本文選題：護(hù)士工作應(yīng)激源量表 + 編制�。� 參考：《中南大學(xué)》2006年博士論文

【摘要】： 目的：編制一套適用于我國(guó)的標(biāo)準(zhǔn)化護(hù)士工作應(yīng)激源量表；對(duì)該量表進(jìn)行條目分析和信效度檢驗(yàn)；建立該量表的全國(guó)常模；構(gòu)建和驗(yàn)證我國(guó)護(hù)士工作應(yīng)激源理論模型，以全面、具體、準(zhǔn)確地反映護(hù)理工作應(yīng)激源的真正內(nèi)涵，為護(hù)理職業(yè)人群工作應(yīng)激源的識(shí)別、測(cè)評(píng)、監(jiān)控提供有效的測(cè)評(píng)工具。 方法：1．采用理論與經(jīng)驗(yàn)相結(jié)合的方法，以Lazaras的應(yīng)激理論模型(Cognitive-Phenomenological-Transactional，CPT)和Demerouti et al的需求-資源模型(Job Demands Resources Model JDR)作為編制量表的基本理論框架，在大量查閱國(guó)內(nèi)外相關(guān)研究成果和廣泛征求專家意見(jiàn)的基礎(chǔ)上，參考國(guó)外著名同類(lèi)量表如職業(yè)應(yīng)激指征(OSI)、職業(yè)應(yīng)激問(wèn)卷修訂版(OSI-R)、一般工作應(yīng)激問(wèn)卷(GJSQ)、McLean’s工作應(yīng)激問(wèn)卷、Gray-Toft和Andreson的護(hù)理應(yīng)激量表(NSS)、Bianchi的護(hù)理應(yīng)激評(píng)估問(wèn)卷(NSEQ)的理論模式和編制策略，結(jié)合我們編制心理測(cè)驗(yàn)工具的經(jīng)驗(yàn)，對(duì)護(hù)士工作應(yīng)激源量表進(jìn)行研制。 2．量表的建構(gòu)：本量表由六個(gè)因素組成，它們分別是與護(hù)理工作性質(zhì)有關(guān)的應(yīng)激源、與工作負(fù)荷有關(guān)的應(yīng)激源、與護(hù)士期望有關(guān)的應(yīng)激源、與接觸瀕死病人有關(guān)的應(yīng)激源、與工作-家庭矛盾有關(guān)的應(yīng)激源、與護(hù)理工作中人際關(guān)系有關(guān)的應(yīng)激源。 3．標(biāo)準(zhǔn)化研究： (1)條目庫(kù)的建立：在閱讀、研究有關(guān)文獻(xiàn)的基礎(chǔ)上，參照國(guó)內(nèi)外護(hù)理工作應(yīng)激評(píng)定量表，制定開(kāi)放式問(wèn)卷，選取不同地區(qū)、不同醫(yī)院、不同年齡、職稱、服務(wù)年限的護(hù)士352人，進(jìn)行條目收集，建立條目庫(kù)。 (2)草本的形成、施測(cè)與分析：從開(kāi)放式問(wèn)卷所獲取的信息中選出有代表性的內(nèi)容構(gòu)成護(hù)士工作應(yīng)激源的評(píng)定指標(biāo)，對(duì)所選出的條目進(jìn)行專家咨詢，形成護(hù)士工作應(yīng)激源量表草本，選取387名護(hù)士進(jìn)行施測(cè)，對(duì)回收資料進(jìn)行分析，條目分析主要包括條目與總分的相關(guān)、決斷值、探索性因素分析及專家評(píng)價(jià)，結(jié)果形成包括6個(gè)分量表的護(hù)士工作應(yīng)激原評(píng)定量表的預(yù)試本。 (3)預(yù)試本施測(cè)與分析：預(yù)試本施測(cè)對(duì)象為469名護(hù)士，回收的資料中，隨機(jī)抽取161人間隔2周后進(jìn)行重測(cè)，另外隨機(jī)抽取200人，用工作倦怠量表(MBI)、癥狀自評(píng)量表(SCL-90)、壓力反應(yīng)問(wèn)卷、生活事件量表(Life Event Scale，LES)、社會(huì)支持評(píng)定量表及簡(jiǎn)易應(yīng)對(duì)方式問(wèn)卷進(jìn)行測(cè)評(píng)，然后對(duì)全部資料進(jìn)行信效度檢驗(yàn)。信度檢驗(yàn)指標(biāo)包括重測(cè)信度、內(nèi)部一致性信度、分半信度、概化系數(shù)等；效度檢驗(yàn)方面，采用因素分析方法進(jìn)行結(jié)構(gòu)效度的檢驗(yàn)，采用護(hù)士工作應(yīng)激源總量表及分量表得分與MBI、SCL-90、壓力反應(yīng)問(wèn)卷、LES、社會(huì)支持評(píng)定量表及簡(jiǎn)易應(yīng)對(duì)方式問(wèn)卷得分的相關(guān)進(jìn)行實(shí)證效度的檢驗(yàn)。 (4)形成正式量表、建立常模：根據(jù)所得信效度指標(biāo)的分析結(jié)果，進(jìn)一步對(duì)測(cè)驗(yàn)條目進(jìn)行修改，建立正式量表；運(yùn)用護(hù)士工作應(yīng)激源評(píng)定量表對(duì)全國(guó)三大地區(qū)(衛(wèi)生部對(duì)我國(guó)醫(yī)護(hù)人員統(tǒng)計(jì)的地域劃分)的護(hù)士進(jìn)行測(cè)試，樣本應(yīng)盡可能包括不同地區(qū)、不同等級(jí)醫(yī)院、不同科室、不同職稱、不同護(hù)理年限等，同時(shí)考慮我國(guó)護(hù)士的年齡、婚姻狀況、教育背景等人口統(tǒng)計(jì)學(xué)因素，分層、整群按比例取樣，共計(jì)3091人。 (5)護(hù)士應(yīng)激源理論模型的研究：采用路徑分析，對(duì)護(hù)士工作應(yīng)激源、護(hù)士工作倦怠、自評(píng)心理癥狀、壓力反應(yīng)、生活事件、社會(huì)支持、應(yīng)對(duì)方式之間的關(guān)系進(jìn)行分析，驗(yàn)證了我們提出的護(hù)士工作應(yīng)激源理論模型。 結(jié)果：1．條目分析：各條目與總分的相關(guān)系數(shù)在0.36～0.75之間，相關(guān)系數(shù)均具統(tǒng)計(jì)學(xué)意義(P＜0.001)；各條目高、低分二組差異比較顯示，各決斷值均具有統(tǒng)計(jì)學(xué)意義(P＜0.001)，區(qū)分度好。 2．信度檢驗(yàn)：(1)重測(cè)信度：各分量表重測(cè)信度系數(shù)分別為0.61～0.80，總量表為0.81；(2)分半信度：各分量表分半信度(經(jīng)Spearman-Brown公式校正)在0.87～0.93之間，總量表為0.95；(3) Cronbach’a系數(shù)：各分量表a系數(shù)在0.88～0.93之間，總量表為0.97；(4)分量表的一致性：各條目與分量表間的相關(guān)系數(shù)為0.47～0.84，各分量表間相關(guān)系數(shù)為0.52～0.83，各分量表與總量表的相關(guān)在0.76～0.91之間；(5)概化研究：結(jié)果顯示各分量表概化系數(shù)Ep~2為0.8858～0.9303，可靠性指數(shù)Φ為0.8625～0.9217，由樣本平均數(shù)估計(jì)總體平均數(shù)的誤差變異分量，即σ~2(Xpi)為0.0894～0.3041。全量表概化系數(shù)Ep~2為0.9798，可靠性指數(shù)Φ為0.9751，由樣本平均數(shù)估計(jì)總體平均數(shù)的誤差變異分量，即σ~2(Xpi)為0.0986。 3．效度檢驗(yàn)：(1)結(jié)構(gòu)效度：探索性因素分析一階因素結(jié)構(gòu)抽取6個(gè)因素，其方差累積貢獻(xiàn)率為56.28％，二階因素結(jié)構(gòu)抽取一個(gè)因素，解釋方差82.59％；驗(yàn)證性因素分析發(fā)現(xiàn)一階因素、二階因素模型中IFI、TLI、GFI、CFI、IFI、TLI、GFI、NFI等值均在可以接受的標(biāo)準(zhǔn)內(nèi)。(2)效標(biāo)效度：護(hù)士工作應(yīng)激源量表與壓力反應(yīng)的總分相關(guān)為0.463；護(hù)士工作應(yīng)激源量表與MBI的總分相關(guān)為0.510；護(hù)士工作應(yīng)激源量表與SCL-90的總分相關(guān)為0.421；護(hù)士工作應(yīng)激源量表與消極應(yīng)對(duì)方式的總分相關(guān)為0.23，均具統(tǒng)計(jì)學(xué)意義(P＜0.01)。 4．常模：(1)粗分常模：首先建立了護(hù)士工作應(yīng)激源量表粗分全量表及各因素的均分常模，各區(qū)域及不同年齡、不同職稱的量表總分及各因素分均分常模；(2)百分位常模：將量表粗分總分以5％為間距建立了百分位常模；(3) T分常模：將量表粗分總分按均數(shù)為50，標(biāo)準(zhǔn)差為10進(jìn)行T分轉(zhuǎn)換后，建立T分總分常模；(4)常模趨勢(shì)分析：對(duì)不同區(qū)域、不同年齡段、不同職稱護(hù)理人員的T分總分值進(jìn)行協(xié)方差分析及Logstic回歸分析，結(jié)果表明：進(jìn)入回歸方程的自變量是工作年限、婚姻、職稱、地域、工作性質(zhì)、工作科室，影響護(hù)士工作應(yīng)激源的主要變量依次為：工作年限、工作科室、職稱、工作性質(zhì)、婚姻、地域。 5．理論建模：護(hù)士工作應(yīng)激源對(duì)護(hù)理人員的壓力反應(yīng)、工作倦怠感及心理癥狀的出現(xiàn)影響重大，影響程度從大到小依次為心理癥狀、工作倦怠感、壓力反應(yīng)。護(hù)理人員的消極應(yīng)對(duì)方式通過(guò)工作應(yīng)激源對(duì)其壓力反應(yīng)、工作倦怠感及心理癥狀的產(chǎn)生有間接影響，對(duì)心理癥狀有直接影響，決定系數(shù)為0.233，，此外，消極應(yīng)對(duì)方式還通過(guò)對(duì)生活事件的影響，影響工作應(yīng)激源對(duì)應(yīng)激反應(yīng)、不良心理癥狀、工作倦怠感的作用，因此，護(hù)士的消極應(yīng)對(duì)方式從三重路徑對(duì)護(hù)理人員工作應(yīng)激的不良適應(yīng)結(jié)果產(chǎn)生影響，是護(hù)士工作應(yīng)激過(guò)程中的重要變量。生活事件對(duì)護(hù)士工作應(yīng)激產(chǎn)生的影響路徑是兩重的，一方面是通過(guò)與工作應(yīng)激源協(xié)同作用以間接方式進(jìn)行，另一方面是對(duì)護(hù)理人員工作應(yīng)激不良反應(yīng)直接產(chǎn)生影響。社會(huì)支持通過(guò)生活事件對(duì)應(yīng)激源、應(yīng)激適應(yīng)結(jié)果產(chǎn)生影響。 結(jié)論：本量表的內(nèi)容符合心理測(cè)量學(xué)要求，區(qū)分度良好；信度指標(biāo)均達(dá)到了測(cè)量學(xué)的要求；結(jié)構(gòu)效度良好，與設(shè)計(jì)時(shí)的構(gòu)想相吻合；該量表能夠反映我國(guó)護(hù)士工作應(yīng)激的現(xiàn)狀及特征，所建立的護(hù)士工作應(yīng)激源的理論模型得到了驗(yàn)證，可以用于解釋護(hù)士工作應(yīng)激作用的過(guò)程；最后，建立了該量表的常模，為我國(guó)護(hù)士工作應(yīng)激的評(píng)估提供了一套有效的方法。
[Abstract]:Objective : To compile a set of standardized nurses working stress source scale suitable for our country ;
carrying out an item analysis and a letter validity check on the scale ;
establishing a national norm of the scale ;
To construct and verify the theory model of the occupational stress source of nurses in our country , to comprehensively and concretely reflect the real connotation of the nursing work stress source , and provide an effective evaluation tool for the identification , evaluation and monitoring of the working stress source of the nursing professional population .






Method : 1 . Based on the theory and experience of the theory and experience , based on Lazaras ' s stress theory model ( CPT ) and Demerouti et al ' s demand - resource model ( JDR ) as the basic theoretical framework of the development scale , the theory model and strategy of nursing stress scale ( NSS ) , McLean ' s job stress questionnaire , Gray - Toft and Anestheon ' s nursing stress scale ( NSS ) , McLean ' s job stress questionnaire , Gray - Toft and Anestheon ' s nursing stress scale ( NSS ) and Bianchi ' s nursing stress assessment questionnaire ( NSEQ ) were consulted .






2 . Construction of the scale : The scale consists of six factors , which are stress sources related to the nature of nursing work , stress sources related to workload , stress sources related to the expectation of nurses , stress sources related to contact with dying patients , stress sources related to work - family conflicts , stress sources related to interpersonal relationships in nursing work .






3 . Standardization research :






( 1 ) The establishment of the entry library : Based on the reading and research of the relevant literatures , a questionnaire was developed by referring to the nursing work stress rating scale at home and abroad , and 352 nurses with different age , title and service life were selected to collect and establish an item pool .






( 2 ) The formation , application and analysis of herbal medicine : selecting the representative content from the information acquired by the open questionnaire to form the evaluation index of the nurses ' working stress source , carrying out expert consultation on the selected items , forming the nurses ' working stress source scale herbal medicine , selecting 387 nurses to carry out the analysis , and analyzing the collected data . The entry analysis mainly includes the correlation , determination value , exploratory factor analysis and expert evaluation of the entry and the total score , and the results form a pre - test version of the nurses working stress original rating scale including six component tables .






( 3 ) Pre - trial test and analysis : 469 nurses were randomly selected for 2 weeks after the pre - trial test , and 200 were randomly selected . Then , 200 people were randomly selected , and then the total data was tested . The reliability test indexes include retest reliability , internal consistency reliability , semi - reliability , generalized coefficient , etc .
In terms of validity test , the method of factor analysis was used to test the structure validity , and the correlation between the total table of nurses ' working stress sources and the scores of the component tables and the scores of MBI , SCL - 90 , stress response questionnaire , LES , social support rating scale and simple coping style questionnaire were tested .






( 4 ) forming a formal scale , establishing a normal mode , modifying the test item further according to the analysis result of the obtained faith validity index , and establishing a formal scale ;
To test the nurses in the three major areas of China ( Ministry of Health for the geographical division of Chinese medical personnel ) by using the Job Stress Source Rating Scale of nurses , the samples should include different regions , different grades of hospitals , different departments , different professional titles , different nursing years and so on , taking into consideration the demographic factors such as the age , marital status , educational background and other demographic factors of the nurses in our country , stratified , and the whole group sampled according to the proportion , totaling 3091 .






( 5 ) The research on the theory model of nurses ' stress source : Using the path analysis , the relationship between nurses ' working stress source , nurses ' job burnout , self - assessment psychological symptoms , stress response , life events , social support and coping styles is analyzed , and the theoretical model of nurses ' work stress source is verified .






Results : 1 . The correlation coefficient of each entry and total score was between 0.36 and 0.75 , and the correlation coefficient was statistically significant ( P < 0.001 ) .
The high and low scores of each item showed statistical significance ( P & lt ; 0.001 ) , and the division was good .






2 . Reliability test : ( 1 ) retest reliability : the retest reliability coefficient of each component table is 0.61 - 0.80 , and the total amount table is 0.81 ;
( 2 ) the semi - reliability of each component table is between 0.87 and 0.93 , and the total amount table is 0.95 ;
( 3 ) The coefficients of each component table a are between 0.88 and 0.93 , and the total amount table is 0.97 ;
( 4 ) consistency of the component table : the correlation coefficient between each item and the component table is 0.47 - 0.84 , the correlation coefficient between each component table is 0.52 - 0.83 , and the correlation coefficient between each component table and the total amount table is 0.76 - 0.91 ;
( 5 ) Generalizability study : The results show that the generalized coefficient of each component is 0.8858 - 0.9303 , the reliability index is 0.8625 - 0.9217 , the error variation component of the overall mean is estimated from the sample mean value , namely , 蟽 ~ 2 ( Xpi ) is 0.0894 ~ 0.3041 . The general average error variance component is estimated from the sample mean , that is , 蟽 ~ 2 ( Xpi ) is 0.0986 .






3 . Validity test : ( 1 ) Structure validity : exploratory factor analysis one - order factor structure extraction 6 factors , its variance cumulative contribution rate is 56.28 % , second - order factor structure draws a factor , explains variance 82.59 % ;
The confirmatory factor analysis found that the first - order factor and the second - order factor model were found to be within the acceptable standard . ( 2 ) The validity of validity : The total score of nurses ' working stress source scale and pressure response was 0.463 ;
The total score of nurses working stress source scale and MBI was 0.510 ;
The total score of nurses working stress source scale and SCL - 90 was 0.421 ;
The total score of nurses ' working stress source scale and passive coping style was 0.23 , which was statistically significant ( P < 0.01 ) .






4 . Common mode : ( 1 ) norm of coarse sub - norm : first , establish the general average scale of the scale of the nurses ' working stress source scale and the average score of each factor , the total score of each region and the different functional scales and the common norm of each factor ;
( 2 ) percentile norm : A percentile norm is established at 5 % of the total score of the gross score of the gauge ;
( 3 ) T sub - norm : the total score of the gross score of the scale is 50 and the standard deviation is 10 to perform T - division conversion , and then a T - division general norm is established ;
( 4 ) Common mode trend analysis : covariance analysis and Logstic regression analysis of the total score of T scores of nursing staff with different regions , different ages and different functional scales . The results show that the variables entering the regression equation are the working years , the marriage , the title , the geographical area , the working property and the working department . The main variables influencing the working stress of nurses are : the working years , the working department , the job title , the working property , the marriage and the geographical area .






5 . Theoretical modeling : The effect of nurses ' working stress on the stress response , job burnout and psychological symptoms of nursing staff has an indirect effect on psychological symptoms , job burnout and stress response .






Conclusion : The content of this scale accords with the requirement of psychometrics , and the division is good ;
The reliability index has reached the requirement of measurement ;
the structural validity is good , and is consistent with the design concept ;
The scale can reflect the present situation and characteristics of nurses ' work stress in our country . The theoretical model of the working stress source of nurses has been verified , which can be used to explain the process of nurses ' work stress .
Finally , the norm of the scale is established , and an effective method is provided for the evaluation of nurses ' working stress in China .
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2006
【分類(lèi)號(hào)】：R47;R395

【引證文獻(xiàn)】

相關(guān)期刊論文 前6條

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