重点院校与普通院校本科护生临床实习中期压力源及应对方式的相关性分析

Correlation between pressure sources and coping styles during clinical practice of undergraduate nurses from key and ordinary medical colleges

目的探讨重点院校与普通院校本科护生临床实习中期压力源及应对方式的相关性，为医学院校采取综合有效的压力干预措施，降低学生实习压力水平，保持实习期间身心健康提供参考。方法选取2015年7-12月四川大学华西医院处于临床实习中期（临床实习5个月）的本科护生，采用实习护生压力源量表（NSSS）、简易应对方式量表（SCSQ）对其进行调查，比较不同类别本科实习护生临床实习中期的压力源及应对方式，分析压力源与应对方式的相关性。结果共发放问卷110份，回收108份，有效问卷105份，有效回收率为95．5％。重点院校本科护生NSSS各维度条目均分（2．76±0．70）分，普通院校本科护生（2．35±0．69）分，差异有统计学意义（t=2．668，P〈0．05）；重点院校本科护生社会支持及职业认同感压力最大（3．25±0．89），普通院校本科护生临床工作压力最大（2．61±1．02），二者在临床教学、患者及家属情况、工作环境与人际关系、监督与评价、社会支持及职业认同感5个压力维度条目均分比较，差异均有统计学意义（t值分别为2．159，2．885，3．084，3．983，3．128；P〈0．05）。重点院校本科护生消极应对方式得分（1．22±0．42）分，普通院校本科护生（0．99±0．52）分。Pearson相关分析结果表明，重点院校本科护生消极应对与整体压力水平呈正相关（r=0．281，P〈0．05），临床教学压力、家庭户口类型及是否为独生子女是其消极应对方式的影响因素；普通院校本科护生消极应对与工作环境与人际关系压力水平呈正相关（1-=0．303，P〈0．05），工作环境与人际关系压力是其消极应对方式的影响因素。结论不同类别本科护生临床实习中期压力源不同，重点院校与普通院校本科护生临床实习中期压力源及应对方式影响因素存在差异，提示临床护理教学应重视重点院校与普通院校本科护生的压力源及应对方式的差异，采取有针对性的压力管理策略，提高实习护生的压力应对和管理能力。

Objective To explore the correlation between pressure sources and coping styles of undergraduate nursing students from key and ordinary medical colleges, so as to provide a reference to medical colleges for reducing students＇ pressure and maintaining their physical and psychological health during internship through organizational and effective interventions. Methods Undergraduate nursing students during their mid- term practice （after five-month practice from July to December 2015） in the West China Hospital, Sichuan University were selected and investigated by nursing student＇s stress scale （NSSS） and simplified coping style questionnaire （SCSQ）, and the correlation between their pressure sources and coping styles during mid-term clinical practice was analyzed by comparison. Results Altogether 110 questionnaires were given out, 108 were retrieved and 105 were valid, and the valid return rate was 95.5%. The average score for NSSS dimensions of undergraduate nurses from key medical colleges was （2.76 ± 0.70）, while that of those nurses from ordinary medical colleges was （2.35±0.69） （t= 2.668, P〈0.05） ; the biggest pressure of undergraduate nursing students from key colleges was social support and professional identity （ 3.25 ± 0.89）, and the biggest pressure of the students from ordinary colleges resulted from clinical work （2.61 ± 1.02）, with a statistically significant difference demonstrated through the comparison between two groups in five pressure dimensions, namely, clinical teaching, conditions of patients and their family members, working environment and interpersonalrelationship, supervision and evaluation as well as social support and professional identity （t = 2.159, 2.885, 3. 084, 3.983, 3.128; P〈0. 05）. The score for negative coping style （NC） of students from key colleges was （1.22±0.42） , while that of students from ordinary colleges was （ 0.99± 0.52）. Pearson correlation analysis showed： the NC style of students from key colleges was positively correlated with the overall pressure level （r = 0.281, P〈0.05）, and the clinical teaching pressure, type of household registration and whether they are the only child, were the influencing factors of NC style; as for the students from ordinary colleges, NC style was impacted by the pressure from working environment and interpersonal relationship, and it was positively correlated with this pressure source （r=0.303, P〈0.05）. Conclusions The undergraduate nursing students from two types of colleges have different pressure sources and coping styles during their mid-term clinical practice, which is affected by different factors. It indicates that clinical nursing teaching should pay attention to different pressure sources and coping styles of undergraduate nursing students from key and ordinary medical colleges, and enhance nursing students＇ ability to cope with and manage pressure with targeted pressure management strategies.