（β = 0.263，P < 0.05），与ECNQ - CCV呈负相关（β = -0.246，P < 0.05）。此外，道德负担感与JAND - CE呈负相关（β = -0.353，P < 0.05），与ECNQ - CCV呈正相关（β = 0.232，P < 0.05）。此外，JAND - CE与ECNQ - CCV呈负相关（β = -0.183，P < 0.用JAND - CE检验道德责任和力量感、道德负担感与ECNQ - CCV之间的间接路径进行中介分析，即将自变量中介变量和中介依赖变量的β系数相乘。道德责任和力量感通过JAND - CE与ECNQ - CCV之间的间接路径显著（即间接路径（0.263×（-0.183））=-0.048，P < 0.05，下限=-0.608，上限=-0.07），道德负担感通过JAND - CE与ECNQ - CCV之间的间接路径显著（间接路径（（-0.353）×（-0.183））=0.065，P < 0.05，下限=0.082，上限=0.758），且上下限之间不包含零值。本研究通过结构方程模型揭示了道德责任和力量感以及道德负担感对伦理冲突的双路径机制，强调了伦理决策能力的中介关键作用。研究结果为完善道德能力培养体系提供了理论依据，同时也警示了道德负担的潜在负面影响。护理管理者应动态评估ICU护士的伦理敏感性和决策能力，为实施个性化伦理冲突干预措施提供参考。
