Correlation Analysis between Moral Courage of ICU Nurses and Hospital Ethical Climate / 中国医学伦理学

【Objective:】 To explore the relationship between the moral courage of nurses in Intensive Care Unit (ICU) and the hospital ethical climate, and to provide a theoretical basis for enhancing the moral courage of ICU nurses. 【Methods:】 A total of 468 ICU nurses from 8 tertiary A hospitals in Shaanxi Province were selected as the subjects by convenience sampling method, and the General Information Form, Hospital Ethical Climate Survey, and Nurses’ Moral Courage Scale were used for the questionnaire survey. 【Results:】 A total of 468 questionnaires were distributed and 463 valid questionnaires were returned, with an effective recovery rate of 98.93%. The score of hospital ethical climate for ICU nurses was (100.69±19.76), and the score of moral courage was (83.67±15.48). There was a positive correlation between hospital ethical climate and moral courage (r=0.866, P<0.001). Hierarchical multiple regression analysis showed that hospital ethical climate entered the influencing factor model of ICU nurses’ moral courage, which can independently explain 57% of the variation in ICU nurses’ moral courage. 【Conclusion:】 The moral courage of ICU nurses was at a medium level, and positively correlated with the hospital ethical climate, that is, the better the hospital ethical climate perceived by ICU nurses, the higher their level of moral courage. Nursing managers should focus on deepening the hospital ethical climate, and enhance the level of hospital ethical climate through scientific methods to promote the improvement of ICU nurses’ moral courage.

Analysis of moral courage and related factors among undergraduate nursing students: a scoping review / Análisis del coraje moral y factores relacionados entre estudiantes de graduación en enfermería: scoping review / Análise da coragem moral e fatores relacionados entre estudantes de graduação em enfermagem: scoping review

ABSTRACT Objective: to analyze scientific evidence on moral courage and related factors among nursing undergraduate students. Method: the protocol of this scoping review was registered on Open Science Framework. A search was performed in five databases, according to the method provided by Joanna Briggs Institute Reviewers, the mnemonic strategy Population, Concept and Context, and a specific checklist. Results: a total of 2,812 results were identified, but only nine studies were eligible and presented three thematic approaches: Moral courage from the perspective of nursing students; Moral courage and related factors; and The teaching of moral courage in the training of nursing students. The factors related to moral courage include moral distress, moral sensitivity, age, and having a previous degree in the health field. Final Considerations: few studies were found with a low evidence level. Most were performed in developed countries, indicating some gaps that need to be addressed in the future.

RESUMEN Objetivo: analizar las evidencias científicas sobre el coraje moral y factores relacionados entre estudiantes de graduación en enfermería. Métodos: se trata de un scoping review con protocolo registrado en el Open Science Framework, realizado en cinco bases de datos, conforme método de Joanna Briggs Institute Reviewers, estrategia mnemónica Población, Concepto y Contexto, y checklist específico. Resultados: se identificaron 2.812 resultados, siendo que nueve estudios fueron seleccionados. Tres enfoques temáticos fueron identificados: Percepción del coraje moral por los estudiantes de enfermería; Coraje moral y factores relacionados; y, la Enseñanza del coraje moral en el ámbito de la formación de estudiantes de enfermería. Entre los factores relacionados con el coraje moral, se destacaron el sufrimiento moral, la sensibilidad moral, la edad y la presencia de un título anterior en el área de la salud. Consideraciones Finales: se evidenciaron pocas publicaciones y con bajo nivel de evidencias provenientes, mayoritariamente, de países desarrollados, indicando que existen vacíos que necesitan ser llenados.

RESUMO Objetivo: analisar as evidências científicas sobre a coragem moral e fatores relacionados entre estudantes de graduação em enfermagem. Métodos: trata-se de uma scoping review com protocolo registrado no Open Science Framework, realizada em cinco bases de dados, conforme método do Joanna Briggs Institute Reviewers, estratégia mnemônica População, Conceito e Contexto, e checklist específico. Resultados: identificou-se 2.812 resultados, sendo que nove estudos foram elegidos. Três enfoques temáticos foram identificados: Percepção da coragem moral pelos estudantes de enfermagem; Coragem moral e fatores relacionados; e Ensino da coragem moral no âmbito da formação de estudantes de enfermagem. Dentre os fatores relacionados com a coragem moral, destacou-se o sofrimento moral, a sensibilidade moral, a idade e a presença de um diploma anterior na área da saúde. Considerações Finais: evidenciou-se poucas publicações e com baixo nível de evidência, sendo oriundas majoritariamente de países desenvolvidos, indicando que lacunas ainda precisam ser preenchidas.

El coraje moral en el cuidado de la salud / Moral courage in health care / Coragem moral nos cuidados de saúde

El cuidado de la salud es prioridad en actuales momentos de incertidumbre sociosanitaria. En ello, los profesionales de enfermería son los trabajadores de salud de primera línea y miembros esenciales del equipo en el afán de cuidar la salud y salvar la vida de las personas. Aunque enfermería es consciente de los desafíos asociados a la crisis pandémica COVID-19 y otras problemáticas sanitarias; continúan demostrando y brindando cuidados de alta calidad no obstante los episodios de deliberación ético- moral que vive con frecuencia, que inducen crisis físicas y mentales que la llevan a vivir procesos de angustia moral que deben explorarse y llamar la atención meticulosa de los administradores de sistemas de salud. Desde estas perspectivas es cuando el coraje moral debe ser una competencia que reconocer y relevar en los procesos de cuidado que realiza. En este sentido, el siguiente relato pretende motivar a la reflexión en torno a las encrucijadas ético-morales que subyacen a la práctica del cuidado de enfermería y la necesidad de potenciar el coraje moral como estrategia de fortalecimiento de la práctica del cuidado.

Health care is a priority in current times of socio-health uncertainty. In this, nursing professionals are front-line health workers and essential team memberstocare for the health and save people's lives. Although nursing is aware of the challenges associated with the COVID-19 pandemic crisis and other health problems; she continuesto demonstrate and provide high-quality care despite the episodes of ethical-moral deliberation that she frequently experiences, which induce physical and mental crises that lead her to experience processes of moral anguish that must be explored and call the meticulous attention of system administrators of health. It is from these perspectives that moral courage should be a skill to be recognized and revealed in the care processes carried out. In this sense, the following story aims to reflecton the ethical-moral crossroads that underlie nursing care practiceand the need to enhance moral courage as a strategy to strengthen the ruleof care

Os cuidados de saúde são uma prioridade nos tempos atuais de incerteza sócio sanitária. Nisso, os profissionais de enfermagem são trabalhadores de saúde da linha de frente e membros essenciais da equipe no esforço de cuidar da saúde e salvar a vida das pessoas. Embora a enfermagem esteja ciente dos desafios associados à crise da pandemia deCOVID-19 e outros problemas de saúde; demonstrando e prestando atendimento de qualidade apesar dos episódios de deliberação ético-moral que ela vivência com frequência, que induzem a crises físicas e mentais que a levam a vivenciar processos de angústia moral que devem ser explorados e chamar a atenção meticulosa dos administradores do sistema de saúde. É a partir dessas perspectivas que a coragem moral deve ser uma habilidade a ser reconhecida e revelada nos processos de cuidado realizados. Nesse sentido,o relato a seguir visa motivar a reflexão sobre a encruzilhada ético-moral que permeia a prática do cuidado de enfermagem e a necessidade de potencializar a coragem moral como estratégia para fortalecer a prática do cuidado

Revision of the Physical Courage at Work Scale / 环境与职业医学

Background According to China's Labor Statistics Yearbook 2020, there were 113293 work-related injuries and 25092 work-related deaths in 2019. It is of great significance to enhance the courage quality of high-risk workers for the maintenance of personal health and the effectiveness of organizational work. Objective To revise the Physical Courage at Work Scale (PCWS) for its application in Chinese employees exposed to high-risk workplace. Methods A total of 1280 high-risk workers completed the revised PCWS for Chinese employees. Item analysis and exploratory factor analysis were used to analyze the scale's construction validity. Confirmatory factor analysis was used to verify the results of exploratory factor analysis, Cronbach's α coefficient was used to verify the reliability of the scale, Pearson correlation analysis of the scale with Mental Quality Questionnaire for Armymen (MQQA) and Norton Courage Measure (CM) was used to verify the validity of the revised PCWS, and Pearson correlation analysis was used to determine the discrimination for each factor of the revised PCWS. Results The results of item analysis showed that the correlation coefficients between the scores of all items and the total score of the revised PCWS were greater than 0.4. The exploratory analysis indicated that there were five factors including immediate danger,providing for family, confronting other's aggression, reporting violations, and contributing to society in the revised version. The confirmatory analysis indicated the five-factor model fitted well (minimum fit function Chi-square/degree of freedom, CMIN/DF=4.60; normed fit index, NFI=0.93; comparative fit index, CFI=0.95; incremental fit index, IFI=0.93; standardized root mean square residual, SRMR=0.05; root mean square error of approximation, RMSEA=0.07). The internal consistency coefficient of the revised PCWS was α=0.95. The correlation coefficients of the revised PCWS with MQQA and CM ranged from 0.11 to 0.28 (P<0.01), and the correlation coefficients between factors of the revised scale ranged from 0.35 to 0.72 (P<0.01). Conclusion The revised PCWS has good reliability and validity in Chinese employees.

Study on the memory-tracing personality development of patients with obsessive-compulsive disorder / 中华行为医学与脑科学杂志

Objective:To study the personality development of obsessive-compulsive disorder (OCD) from the perspective of memory-tracing.Methods:From January 2016 to May 2017, totally 103 patients with OCD (patient group) and 88 normal subjects (control group) matched with age, gender, and educational level in the national urban population norm database of Wang Weidong memory-tracing personality developmental inventory (WMPI) were included.WMPI was used to evaluate and compare all subjects.SPSS 22.0 software and nonparametric test were used for statistically analysis, and independent sample t-test and nonparametric test were used for data camparison. Results:1.In terms of external influencing factors of personality development: on the part of life events, the score of family affair in the patient group was higher than that in the control group( P<0.05) in childhood.In terms of upbringing, the scores of strictness (5.637±3.463) and punishment (6.275±4.565) in the patient group were higher than those ((4.341±3.092), (5.000±3.698)) in the control group in childhood( t=-2.703, -2.093, both P<0.05). 2.In the aspect of personality elements: (1) Among courage subscales, the scores of natural fear (7.686±3.441) and adaptability (15.000±5.321) in the patient group were higher than those((6.023±3.991), (12.841±6.070)) in the control group in childhood ( t=-3.085, -2.613, both P<0.05) .For all three stages, interpersonal fear scores in the patient group ((20.284±8.255), (22.804±7.458), (22.725±7.145))were all higher than those ((16.205±7.937), (19.841±6.319), (18.364±6.277))in the control group( t=-3.458, -2.929, -4.437, P<0.01). (2) Among interpersonal relationship, the dependence dimension scores were higher in the patient group (10.804±3.621) than those (8.830±4.850) in the control group during childhood( t=-3.205, P<0.01). (3) Among sex development, the scores of heterosexual communications (11.941±4.878), love concept (15.098±4.180) and sexual concept (8.892±2.988) were higher in the patient group than those ((9.125±5.040), (11.761±5.202), (6.943±3.288)) in the control group in adolescence(all P<0.01). (4) Among ego, the score of self-care dimension in the patient group (6.465±2.890) was higher than that in the control group(4.239±2.861) in childhood ( P<0.01). In the dimension of autonomy, the scores of the patient group ((10.772±2.694), (11.347±2.621)) were higher than those in the control group ((8.011±4.039), (9.818±2.693)) in childhood and adolescence (both P<0.01). (5) Among the way of thinking, the score of absolute thinking dimension in the patient group was higher than that in control group in childhood ( P<0.01). In the dimension of cautious, the scores of patient group were higher than those in the control group in childhood and adolescence (both P<0.01). (6)Among volition, the scores of decisive dimension in the patient group were higher than those in the control group in adolescence and youth (both P<0.01). In the dimension of consciousness, the score of patient group was higher than that in the control group in youth( P<0.01). In the dimension of insistence, the score of the patient group were higher than those in the control group in childhood and youth (both P<0.01). (7) Among worldviews, the scores of motivations, perspective of career and perspective of friendship in the patient group were higher than those in the control group in adolescence (all P<0.01). The score of value dimension in patient group was lower than that in the control group in the youth ( P<0.01). Conclusion:Patients with OCD have more strictness and punishment during their childhood in terms of upbringing.This leads to a lack of courage, poor interpersonal relationships, low self-care or autonomy, high attachment, absolutization of thinking and suppressing themself more in their childhood.In their adolescence and youth, their lack of courage, poor self-care or autonomy and the way of thinking cautious and stubborn will further aggravate and gradually show a more conservative sexual development and traditional world outlook.

Coraje para enfrentar el COVID-19 / Courage to face COVID-19

Los llamados a la solidaridad, a la justicia social, a la beneficencia, y, a la no maleficencia, son todos y han sido, llamados de los valores de la bioética para la enseñanza y para la práctica médicas, ayer, durante la pandemia de COVID-19, y siempre. Son pocos en estas lides, como mentores o como profesionales de la medicina, que no hayan honrado ese llamado. A veces pareciera no ser así, porque el ruido de los pocos es, no solo detestable, sino asfixiante. Pero comenzamos a ver resultados de ese cumplimiento, no con el Juramento Hipocrático, sino con el Otro, con el prójimo, con quien busca conocer cómo preservar la salud y con quién recuperarla. Precisamente con aquel y aquellos que en la confidencialidad ponen su vida y su bienestar en manos de la ciencia y en el calor de una práctica humanista

The calls to solidarity, to social justice, to charity, and, to non-maleficence, are all and have been, calls of the values ​​of bioethics for teaching and medical practice, yesterday, during the pandemic of COVID-19, and always. Few in these struggles, as mentors or as medical professionals, have not honored that call. Sometimes it seems not to be so, because the noise of the few is not only detestable, but suffocating. But we begin to see results of that fulfillment, not with the Hippocratic Oath, but with the Other, with the neighbor, with whom he seeks to know how to preserve health and with whom to recover it. Precisely with those and those who, in confidentiality, put their lives and well-being in the hands of science and in the warmth of a humanistic practice.

Conocimiento y valores: binomio esencial en la formación profesional / Knowledge and values: essential binomial in professional training

Introducción: La formación de valores es un proceso gradual, donde es necesario buscar e indagar cuáles valores y por qué vías se deben formar, desarrollar, afianzar y potenciar en diferentes momentos de la vida, según las necesidades que se van presentando en la formación de un profesional. Objetivo: Evaluar la posición que asumen los estudiantes ante diferentes situaciones que pueden ocurrir a lo largo de su formación académica y una vez que comiencen su vida laboral. Método: Se realizó una investigación exploratoria utilizando como técnica la encuesta que fue aplicada a 52 estudiantes del sexto año de la asignatura de Ginecología y Obstetricia de la Facultad de Ciencias Médicas "Salvador Allende" en el curso académico 2013-2014. Resultados: En la situación relacionada con el compañerismo llama la atención que existan alumnos que no tienen interiorizado este valor y justifican actitudes erróneas relacionadas con esto. Es de señalar que la mayoría de los estudiantes consideran correcto el valor honestidad, pero es preocupante que algunos de los encuestados se identifican con actitudes deshonestas y no asumen una posición de rechazo y no aceptación ante el fraude. Conclusión: La mayoría de los estudiantes tienen valores y actitudes consecuentes con un buen profesional de la salud, pero no se puede dejar de tener en cuenta la identificación con determinados aspectos y conductas negativas que denoten falta de valores y principios éticos y su posible presencia en los futuros facultativos que pueden afectar la calidad de los servicios, la atención integral a la población, a los y las colegas y a la ética profesional y en este sentido debe continuar trabajándose(AU)

Introduction: The formation of values ​​is a gradual process, where it is necessary to search and investigate which values ​​and through which routes should be formed, developed, strengthened and strengthened at different times of life, according to the needs that are presented in the training of A professional. Objective: To evaluate the position that students assume in different situations that may occur throughout their academic training and once they begin their working life. Method: An exploratory investigation was carried out using as a technique the survey that was applied to 52 students of the sixth year of the subject of Gynecology and Obstetrics of the School of Medical Sciences "Salvador Allende" in the academic year 2013-2014. Results: In the situation related to companionship, it is striking that there are students who do not have this value internalized and justify erroneous attitudes related to this. It should be noted that most students consider honest value correct, but it is worrisome that some of the respondents identify with dishonest attitudes and do not assume a position of rejection and non-acceptance of fraud. Conclusion: Most students have values ​​and attitudes consistent with a good health professional, but we can not fail to take into account the identification with certain aspects and negative behaviors that denote lack of values ​​and ethical principles and their possible presence in the future facultative that can affect the quality of the services, the integral attention to the population, to the and the colleagues and to the professional ethics and in this sense it must continue working(AU)

El prisma del lenguaje / The prism of language

Se trata de una revisión del Prólogo de Amado Alonso, al Curso de Lingüística General de F. De Saussure, donde se muestran las dificultades en la constitución de su objeto, la crítica de la Escuela de Praga y la revalorización del habla. A partir de allí, las incidencias en antropología y psicoanálisis, en éste, paso necesario para formular su teoría del sujeto. Especialmente la trama del lenguaje y la división del sujeto.

This is a review of the Prologue of Amado Alonso, General Linguistics Course F. De Saussure, showing the difficulties in the constitution of the object, criticism of the Prague School speech and presentation. From there, the incidences in anthropology and psychoanalysis, in this, a necessary step to formulate his theory of the subject. Especially the plot of the language and the division of the subject.