BACKGROUND & AIMS: OBJECTIVE:To determine the level of student drop-out from UK dental schools and to establish if drop-out is increasing, remaining steady or decreasing.

DESIGN:Retrospective analysis of data from the University Statistical Record.

SETTING:UK dental schools 1989-1994.

SUBJECTS AND METHODS:The data covered all dental students entering and leaving dental schools during the relevant time period.

RESULTS:The drop-out rate from UK dental schools between 1989 and 1994 ranged from 8.4% to 16.8% and is equivalent to the output of two to three medium-sized dental schools. Drop-out rate was higher in the three most recent years studied (1992-1994; 14.8%) than in the three earliest years studied (1989-1991; 10.6%).

CONCLUSIONS:Student drop-out is a significant and increasing problem for UK dental schools. Unless controlled, it will result in fewer dentists qualifying in the UK and exacerbate shortages in qualified dentists that may occur in future years.

背景与目标： 目标 : 确定英国牙科学校学生辍学的水平，并确定辍学是增加，保持稳定还是减少。
设计 : 大学统计记录数据的回顾性分析。
设置 : 英国牙科学校1989-1994。
主题和方法 : 数据涵盖了相关时间段内进入和离开牙科学校的所有牙科学生。
结果 : 英国牙科学校1989年和1994的辍学率从8.4% 到16.8% 不等，相当于两到三所中等牙科学校的产量。最近三年 (1992-1994; 14.8%) 的辍学率高于最早三年 (1989-1991; 10.6%)。
结论 : 对于英国牙科学校来说，学生辍学是一个重大且日益严重的问题。除非受到控制，否则将导致英国的牙医资格减少，并加剧未来几年可能出现的合格牙医短缺。

BACKGROUND & AIMS: :Breast and cervical cancer are the most common causes of cancer mortality among women worldwide, but actually they are largely preventable diseases. There is limited data on breast and cervical cancer knowledge, screening practices and attitudes of nurses in Turkey. A self-administered questionnaire was used to investigate the knowledge and attitude of nurses on risk factors of the breast and cervical cancer as well as screening programmes such as breast self-examination (BSE), clinical breast examination, mammography (MMG) and papanicolaou (pap) smear test. In total, 125 out of 160 nurses participated in the study (overall response rate was 80.6%). The risk factors and symptoms of breast cancer was generally well known, except for early menarche (23.2%) and late menopause (28.8%). For cervical cancer, the correct risk factors mostly indicated by the nurses were early age at first sexual intercourse (56%), smoking (76%), multiple sexual partners (71.2%). As for screening methods, it was believed that BSE was a beneficial method to identify the early breast changes (84.8%) and MMG was able to detect the cancer without a palpable mass (57.6%). Little was known about the fact that women should begin cervical cancer screening approximately 3 years after the onset of sexual intercourse (23.2%) and if repeated pap smear test were normal, it could be done every 2-3 years. Most of the nurses considered that MMG decreases the mortality in breast cancer (65.6%) and also believed that pap smear test decreases the mortality in cervical cancer (75.2%). Despite high level of knowledge of breast cancer risk factors, symptoms and screening methods, inadequate knowledge of cervical cancer screening method were found among nurses.

背景与目标： : 乳腺癌和宫颈癌是全世界女性癌症死亡的最常见原因，但实际上它们在很大程度上是可以预防的疾病。土耳其有关乳腺癌和宫颈癌知识，筛查实践和护士态度的数据有限。采用自编问卷调查护士对乳腺癌和宫颈癌危险因素的知识和态度，并进行乳房自我检查 (BSE)，临床乳房检查，乳房x线检查 (MMG) 和巴氏涂片检查等筛查计划。总共160名护士中有125名参加了研究 (总有效率为80.6%)。除初潮早期 (23.2%) 和绝经晚期 (28.8%) 外，乳腺癌的危险因素和症状通常是众所周知的。对于宫颈癌，护士指出的正确危险因素主要是初次性交年龄早 (56%)，吸烟 (76%)，多性伴侣 (71.2%)。至于筛选方法，认为BSE是识别早期乳房变化的有益方法 (84.8%)，并且MMG能够在没有可触及肿块的情况下检测癌症 (57.6%)。对于女性应在性交开始后大约3年开始进行宫颈癌筛查 (23.2%)，并且如果重复的巴氏涂片检查正常，则每2-3年进行一次，这一事实知之甚少。大多数护士认为MMG可以降低乳腺癌的死亡率 (65.6%)，并且还认为子宫颈抹片检查可以降低宫颈癌的死亡率 (75.2%)。尽管对乳腺癌危险因素，症状和筛查方法的了解程度很高，但护士对宫颈癌筛查方法的了解不足。

BACKGROUND & AIMS: OBJECTIVE:To describe the changing role of school nurses in eight New Zealand (NZ) secondary schools from low socio-economic areas with high Pacific Island and Māori rolls. METHODS:An evaluation of a pilot addressing under-achievement in low-decile schools in Auckland, NZ (2002-05). Annual semi-structured school nurse interviews and analysis of routinely collected school health service data were undertaken. RESULTS:Two patterns of school nurse operation were identified: an embracing pattern, where nurses embraced the concept of providing school-based health services; and a Band-Aid pattern, where only the basics for student health care were provided by school nurses. CONCLUSIONS AND IMPLICATIONS:School nurses with an embracing pattern of practice provided more effective school-based health services. School health services are better served by nurses with structured postgraduate education that fosters the development of a nurse-practitioner role. Co-ordination of school nurses either at a regional or national level is required.

背景与目标：

BACKGROUND & AIMS: AIM:To explore nurses' understanding and interpretation of evidence-based practice (EBP). BACKGROUND:EBP has been welcomed into the nursing lexicon without a critical examination of its interpretation by practitioners. The literature suggests that there is a great deal of confusion and contradiction over the meaning and application of EBP. Although work has been conducted on how EBP might be implemented, the general issue of how nurses understand and use EBP is largely unexplored. This paper seeks to examine in depth the understandings of EBP, to enable managers, educationalists and policy makers to implement it more effectively. METHODS:All registered nurses, midwives and health visitors in one UK National Health Service (NHS) Trust were asked to complete a questionnaire in October 2006. RESULTS:Despite a disappointing response rate (8.9%, 218/2438), the survey revealed interesting tensions and contradictions in nurses' understanding of EBP. National and local guidelines, practitioners' own experience and patients' preferences were the main influences on nurses' practice. Published research had relatively little impact, particularly among nurses graded E, F and G and those who had not attended a study day on EBP. CONCLUSIONS:The hierarchies of evidence propounded in local and national guidelines are not adopted by practising nurses, who use other sources of evidence, such as reflection on their own experiences, when making clinical decisions. However, subsuming published evidence to clinical judgement does not contradict the original tenets of EBP. IMPLICATIONS FOR NURSING MANAGEMENT:Unless it is incorporated into national or local guidelines, research has relatively little impact on practice. To develop nursing practice and nursing knowledge, nurse leaders need to foster the synthesis of experiential knowledge and published research, in accordance with the founding principles of the EBP movement.

背景与目标：

BACKGROUND & AIMS: AIMS:The aim of the present study was to compare the levels of stress, depression, and intention to leave among clinical nurses employed in different medical units in relation to their demographic characteristics under the National Health Insurance (NHI) System in Taiwan. METHODS:Cross-sectional Spearman's correlation, one-way ANOVA with Scheffe post hoc analysis tests, and multiple regression analyses were conducted. Several self-report questionnaires, such as the Center for Epidemiological Studies Depression Scale, the Perceived Stress Scale and Intention to Leave Scale, were administered. A total of 314 research participants were surveyed, all of whom came from regional hospitals in Northern Taiwan. RESULTS:Marital status and working tenure were significant predictors to the levels of stress, depression, and intention to leave among nurses before taking the medical units into consideration. However, with adding medical units as predictors, the effect of marital status and working tenure were insignificant except for the stress model, indicating medical units were showing dominant effect over other variables. In particular, internal medical ward (IMW) nurses experienced a higher prevalence of depression than emergency room (ER) nurses and professional nursing practitioners. External medical ward (EMW) nurses also experienced greater depression than emergency room (ER) nurses. Both IMW and EMW nurses perceived significantly greater stress than ER and dialysis center. Moreover, IMW nurses also perceived greater stress than operating room (OR) nurses and showed stronger intention to leave than their counterparts in the outpatient service departments. CONCLUSIONS:The results indicated that significant differences existed among various medical units with regards to nurses' stress, depression, and intention to leave. Nurses working in internal and external medical wards, especially the inexperienced and married ones, experienced greater depression and stress, thereby developing stronger intention to leave their job.

背景与目标：

BACKGROUND & AIMS: AIM:This article is a report of a study of occupational burnout among nurses in China. BACKGROUND:Burnout is described as feelings of emotional exhaustion, depersonalization and reduced personal accomplishment. It is well-known that burnout is a major problem for many professions. Nurses are considered to be particularly susceptible to this. Measuring burnout among nurses is important because their well-being has implications for stability in the healthcare workforce and for the quality of care provided. METHOD:The sample consisted of 495 nurses from three provincial hospitals in China. The Maslach Burnout Inventory -- General Survey (MBI-GS) was used to measure burnout, and the Occupational Stress Inventory -- Revised edition was used to measure two dimensions of occupational adjustment (occupational stress and coping resources). After statistical testing for validity and reliability of the MBI-GS with nurses in China, participants' scores were evaluated and analysed. RESULTS:Scores for burnout of surgical and medical nurses were statistically significantly higher than those of other nurses (P < 0.05). Lower educational status was associated with lower professional efficacy, and younger nurses reported higher levels of burnout. The most significant predictors of emotional exhaustion were role overload, responsibility, role insufficiency and self-care (P < 0.05). The most significant predictors of cynicism were role insufficiency, role boundary, responsibility and self-care (P < 0.05). The most significant predictors of professional efficacy were role insufficiency, social support and rational/cognitive coping (P < 0.05). CONCLUSION:It is important to reduce occupational stress in nurses and to strengthen their coping resources to prevent burnout. This could be achieved with job redesign, modification of shiftwork systems, and by offering occupational health education.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:Nurse educators need an enhanced understanding of factors contributing to nursing student success to decrease attrition and increase retention. Improved understanding of factors related to successful nurse preparation could improve educational processes and facilitate student success, thereby addressing the worldwide nursing shortage as well as increasing the competence and expertise of new graduates. Student-faculty trust and related characteristics have been identified as factors associated with student success (Applebaum, 1995). Research investigating trust in communications and education has been conducted with students in other disciplines but not with nursing students. This research investigated the complex relationships between students' trust in faculty, the students' mood states, and students' educational performance and outcomes. METHOD:The study utilized a quantitative, cross-sectional, descriptive, and correlational design. Student volunteers were recruited from a baccalaureate nursing education program located in the southwest United States. Participants completed three instruments: the Health Sciences Reasoning Test (HSRT), Profile of Mood States (POMS), and Interpersonal Trust Scale (ITS). The resulting scores were compared and contrasted along with selected demographic variables. RESULTS:The study identified a significant relationship between total mood disturbance and interpersonal trust. The trends in the POMS subscales of Anger and Confusion are of particular interest, as the two factors strongly influenced shifts in Total Mood Disturbance. As students progressed through the nursing program, experiences of Anger and Confusion increased with each progressive semester and were accompanied by corresponding decreases in trust. CONCLUSIONS:The results complement established findings relating mood and cognitive function. Alterations in the student's level of trust potentially could share relationships with cognition and critical thinking, although perhaps not in a direct and linear fashion.

背景与目标：

BACKGROUND & AIMS: Objective:this study explores the process of the development of an intention to leave bedside nursing. Method:the process was studied from the perspective of 21 nurses using the grounded theory method. Data were collected using semi-structured interviews and the constant comparative method of Corbin and Strauss was used for data analysis. Results:according to the participants, the two main categories, "social image of nursing", and "culture and structure of the bedside", were the contextual factors that influence why nurses are leaving bedside care provision. Disappointment with a perceived lack of progress or improvement in the clinical experience formed primary psychosocial concerns for the participants. Competence and a process of self-control were steps taken by the participants. These, associated with interventional conditions produced the outcomes of the loss of professional commitment and desire to leave bedside nursing. "Failure to integrate personal expectations with organizational expectations: in search of escape" was the central category of the study that linked the categories together. Conclusion:the findings of this study provide useful information about the needs of nurses for overcoming the intention to leave bedside care. The identification of this process can help in recognizing emerging problems and providing solutions for them. Objetivo:este estudo explora o processo de desenvolvimento da intenção de deixar a enfermagem de cabeceira. Método:o processo foi estudado desde a perspectiva de 21 enfermeiras utilizando o método da Grounded Theory (Teoria Fundamentada). Os dados foram coletados utilizando entrevistas semi-estruturadas e o método comparativo constante de Corbin e Strauss se utilizou para analisar os dados. Resultados:segundo os participantes, duas categorias principais, "imagem social da enfermagem" e "cultura e estrutura de cabeceira", foram os fatores contextuais que influenciam as razões para que as enfermeiras estejam deixando o cuidado de cabeceira. A decepção com a percepção de falta de progresso ou melhora na experiência clínica cria preocupações psicossociais primárias para as participantes. A competência e o processo de autocontrole são passos dados pelas participantes. Isso associado a condições de intervenção foram os resultados da perda do compromisso profissional que as leva a deixar o cuidado de cabeceira. "O fracasso em integrar expectativas pessoais e expectativas da organização: em busca de uma saída" foi a categoria central do estudo que uniu as categorias. Conclusão:os achados deste estudo proporcionam informação útil sobre as necessidades das enfermeiras para superar as intenções de deixar o cuidado de cabeceira. A identificação deste processo pode ajudar a reconhecer os problemas emergentes e oferecer soluções para resolvê-los. Objetivo:este estudio explora el proceso de desarrollo de la intención de dejar la enfermería de cuidado de cabecera. Método:el proceso fue estudiado desde la perspectiva de 21 enfermeras utilizando el método de la Grounded Theory (Teoría Fundamentada). Los datos se recogieron utilizando entrevistas semiestructuradas; para analizar los datos se utilizó el método comparativo constante de Corbin y Strauss. Resultados:según los participantes dos categorías principales ("imagen social de la enfermería" y "cultura y estructura del cuidado de cabecera ") fueron los factores contextuales que influenciaron las razones para que las enfermeras deseasen dejar el cuidado de cabecera. La decepción con una percepción de falta de progreso o mejora en la experiencia clínica causó preocupaciones psicosociales primarias en las participantes. La competencia y el proceso de autocontrol fueron considerados por las participantes, y esto asociado a las condiciones de intervención resultaron en la pérdida del compromiso profesional que las lleva a dejar el cuidado de cabecera. La categoría central del estudio que unió las categorías encontradas fue: "Fracaso para integrar las expectativas personales con expectativas de la organización: en busca de una salida". Conclusión:los hallazgos de este estudio proporcionan información útil sobre las necesidades de las enfermeras para superar las intenciones de abandonar el cuidado de cabecera. La identificación de este proceso puede ayudar a reconocer los problemas emergentes y ofrecer soluciones para resolverlos.

背景与目标：

BACKGROUND & AIMS: :The end of the twentieth century and the beginning of the twenty-first century are marked by technology revolution and strategic changes in organizations. Strategies such as the e-learning, has been used for training human resources. This study aimed to compare the knowledge acquired among groups of nurses who used e-learning and those who undergone a traditional classroom training. The true-experimental design was used followed by a quantitative analysis. This study was performed at the Hospital and Maternity São Luiz. The study population was composed by 60 nurses, randomly assigned to two groups, named A and B. Group A received the traditional classroom training and group B received the computer-assisted training. In the data collection, participants filled in a questionnaire before and after the training to evaluate their knowledge and to characterize the population. Results showed there was an equal acquisition of knowledge in both groups; confirming the efficacy of both methods.

背景与目标： : 20世纪末和二十一世纪初的特点是技术革命和组织的战略变革。电子学习等战略已用于培训人力资源。这项研究旨在比较使用电子学习的护士组和接受传统课堂培训的护士组之间获得的知识。使用真实实验设计，然后进行定量分析。这项研究是在圣路易斯医院和产妇进行的。研究人群由60名护士组成，随机分为A和B两组。A组接受传统课堂培训，B组接受计算机辅助培训。在数据收集中，参与者在培训前后填写了调查表，以评估他们的知识并确定人口特征。结果表明，两组的知识获得均等; 证实了两种方法的有效性。

BACKGROUND & AIMS: :While the nephrology nursing shortage persists despite the continued growth of the population of individuals with Stage 5 chronic kidney disease, there is a paucity of empirical data regarding nephrology nurses' perceptions of their work environments. Moreover, there are no studies that have examined the relationship of work environment attributes to patient and nurse outcomes in dialysis settings. The purpose of this study was to examine the relationships between staff nurses' perceptions of dialysis work environments, nurses' intentions to leave their current jobs, nurse turnover, patient satisfaction, and patient hospitalization rates. A descriptive, correlational design was used. Nurse level and facility level data were obtained. The sample for nurse-level data consisted of 199 registered nurses in staff nurse roles in 56 dialysis facilities of a national dialysis company. The sample for facility-level analysis consisted of 46 dialysis facilities, and nurse-level data were aggregated for facility-level analysis. The Practice Environment Scale-Nursing Work Index (PES-NWI) was used to measure nurses' perceptions of the dialysis work environment. Nurses' intention to leave their jobs and facility-level turnover rates were the nurse outcomes examined in this study. Facility-level patient satisfaction and hospitalization rates were the patient outcomes examined. Correlation coefficients were computed to measure the relationships between study variables, and independent t-tests were performed to examine subgroup differences in work environment perceptions. Overall, nurses rated the work environment somewhat favorably. Nurses who expressed intention to leave their jobs rated the work environment more negatively compared to nurses who intended to stay. Significant correlations were found between nurses' perceptions of the dialysis work environment, nurses' intention to leave their jobs, nurse turnover rates, and patient hospitalizations. Study findings suggest that nurses' perceptions of the dialysis work environment are important for nurse and patient outcomes in dialysis settings. Further research is needed to explore the predictive ability of the work environment for nurse and patient outcomes in hemodialysis units.

背景与目标： : 尽管患有5期慢性肾脏病的人群持续增长，但肾脏病护理短缺仍然存在，但有关肾脏病护士对其工作环境的看法的经验数据很少。此外，没有研究检查透析环境中工作环境属性与患者和护士结果之间的关系。这项研究的目的是研究护士对透析工作环境的看法，护士离职的意图，护士更替，患者满意度和患者住院率之间的关系。采用描述性、相关设计。获得护士级别和设施级别数据。护士级数据的样本由一家国家透析公司的56个透析设施中的199名担任护士角色的注册护士组成。用于设施级别分析的样本由46个透析设施组成，并汇总了护士级别的数据以进行设施级别分析。实践环境量表-护理工作指数 (pes-nwi) 用于衡量护士对透析工作环境的看法。护士离职的意图和机构级别的更替率是本研究中检查的护士结果。设施级别的患者满意度和住院率是检查的患者结局。计算相关系数以衡量研究变量之间的关系，并进行独立的t检验以检查工作环境感知的亚组差异。总体而言，护士对工作环境的评价有些不错。与打算留下的护士相比，表示打算离职的护士对工作环境的评价更为负面。在护士对透析工作环境的看法，护士离职的意愿，护士更替率和患者住院之间发现了显着的相关性。研究结果表明，护士对透析工作环境的看法对于透析环境中的护士和患者结果很重要。需要进一步的研究来探索血液透析单元中工作环境对护士和患者结果的预测能力。

BACKGROUND & AIMS: OBJECTIVES:To test an educational intervention designed to improve lactation knowledge, attitudes, and beliefs of NICU nurses and to improve their intentions to provide mothers with lactation support. DESIGN:Quasi-experimental, time-series pretest/posttest. SETTING:NICU of a Midwestern, free-standing, tertiary-care children's hospital. PARTICIPANTS:Convenience sample of 64 NICU nurses and 2 separate convenience samples of mothers of infants hospitalized in the NICU (n=19 and 13, respectively). METHODS:Nurses were measured on study outcomes at multiple time points, beginning with 2 weeks before and ending at 3 months after attendance to a 4-hour educational program. Mothers were sampled before and 3 months after the intervention. MAIN OUTCOME MEASURE(S):Nurses' lactation knowledge, attitudes, beliefs, and intentions to support lactation and mothers' perceptions of lactation support in the NICU. RESULTS:Findings suggest that this educational intervention was effective for improving NICU nurses' lactation knowledge and attitudes, and that these improvements were maintained over time. Further, the supportive atmosphere for lactation in this NICU significantly improved following the implementation of the educational intervention for nurses. CONCLUSION:Intermittent, short educational programs which include practical how-to's and motivational encouragement for staff may provide the empowerment nurses need in order to be supportive of lactation.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Screening, brief intervention, and referral to treatment (SBIRT) for substance use has an impact on morbidity and mortality and health care cost. LOCAL PROBLEM:Nurses in ambulatory care settings may lack knowledge about evidence-based substance use SBIRT. METHODS:A comparison of pre- and postintervention data was performed to determine whether knowledge improved and to identify facilitators and barriers to SBIRT implementation. INTERVENTIONS:Nurses completed an online self-paced program focusing on alcohol and drug use screening, motivational interviewing used in a brief intervention, and referral to specialty treatment. RESULTS:Postintervention knowledge scores increased (P < .001). Facilitator and barrier themes included time, education, resources, receptivity, and interprofessional collaboration. CONCLUSIONS:The implementation of the SBIRT online program was feasible for nurses to complete during work hours and resulted in increased SBIRT-related knowledge.

背景与目标：

BACKGROUND & AIMS: :Health care systems are changing at an unprecedented rate, but few are making the changes in a system affecting nearly 200,000 staff in over 1,100 different sites of service delivery originating from 171 medical centers nationwide, as is the Veterans Health Administration. The issues of change, quality of care, morale and opportunities involved in being a nurse today in a system undergoing this magnitude of change is presented within the framework of the quality of care initiatives that have been launched by VA. The new organization design of VA, emphasizing local decision-making, a description of the multiple quality programs recently introduced and integrative strategies that have been used by the Nursing Strategic Healthcare Group, the VA corporate level policy and nursing programs information center for the country, to support the change process are discussed.

背景与目标： : 医疗保健系统正在以前所未有的速度变化，但很少有人在影响来自全国171医疗中心的1,100多个不同服务提供地点的近200,000名员工的系统中做出变化，退伍军人健康管理局也是如此。在VA发起的护理质量计划的框架内，介绍了当今在经历如此巨大变化的系统中担任护士所涉及的变化，护理质量，士气和机会等问题。VA的新组织设计，强调本地决策，对最近引入的多种质量计划的描述以及护理战略医疗小组，VA企业级政策和护理计划信息中心使用的整合策略。国家，讨论了支持变更过程的内容。

BACKGROUND & AIMS: BACKGROUND:It is important to clarify nurses' perceptions of conditions for patient education in daily work as research findings are ambiguous. There is a gap between societal regulations on nurses' competence in accomplishment/achievement of patient education and research findings. AIM:The aim was to describe nurses' perceptions of conditions for patient education, focusing on aspects of competence. The aim was also to describe differences in conditions for nurses working in primary, municipal and hospital care. METHODS:The study is a cross-sectional survey and is part of a project about nurses' patient-education. A randomized selection of nurses (842) received a questionnaire comprising 47 items concerning factual experience and attitudes to patient education and 13 background items. Questionnaires were returned by 83% of participants. Descriptive statistics, non-parametric tests and content analysis for open-ended items were used. RESULTS:Nurses' perceptions of conditions for patient education differ between health-care settings. Primary care nurses are at an advantage in following research in patient education, perception of their own competence (prioritizing and knowing their mandate in patient teaching), pedagogical education and post graduate specializations. CONCLUSIONS:Nurses' patient education must be more visualized and appropriate conditions created at each workplace. In this change process, managers' support is considered vital.

背景与目标：

BACKGROUND & AIMS: :Oncology nurses encounter increasingly complex ethical challenges in clinical practice. This ethnographic study explored 30 oncology nurses' descriptions of ethical situations and 12 key informants' perspectives on factors that influence the development of ethically difficult situations. Nurses described the goals of preventing patient suffering and injury, being honest with patients, and contributing meaningfully to patient improvement and stated goals. Nurses experienced six primary challenges in meeting their goals: being the eyes and arms of patient suffering, experiencing the precariousness of competing obligations, navigating the intricacies of hope and honesty, managing the urgency caused by waiting, straining to find time, and weighing risks of speaking up in hierarchal structures. Nurse actions included addressing concerns, creating other avenues, murmuring to one another, staying silent, and looking away. Several factors influenced nurses' responses to ethical challenges. Results imply a contextual model of moral action that reveals a need for altering practice environments in addition to improving nurses' ethics skills. Nurses are very aware of their moral responsibilities in ethically difficult situations and need work environments conducive to interprofessional collaboration and open dialogue.

背景与目标： : 肿瘤护士在临床实践中遇到越来越复杂的伦理挑战。这项人种学研究探索了30位肿瘤学护士对道德状况的描述，以及12位关键信息提供者对影响道德困难状况发展的因素的看法。护士描述了预防患者痛苦和伤害，对患者诚实以及为患者改善和既定目标做出有意义贡献的目标。护士在实现目标方面经历了六个主要挑战: 成为患者痛苦的眼睛和手臂，经历竞争义务的不稳定，驾驭希望和诚实的复杂性，管理等待引起的紧迫性，努力寻找时间以及权衡在层次结构中说话的风险。护士的行动包括解决问题，创造其他途径，互相抱怨，保持沉默和移开视线。几个因素影响了护士对道德挑战的反应。结果暗示了道德行为的上下文模型，该模型揭示了除了提高护士的道德技能外，还需要改变实践环境。护士非常清楚自己在道德上困难的情况下的道德责任，需要有利于专业间合作和公开对话的工作环境。