| Objective:(1)To explore the status of clinical nurses’ moral behaviors and make the moral sensitivity questionnaire more consistent with Chinese social and cultural background;(2)To explore the theoretical connotation of nurses’ moral sensitivity,and develop a moral sensitivity questionnaire based on nursing practice in China;(3)To explore the status of nurses’ empathy,moral sensitivity and caring behavior and as well as the mechanism among them.Methods:(1)Focus group and in-depth semi structured interviews were conducted with 21 head nurses and 9 nurses,respectively.The data were analysed by content analysis.(2)Using the method of grounded theory,15 nurses were selected for semi-structured in-depth interviews with the purpose of sampling,and the data were analyzed according to the three-level code.Through continuous comparison,the categories and main categories were gradually formed,and finally the core categories were constructed.On the basis of constructing the theoretical model of nurses’ moral sensitivity,a questionnaire of nurses’ moral sensitivity was developed and its reliability and validity were tested.(3)578 nurses from 21 public hospitals in northern Anhui were selected by convenient sampling to conduct a questionnaire survey.The questionnaire included the general information questionnaire,the self-made nurse moral sensitivity questionnaire,the Jefferson empathy scale,and the caring behavior scale.Pearson correlation analysis,stepwise regression analysis,and Bootstrap method were used to test the mediating effect of moral sensitivity between empathy and caring behavior.Results:(1)Obtaining ethical issues such as protecting patient privacy,respecting patient autonomy,awareness of avoiding harm,communication,emotional engagement,and lack of psychological care for special patients.And the causes of moral problems,a total of 7 themes;(2)The model of nurses’ moral sensitivity consists of four dimensions:responsibility perception,moral awareness,empathy and consequence awareness.The questionnaire contained 4 dimensions and 18 items in total.The factor load of each item was between 0.630 and 0.876,and the cumulative variance contribution rate was 74.425%.The revised confirmatory factor analysis indexes were within the acceptable range(χ2/df=3.588,RMSEA=0.077,RMR=0.049,NFI=0.922,IFI=0.942,CFI=0.942,TLI=0.929.The Cronbach’s alpha coefficient of the total scale was 0.875,and the alpha coefficient of the 4 dimensions were between 0.802～0.947.(3)①The scores of empathy,moral sensitivity and caring behavior of nurses in this survey were(113.06±16.22),(110.74±10.16)and(127.82±17.26)respectively.The correlation analysis showed that the empathy,moral sensitivity and caring behavior of nurses were positively correlated(r=0.496,0.557,r=0.652,P<0.01).②Nurse empathy can directly predict caring behavior(β=0.528,P<0.01),nurses’ moral sensitivity played a part of intermediary role between empathy and caring behavior(β=0.322,P<0.01),the proportion of intermediary effect was 60.98%.Conclusion:(1)There are still some ethical issues in clinical nursing practice,and the reasons for these issues are manifold.Efforts should be made related to nurses,patients,workload,the ethical climate,and rules and regulations to improve the situation.(2)Nurses’ moral sensitivity is a multi-dimensional psychological concept that includes cognition and emotion.The questionnaire of nurses’ moral sensitivity has good reliability and validity,and can be used to measure the level of nurses’ moral sensitivity in China.(3)Nurses’ empathy,moral sensitivity and caring behavior are closely related,which suggests that we should pay full attention to the long-term and continuous cultivation of nurses’ moral quality in order to further optimize the quality of nursing services. |
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