目的 探讨新入职护士“四主题法”分阶段培训的方法及效果。方法 将2016年入职的97名护士作为研究对象,运用“四主题法”分阶段进行护理伦理培训。制订护理伦理四主题表,包括医疗适应性、患者选择、生活质量、情景特征4个主题38个方面。第1阶段采用理论授课的方式,讲解护理伦理学基础理论知识和护理伦理四主题的基本概念;第2阶段采用翻转课堂与PBL教学结合,运用四主题表以小组讨论形式进行案例分析讨论;第3阶段采用床边教学,运用四主题表分析临床案例和护理问题。比较培训前后新入职护士的护理伦理学基础知识理论成绩和护士核心能力中伦理实践能力。结果 培训后,护士的护理伦理学基础知识成绩为（77.14±22.26）分,高于培训前的（38.47±20.51）分,差异有统计学意义（t=15.89,P<0.001）。培训第2阶段和第1阶段的护士伦理实践能力得分差异没有统计学意义（P=0.146）,第3阶段高于第1、2阶段和培训前（均P<0.001）。结论 运用“四主题法”分阶段进行护理伦理学培训能帮助新入职护士掌握护理伦理学知识,提升伦理实践能力。

Objective To explore the effects of a phased training with four topics approach on practically ethical ability of new nurses. Methods A total of 97 new nurses who joined in the hospital in 2016 for standardized training were recruited and four topics approach was used for the ethical training.A table was developed with four themes of nursing ethics,including medical adaptability,patient selection,quality of life,and situational characteristics. In the first stage,the basic theoretical knowledge of nursing ethics and concepts of four topics were taught. In the second stage,group discussion was conducted guided by the table with flipped classroom and PBL method. In the third stage,clinical cases and nursing problems were analyzed using the table. The changes of the theoretical knowledge scores and practically ethical ability were compared pre-training and post-training. Results The theoretical score of post-training（77.14±22.26） was significantly higher than that of the pre-training（38.47±20.51）（t=15.89,P<0.001）. There were no significant differences regarding the practically ethical ability scores in phases 2 and phase 1（P=0.146）. However,the score of phase 3 was significantly higher than those of phase 1 and 2（P<0.001）.Conclusion The approach of four topics can improve the ethical awareness,ethical decision-making ability and practical nursing service ability of new nurses.