Abstract:

Objective To systematically evaluate the psychological feelings and real experience of ICU nurses’ moral dilemma，and the aim is to provide references for the formulation of targeted psychological intervention programs. Methods Pubmed，CINAHL，Embase，Web of Science，Cochrane Library，PsycNET，CNKI，Wanfang database，VIP database，and China Biomedical Literature Database were searched by computer to retrieve qualitative studies on psychological perceptions and real experiences of moral dilemmas of ICU nurses，and the search time was from the establishment of databases to March 2023. The quality of literature was evaluated using the 2016 version of the Australian JBI Centre for Evidence-Based Health Care Quality Evaluation Criteria for qualitative studies，and the results were integrated and analyzed by the Meta integration method. Results A total of 10 pieces of literature were included，including 3 phenomenological studies and 7 descriptive studies. The results of 27 studies were summarized into 8 new categories，and 3 integrated results were obtained：①The internal and external causes of moral dilemmas，including conflicting concepts of life and death，differences of the idea of the superior death，conflict of clinical decision-making，and insufficient organizational support；②The progressive effects of moral dilemmas，including aggravating negative emotional burden and breeding professional identity bias；③Coping strategies for moral dilemmas，including active self-debugging and seeking support from colleagues. Conclusion It is urgent to popularize the scientific concept of life and death of patients and families，deepen the concept of superior death of ICU nurses，and alleviate the conflict of nursing and patient decision-making. It is important to pay attention to the negative emotional state of ICU nurses，improve their professional identity，improve the self-adjustment ways of ICU nurses，and to provide multi-organization support for ICU nurses.

Key words: Intensive Care Units, Nurses, Moral Dilemma, Qualitative Research, Meta-Synthesis, Evidence-Based Nursing, Nursing Administration Research

摘要：

目的 系统评价ICU护士道德困境的心理感受和真实经历，旨在为制订针对性的心理干预方案提供参考。方法 计算机检索PubMed、CINAHL、Embase、Web of Science、Cochrane Library、PsycNET、中国知网、万方数据库、维普数据库、中国生物医学文献数据库等中英文数据库，筛选有关ICU护士道德困境的心理感受和真实经历的质性研究，检索时限为建库至2023年3月。采用澳大利亚乔安娜布里格斯研究所循证卫生保健中心制订的质性研究质量评价标准（2016版）进行文献质量评价，采用汇集性整合方法对结果进行分析、整合。结果 共纳入10篇文献，包括3篇现象学研究、7篇描述性质性研究。提炼出27个研究结果，归纳成8个新类别，综合成3个整合结果：①道德困境的内外缘由，包括生死观念矛盾、优逝理念参差、临床决策冲突、组织支持不足；②道德困境的渐进影响，包括加重消极情绪负担、滋生职业认同偏倚；③道德困境的应对策略，包括积极自我调试、寻求多元支持。结论 亟需普及患者及家属科学生死观，深化优逝理念，缓和医护患决策冲突；关注ICU护士负性的情绪状态，提高其职业认同感；改善ICU护士自我调适途径，给予多元组织支持。

关键词: 重症监护病房, 护士, 道德困境, 质性研究, Meta整合, 循证护理学, 护理管理研究