【原】#护理选题：护士执业环境与护士对患者安全的沉默行为的关系：护士职业歧视的中介作用

#圆桌话题# 

1. 变量：①护士执业环境量表：the Practice Environment Scale of the Nursing Work Index, PES-NWI。②员工沉默量表：Tangirala 和 Ramanujam改变的沉默量表，用于评估护士对患者安全的沉默行为。③职业歧视指数：Experiences of Discrimination Index

2. 其主题：护士对患者安全的沉默行为的决定性因素还未确定，本研究只是从护士的执业环境角度出发，后续还可以继续探讨。

Kritsotakis, G., Gkorezis, P., Andreadaki, E., Theodoropoulou, M., Grigoriou, G., Alvizou, A., Kostagiolas, P., & Ratsika, N. (2021). Nursing practice environment and employee silence about patient safety: The mediating role of professional discrimination experienced by nurses. Journal of Advanced Nursing, 00, 1– 12. 

https:///10.1111/jan.14994

护士执业环境与护士对患者安全的沉默行为的关系：护士职业歧视的中介作用

Aims To examine the associations between nurse work environment with nurses’ silence about patient safety and the mediating effects of professional discrimination experienced by nurses.

研究目的：探讨护士执业环境环境与护士对患者安全的沉默行为之间的关系及护士职业歧视的中介效应。

Design Multicentre cross-sectional study.

研究设计：多中心横断面研究

Methods Between January and April 2019, 607 nurses and nursing assistants from seven hospitals in Greece assessed their clinical environment using the 'Practice Environment Scale of the Nursing Work Index Revised-PES-NWIR’, and the silence about patient safety. The 'Experiences of Discrimination Index’ was adapted to specifically address experienced discrimination based on the nursing profession. The PROCESS macros for SPSS were used to examine the above associations.

研究方法：2019年1月至4月，来自希腊7家医院的607名护士和护理助理使用护士执业环境量表、员工沉默量表对其临床环境进行评估。使用职业歧视指数评估护理专业人员的职业歧视经历。

Findings Better nurse practice environment, with the exception of 'staffing and resource adequacy’ dimension, was directly associated with less experienced professional discrimination, and directly and indirectly associated with less silence about patient safety, through the mediating role of professional discrimination experienced by nurses.

研究结果：（1）护士的执业环境直接作用于护士对患者安全的沉默行为（负相关，即：护士的执业环境越好，则护士对患者安全的沉默行为越少）。（2）护士执业环境对于护士对患者安全的沉默行为是可以通过护士职业歧视间接的产生作用。即：护士执业环境越好，则护士收到的职业歧视越少，进而护士对患者安全的沉默行为也就越少。

Conclusions Silence about patient safety is dependent on the clinical work environment and may be a response of nurses to discrimination in the work context. Both an improvement in the nurse work environment and a decrease in professional discrimination would minimize silence about patient safety.

研究结论：对患者安全的沉默取决于临床执业环境，可能是护士对工作环境中歧视的反应。护士执业环境的改善和职业歧视的减少都将最大限度地减少对病人安全的沉默行为。

Impact On many occasions, nurses are directly or indirectly discouraged from voicing their concerns about patient safety or are ignored when they do, leading to employee silence and decreasing the standard of care. Nurses’ work-related determinants for silence are not clearly understood in the patient safety context. A favourably evaluated nurse practice environment is associated with less experienced professional discrimination and less silence about patient safety. To minimize silence about patient safety, both the nurse work environment and the experienced professional discrimination should be taken into consideration by nurse and healthcare managers.

研究意义：在许多情况下，护士们直接或间接地被劝阻不要说出他们对病人安全的担忧，或者当他们说出这些担忧时，护士们被忽视了，这导致了员工们的沉默，降低了护理标准。在病人安全的背景下，对与护士工作有关的沉默的决定因素没有明确的理解。但是现有数据证实，护士的执业环境与职业歧视经历与护士对患者安全的沉默行为有关系，对管理者而言，可以考虑这两点因素，以降低临床实践中护士对患者安全的沉默行为。