摘要
背景：近年来，我国医患关系、护患关系紧张甚至引发激烈冲突，危及医护患的切身利益，彼此间的角色认知偏差及其沟通不畅被视为主要因素之一。课题组前期研究发现，公众、患者等群体对医生、护士的角色认知存在刻板印象，且期望角色认知和现实角色认知不一致（即认知偏差）。本课题作为其后续研究，主要探索患者形成护士角色认知的机制。
目的：探索患者对护士角色认知影响因素的初步理论框架；尝试从外在因素、护患互动过程、患者自身因素多层面分析患者形成护士角色认知的影响因素，并构建患者对护士角色认知的形成机制模型，以期为后续开展促进护患角色认知的相关研究提供理论依据。
方法：①在充分分析国内外相关文献的基础上，对12例患者和10位医务工作者对护士角色的认知体验及其影响因素进行半结构式访谈，结合相关理论分析，提出了患者对护士角色认知形成机制的理论框架。②结合文献分析和质性访谈研究结果，形成患者对护士角色认知的外在影响因素调查问卷初稿，采用专家咨询法（15位专家，2轮咨询）对问卷的结构维度和条目进行咨询修订；经预调查修订形成患者对护士角色认知外在影响因素调查问卷。同时，引入、汉化并修订适合国情的护士照护行为量表。③根据形成的理论框架，应用自行编制的患者对护士角色认知外在影响因素调查问卷、汉化的中文版护士照护行为量表、以及课题组前期研制的患者对护士角色认知测量工具和人口统计学问卷，分别从外在因素、护患互动过程以及患者自身因素三方面，采用方便抽样法调查中山市2家医院468名患者，分析患者形成护士角色认知的影响因素，并构建患者对护士角色认知的机制模型。
结果：①自行编制的患者对护士角色认知外在影响因素调查问卷的Cronbach’sα系数0.850-0.954；重测信度0.618-0.827；内容效度指数S-CVI/UA为0.97。②中文版照护行为量表Cronbach’s α系数0.855-0.959；重测信度0.656-0.883，内容效度指数S-CVI/UA为0.95。③被调查患者对护士角色认知各维度均分从高到低依次为：职业自律性4.46±0.65，职业素养4.45±0.69，职业形象定位4.44±0.68；患者对护士角色认知外在影响因素各维度均分从高到低依次为：护士因素3.21±1.35，社会背景因素2.15±0.95，媒介因素2.03±0.92，医院管理因素1.90±0.82；患者感知的护士照护行为中，总平均分4.69±0.20，各维度均分从高到低依次为：知识与技能5.12±0.86，服务的可及性4.86±0.92，尊重4.43±1.01，服务的连续性4.29±1.08。④患者形成护士角色认知的影响因素包括：影响患者对护士职业自律性认知的因素为医院管理因素（β=-0.184）、服务的连续性（β=-0.232）、社会背景因素（β=-0.150）、健康状况（β=0.138）、既往住院经历（β=0.106）；影响患者对护士职业形象定位认知的因素为服务的连续性（β=0.254）、媒介因素（β=-0.200）、健康状况（β=0.151）、既往住院经历（β=0.114）；影响患者对护士职业素养认知的因素为服务的连续性（β=0.228）、医院管理因素（β=-0.161）、目前健康状况（β=0.135）、社会背景因素（β=-0.133）、既往住院经历（β=0.115）。⑤外在影响因素对患者形成护士角色认知各维度具直接预测作用：对职业自律性、职业形象定位、职业素养具有直接负向影响，其路径系数的标准化估计值为-0.545、-0.358、-0.370；护士的照护行为对患者形成护士角色认知各维度具有直接预测作用：对职业自律性、职业形象定位、职业素养产生正向影响，其路径系数的标准化估计值为0.402、0.343、0.275；外在影响因素对患者感知的护士照护行为有直接负向影响，其路径系数的标准化估计值为-0.467。
结论：①本研究自行编制的患者对护士角色认知外在影响因素调查问卷，适用于我国患者对护士角色认知外在影响因素的研究；汉化修订的中文版照护行为量表适用于我国患者对护士照护行为的评价。②明晰了患者形成护士角色认知的机制：人际间系统因素中“护士服务的连续性”是患者形成护士角色认知的首要影响因素；社会背景因素、医院管理因素和媒介因素是影响患者形成护士角色认知的社会系统因素；患者的健康状况、既往住院经历是其形成护士角色认知的个体影响因素。③构建了患者形成护士角色认知的机制模型，并基于模型提出了促进患者对护士角色积极评价的建议。本研究成果可为制定着眼于“优化职业形象、加强职业自律、提升职业素养”的护士培训策略提供有价值依据，以促进患者更多形成护士角色认知的积极评价；谋求医护患利益的共赢，营造我国的和谐医疗环境和惠及大众的健康需求。
Background: In recent years, doctor-patient and nurse-patient relationship aregrowing more and more tension, even aroused violent clashes, which endangered personalinterest of doctors, nurses and patients. The main reason of the problems was regarded asroles cognitive bias and communication breakdown among them. Study group found inpreliminary research found that the public and patients had stereotypes on the role ofdoctors and nurses. And inconformity existed between expected role cognition and realrole cognition (That is bias). As for subsequent research, this study mainly exploredmechanism of patients on the nurse role.
Objectives: To explore theoretical framework of influence factors on patients’perception to the nurse role. To analyze influence factors on patients’ perception to thenurse role from multi-elements, such as external factors, nurse-patient interactive processand patient self-factors. To structure formation mechanism of patients’ perception to thenurse role for providing theory evidence on subsequent related development of patients’perception on nurses.
Methods:①On the basic of analyzing the literature,12patients and10medicalworkers had been gone through semi-structured interviews on the perception and influencefactors of nurses’ role. According to relative theoretical research, theoretical framework onpatients’ perception to the nurse role had been put forward.②Combining literatureanalysis and qualitative interview findings, questionnaire draft of external factors onpatients perception to the nurse role had been formed. Questionnaire structure dimensionsand the items had been consulted and revised by expert consulting method. Previoussurvey and edition formed external factors questionnaire on the patients’ perception to thenurse role. At the same time, Caring Behavior Inventory had been introduced and revised.③According to the theoretical framework, using questionnaire method, applying externalfactors questionnaires on patients’ perception to nurse role, Caring Behavior Inventory-24in Chinese version, researching previous study on measurement tools of patients’perception to the nurse role as well as demographic questionnaire, convenience samplingmethod had been used to investigate468patients in two hospitals in Zhongshan city fromexternal factors, nurse-patient interactive process and patients’ self-factors, and analyzedinfluence factors of patients’ perception to the nurse role with formation of cognitivemechanisms on patients’ perception to the nurse role.
Results:①The internal reliability of self-compiled external factors questionnaire on patients’ perception to the nurse role based on Cronbach’s alpha was0.850-0.954. Re-testreliability was0.618-0.827. S-CVI/UA was0.97.②Chinese version of Caring BehaviorInventory-24based on Cronbach’s alpha was0.855-0.959. Re-test reliability was0.656-0.883. S-CVI/UA was0.95.③The mean score for the nurse role which coming frompatients were: The mean score for occupation of self-discipline was4.46±0.65, occupationaccomplishment came next and score was4.45±0.69, positioning occupation image scorewas4.44±0.68; nurses’ factor was being the greatest influence factors among the externalfactors which patients to the nurse role, and score was3.21±1.35, social background camenext and the score was2.15±0.95, the score of media factor was2.03±0.92. Patientsthought hospital management factors with minimal impact and score was1.90±0.82;general mean score of patient perception in nurses caring behaviors was4.69±0.20,Knowledge and Skills got the highest score and it was5.12±0.86, Assurance came nextand score was4.86±0.92, the score of Respect was4.43±1.01, Connectedness came lastand the score was4.29±1.08.④Self-discipline factors among the factors which patientsperceive the nurse role: hospital management factor (β=-0.184), connectedness (β=-0.232),social background factor (β=-0.150), health condition (β=0.138), previous hospitalexperience (β=0.106); influence factor of positioning occupation image: connectedness(β=0.254), media factor (β=-0.200), health condition (β=0.151), hospital managementfactor (β=-0.161), current health condition (β=0.135), social background factor (β=-0.133),previous hospital experience (β=0.115).⑤External factors played direct prediction on thestereotypes: a positive influence on occupation of self-discipline, positioning occupationimage, occupation accomplishment. Standard estimated values of path coefficient were0.402、0.343、0.274; External factors had direct negative influence on caring behaviors andstandard estimated values of path coefficient were-0.467.
Conclusion:①This study self-compiled external influence factors questionnaire ofpatients’ perception to nurses role, which applicable to this research: Caring BehaviorInventory-24in Chinese version well applied to the assessment of patients’ perception tothe nurses’ caring behaviors in China.②Clarity the mechanism of patients’ perception tothe nurse role: service continuity among interpersonal system factors was the initialinfluence factor of patients’ perception to the nurse role. Social background factors,hospital management factors and media factors are the factors influencing patients’perception to the nurse role among social system factors. Patients’ health status andprevious hospital experience among patients’ individual factor were influencing patients’ perception to the nurse role.③Constructed mechanism model of patients’ perception tothe nurse role, and proposed intervention strategies to promote patients making positiveassessment on the nurse role. The results of this study provided valuable evidence onmaking nurses training strategies which focus on optimizing professional image,strengthening self-disciplined occupation, enhancing professional quality, sought thesituation among doctors, nurses and patients and built harmonious medical environment ofour country for benefiting public health requirement.
引文
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