本科护生实习应激及其影响因素关系的模型构建

Establishment of Model of Stress and Related Influencing Factors for Undergraduate Nursing Students

目的对本科实习护生的实习应激源、中介机制、应激反应进行研究,建立一个本科护生实习应激及其影响因素关系的结构方程模型。方法采取分层—随机—整群抽样方法,抽取本科实习护生682名,使用相应量表调查其实习应激源、应对方式、自我效能、社会支持、人格特质、职业倦怠、离职意愿和身心健康状况,建立本科护生实习应激及其影响因素关系的模型,运用LISREL 8.70进行检验和修正,采用最大似然法进行参数估计。结果本科护生实习应激模型拟合较好(χ2/df<5,CFI、IFI、GFI均大于0.90,RMSEA<0.08),进入构建模型且与身心健康得分发生直接关系的变量为:离职意愿(β=-0.13)、职业倦怠(β=0.15)、积极应对(β=-0.10)、消极应对(β=0.65)、神经质(β=6.77)、内外向因素(β=-1.62);职业倦怠是一个重要的中介变量;实习应激可直接作用(β=0.01)和间接作用于身心健康。结论可以通过提高和加强正性中介因素(如自我效能)、削弱和减轻负面中介因素(如消极应对、职业倦怠)等措施,降低或缓冲护生实习应激强度,以提高其身心健康水平。

Objective To establish one structural equation model based on the relationship between the intern stressor and its influential factors for undergraduate intern nurses. Methods A stratified-random-cluster sampling method was applied. 682 students were surveyed with a series of questionnaires including such items as assessing intern stressor, social support, personality, coping style, self-efficacy, occupational burnout, general health, turnover intention and general data. Maximum likelihood method was conducted for parameter estimation with LISREL 8.70. Results The final model showed good fit indexO（X^2/df〈5,and CFI, IFI, GFI〉0.90, RMSEA 〈0.08）. Factors included in the structural equation model were： turnover intention （β=-0.13）, occupational burnout （β=0.15）, positive coping style （β=-0.10）, negative coping style （β=0.65）, neuroticism （β=6.67）, introversion and extraversion （β=-1.62）. Burnout was a significant factor impacting health status while occupational stressor has great influence on students＇ mental status both directly （β=0.01） and indirectly. Conclusion Health status of intern nurses can be improved by enhancing positive mediate factors such as self-efficacy and reducing such negative factors as negative coping style and occupational burnout.