ICU护士谵妄护理压力结构方程模型的构建  

Development of a structural equation model for strain of care for delirium among ICU nurses

作　　者：李超群 胡少华[3] 高业兰[3] 张刘会 吴玲[2] 金长雨 LI Chaoqun;HU Shaohua;GAO Yelan;ZHANG Liuhui;WU Ling;JIN Changyu(Public Teaching Department,Anhui Finance and Trade Vocational College,Hefei,230000,China)

机构地区：[1]安徽财贸职业学院公共教学部,合肥市230000 [2]安徽医科大学第一附属医院急诊重症监护室,合肥市230000 [3]安徽医科大学第一附属医院护理部,合肥市230000

出　　处：《中国护理管理》2025年第2期191-196,共6页Chinese Nursing Management

基　　金：安徽医科大学校科研基金项目(2022xkj290);安徽省临床重点专科建设项目(皖卫传[2019]91号)。

摘　　要：目的:以工作要求—控制—支持(JDCS)模型为理论框架构建ICU护士谵妄护理压力模型,分析ICU护士谵妄护理压力现状及影响因素,以期为制定方案降低ICU护士谵妄护理压力,提升ICU护士谵妄护理专业能力提供参考。方法:采用便利抽样法,于2023年2月—8月选取安徽省3所三级甲等医院的268名ICU护士作为调查对象,采用一般资料调查表、道德困境量表、心理授权量表、组织支持感量表、谵妄护理压力量表进行调查,依据JDCS理论模型及相关性分析结果构建初始模型,采用结构方程模型分析ICU护士谵妄护理压力的影响因素及作用路径。结果:ICU护士的谵妄护理压力得分为(54.39±8.12)分;结构方程模型拟合结果:χ^(2)/df=2.497,CFI=0.953,GFI=0.914,RMSEA=0.075,NFI=0.925,TLI=0.939,IFI=0.954;ICU护士道德困境程度对其谵妄护理压力产生直接正向影响(β=0.336);心理授权对谵妄护理压力产生直接负向影响(β=-0.276),同时,心理授权也通过影响道德困境对谵妄护理压力产生间接影响[β=-0.078,95%CI(-0.171,-0.025)];组织支持对谵妄护理压力产生直接负向影响(β=-0.195),同时,组织支持通过心理授权和道德困境间接影响谵妄护理压力[β=-0.254,95%CI(-0.382,-0.151)]。结论:ICU护士谵妄护理压力处于较高水平,护理管理者可通过强化ICU护士组织支持及心理授权水平,以降低其道德困境程度,是应对谵妄护理压力的有效途径。Objective:The Job Demand-Control-Support(JDCS)model was used as a theoretical framework to develop the structural equation model for strain of care for delirium in ICU nurses and explore its current status and influencing factors.Methods:A total of 268 ICU nurses from three tertiary grade A hospitals in Anhui province were selected by convenient sampling from February to August 2023.The Moral Distress Scale,the Psychological Empowerment Scale,the Perceived Organizational Support Scale,and the Strain of Care for Delirium Index were used to collect data.The structural equation model was used to establish and revise the strain of care for delirium model.Results:The strain of care for delirium of the participants was 56.32±14.68.The structural equation model fitted well(χ^(2)/df=2.497,CFI=0.953,GFI=0.914,RMSEA=0.075,NFI=0.925,TLI=0.939,IFI=0.954).Nurses'moral distress had a direct positive influence on the strain of care for delirium(β=0.336).Psychological empowerment had a direct negative impact on the strain of care for delirium(β=-0.276),while psychological empowerment also indirectly affected the strain of care for delirium by influencing moral distress(β=-0.078,95%CI:-0.171,-0.025).Organizational support had a direct negative effect on the strain of care for delirium(β=-0.195),while organizational support indirectly affected the strain of care for delirium through psychological empowerment and moral distress(β=-0.254,95%CI:-0.382,-0.151).Conclusion:The strain of care for delirium among ICU nurses is at a high level.Nursing managers can reduce their moral distress by strengthening nurses'organizational support and psychological empowerment level,which is an effective way to cope with the strain of care for delirium.

关 键 词：重症监护室 护士 谵妄 工作压力 工作要求 工作控制 结构方程模型 

分 类 号：R47[医药卫生—护理学] R197[医药卫生—临床医学]