知觉压力和职业不确定感在外科医务人员工作场所韧性与健康生产力受损间的链式中介作用

摘要/Abstract

摘要： 目的探讨知觉压力、职业不确定性在工作场所韧性对外科医务人员健康生产力受损影响机制中的多重中介作用。方法 2023年3—5月,采用便利抽样法,选取四川省6所三级甲等医院342名外科医务人员为调查对象,采用一般资料调查表、知觉压力量表、职业不确定性量表、工作场所韧性量表和健康生产力受损量表进行调查。构建并检验知觉压力和职业不确定性的链式中介模型。结果四川省6所342名三级甲等医院外科医务人员知觉压力得分为（32.92±10.85）分,职业不确定性得分为（98.92±27.93）分,工作场所韧性得分为（64.01±16.52）分,健康生产力受损得分为（14.33±4.35）分。外科医务人员健康生产力受损与工作场所韧性呈负相关（r=-0.667,P<0.05）,与知觉压力和职业不确定性均呈正相关（r=0.687、0.692,均P<0.05）。工作场所韧性对隐性缺勤的总间接效应为0.317,占总效应的41.93%,其中知觉压力和职业不确定性对健康生产力受损的特定中介效应分别占18.39%和15.74%,两者的链式中介作用占7.80%。结论四川省三级甲等医院外科医务人员健康生产力受损处于中等偏上水平,知觉压力和职业不确定性在工作场所韧性对外科医务人员隐性健康生产力受损影响机制中的多重中介作用成立。医疗管理者应关注健康生产力受损水平高的医务人员,降低其知觉压力和职业不确定性,以进一步改善医务人员身心健康。

关键词: 医务人员, 知觉压力, 职业不确定性, 工作场所韧性, 健康生产力受损, 链式中介

Abstract: Objective To explore the multiple mediating effects of perceived stress and occupational uncertainty in the influence mechanism of workplace resilience on the impairment of health productivity among surgical medical staff. Methods From March to May 2023,a convenience sampling method was used to select 342 surgical medical staff from 6 grade-A tertiary hospitals in Sichuan Province as the survey subjects. The survey was conducted using a general information questionnaire,perceived stress scale,occupational uncertainty scale,workplace resilience scale,and health productivity impairment scale. Construct and test the chain mediation model of perceived stress and occupational uncertainty. Results The scores of perceived stress,occupational uncertainty,workplace resilience and health productivity impairment of 342 surgical medical staff in 6 grade-A tertiary hospitals in Sichuan Province were （32.92±10.85）,（98.92±27.93）,（64.01±16.52） and （14.33±4.35）points,respectively. The impaired health productivity of surgical medical staff was negatively correlated with workplace resilience（r=-0.667,P<0.05）,and positively correlated with perceived stress and occupational uncertainty（r=0.687,0.692,both P<0.05）. The total indirect effect of workplace resilience on hidden absence was 0.317,accounting for 41.93% of the total effect. Among them,the specific mediating effects of perceived stress and occupational uncertainty on health productivity impairment accounted for 18.39% and 15.74%,respectively,and the chain mediating effect of the two accounted for 7.80%. Conclusion The impaired health productivity of surgical medical staff in grade-A tertiary hospitals in Sichuan Province is at a moderate to high level,and the multiple mediating effects of perceived stress and occupational uncertainty in the mechanism of workplace resilience on the impaired hidden health productivity of surgical medical staff are established. Medical managers should pay attention to medical staff with high levels of health productivity impairment,reduce their perceived stress and occupational uncertainty,so as to further improve their physical and mental health.

Key words: Medical staff, Perceived stress, Occupational uncertainty, Workplace resilience, Impaired health productivity, Chain intermediary

中图分类号:

R181.3⁺1

缪世茜, 邓小娇. 知觉压力和职业不确定感在外科医务人员工作场所韧性与健康生产力受损间的链式中介作用. [J]职业与健康, 2024, 40(18): 2484-2490.

MIAO Shiqian, DENG Xiaojiao. Chain mediating effect of perceived stress and occupational uncertainty on workplace resilience and the impairment of health productivity among surgical medical staff. [J]OCCUPATION AND HEALTH, 2024, 40(18): 2484-2490.

参考文献

[1] 陈芳芳,崔泽实.ECRI发布2023年需要关注的Top 10患者安全问题专题报告[J].中国医学装备,2023,20(3):5.
[2] 本刊讯. 中国医院协会发布2022版患者安全目标[J].上海护理,2022,22(10):57.
[3] 宋美璇,王玉香,李显蓉.心理弹性对外科护理人员工作压力与职业倦怠的中介效应[J].职业与健康,2021,37(7):888-892.
[4] 杨焱平,牟绍玉.护士长隐性缺勤现状及影响因素分析[J].护理学杂志,2020,35(9):61-63.
[5] PERRY L,LAMONT S,BRUNERO S,et al.The mental health of nurses in acute teaching hospital settings:a cross-sectional survey[J].BMC Nurs.2015,5(27);14:15.
[6] 张祎凡,张旺喆麒,王梦佳,等.工作场所韧性量表的汉化及信效度检验[J].职业与健康,2023,39(1):55-58.
[7] KESTER K,WEI H.Building nurse resilience[J].Nurs Manage,2018,49(6):42-45.
[8] 张敏柔,黄惠根,邓亚芳,等.知觉压力量表在护士群体中应用的信效度检验[J].职业与健康,2022,38(13):1788-1791,1796.
[9] 谷静,陈一萍,李琳波,等.护士职业不确定感的研究现状与思考[J].护理研究,2022,36(3):447-449.
[10] 高倩,王明欣,周春姣,等.压力知觉和隐性缺勤在三级甲等医院外科护士工作-家庭冲突和职业倦怠间的链式中介作用[J].职业与健康,2022,38(16):2177-2181.
[11] 卢同波,何俊,许锐,等.江苏省康复治疗师组织认同在职业韧性与工作场所隐性缺勤行为间的中介效应[J].医学与社会,2021,34(11):93-96.
[12] COHEN S,KAMMARCK T,MERMELSTEIN R.A global measure of perceived stress[J].J Health Soc Behav,1983,24(4):385-396.
[13] 赵芳,戴俊明,颜士勇,等.健康生产力受损量表(SPS-6)中文版的信度和效度研究[J].中华劳动卫生职业病杂志,2010,28(9):679-682.
[14] 杨楠,宋海庆,吉训明,等.2022年版美国心脏协会/美国卒中协会自发性脑出血患者管理指南更新要点及解读[J].中国脑血管病杂志,2022,19(11):729-732,748.
[15] 张宝月,侯尚妍,吕孝臣.成都市三级甲等医院神经外科护士良心压力现状及其对隐性缺勤的影响[J].职业与健康,2021,37(19):2643-2646.
[16] 赵文文. 心外科ICU护士职业紧张及睡眠质量的现状研究[J].全科护理,2019,17(28):3579-3582.
[17] 孙雪娇,张兰君,孙瑜,等.职业价值感在杭州市护士心理契约破裂与职业认同之间的缓冲作用调查[J].医学与社会,2020,33(4):122-124,135.
[18] 唐娇,刘欣怡,覃楠玲,等.心理韧性在眼科护士工作家庭冲突对职业倦怠影响中的中介作用[J].职业与健康,2022,38(14):1893-1897,1901.
[19] 何要柳. 护士出勤主义行为与工作压力源和健康生产力受损的相关性研究[D].昆明:昆明医科大学,2022.
[20] 吴杰毅,肖康乐,于淼,等.心理韧性在实习护生工作场所欺凌与职业认同间中介效应[J].中国职业医学,2022,49(2):158-164.
[21] ABURN G,GOTT M,HOARE K.What is resilience?An integrative review of the empirical literature[J].J Adv Nurs,2016,72(5):980-1000.
[22] BOS V D,KEE S.Uncertainty management:the influence of uncertainty salience on reactions to perceived procedural fairness[J].J Pers Soc Psychol,2001,80(6):931-941.
[23] 黄丽,戴俊明,张浩,等.医务人员职业倦怠与健康生产力受损的关联[J].环境与职业医学,2013,30(5):321-327.
[24] 常晓冬. 三甲医院临床护士工作压力知觉调研及应对策略研究[D].新乡:新乡医学院,2022.
[25] 陶金. 正念对护士职业倦怠的干预[D].南京:东南大学,2022.
[26] 杜萍. 正念疗法对儿科护士职业倦怠干预效果的Meta分析[J].山东医学高等专科学校学报,2023,45(5):333-335,316.