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Abstract：
BACKGROUND: Abusive supervision by the nurse manager significantly influences nurses\' withholding voice about patient safety. The role of impression management motivation and speak up-related climate is crucial in understanding their connection. This study aimed to explore the relationship between abusive supervision, impression management motivation, speak up-related climate, and withholding voice about patient safety.
METHODS: This cross-sectional study employed a convenience sampling method to recruit 419 clinical nurses from Taizhou Hospital, Zhejiang Province, China, between 1 November 2022 and 31 January 2023. The study adhered to the STROBE checklist. Abusive supervision and impression management motivation were assessed using the Chinese versions of the Abusive Supervision Scale and the Impression Management Motivation Scale, respectively. Withholding voice about patient safety and speak up-related climate were identified using the Chinese version of the Speaking Up about Patient Safety Questionnaire.
RESULTS: Nurse leaders\' abusive supervision (β=0.40, p<0.01) and nurses\' impression management motivation (β=0.10, p<0.01) significantly and positively influenced nurses\' withholding voice about patient safety. We introduced impression management motivation as a mediating variable, and the effect of abusive supervision on nurses\' withholding voice decreased (β from 0.40 to 0.38, p< 0.01). Nurses\' speak up-related climate played a moderating role between abusive supervision and impression management motivation (β= 0.24, p<0.05).
CONCLUSIONS: Abusive supervision by nursing leaders can result in nurses withholding voice about patient safety out of self-protective impression management motives. This phenomenon inhibits nurses\' subjective initiative and undermines their proactive involvement in improving patient safety, and hinders the cultivation of a culture encouraging full participation in patient safety, which should warrant significant attention.
METHODS: This cross-sectional study employed a convenience sampling method to recruit 419 clinical nurses from Taizhou Hospital, Zhejiang Province, China, between 1 November 2022 and 31 January 2023. The study adhered to the STROBE checklist. Abusive supervision and impression management motivation were assessed using the Chinese versions of the Abusive Supervision Scale and the Impression Management Motivation Scale, respectively. Withholding voice about patient safety and speak up-related climate were identified using the Chinese version of the Speaking Up about Patient Safety Questionnaire.
RESULTS: Nurse leaders\' abusive supervision (β=0.40, p<0.01) and nurses\' impression management motivation (β=0.10, p<0.01) significantly and positively influenced nurses\' withholding voice about patient safety. We introduced impression management motivation as a mediating variable, and the effect of abusive supervision on nurses\' withholding voice decreased (β from 0.40 to 0.38, p< 0.01). Nurses\' speak up-related climate played a moderating role between abusive supervision and impression management motivation (β= 0.24, p<0.05).
CONCLUSIONS: Abusive supervision by nursing leaders can result in nurses withholding voice about patient safety out of self-protective impression management motives. This phenomenon inhibits nurses\' subjective initiative and undermines their proactive involvement in improving patient safety, and hinders the cultivation of a culture encouraging full participation in patient safety, which should warrant significant attention.
摘要：
背景：护士经理的滥用监督会显著影响护士对患者安全的隐瞒声音。印象管理动机和与说话相关的氛围的作用对于理解它们之间的联系至关重要。本研究旨在探讨虐待监督与虐待监督之间的关系，印象管理动机，谈论与气候相关的气候，隐瞒关于病人安全的声音。
方法：本横断面研究采用便利抽样方法，从台州医院招募419名临床护士，浙江省,中国,2022年11月1日至2023年1月31日。这项研究遵循了STROBE核对表。使用中文版的虐待监督量表和印象管理动机量表对虐待监督和印象管理动机进行评估，分别。使用中文版的“关于患者安全的发言”问卷确定了关于患者安全的保留声音和与说话相关的气候。
结果：护士领导的滥用监督（β=0.40，p<0.01）和护士的印象管理动机（β=0.10，p<0.01）显着积极地影响了护士对患者安全的声音。我们引入了印象管理动机作为中介变量，滥用监督对护士隐瞒声音的影响降低（β从0.40降至0.38，p<0.01）。护士与说话相关的氛围在虐待监督和印象管理动机之间起调节作用（β=0.24，p<0.05）。
结论：护理领导的虐待监督可能导致护士出于自我保护印象管理的动机而对患者安全隐瞒声音。这种现象抑制了护士的主观能动性，破坏了他们在提高患者安全方面的积极参与。并阻碍了鼓励充分参与患者安全的文化的培养，这应该引起人们的极大关注。
方法：本横断面研究采用便利抽样方法，从台州医院招募419名临床护士，浙江省,中国,2022年11月1日至2023年1月31日。这项研究遵循了STROBE核对表。使用中文版的虐待监督量表和印象管理动机量表对虐待监督和印象管理动机进行评估，分别。使用中文版的“关于患者安全的发言”问卷确定了关于患者安全的保留声音和与说话相关的气候。
结果：护士领导的滥用监督（β=0.40，p<0.01）和护士的印象管理动机（β=0.10，p<0.01）显着积极地影响了护士对患者安全的声音。我们引入了印象管理动机作为中介变量，滥用监督对护士隐瞒声音的影响降低（β从0.40降至0.38，p<0.01）。护士与说话相关的氛围在虐待监督和印象管理动机之间起调节作用（β=0.24，p<0.05）。
结论：护理领导的虐待监督可能导致护士出于自我保护印象管理的动机而对患者安全隐瞒声音。这种现象抑制了护士的主观能动性，破坏了他们在提高患者安全方面的积极参与。并阻碍了鼓励充分参与患者安全的文化的培养，这应该引起人们的极大关注。
