护士工作应激源量表的编制及常模的建立

发布时间：2018-05-19 23:02

本文选题：护士工作应激源量表 + 编制　；参考：《中南大学》2006年博士论文

【摘要】： 目的：编制一套适用于我国的标准化护士工作应激源量表；对该量表进行条目分析和信效度检验；建立该量表的全国常模；构建和验证我国护士工作应激源理论模型，以全面、具体、准确地反映护理工作应激源的真正内涵，为护理职业人群工作应激源的识别、测评、监控提供有效的测评工具。方法：1．采用理论与经验相结合的方法，以Lazaras的应激理论模型(Cognitive-Phenomenological-Transactional，CPT)和Demerouti et al的需求-资源模型(Job Demands Resources Model JDR)作为编制量表的基本理论框架，在大量查阅国内外相关研究成果和广泛征求专家意见的基础上，参考国外著名同类量表如职业应激指征(OSI)、职业应激问卷修订版(OSI-R)、一般工作应激问卷(GJSQ)、McLean’s工作应激问卷、Gray-Toft和Andreson的护理应激量表(NSS)、Bianchi的护理应激评估问卷(NSEQ)的理论模式和编制策略，结合我们编制心理测验工具的经验，对护士工作应激源量表进行研制。 2．量表的建构：本量表由六个因素组成，它们分别是与护理工作性质有关的应激源、与工作负荷有关的应激源、与护士期望有关的应激源、与接触濒死病人有关的应激源、与工作-家庭矛盾有关的应激源、与护理工作中人际关系有关的应激源。 3．标准化研究： (1)条目库的建立：在阅读、研究有关文献的基础上，参照国内外护理工作应激评定量表，制定开放式问卷，选取不同地区、不同医院、不同年龄、职称、服务年限的护士352人，进行条目收集，建立条目库。 (2)草本的形成、施测与分析：从开放式问卷所获取的信息中选出有代表性的内容构成护士工作应激源的评定指标，对所选出的条目进行专家咨询，形成护士工作应激源量表草本，选取387名护士进行施测，对回收资料进行分析，条目分析主要包括条目与总分的相关、决断值、探索性因素分析及专家评价，结果形成包括6个分量表的护士工作应激原评定量表的预试本。 (3)预试本施测与分析：预试本施测对象为469名护士，回收的资料中，随机抽取161人间隔2周后进行重测，另外随机抽取200人，用工作倦怠量表(MBI)、症状自评量表(SCL-90)、压力反应问卷、生活事件量表(Life Event Scale，LES)、社会支持评定量表及简易应对方式问卷进行测评，然后对全部资料进行信效度检验。信度检验指标包括重测信度、内部一致性信度、分半信度、概化系数等；效度检验方面，采用因素分析方法进行结构效度的检验，采用护士工作应激源总量表及分量表得分与MBI、SCL-90、压力反应问卷、LES、社会支持评定量表及简易应对方式问卷得分的相关进行实证效度的检验。 (4)形成正式量表、建立常模：根据所得信效度指标的分析结果，进一步对测验条目进行修改，建立正式量表；运用护士工作应激源评定量表对全国三大地区(卫生部对我国医护人员统计的地域划分)的护士进行测试，样本应尽可能包括不同地区、不同等级医院、不同科室、不同职称、不同护理年限等，同时考虑我国护士的年龄、婚姻状况、教育背景等人口统计学因素，分层、整群按比例取样，共计3091人。 (5)护士应激源理论模型的研究：采用路径分析，对护士工作应激源、护士工作倦怠、自评心理症状、压力反应、生活事件、社会支持、应对方式之间的关系进行分析，验证了我们提出的护士工作应激源理论模型。结果：1．条目分析：各条目与总分的相关系数在0.36～0.75之间，相关系数均具统计学意义(P＜0.001)；各条目高、低分二组差异比较显示，各决断值均具有统计学意义(P＜0.001)，区分度好。 2．信度检验：(1)重测信度：各分量表重测信度系数分别为0.61～0.80，总量表为0.81；(2)分半信度：各分量表分半信度(经Spearman-Brown公式校正)在0.87～0.93之间，总量表为0.95；(3) Cronbach’a系数：各分量表a系数在0.88～0.93之间，总量表为0.97；(4)分量表的一致性：各条目与分量表间的相关系数为0.47～0.84，各分量表间相关系数为0.52～0.83，各分量表与总量表的相关在0.76～0.91之间；(5)概化研究：结果显示各分量表概化系数Ep~2为0.8858～0.9303，可靠性指数Φ为0.8625～0.9217，由样本平均数估计总体平均数的误差变异分量，即σ~2(Xpi)为0.0894～0.3041。全量表概化系数Ep~2为0.9798，可靠性指数Φ为0.9751，由样本平均数估计总体平均数的误差变异分量，即σ~2(Xpi)为0.0986。 3．效度检验：(1)结构效度：探索性因素分析一阶因素结构抽取6个因素，其方差累积贡献率为56.28％，二阶因素结构抽取一个因素，解释方差82.59％；验证性因素分析发现一阶因素、二阶因素模型中IFI、TLI、GFI、CFI、IFI、TLI、GFI、NFI等值均在可以接受的标准内。(2)效标效度：护士工作应激源量表与压力反应的总分相关为0.463；护士工作应激源量表与MBI的总分相关为0.510；护士工作应激源量表与SCL-90的总分相关为0.421；护士工作应激源量表与消极应对方式的总分相关为0.23，均具统计学意义(P＜0.01)。 4．常模：(1)粗分常模：首先建立了护士工作应激源量表粗分全量表及各因素的均分常模，各区域及不同年龄、不同职称的量表总分及各因素分均分常模；(2)百分位常模：将量表粗分总分以5％为间距建立了百分位常模；(3) T分常模：将量表粗分总分按均数为50，标准差为10进行T分转换后，建立T分总分常模；(4)常模趋势分析：对不同区域、不同年龄段、不同职称护理人员的T分总分值进行协方差分析及Logstic回归分析，结果表明：进入回归方程的自变量是工作年限、婚姻、职称、地域、工作性质、工作科室，影响护士工作应激源的主要变量依次为：工作年限、工作科室、职称、工作性质、婚姻、地域。 5．理论建模：护士工作应激源对护理人员的压力反应、工作倦怠感及心理症状的出现影响重大，影响程度从大到小依次为心理症状、工作倦怠感、压力反应。护理人员的消极应对方式通过工作应激源对其压力反应、工作倦怠感及心理症状的产生有间接影响，对心理症状有直接影响，决定系数为0.233，，此外，消极应对方式还通过对生活事件的影响，影响工作应激源对应激反应、不良心理症状、工作倦怠感的作用，因此，护士的消极应对方式从三重路径对护理人员工作应激的不良适应结果产生影响，是护士工作应激过程中的重要变量。生活事件对护士工作应激产生的影响路径是两重的，一方面是通过与工作应激源协同作用以间接方式进行，另一方面是对护理人员工作应激不良反应直接产生影响。社会支持通过生活事件对应激源、应激适应结果产生影响。结论：本量表的内容符合心理测量学要求，区分度良好；信度指标均达到了测量学的要求；结构效度良好，与设计时的构想相吻合；该量表能够反映我国护士工作应激的现状及特征，所建立的护士工作应激源的理论模型得到了验证，可以用于解释护士工作应激作用的过程；最后，建立了该量表的常模，为我国护士工作应激的评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 .
【学位授予单位】：中南大学
【学位级别】：博士
【学位授予年份】：2006
【分类号】：R47;R395

【引证文献】