Abstract:

Objective To investigate the current status of rumination and professional grief among hospice nurses，and to explore the mediating effect of death attitude between the two. Methods A total of 323 nurses in hospitals with hospice services and hospice wards in Hangzhou City were surveyed from April to July 2024 by convenience sampling method. They were investigated with general information questionnaire，Event Related Rumination Inventory，Death Attitude Profile-Revised，and Grief State Scale for Nurses by convenience sampling method. The structural equation model was used to analyze the mediating effect of death attitude between rumination and professional grief among hospice nurses. Results A total of 331 questionnaires were collected，among which 8 invalid questionnaires were deleted，and 323 valid questionnaires were retrieved，with the valid questionnaire recovery rate of 97.58%. The score of intrusive rumination dimension for hospice nurses was 13.34（7.00，20.00），and the score of deliberate rumination dimension was 16.92（11.00，24.00）. The negative attitude towards death scored 38.35（29.00，48.00），while the positive attitude towards death scored 62.88（49.00，78.00）. The total score of Grief State Scale for Nurses was 47.05（40.00，53.00）. Hospice nurses’ intrusive rumination was positively correlated with negative attitudes toward death，professional grief，and negatively correlated with positive attitudes toward death（all P<0.05）；deliberate rumination was negatively correlated with negative attitudes toward death，professional grief，and positively correlated with positive attitudes toward death（all P<0.05）. Negative death attitudes and positive death attitudes partially mediated between intrusive rumination and professional grief，with mediation effects of 0.053 and 0.037，accounting for 12.70% and 9.25% of the total effect. Negative death attitudes and positive death attitudes similarly partially mediated between deliberate rumination and professional grief，with mediation effects of -0.033 and -0.080，accounting for 10.03% and 21.33% of the total effect. Conclusion Death attitudes are a mediating variable between hospice nurses’ rumination and professional grief. Nursing managers can take effective measures to improve hospice nurses’ ruminative contemplation ability and positively guide positive attitudes toward death，thereby reducing their professional grief levels.

Key words: Hospice Care, Professional Grief, Death Attitudes, Rumination, Mediation Analysis, Nursing Administration Research

摘要：

目的 调查安宁疗护中护士反刍性沉思与职业悲伤的现状，探讨死亡态度在两者间的中介效应，旨在为护理管理者制订科学、合理的干预措施提供依据。方法 采用便利抽样法，于2024年4月—7月选取杭州市4所医院从事安宁疗护工作的护士作为调查对象，采用一般资料调查表、事件相关反刍性沉思问卷、死亡态度描绘量表、护士悲伤状态量表进行调查。采用结构方程模型检验死亡态度在护士反刍性沉思与职业悲伤间的中介效应。结果 共回收问卷331份，其中有效问卷323份，有效问卷回收率为97.58%。护士侵入性反刍性沉思维度得分为13.34（7.00， 20.00）分，目的性反刍性沉思维度得分为16.92（11.00，24.00）分；负向死亡态度分量表得分为38.35（29.00，48.00）分，正向死亡态度分量表得分为62.88（49.00，78.00）分；护士悲伤状态量表总分为47.05（40.00，53.00）分。安宁疗护中护士的负向死亡态度、正向死亡态度在侵入性反刍性沉思和职业悲伤间起部分中介作用，中介效应值分别为0.053、0.037，占总效应的12.70%、9.25%；负向死亡态度与正向死亡态度在目的性反刍性沉思和职业悲伤间同样起部分中介作用，中介效应值分别为-0.033、-0.080，占总效应的10.03%、21.33%。结论 安宁疗护中护士的死亡态度是其反刍性沉思与职业悲伤间的中介变量。护理管理者可采取有效措施改善护士的反刍性沉思能力、促使其形成正向死亡态度，进而降低护士的职业悲伤水平。

关键词: 安宁疗护, 职业悲伤, 死亡态度, 反刍性沉思, 中介效应分析, 护理管理研究