The Prevalence of Ethical Conflicts and Influencing Factors Among Critical Care Nurses in China: A National Cross-sectional Study.

Ethical conflicts in nursing compromise both the quality of care provided to patients and the mental well-being of nurses. However, research on ethical conflicts in nursing in China is scarce. This study was developed to investigate the current situation of ethical conflict among critical care nurses and associated factors using a large-scale sample. From January 2022 to June 2022, convenience sampling was used to recruit critical care nurses in 7 geographic regions in China. The Ethical Conflict in Nursing Questionnaire-Critical Care Version was used to measure level of ethical conflict. A hierarchical linear regression analysis was adopted to determine the significant factors associated with ethical conflict and examine the relative contribution of different groups of factors to the explained variance. One thousand five hundred sixteen participants from 28 provinces were enrolled. The medians and interquartile range of the overall Chinese version of the Ethical Conflict in Nursing Questionnaire-Critical Care Version score were 75.5 (35.0, 125.0). Participant mean scores were high on scenarios related to resource management, withholding and withdrawing treatment, and procedures and treatments. After controlling for individual characteristics, educational factors, work-related variables, socioeconomic variables, and organizational factors, ethical conflict was found to be associated with educational level, job title, type of intensive care unit, monthly household income, geographic region, and frequency of meeting/discussing about ethical issues in the workplace. The organizational factors of ethics-related meetings and discussions in the workplace contributed the most to the explained variance. Based on the findings, critical care nurses in China have a moderate level of exposure to ethical conflicts. Similarities and differences are shared between this study and international studies with regard to the most conflictive scenarios in critical care nursing practice. Multilevel factors were found to be associated with ethical conflict in critical care nurses in China. The results may be used to assist nurse administrators to identify populations at greater risk of ethical conflict and to develop interventions targeted at different nursing levels to mitigate the experience of ethical conflict and improve mental well-being in critical care nurses.