Xiong Yang, Fu Ya-Qian, Li Zhuo-Heng, Tang Yu-Rong, Liu Zi-Yu, Liu Bi-Rong, Huang Zhuo-Er, Yi Qi-Feng
Xiangya School of Nursing, Central South University.
Nurs Ethics. 2025 Aug;32(5):1656-1669. doi: 10.1177/09697330251331195. Epub 2025 Apr 16.
BackgroundMoral distress is a significant challenge faced by clinical internship nursing students. Most current studies investigate the impact of external factors on nursing students' moral distress. However, there is a lack of in-depth exploration of the interactions between various moral distress items.Research objectiveThis study aims to construct a network structure of moral distress among clinical internship nursing students, while exploring the touchpoints of moral sensitivity and moral resilience on moral distress, to identify potential targets for moral distress intervention.Research designA cross-sectional design utilized acceptable validity scales. Network analysis was conducted using R (Version 4.4.0). Regularized partial correlation was utilized to describe the associations between different nodes in the network. Central nodes were identified through centrality indices.Participants and research contextThe participants in this study are 372 nursing students undergoing clinical internships at a comprehensive teaching hospital in Changsha, China.Ethical considerationsThis study was approved by the hospital ethics committee (Review Number: Express 241098). Written informed consent was obtained from all participants.ResultsIn the moral distress network, the connections between MD3 "I provide life-sustaining treatment per the family's wishes" and MD4 "Despite only extending survival, I implement life-saving measures" are the strongest. MD18 "Decline in service quality due to poor team communication," MD19 "I ignore situations lacking adequate information for informed consent," and MD17 "I collaborate with colleagues unable to meet the patient's treatment needs" are the central nodes of the moral distress network. In the relational network, MD19 is a critical connection point linking moral distress with moral sensitivity and moral resilience.ConclusionFuture interventions for moral distress could focus on the strongly related and significant distress (MD3, MD4, MD18, MD19, MD20, and MD17) mentioned in this study, and develop scientific and targeted interventions to reduce clinical internship nursing students' moral distress.
背景
道德困扰是临床实习护生面临的一项重大挑战。目前大多数研究调查的是外部因素对护生道德困扰的影响。然而，对于各种道德困扰项目之间的相互作用缺乏深入探讨。
研究目的
本研究旨在构建临床实习护生道德困扰的网络结构，同时探索道德敏感性和道德复原力对道德困扰的影响点，以确定道德困扰干预的潜在靶点。
研究设计
采用横断面设计，使用效度可接受的量表。使用R（版本4.4.0）进行网络分析。利用正则化偏相关描述网络中不同节点之间的关联。通过中心性指标确定中心节点。
参与者与研究背景
本研究的参与者为372名在中国长沙一家综合性教学医院进行临床实习的护生。
伦理考量
本研究经医院伦理委员会批准（审批号：快审241098）。所有参与者均获得书面知情同意。
结果
在道德困扰网络中，MD3“我按照家属意愿提供维持生命的治疗”与MD4“尽管只能延长生存期，我仍实施挽救生命的措施”之间的联系最强。MD18“团队沟通不畅导致服务质量下降”、MD19“我忽略缺乏充分信息进行知情同意的情况”和MD17“我与无法满足患者治疗需求的同事合作”是道德困扰网络的中心节点。在关系网络中，MD19是连接道德困扰与道德敏感性和道德复原力的关键连接点。
结论
未来针对道德困扰的干预措施可聚焦于本研究中提到的强相关且显著的困扰（MD3、MD4、MD18、MD19、MD20和MD17），并制定科学、有针对性的干预措施，以减轻临床实习护生的道德困扰。
