健康促进行为在护理工作环境与护士评价护理质量的中介作用

职业与健康 ›› 2023, Vol. 39 ›› Issue (23): 3250-3254.

健康促进行为在护理工作环境与护士评价护理质量的中介作用

赵亮亮^1a, 尚磊^1b, 罗正学²

1.空军军医大学军事预防医学系 a 卫生事业管理与医学教育教研室,b 卫生统计学教研室,陕西西安 710032;
2.空军特色医学中心办公室,北京 100142

收稿日期:2023-04-06 修回日期:2023-05-16 出版日期:2023-12-01 发布日期:2026-03-26
通信作者: 罗正学,教授,E-mail：luohan@fmmu.edu.cn
作者简介:赵亮亮,女,在读硕士研究生,研究方向为健康促进与健康管理。

Mediating effect of health-promoting behaviors between nursing work environment and nurse-assessed quality nursing care

ZHAO Liangliang^1a, SHANG Lei^1b, LUO Zhengxue²

1. a Department of Health Care Management and Medical Education,b Department of Health Statistics,School of Military Preventive Medicine,Air Force Medical University,Xi'an Shaanxi 710032,China;
2. Office,Air Force Specialty Medical Center,Beijing 100142,China

Received:2023-04-06 Revised:2023-05-16 Online:2023-12-01 Published:2026-03-26
Contact: LUO Zhengxue,Professor,E-mail：luohan@fmmu.edu.cn

摘要/Abstract

摘要： 目的调查护理工作环境与护士评价护理质量的关系及健康促进行为的中介作用,旨在为管理者制定提高护理质量的针对性措施提供参考依据。方法 2022年1月,采用便利抽样法分别从北京和西安各选取1家三级甲等医院共824名护士为研究对象,采用护士一般情况问卷、护理工作环境量表、健康促进行为量表和护士评价护理质量量表进行问卷调查,采用结构方程模型分析健康促进行为在护理工作环境对护士评价护理质量影响的中介作用。结果护理工作环境、健康促进行为和护士评价护理质量得分分别为（3.39±0.51）、（3.13±0.52）和（4.64±0.51）分,护理工作环境、健康促进行为和护士评价护理质量间均呈正相关关系（r=0.426~0.642,均P<0.05）。结构方程模型显示,护理工作环境对护士评价护理质量有直接正向预测作用（β=0.507,P<0.05）,健康促进行为对护理质量有部分中介作用（β=0.096,P<0.05）,中介效应占比为15.9%。结论护理管理者应创建有利于护理人员参与的健康护理工作环境,并促进护理人员的整体健康促进行为,尤其是应促进护士医院事务参与度和体力活动,使护理人员能更好为患者提供高质量的护理服务。

关键词: 护理工作环境, 健康促进行为, 护理质量, 结构方程模型

Abstract: Objective To investigate the relationship between the nursing work environment and nurse-assessed quality nursing care and the mediating effect of health-promoting behaviors,so as to provide a reference for managers to formulate targeted measures to improve quality nursing care. Methods In January 2022,a total of 824 nurses from a grade-A tertiary hospital in Beijing and Xi'an were selected as the research objects by convenience sampling,respectively. The nurses' general information questionnaire,nursing work environment scale,health-promoting behaviors scale,and quality nursing care scale were used for the questionnaire investigation. The structural equation model was used to analyze the mediating effect of health-promoting behaviors between the nursing work environment and nurse-assessed quality nursing care. Results The score of the nursing work environment,health-promoting behaviors and nurse-assessed quality nursing care was （3.39±0.51）,（3.13±0.52） and （4.64±0.51） points,respectively. The nursing work environment,health-promoting behaviors,and nurse-assessed quality nursing care were positively correlated（r=0.426-0.642,all P<0.05）. The structural equation model showed that the nursing work environment had a direct positive predictive effect on nurse-assessed quality nursing care（β=0.507,P<0.05）,the health-promoting behaviors had a partial mediating effect on nurse-assessed quality nursing care（β=0.096,P<0.05）,and the mediating effect accounted for 15.9%. Conclusion The nursing managers should build a healthy nursing work environment conducive to the participation of nurses and promote the overall health-promoting behaviors of nurses,especially the participation in hospital affairs and physical activities so that nurses can better provide high-quality nursing services for patients.

Key words: Nursing work environment, Health-promoting behaviors, Quality nursing care, Structural equation model

中图分类号:

R181.3

赵亮亮, 尚磊, 罗正学. 健康促进行为在护理工作环境与护士评价护理质量的中介作用. [J]职业与健康, 2023, 39(23): 3250-3254.

ZHAO Liangliang, SHANG Lei, LUO Zhengxue. Mediating effect of health-promoting behaviors between nursing work environment and nurse-assessed quality nursing care. [J]OCCUPATION AND HEALTH, 2023, 39(23): 3250-3254.

参考文献

[1] LABRAGUE L J,SANTOS J A A,FRONDA D C.Factors associated with missed nursing care and nurse-assessed quality of care during the COVID-19 pandemic[J].J Nurs Manag,2022,30(1):62-70.
[2] LIU Y,AUNGSUROCH Y.Factors influencing nurse-assessed quality nursing care:A cross-sectional study in hospitals[J].J Adv Nurs,2018,74(4):935-945.
[3] GOMES P M.Nursing practice environment and the nurse manager intervention:Critical review[J].Trends Nur Health Care Res,2021,1(1):1-5.
[4] HUANG X,WANG L,DONG X,et al.Effects of nursing work environment on work-related outcomes among psychiatric nurses:A mediating model[J].J Psychiatr Ment Health Nurs,2021,28(2):186-196.
[5] CHEN L,ZHANG J,FU W.Health-promoting lifestyles and their related influences among nursing assistants in nursing homes in China[J].Appl Nurs Res,2018,39:97-102.
[6] MUSTAFAEI NAJAF-ABADI H,REZAEI B.Health-promoting behaviours of Iranian nurses and its relationship with some occupational factors:A cross sectional study[J].J Nurs Manag,2018,26(6):717-725.
[7] 王丽,李乐之.中文版护理工作环境量表的信效度研究[J].中华护理杂志,2011,46(2):121-123.
[8] MA W,JIANG Y,LIANG T,et al.Newly graduated nurses' perceptions of work environment:A cross-sectional study in China[J].Int J Nurs Pract,2021,27(6):e12929.
[9] LAKE E T,FRIESE C R.Variations in nursing practice environments:relation to staffing and hospital characteristics[J].Nurs Res,2006,55(1):1-9.
[10] 曹文君,郭颖,平卫伟,等.HPLP-Ⅱ健康促进生活方式量表中文版的研制及其性能测试[J].中华疾病控制杂志,2016,20(3):286-289.
[11] LIU Y,AUNGSUROCH Y,GUNAWAN J,et al.Development and psychometric evaluation of a quality nursing care scale from nurses’ perspective[J].Nurs Open,2021,8(4):1741-1754.
[12] 徐诚玲,郭秀梅,袁宁,等.儿科护士心理资本和心理契约对职业倦怠的影响[J].职业与健康,2021,37(1):11-15.
[13] CHEN Q,GOTTLIEB L,LIU D,et al.The nurse outcomes and patient outcomes following the High-Quality Care Project[J].Int Nurs Rev,2020,67(3):362-371.
[14] MCHUGH M D,STIMPFEL A W.Nurse reported quality of care:a measure of hospital quality[J].Res Nurs Health,2012,35(6):566-575.
[15] GAALAN K,KUNAVIKTIKUL W,AKKADECHANUNT T,et al.Factors predicting quality of nursing care among nurses in tertiary care hospitals in Mongolia[J].Int Nurs Rev,2019,66(2):176-182.
[16] GEA-CABALLERO V,MARTÍNEZ-RIERA J R,GARCÍA-MARTÍNEZ P,et al. Study of the strengths and weaknesses of nursing work environments in primary care in Spain[J].Int J Environ Res Public Health,2021,18(2):434.
[17] 吕鹏,王芬,朱亚鑫,等.四川省护士工作环境现状及影响因素研究[J].中国卫生统计,2020,37(1):90-93.
[18] YING L,FITZPATRICK J M,PHILIPPOU J,et al.The organisational context of nursing practice in hospitals in China and its relationship with quality of care,and patient and nurse outcomes:A mixed‐methods review[J].J Clin Nurs,2021,30(1-2):3-27.
[19] 钱庆庆,范玲.护士健康促进生活方式与亚健康状态的相关性研究[J].职业与健康,2019,35(21):2936-2939.
[20] 周晓霞,叶徐婵.多中心研究职业紧张在手术室护士健康促进行为和职业生活质量中的中介作用[J].现代医学,2021,49(6):675-679.
[21] 谷波,赵上萍,张骏.四川省三级医院护士健康促进生活方式与职业压力的相关性[J].护理学杂志,2019,34(1):60-62.
[22] ROSS A,JUMIN LEE L,WEHRLEN L,et al.Factors that influence health-promoting behaviors in cancer caregivers[J].Oncol Nurs Forum,2020,47(6):692-702.
[23] HEIDKE P,MADSEN W L,LANGHAM E M.Registered nurses as role models for healthy lifestyles[J].Aust J Adv Nurs,2020,37(2):11-18.
[24] AMBANI Z,KUTNEY LEE A,LAKE E T.The nursing practice environment and nurse job outcomes:A path analysis of survey data[J].J Clin Nurs,2020,29(13-14):2602-2614.
[25] HINNO S,PARTANEN P,VEHVILÄINEN-JULKUNEN K.The professional nursing practice environment and nurse-reported job outcomes in two European countries:a survey of nurses in Finland and the Netherlands[J].Scand J Caring Sci,2012,26(1):133-143.
[26] KEELE R.To Role Model or Not? Nurses’ Challenges in Promoting a Healthy Lifestyle[J].Workplace Health Saf,2019,67(12):584-591.
[27] ROSS A,BEVANS M,BROOKS A T,et al.Nurses and health-promoting behaviors:Knowledge may not translate into self-care[J].AORN J,2017,105(3):267-275.
[28] AIKEN L H,SERMEUS W,VAN DEN HEEDE K,et al.Patient safety,satisfaction,and quality of hospital care:cross sectional surveys of nurses and patients in 12 countries in Europe and the United States[J].BMJ,2012,344(e1717):1-14.