專科護理師的倫理決策能力、道德復原力與道德困擾之相關性研究

研究背景：隨著高齡化社會來臨與醫療科技日新月異，臨床決策情境日益複雜，醫療人員在面對病人與家屬多元期待時，常需處理倫理與道德之間的衝突與兩難。道德困擾成為臨床工作中常見且具挑戰性的心理經驗，對醫療人員的職業倦怠與照護品質均可能造成負面影響。專科護理師作為連結病人、家屬與醫療團隊的關鍵角色，需經常在壓力情境中做出即時決策，因此其倫理決策能力與道德復原力，可能對其道德困擾程度具有關鍵影響。研究目的：探討專科護理師的人口學特性、倫理決策能力與道德復原力與其道德困擾之間的關聯性，並進一步檢測三者是否為道德困擾的重要預測因素。研究方法：本研究為橫斷面與相關性研究設計，採方便取樣，以中部地區之各一家醫學中心及區域教學醫院之專科護理師為研究對象，研究工具(問卷)包含人口學基本資料、倫理決策能力量表、道德復原力量表、醫療人員道德困擾量表。統計分析以包含皮爾森積差相關與階層回歸分析，採用套裝軟體SPSS 22版執行資料分析。研究結果：本研究共140名專科護理師完成有效問卷，男性6位(4.3%)，女性134位(95.7%)，年齡介於23~60歲之間。結果顯示在人口學變項中，不同的教育程度與自覺心理狀況在道德困擾具有顯著差異，亦即教育程度較高與自覺心理狀況良好的專科護理師，道德困擾程度相對較低。此外，道德困擾分別與倫理決策能力(r = -0.26, p = .002)、道德復原力(r = -0.45, p < .001)呈顯著負相關。在階層迴歸分析中，則是教育程度與道德復原力對道德困擾具顯著預測力，最終模型解釋道德困擾變異量達25.9%（R² = 0.259, p < .001），其中以道德復原力之標準化回歸係數最大，為主要影響因子。而倫理決策對道德困擾的預測並未達顯著。結論：本研究發現，專科護理師的倫理決策能力與道德復原力對道德困擾具顯著負向影響，但是階層迴歸分析顯示對道德困擾的預測因子是道德復原力，而倫理決策能力則變得不顯著。因此，建議道德復原力的強化是重要的。研究結果強調，應於專科護理師之教育與訓練課程規劃中強化道德復原力之培養，並建構具倫理支持的臨床文化與組織制度，包含設置倫理諮詢機制、推動倫理工作坊與心理支持措施，以協助其有效因應臨床倫理挑戰，進而提升照護品質與工作穩定性。而對於倫理決策能力是否為道德困擾的預測因子，則仍須進一步研究。

Background: With the advent of an aging society and rapid advances in medical technology, clinical decision-making situation have become increasingly complex. Healthcare professionals often face ethical and moral dilemmas when responding to the diverse expectations of patients and their families. Moral distress has emerged as a common and challenging psychological experience in clinical practice, which may negatively impact occupational burnout of healthcare professionals and the quality of care. As key intermediaries between patients, their families, and healthcare teams, nurse practitioners are often required to make timely decisions under pressure. Therefore, their ethical decision-making competence and moral resilience may play a crucial role in influencing the degree of moral distress they experience.Aim: To examine the relationships between demographic characteristics, ethical decision-making competence, moral resilience, and moral distress among nurse practitioners.Methods: This study employed a cross-sectional, correlational design with convenience sampling. The participants were nurse practitioners from a medical center and a regional teaching hospital in central Taiwan. Data were analyzed using SPSS version 22, including Pearson’s correlation and hierarchical regression analyzes.Results: A total of 140 nurse practitioners completed valid questionnaires, including 6 males (4.3%) and 134 females (95.7%), with ages ranging from 23 to 60 years. The results revealed that among demographic variables, both educational level and perceived mental health status were significantly associated with moral distress. Specifically, nurse practitioners with higher educational attainment and better perceived mental health reported lower levels of moral distress. Moreover, moral distress was significantly negatively correlated with ethical decision-making competence (r = -0.26, p = .002) and moral resilience (r = -0.45, p < .001). The hierarchical regression analysis further indicated that the educational level and moral resilience were significant predictors of moral distress, with the final model explaining 25.9% of the variance (R² = 0.259, p < .001). Among these predictors, moral resilience had the largest standardized regression coefficient, making it the most influential factor. In contrast, ethical decision-making competence was not a significant predictor in the regression model.Conclusion: This study found that both ethical decision-making competence and moral resilience were significantly negatively associated with moral distress among nurse practitioners. However, the results of hierarchical regression analysis indicated that only moral resilience remained a significant predictor of moral distress, while the predictive effect of ethical decision-making competence was no longer significant. Therefore, strengthening moral resilience is recommended as a key strategy. The findings highlight the importance of integrating moral resilience training into the education and professional development of nurse practitioners. Additionally, it is essential to foster an ethically supportive clinical culture and organizational structure, including the implementation of ethics consultation services, the promotion of ethics workshops, and the provision of psychological support. These measures can help nurse practitioners effectively cope with ethical challenges in clinical practice, thereby improving the quality of care and workforce stability. Further research is needed to clarify the predictive role of ethical decision-making competence in relation to moral distress.