烧伤重症监护病房护士工作投入与自我效能感对临床实践能力的影响

陈瀚熙; 刘汶佶; 刘冰; 黄志锋; 张秋萍; 萧惜玲; 赖文; 郑少逸

doi:10.3760/cma.j.cn501225-20220905-00379

烧伤重症监护病房护士工作投入与自我效能感对临床实践能力的影响

doi: 10.3760/cma.j.cn501225-20220905-00379

1.
南方医科大学附属广东省人民医院（广东省医学科学院)护理部，广州　　510080
2.
南方医科大学附属广东省人民医院(广东省医学科学院)烧伤与创面修复外科，广州　　510080

基金项目:

广东省人民医院2021年国家自然科学基金面上项目启动经费 7217040204

广州市科学技术局基础与应用基础研究一般项目 2060206

广东省医学科学技术研究基金项目 A2019023

详细信息

通讯作者:
郑少逸，Email：zsysskbox@163.com

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出版历程
- 收稿日期: 2022-09-05

Influence of work engagement and self-efficacy of nurses on clinical practice ability in burn intensive care unit

1.
Department of Nursing, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
2.
Department of Burn and Wound Repair Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China

Funds:

Start-up Fund of Guangdong Provincial People's Hospital for the General Program of National Natural Science Foundation of China in 2021 7217040204

General Project of Basic and Applied Basic Research of Guangzhou Municipal Bureau of Science and Technology 2060206

Guangdong Provincial Medical Research Fund A2019023

More Information

Corresponding author: Zheng Shaoyi, Email: zsysskbox@163.com

摘要

摘要: 目的分析烧伤重症监护病房（BICU）护士工作投入与自我效能感对临床实践能力的影响，并探讨其潜在作用路径。方法采用横断面调查研究方法。2020年5—10月，采用分层抽样法选取我国30家设置BICU的医院，对其中符合入选标准的BICU护士，采用护理问题对应行动（OPSN）自我评价量表、Utrecht工作投入量表（UWES）、一般自我效能感量表（GSES）分别评估其临床实践能力、工作投入、自我效能感，统计各指标量表总得分并计算条目平均分。使用自行设计的一般资料调查表，调查护士性别、年龄、婚姻状况、学历、工作年限、职称、所属医院所在经济分区。比较将护士按一般资料分类后前述3个评估指标量表总得分，对数据进行独立样本 t检验或单因素方差分析；对3个评估指标的量表总得分之间的相关性进行Pearson相关性分析。基于前述3个评估指标量表总得分，建立结构方程模型，进行3个评估指标关系的中介分析和结构模型路径分析，用Bootstrap法进行作用路径验证。结果共发放问卷401份，收回有效问卷337份，有效回收率为84.04%。337名护士临床实践能力、工作投入、自我效能感的量表总得分分别为（98.2±11.7）、（67.7±18.6）、（26.6±5.6）分，条目平均分分别为（3.9±0.5）、（4.5±1.2）、（2.7±0.6）分。337名护士中，女性、年龄在40岁及以下者居多，大多数护士都处于已婚状态、拥有本科学历，工作年限≤10年的护士占比较大，职称为护师和来自东南地区者均约占50%。不同年龄、学历、工作年限、职称护士临床实践能力的量表总得分比较，差异均有统计学意义（ F值分别为3.26、4.36、3.12、2.80 ，P<0.05）；不同工作年限护士工作投入的量表总得分比较，差异有统计学意义（ F=4.50， P<0.05）；不同年龄、工作年限、职称护士自我效能感的量表总得分比较，差异均有统计学意义（ F值分别为4.91、4.50、2.91， P<0.05）。护士工作投入的量表总得分与临床实践能力的量表总得分、自我效能感的量表总得分均呈显著正相关（ r值分别为0.30、0.51， P<0.05），护士自我效能感的量表总得分与临床实践能力的量表总得分呈显著正相关（ r=0.37， P<0.05）。模型适配度良好，中介模型成立；护士工作投入对自我效能感和临床实践能力均有显著正向影响（ β值分别为0.54、0.16， P<0.05），护士自我效能感对临床实践能力有显著正向影响（ β=0.29， P<0.05）；工作投入直接作用于自我效能感及临床实践能力，自我效能感直接作用于临床实践能力并在工作投入与临床实践能力之间起中介作用。Bootstrap法验证显示，自我效能感在工作投入对临床实践能力的影响中发挥显著的中介作用（效应量为0.16，95%置信区间为0.08~0.24， P<0.05），占工作投入对临床实践能力总效应（效应量为0.32）的一半。结论 BICU护士临床实践能力中等偏上，自我效能感中等，工作投入高；工作投入和自我效能感与临床实践能力相互之间均呈显著正相关，工作投入可直接或通过自我效能感的中介作用间接影响临床实践能力。
- 烧伤 /
- 重症监护病房 /
- 雇员能力评定 /
- 工作投入 /
- 自我效能感 /
- 临床实践能力 /
- 中介效应
Abstract: Objective To analyze the influence of work engagement and self-efficacy of nurses on clinical practice ability in burn intensive care unit (BICU), and to explore its potential pathways of action. Methods A cross-sectional survey was conducted. From May to October 2020, a total of 30 hospitals with BICU in China were selected by stratified sampling method. Among BICU nurses who met the inclusion criteria, their clinical practice ability, work engagement, and self-efficacy were evaluated by self-evaluation scale of oriented problem-solving behavior in nursing practice (OPSN), Utrecht work engagement scale (UWES), and general self-efficacy scale (GSES), respectively. The total scale scores of each index and the average item scores were recorded. The self-designed general data questionnaire was used to investigate the nurses' gender, age, marital status, education background, working years, professional title, and the economic region of the hospital that they belonged to. The total scale scores of the above-mentioned three evaluation indexes were compared after the classification of nurses according to general data, and the data were statistically analyzed with independent sample t test or one-way analysis of variance. Pearson correlation analysis was used to analyze the correlation between the total scale scores of the three evaluation indexes. Based on the total scale scores of the above-mentioned three evaluation indexes, a structural equation model was established, the mediation analysis of the relationship among the three evaluation indexes and the pathway analysis of the structural model were conducted, and the Bootstrap method was used to verify the pathways of action. Results A total of 401 questionnaires were distributed, and 337 valid questionnaires were returned, with a valid return rate of 84.04%. The total scale scores of clinical practice ability, work engagement, and self-efficacy of 337 nurses were 98.2±11.7, 67.7±18.6, and 26.6±5.6, respectively, and the average item scores were 3.9±0.5, 4.5±1.2, and 2.7±0.6, respectively. Among the 337 nurses, the majority were female, aged 40 or below, married, and had a bachelor's degree with work experience of ≤10 years; both nurses with professional nurse title and nurses from the Southeast region accounted for about 50%. There were statistically significant differences in the total scale score of clinical practice ability among nurses with different ages, education backgrounds, working years, and professional titles (with F values of 3.26, 4.36, 3.12, and 2.80, respectively, P<0.05). There was statistically significant difference in the total scale score of work engagement among nurses with different working years ( F=4.50, P<0.05). There were statistically significant differences in the total scale score of self-efficacy among nurses with different ages, working years, and professional titles (with F values of 4.91, 4.50, and 2.91, respectively, P<0.05). The total scale score of nurses' work engagement was significantly positively correlated with the total scale score of clinical practice ability and the total scale score of self-efficacy (with rvalues of 0.30 and 0.51, respectively, P<0.05). The total scale score of nurses' self-efficacy was significantly positively correlated with the total scale score of clinical practice ability ( r=0.37, P<0.05). The model had good adaptability, and the intermediary model was established. Nurses' work engagement had a significantly positive effect on both self-efficacy and clinical practice ability (with βvalues of 0.54 and 0.16, respectively, P<0.05), and nurses' self-efficacy had a significantly positive effect on clinical practice ability ( β=0.29, P<0.05). Work engagement had a direct effect on self-efficacy and clinical practice ability, and self-efficacy had a direct effect on clinical practice ability and played a mediating role between work engagement and clinical practice ability. Bootstrap validation showed that self-efficacy played a significantly mediating role in the influence of work engagement on clinical practice ability (with effect size of 0.16, with 95% confidence interval of 0.08-0.24, P<0.05), accounting for half of the total effect of work engagement on clinical practice ability (with effect size of 0.32). Conclusions BICU nurses have an above-average level of clinical practice ability, a medium level of self-efficacy, and a high level of work engagement. Work engagement and self-efficacy are positively correlated with clinical practice ability. Work engagement can directly affect clinical practice ability or indirectly affect clinical practice ability through the mediating role of self-efficacy.
- Burns /
- Intensive care units /
- Employee performance appraisal /
- Work engagement /
- Self-efficacy /
- Clinical practice ability /
- Intermediary effect
陈瀚熙：研究设计、方案实施、论文撰写；刘汶佶、刘冰：数据分析、论文撰写；黄志锋、张秋萍、萧惜玲、赖文：采集数据；郑少逸：研究指导、论文修改

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参考文献(23)

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1 337名烧伤重症监护病房护士工作投入和自我效能感对临床实践能力的作用路径模型结构

注：B1指示活力维度，B2指示奉献维度，B3指示专注维度，A1指示发现、探索问题维度，A2指示个性化护理维度，A3指示沟通协调维度，A4指示心理支持维度，A5指示护理行为评价维度；e1~e10为各变量对应的残差项；直线箭头表示假定变量间有因果关系，箭头由原因变量指向结果变量；弧形的双向箭头表示假定2个变量相关，但不存在因果关系；0.54、0.29、0.16为作用路径系数，衡量变量之间的效应大小；工作投入、临床实践能力下方箭头旁的数字为测量模型标准化因子负荷量平方，>0.60则说明测量变量拥有良好的信度

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表1 337名烧伤重症监护病房护士不同一般资料下临床实践能力和工作投入及自我效能感的量表总得分比较

项目与类别	人数	构成比（%）	临床实践能力（分， x ¯ ± s ）	工作投入（分， x ¯ ± s ）	自我效能感（分， x ¯ ± s ）	统计量值1	P ₁值	统计量值2	P ₂值	统计量值3	P ₃值
性别
男	43	12.8	98±12	66±18	27±6	t=0.22	0.824	t=0.73	0.468	t=-0.94	0.348
女	294	87.2	98±12	68±19	27±6	t=0.22	0.824	t=0.73	0.468	t=-0.94	0.348
年龄（岁）
18~30	161	47.8	96±11	67±18	26±5	F=3.26	0.022	F=1.62	0.186	F=4.91	0.002
31~40	130	38.6	99±13	67±20	27±6
41~50	36	10.7	104±10	70±17	29±6
>50	10	3.0	98±12	79±17	31±4
婚姻状况
已婚	214	63.5	99±13	67±19	27±6	t=1.57	0.094	t=-0.44	0.659	t=1.05	0.293
未婚	123	36.5	97±10	68±18	26±5	t=1.57	0.094	t=-0.44	0.659	t=1.05	0.293
学历
专科	49	14.5	94±10	71±16	27±5	F=4.36	0.013	F=1.80	0.168	F=2.14	0.119
本科	279	82.8	99±12	67±19	30±5
研究生	9	2.7	105±9	75±19	27±6
工作年限
1~5	95	28.2	98±10	70±16	26±5	F=3.12	0.015	F=4.50	0.002	F=4.50	0.002
6~10	107	31.8	96±12	63±19	26±5
11~15	59	17.5	97±14	65±19	26±6
16~20	31	9.2	103±10	76±17	30±6
>20	45	13.4	102±11	70±20	28±6
职称
护士	61	18.1	94±11	69±15	26±5	F=2.80	0.026	F=1.51	0.199	F=2.91	0.022
护师	171	50.7	98±11	65±19	26±6
主管护师	84	24.9	100±13	70±20	27±6
副主任护师	18	5.3	103±11	73±20	30±5
主任护师	3	0.9	104±5	76±16	32±5
经济分区
东北地区	44	13.1	100±14	64±19	28±6	F=0.94	0.422	F=1.06	0.365	F=2.00	0.114
东南地区	169	50.1	98±10	68±18	27±5
西部地区	60	17.8	96±13	68±19	26±6
中部地区	64	19.0	99±12	70±18	27±5
注：采用护理问题对应行动自我评价量表、Utrecht工作投入量表、一般自我效能感量表分别评估护士临床实践能力、工作投入、自我效能感；经济分区指护士所属医院所在我国经济分区；统计量值1、 P ₁值，统计量值2、 P ₂值，统计量值3、 P ₃值分别为不同一般资料下护士临床实践能力、工作投入、自我效能感的量表总得分总体比较所得

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表2 337名烧伤重症监护病房护士自我效能感在工作投入与临床实践能力间的中介效应分析结果

路径	效应量	标准误	95%置信区间	P值	效应占比（%）
间接效应：工作投入→自我效能感→临床实践能力	0.16	0.04	0.08~0.24	<0.001	50
直接效应：工作投入→临床实践能力	0.16	0.07	0.03~0.30	0.018	50
总效应：直接效应+间接效应	0.32	0.05	0.21~0.42	<0.001	100