护士道德困境与道德伤害间的链式效应

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[中图分类号]R-052 [文献标志码]A [文章编号]1001-8565（2025）11-1476-07

DOI：10.12026/j.issn.1001-8565.2025.11.14

Abstract：Objective：To investigate the chain effect of moral leadership and ethical climate on moral distress and moral injury.Methods：A total of 6O6 nurses in Shandong Province，China，were selected using a convenience sampling method at August 2O23.Participants were evaluated using the Moral Distress Scale，the Moral Injury Symptoms Scale，the Moral Leadership Measure，and the Hospital Ethical Climate Survey. Results： This study provided a model describing the interrelationships among moral distress，moral leadership， ethical climate，and moral injury.Moral distress hada negative impacton moral injury，while moral leadership and ethical climate had positive efects on both moral distress and moral injury.Moreover，moral leadership and ethical climate could moderate therelationship between moral distress and moral injury，playing a partial mediating role.The final model showed that moral distress，moral leadership，ethical climate，and moral injury formed a chain effect.Conclusion：Nursing managers and nurses should actively participate in moral training and education to enhance their ability toaddress moral distress.Meanwhile，healthcare organizations should cultivate moral leaders，improve the ethical climate in the workplace，promptly identifyand intervene in moral injury，and maintain nurses’mental health.

Keywords： moral distress；moral leadership；nursing management; nursing ethics

护理的本质是道德实践，当护士因资源、政策、法规等因素作出不恰当的或与最佳的护理相冲突的道德决策时，他们可能产生内疚、自责等负面情绪，如果长时间未解决可能造成道德伤害[1-2]。（剩余11622字）