【作者】 李翠翠；

【导师】 祝筠；

【作者基本信息】 山东大学 ， 护理（专业学位）， 2023， 硕士

【摘要】 目的本研究基于社会嵌入模型和自我决定理论,从部门情境特征、工作资源和个人资源的角度出发,了解急诊科护士工作繁荣的现状及影响因素,分析挑战性-阻碍性压力、授权型领导、内在动机与工作繁荣的关系;通过构建结构方程模型,探讨内在动机在挑战性-阻碍性压力、授权型领导与工作繁荣间的中介作用;为护理管理者采取针对性的干预措施以提高急诊科护士的工作繁荣水平提供参考依据。方法本研究采用横断面研究设计,2022年6—8月,便利抽取山东省济南市6所三级甲等医院的急诊科护士为研究对象。研究工具有一般资料调查表、工作繁荣量表、挑战性-阻碍性压力量表、授权型领导量表、内在动机量表。数据分析使用SPSS25.0和AMOS23.0,具体的统计学方法有描述性分析、独立样本t检验、单因素方差分析、Pearson相关性分析、多元线性回归分析及结构方程模型的构建。结果1.本研究共纳入337名急诊科护士。急诊科护士的工作繁荣得分为(51.05±8.22)分,条目均分为(5.11±0.82)分,活力维度得分为(24.68±4.54)分,学习维度得分为(26.37±4.50)分;挑战性压力得分为(20.64±4.72)分,阻碍性压力得分为(13.56±3.79)分;授权型领导得分为(45.51±9.38)分;内在动机得分为(75.73±12.50)分。2.单因素分析结果显示,急诊科护士的工作繁荣得分在性别(t=2.259,P<0.05)、每周工作时间(F=4.909,P<0.01)方面,差异具有统计学意义。3.相关性分析结果显示,急诊科护士的挑战性压力、授权型领导、内在动机分别与工作繁荣呈正相关(r=0.233～0.525,均P<0.001),阻碍性压力与工作繁荣呈负相关(r=-0.165,P<0.01)。4.多元线性回归分析结果显示,每周工作时间(β=-0.114,P<0.05)、授权型领导(β=0.380,P<0.001)、内在动机(β=0.253,P<0.001)、挑战性压力(β=0.220,P<0.001)、阻碍性压力(β=-0.160,P<0.01)是急诊科护士工作繁荣的影响因素,共同解释工作繁荣总变异的40.4%。5.结构方程模型结果显示,挑战性压力不仅对工作繁荣有直接的正向影响(β=0.259,P<0.001),还可通过内在动机对工作繁荣有间接影响(β=0.055,P<0.01),间接效应95%CI[0.021,0.107],内在动机在挑战性压力与工作繁荣的中介作用成立;阻碍性压力不仅对工作繁荣有直接的负向影响(β=-0.195,P<0.01),也可通过内在动机对工作繁荣有间接影响(β=-0.059,P<0.01),间接效应95%CI[-0.114,-0.021],内在动机在阻碍性压力与工作繁荣的中介作用成立;授权型领导不仅对工作繁荣有直接的正向影响(β=0.479,P<0.001),还可通过内在动机对工作繁荣有间接影响(β=0.069,P<0.01),间接效应95%CI[0.035,0.119],内在动机在授权型领导与工作繁荣的中介作用成立。结论1.急诊科护士的工作繁荣处于中等水平。护理管理者应重视急诊科护士这一积极的工作体验。2.每周工作时间、挑战性压力、阻碍性压力、授权型领导、内在动机是显著影响急诊科护士工作繁荣的因素。护理管理者应从工作繁荣的影响因素出发,制定改善急诊科护士工作繁荣的干预措施。3.内在动机分别在挑战性压力、阻碍性压力、授权型领导与工作繁荣之间起部分中介作用。挑战性压力、授权型领导均可通过增加急诊科护士的内在动机间接提高工作繁荣,而阻碍性压力通过降低护士的内在动机间接导致工作繁荣的下降。护理管理者应实施授权型的领导风格,适当增加急诊科护士的挑战性压力,降低其阻碍性压力,同时采取相应措施激发护士的内在动机,进而提高护士的工作繁荣,提升护理质量。更多还原

【Abstract】 ObjectivesBased on the Socially Embedded Model and Self-determination Theory,the survey was conducted to understand the current situation and influencing factors of thriving at work of emergency department nurses from the perspectives of departmental contextual characteristics,work resources,and personal resources,and to analyze the relationship between challenge-hindrance stressors,empowering leadership,intrinsic motivation,and thriving at work;to explore the mediating role of intrinsic motivation between challenge-hindrance stressors,empowering leadership and thriving at work by constructing a structural equation model;and to provide a reference basis for nursing managers to adopt targeted interventions to improve thriving at work of emergency department nurses.MethodsA cross-sectional research design was adopted for this investigation to facilitate the sampling of emergency department nurses in six tertiary hospitals in Jinan,Shandong Province,from June to August 2022.The survey instruments were General Information Questionnaire,Thriving at Work Scale,Challenge-Hindrance Stressors Scale,Empowering Leadership Scale,and Intrinsic Motivation Scale.Data analysis was performed using SPSS 25.0 and AMOS 23.0 with descriptive analysis,independent sample t-test,one-way ANOVA,Pearson correlation analysis,multiple linear regression analysis,and structural equation model.Results1.337 emergency department nurses were included in this study,with a thriving at work score of(51.05±8.22)and the average score for an item was(5.11±0.82).Vitality dimension score was(24.68±4.54)and learning dimension score was(26.37±4.50).Challenge stressors score was(20.64±4.72)and hindrance stressors score was(13.56±3.79).Empowering leadership score was(45.51 ±9.38).Intrinsic motivation score was(75.73±12.50).2.The findings of the univariate analysis revealed that thriving at work scores of emergency department nurses were statistically significant across gender(t=2.259,P<0.05)and weekly work hours(F=4.909,P<0.01).3.The results of correlation analysis showed that challenge stressors,empowering leadership,and intrinsic motivation were respectively positively correlated with thriving at work(r=0.233～0.525,all P<0.001),and hindrance stressors were negatively correlated with thriving at work(r=-0.165,P<0.01)among emergency department nurses.4.Multiple linear regression analysis revealed that weekly work hours(β=-0.114,P<0.05),empowering leadership(β=0.380,P<0.001),intrinsic motivation(β=0.253,P<0.001),challenge stressors(β=0.220,P<0.001),and hindrance stressors(β=-0.160,P<0.01)were influencing factors of thriving at work among emergency department nurses,which together explained 40.4%of the total variance in thriving at work.5.The results of structural equation model showed that challenge stressors not only had a direct positive effect on thriving at work(β=0.259,P<0.001),but also could have an indirect effect on thriving at work through intrinsic motivation(β=0.055,P<0.01),with 95%CI[0.021,0.107]for the indirect effect,and the mediating role of intrinsic motivation in challenge stressors and thriving at work was established.Hindrance stressors not only had a direct negative effect on thriving at work(β=-0.195,P<0.01),but can also had an indirect effect on thriving at work through intrinsic motivation(β=-0.059,P<0.01),with an indirect effect 95%CI[-0.114,-0.021],and that the mediating role of intrinsic motivation in hindrance stressors and thriving at work was valid.Empowering leadership not only had a direct positive effect on thriving at work(β=0.479,P<0.001),but also had an indirect effect on thriving at work through intrinsic motivation(β=0.069,P<0.01),with 95%CI[0.035,0.119]for the indirect effect,and the importance of intrinsic motivation as a mediator in empowering leadership and thriving at work has been proven.Conclusions1.Thriving at work of emergency department nurses is at a medium level.Nursing managers should focus on this positive work experience for emergency department nurses.2.Weekly work hours,challenge stressors,hindrance stressors,empowering leadership,and intrinsic motivation are factors that significantly affect the thriving at work of emergency department nurses.Nursing managers should develop interventions to improve the thriving at work of emergency department nurses in terms of the factors influencing thriving at work.3.Intrinsic motivation respectively partially mediates the relationship between challenge stressors,hindrance stressors,empowering leadership and thriving at work.Challenge stressors and empowering leadership can both indirectly increase thriving at work by increasing the intrinsic motivation of emergency department nurses,whereas hindrance stressors indirectly leads to a decrease in thriving at work by decreasing the intrinsic motivation of nurses.Nursing managers should implement an empowering leadership style,appropriately increase the challenge stressors and decrease the hindrance stressors of emergency department nurses,and take appropriate measures to motivate nurses’ intrinsic motivation,thereby increasing nurses’ thriving at work and improving nursing quality.更多还原