基于扎根理论的外科护士群体执业风险形成机制研究

Research on the formation mechanism of practice risk of surgical nurses group based on grounded theory

目的基于扎根理论探讨外科护士群体执业风险形成机制并提供政策建议。方法采用目的抽样法,于2023年12月至2024年1月对来自华中科技大学同济医学院附属同济医院外科的13个科室22名护理人员进行半结构访谈,运用NVivo软件对访谈资料进行分析。结果共提炼出37个概念和17个范畴,归纳凝练出组织治理局限和社会文化制约2个维度导致风险评估前控机制失准影响护士执业活动中的风险交流过程,执业主体和服务对象在风险交流过程中产生慎独精神缺位、领导权力滥用、护患信任危机三类风险轨迹,最终导致就医体验不佳、护士职业怠卷、患方不满情绪表达的风险结局行为,诱发执业风险的发生。结论提示相关职能部门应逐步改善组织治理局限和社会文化制约要素,纠正执业风险轨迹,扭转执业风险结局行为,从而营造和谐安全的执业环境。

Objective To explore the formation mechanism of practice risk of surgical nurses and to provide policy suggestions based on grounded theory.Methods Purposive sampling method was used to conduct semi-structured interviews with 22 nursing staff from 13 departments in the Department of Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from December 2023 to January 2024,and the interview data were analysed using NVivo software.Results A total of 37 concepts and 17 categories were extracted,and it was concluded that two dimensions of the limitation of organizational governance and social and cultural constraints led to the inaccurate pre-control mechanism of risk assessment,which affected the risk communication process of nurses’practice activities.In the process of risk communication,practitioners and clients produced three kinds of risk trajectories,namely,lack of prudence,abuse of leadership power,and crisis of trust between nurses and patients,which eventually led to risky ending behaviors of poor medical experience,nurses’job burnout,and the expression of patients’dissatisfaction,and induced the occurrence of practice risks.Conclusion It is suggested that relevant functional departments should gradually improve the limiation of organizational governance and social and cultural constraints,correct the practice risk trajectory and reverse the practice risk ending behavior,so as to create a harmonious and safe practice environment.