The relationships of ethical climate, physician–nurse collaboration and psychological empowerment with critical care nurses' ethical conflict in China: A structural equation model

To explore the relationships of ethical climate, physician-nurse collaboration and psychological empowerment with ethical conflict in critical care nurses.Ethical conflict is a major ethical issue in nursing practice. Little research has been done on the associated factors from both organizational and personal perspectives, especially in China.From October 2021 to March 2022, we collected the data from 342 critical care nurses in three tertiary general hospitals in China via questionnaires about four variables (ethical climate, physician-nurse collaboration, psychological empowerment and ethical conflict). Data were analysed using Spearman's correlation and a structural equation model through statistical product and service solutions (SPSS) and analysis of moment structure (AMOS).Critical care nurses' ethical conflict showed a negative correlation with ethical climate (r = -0.351), physician-nurse collaboration (r = -0.347) and psychological empowerment (r = -0.259) (all p < 0.001). Physician-nurse collaboration partially mediated the relationship between ethical climate and ethical conflict. Additionally, physician-nurse collaboration and psychological empowerment served as sequential mediators in the association.These findings suggested that negative ethical climate can lead to poor physician-nurse collaboration and ultimately ethical conflict. The intermediary role of psychological empowerment and physician-nurse collaboration was also identified.Nursing managers should use the study as a fundamental basis to evaluate factors that can affect nurses' ethical conflict and develop effective strategies to mitigate this issue, which may help improve nurses' wellbeing and quality of patient care.