Nursing Ethics最新文献

{"title":"What factors influence patient autonomy in healthcare decision-making? A systematic review of studies from the Global South.","authors":"Muhammad Umair Akhtar, Muhammad Esswan Bhatti, Salim Fredericks","doi":"10.1177/09697330241272794","DOIUrl":"10.1177/09697330241272794","url":null,"abstract":"<p><p>BackgroundThe principle of respect for autonomy (PRA) is a central tenet of bioethics. In the quest for a global bioethics, it is pertinent to ask whether this principle can be applied as it is to cultures and societies that are devoid of the Western sociopolitical historical pressures that led to its emergence. Relational autonomists have argued for a more inclusive approach to patient autonomy which takes into account factors such as interdependency and social relations. However, at the outset of any relational approach, it is necessary to identify underlying factors that influence patient autonomy in non-Western cultures.ObjectiveTo conduct a review of the literature to uncover the mechanisms through which social, cultural, and religious factors influence and impact the application of the PRA in healthcare decision-making in non-Western cultures and societies.MethodsWe conducted a systematic review through a comprehensive search of three major electronic databases of biomedical sciences. Returned citations were imported to Covidence, full texts were assessed for eligibility, included articles were thoroughly reviewed and data was synthesized. PRISMA guidelines were followed.ResultsOur search retrieved 590 non-duplicate results, 50 of which were included after screening and full-text eligibility checks. The included studies were predominantly qualitative in nature, with few quantitative, mixed-methods, and review studies included. Our synthesis of data identified nine key factors that influenced patients' autonomous decision-making through cultural, social, religious, or intersectional pathways.ConclusionTwo main conclusions emerge from this review. Firstly, there is a notable dearth of bioethical research examining the influence of diverse factors on patients' inclination towards different conceptions of autonomy. Secondly, the analysis of prevalent collectivist cultures and deference of autonomy adds value to the solution-oriented relational autonomy debate. This raises questions regarding how decision-making can be truly autonomous in the presence of such large-scale factors, warranting further attention.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"875-891"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resilience, compassion fatigue, moral distress and moral injury of nurses.","authors":"Hamdan Mohammad Albaqawi, Mohammed Hamdan Alshammari","doi":"10.1177/09697330241287862","DOIUrl":"10.1177/09697330241287862","url":null,"abstract":"<p><p><b>Background:</b> Compassion fatigue, moral distress, and moral injury are interconnected phenomena that have a detrimental impact on the delivery of nursing care. Nurses possess the inherent resilience necessary to effectively handle these three adverse occurrences. <b>Aim:</b> To determine the mediating impact of resilience on compassion fatigue, moral distress, and moral injury among nurses in Saudi Arabia. <b>Design:</b> The final product was a structural equation model (SEM) generated using a quantitative correlation cross-sectional design, and we followed the STROBE guidelines for this study. <b>Methods:</b> The study involved a sample of 511 staff nurses, who were selected using consecutive sampling. The study was conducted in three government hospitals in Saudi Arabia. <b>Ethical considerations:</b> This study received approval from Ethics Committee under approval number H-2021-151 on March 5, 2021. The survey's description and consent statements were clearly presented on Google survey forms in both English and Arabic. <b>Results:</b> Results showed that resilience negatively influenced moral distress, while compassion fatigue and moral injury had a positive influence. Likewise, compassion fatigue had a direct, positive effect on moral distress and moral injury, and moral distress had a direct, positive effect on moral injury. Analyses also showed that resilience had positive, indirect effects on moral injury through the mediation of both compassion fatigue and moral distress. Similarly, compassion fatigue had a positive, indirect effect on moral injury through the mediation of moral distress. <b>Conclusion:</b> Because resilience enables nurses to adapt, it helps them overcome obstacles in their career and professional lives. Resilience is frequently cited by nurses as a protective quality. Moral injury, compassion fatigue, and moral distress can negatively impact the health of nurses. <b>Implications for the profession and/or patient care:</b> Nurse leaders should develop programmes and initiate efforts to improve nurses' resilience as an important protective trait against compassion fatigue, moral distress, and moral injury. <b>Patient or Public Contribution:</b> There was no public or patient participation in this study.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"798-813"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Moral spaces\": A feasibility study to build nurses' ethical confidence and competence.","authors":"Georgina Morley, Dianna Jo Copley, James F Bena, Shannon L Morrison, Rosemary B Field, Julia Gorecki, Cristie Cole Horsburgh, Nancy M Albert","doi":"10.1177/09697330241284356","DOIUrl":"10.1177/09697330241284356","url":null,"abstract":"<p><p><b>Background:</b> Pre-licensure ethics nursing education does not adequately prepare and instill confidence in nurses to address ethical issues, and yet ethics education provides nurses with greater confidence to take moral action, which can mitigate the negative effects of moral distress.<b>Objectives:</b> To assess the feasibility and acceptability of a nursing ethics education programme that included simulated case-based ethics competencies as a form of evaluation. The programme aimed at building nurses' ethical knowledge and confidence to respond to ethical challenges in practice.<b>Research design:</b> A prospective, longitudinal, correlational, single-cohort feasibility study using an investigator-developed survey and intervention field data.<b>Participants and research context:</b> Registered nurses were recruited from an academic quaternary-care medical center and 9 small- to mid-sized regional hospitals within one health system in the Midwest United States.<b>Ethical considerations:</b> IRB approval was obtained. Participants could complete the educational programme regardless of research process participation.<b>Findings:</b> Of 20 participants, 19 (95%) provided post-programme surveys and 18 completed competencies. Median (IQR) scores with quartiles for scheduling, timing, and length of sessions were all 10.0 [9.0, 10.0], and participants perceived that the content was interesting, increased knowledge and confidence in ethics, increased skills in providing ethical care, and would recommend the programme to colleagues. Of factors, an increase in ethics knowledge had the highest \"always agree\" (17, 89.5%) response. Most participants reported that ethics competencies were appropriate 9.0 [9.0, 10.0] and sufficiently challenging 10.0 [9.0, 10.0].<b>Discussion:</b> The education programme developed nurses' ethics knowledge and confidence. The single-cohort feasibility design provided early-stage intervention outcomes; however, a larger randomized controlled trial would substantiate programme value.<b>Conclusion:</b> This novel ethics education programme was highly feasible and acceptable to hospital-based nurses who reported increased knowledge and confidence in providing ethical care. Simulated case-based ethics competencies were an appropriate evaluation method.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"782-797"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative nurses' empathic tendencies, quality of life, individualized care perceptions.","authors":"Emel Emine Kayikci, Cemile Savci, Ayse Cil Akinci","doi":"10.1177/09697330251314091","DOIUrl":"10.1177/09697330251314091","url":null,"abstract":"<p><p><b>Background:</b> Palliative care is an important part of health services. The individualized care perceptions are is critical for supporting individuality during care and providing quality nursing care. Individualized care not only has, as well as having foundation of the philosophy of nursing but also, is also related to the nurses' empathic tendencies and professional quality of life of nurses.<b>Aim:</b> This study was conducted to examine the relationships between the empathic tendencies, professional quality of life, and individualized care perceptions of palliative care nurses.<b>Research design:</b> This is a cross-sectional study.<b>Participants and research context:</b> The study was conducted with 141 nurses working in palliative care between December 2023 and February 2024. The data of the study were collected using a \"Participant Information Form,\" the \"Emphatic Tendency Scale (ETS),\" the \"Professional Quality of Life Scale (ProQOL R-IV),\" and the \"Individualized Care Scale-Nurse Version A (ICS-Nurse-A).\"<b>Ethical considerations:</b> Ethics committee approval was obtained to conduct the study. Individuals who agreed to participate in the study were informed of the purpose of the study, and their written consent was obtained.<b>Findings:</b> The participants had moderate levels of empathic tendencies, compassion satisfaction, and burnout, while their compassion fatigue and individualized care perceptions were high. There was a positive correlation between empathic tendencies and individualized care perceptions (<i>p</i> < .01). Empathic tendency and compassion satisfaction were significant positive predictors of the individualized care perceptions of the participants and respectively explained 13% and 20% of the total variance in their individualized care perceptions. On the other hand, burnout was a significant negative predictor of their individualized care perceptions and explained 5% of the total variance in their individualized care perceptions.<b>Conclusions:</b> High levels of empathic tendencies and compassion satisfaction had positive effects on the individualized care perceptions of palliative care nurses, whereas high levels of burnout had a negative effect on the same variable.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"941-954"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient's sexual dignity discomfort in healthcare setting: A concept development.","authors":"Sihyun Park, Hyunji Woo, Yegyu Lee, Yejung Ko","doi":"10.1177/09697330251314095","DOIUrl":"10.1177/09697330251314095","url":null,"abstract":"<p><p><b>Background:</b> Body touch and close physical proximity are inevitable in some healthcare procedures and can evoke feelings of shame, humiliation, and anger in patients. Given the increasing recognition of human dignity, exploring the occurrence of these negative emotional experiences and identifying mechanisms for their prevention are crucial.<b>Aim:</b> To develop and define the concept of \"patient's sexual dignity discomfort.\" Design: A hybrid model of concept development was utilized.<b>Methods:</b> In the theoretical phase, a scoping review was conducted to establish a working definition of patient's sexual dignity discomfort. This definition was refined and validated using qualitative data collected during the fieldwork phase. In the analytical phase, a final conceptual model of patient's sexual dignity discomfort was proposed by integrating findings from both the theoretical and fieldwork phases.<b>Ethical considerations:</b> All participants completed an informed consent process, and interviews were conducted via Zoom or phone by a certified psychiatric nurse to ensure confidentiality, anonymity, and comfort.<b>Results:</b> Four themes describing attributes of patient's sexual dignity discomfort were explored: experiencing shame and embarrassment, vulnerability-induced loss of control, dehumanization and objectification, and uncertain sexual autonomy. Patient's sexual dignity discomfort occurs when patients perceive care procedures as sexually inappropriate or as involving unnecessary sexual activity, particularly when healthcare providers display unprofessional attitudes or when patients lack consent or are not mentally prepared for the procedure because of insufficient information. This discomfort leads patients to refuse or avoid healthcare treatments and prioritize finding better healthcare services over their health. It can also prompt providers to avoid patients, resulting in a compromised quality of care and poor health outcomes.<b>Conclusions:</b> Patient's sexual dignity discomfort poses a significant threat to the quality of patient care and preservation of dignity. Nurses can trigger this intentionally or unintentionally, highlighting the need for comprehensive education and training to prevent it.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"955-970"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring trust in healthcare with instruments developed in different disciplines - A scoping review.","authors":"Venla Karikumpu, Arja Häggman-Laitila, Anja Terkamo-Moisio","doi":"10.1177/09697330241272806","DOIUrl":"10.1177/09697330241272806","url":null,"abstract":"<p><p>BackgroundTrust is a key character at organizational level. Understanding the level of trust with timely relevant instrument is a significant process to capture the level of trust beyond organizational changes in healthcare.ObjectivesTo gather, assess, and synthesize the items of instruments evaluating trust in healthcare organizations.DesignScoping review methodology.MethodsThe literature search with deductive-inductive content analysis. The data were charted from articles that involved the use of trust instruments in healthcare organizations.Data SourcesSearch from eight databases was updated in January 2024 and included peer-reviewed articles published between 2010 and 2023.ResultsA total of 13 instruments were found measuring trust in the organization, trust in the leader, and trust among peers in healthcare. The items of instruments about trust in the organization included strategic and operational cultures. The trust in the leader consisted of competence, consistency, openness, appreciative acceptance, and loyalty and risk, while instruments about trust among peers included dimensions of moral partnership, common interest, and competent peers.ConclusionsComprehensively measuring trust in the leader, trust in the organization, and trust among peers is significant due to the multifaceted dimension of trust. Measuring trust offers a possibility to recognize the working relationships and cultures in healthcare organizations.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"724-737"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11993817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lived experience of ethical challenges among undergraduate nursing students during their clinical learning.","authors":"Silvia Gonella, Elena Viottini, Chris Gastmans, Sara Tambone, Alessio Conti, Sara Campagna, Valerio Dimonte","doi":"10.1177/09697330241262311","DOIUrl":"10.1177/09697330241262311","url":null,"abstract":"<p><p>BackgroundUndergraduate nursing students may experience several ethical challenges during their clinical learning placement that can lead to moral distress and intention to leave the profession. Ethical challenges are complex phenomena and ethical frameworks may help improve their understanding and provide actionable recommendations to enhance students' readiness for practice.AimTo explore undergraduate nursing students' ethical challenges experienced during their clinical learning and their suggestions for better ethics education; to illuminate students' experience against a foundational ethical framework.Research designQualitative study based on interpretative phenomenology. Semi-structured, in-person or at distance, one-to-one interviews were performed, audio-recorded, and transcribed verbatim. The 'Dignity-enhancing care framework' was employed to frame the study findings.Participants and research contextNineteen nursing graduands attending seven sites of one Northwestern Italian University were interviewed.Ethical considerationThe study protocol was approved by the Ethics Committee of the University of Torino (number 0187646/2023). All participants provided written informed consent.FindingsStudents experienced several ethical challenges concerning daily practice such as pain control or the decision to restrain patients, and reported deficient professional ethics with healthcare professionals who demonstrated poor caring attitudes and teamwork. Moreover, they perceived professionals poorly committed to their role of educators and complained of poor support in the learning process. When a supportive, dialogical, and relational context lacked, students experienced negative feelings about the profession and the healthcare system and reported the intention to leave the profession. Dialogue with peers, family members or significant others, nursing educators, and clinical nurse supervisors, as well as self-learning activities and discussion-based teaching methods grounded on real scenarios helped to overcome challenging situations.ConclusionWhile complying with normative standards, nursing education policies should encourage the adoption of dynamic teaching methods and sustain a regular, dialogical approach within and between the clinical and academic contexts to improve readiness for practice.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"814-827"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nursing ethics and the perspectivity of nursing: Response to '30 years of nursing ethics'.","authors":"Settimio Monteverde","doi":"10.1177/09697330251322268","DOIUrl":"10.1177/09697330251322268","url":null,"abstract":"","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"696-697"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The nurses' clinical environment belongingness and professional identity: The mediating role of professional values.","authors":"Somaye Bakhshi Zadeh, Ali Mohammad Parviniannasab, Mostafa Bijani, Azizallah Dehghan, Aezam Zare","doi":"10.1177/09697330241268901","DOIUrl":"10.1177/09697330241268901","url":null,"abstract":"<p><p>BackgroundBelonging to the clinical environment and the professional values of the performers play a role in forming a professional identity. Therefore, it is necessary to understand the degree of connection among these concepts.AimThis study aimed to examine the mediating effects of professional values on the relationship between nurses' clinical environment belongingness and professional identity.DesignIn the present study, a descriptive cross-sectional multicenter design was used.Participants and research contextA convenient sample of 635 nurses recruited from three hospitals in Fars Province, Southern Iran, from September 2023 to January 2024. Nurses Professional Values Scale-Revised, Clinical Environment Belongingness Scale, and Professional Identity Scale were used to collect the data. The mediation model was analyzed using SPSS v27 and the Process Macro 4.0.Ethical considerationsThe protocol of this study was approved by the Research Ethics Committee of Fasa University of Medical Sciences, and informed consent was obtained from all nurses. The study conforms to the principles outlined in the Declaration of Helsinki.ResultsBased on the results of regression analysis, clinical environment belongingness had a positive and significant impact on professional identity (β = 0.366, <i>p</i> < 0.001) and professional value (β = 0.676, <i>p</i> < 0.001). Professional value significantly predicted professional identity (β = 0.170, <i>p</i> < 0.001). The indirect effect of clinical environment belongingness on professional identity via professional values was statistically significant (β = 0.115, SE = 0.024, 95% CI = [0.068, 0.162]), and this effect was directly (β = 0.336, SE = 0.034, 95% CI = [0.297, 0.434]) significant.ConclusionsThe new theoretical framework for nurses developed in this study can contribute to professional development. It is further recommended that the promotion of professional value and clinical environment belongingness may be effective in enhancing the professional identity of the nursing staff, as indicated by the results.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"851-863"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reflexive moralization: The crucial role of clinician moral well-being.","authors":"Clare Whitney","doi":"10.1177/09697330251339057","DOIUrl":"https://doi.org/10.1177/09697330251339057","url":null,"abstract":"<p><p>BackgroundMoralization, or the application of moral value onto individuals' actions or identities, has broad impact in the context of health and healthcare. In particular, moralization may result in interpersonal and institutional consequences for certain groups of individuals such as people who use substances during pregnancy or while feeding human milk. Reflexive moralization is an underexplored phenomenon that represents the reflex-like nature of some instances of moralization. <b>Objectives:</b> The purpose of this study was to explore and explain how reflexive moralization impacts the perinatal care of substance-exposed dyads.Research DesignIn this targeted sub-analysis, dimensional analysis was used in the mode of emergent fit to analyze qualitative interviews conducted for a parent study investigating the circumstances under which clinicians bring moral considerations into the care of substance-exposed dyads.Participants and Research ContextInterviews with fifteen perinatal health clinician providing health or social care to substance-exposed dyads were included in this analysis.Ethical ConsiderationsThe X IRB determined this study exempt. All participants provided informed consent prior to enrolling in the study.ResultsFindings revealed novel dimensions of reflexive moralization, including the process of sympathization, which occurs when clinicians demoralize and transform their reflexive moralization into a tool for care. In order for the transformative process of sympathization to occur, clinician moral well-being must be assessed as sufficient, meaning clinicians must feel they have the capacity and competence to provide adequate care to patients. <b>Discussion:</b> Future research should further investigate the nature of clinician moral well-being in order to measure and develop interventions to support it.ConclusionsClinician moral well-being plays a pivotal role in clinical care delivery for substance-exposed dyads, in the context of reflexive moralization.</p>","PeriodicalId":49729,"journal":{"name":"Nursing Ethics","volume":" ","pages":"9697330251339057"},"PeriodicalIF":2.9,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}