護理臨床教師感受到的壓力和支持以及其使命感：重複測試研究

Nursing Preceptors’ Perceived Stress and Support, and Their Commitment: A Repeated Measures Study

王維芳(Wei-Fang Wang)

指導教授 ： 洪志秀教授

高雄醫學大學/護理學院/護理學系博士班/博士(2017年)

摘要

摘要
研究背景: 面對醫療環境的壓力，護理臨床教師是新人延攬及留任的關鍵角色。護理臨床教師除了臨床工作之外，還需要承擔額外的教學責任，因此更感受到承擔的角色壓力。雖然使命感是維持護理臨床教師教學的熱忱，但是會受到角色壓力與組織支持的影響，並且隨著時間和經驗的不同而產生變化。過去橫斷式的研究設計無法呈現護理臨床教師在教學歷程中的角色壓力、組織支持和使命感之變化趨勢。
研究目的: 探討護理人員在初任護理臨床教師六個月期間，所感受到的角色壓力、組織支持以及其使命感之變化與關係。
研究方法: 採用重複測量的縱貫性研究設計和方便取樣，在南部某醫學中心，以單組重複測量的方法，分別在護理臨床教師培訓之前，之後二個月、四個月、六個月進行施測。以從事臨床護理工作並且獲得單位推薦擔任護理臨床教師者為研究對象。研究工具包括基本屬性量表、護理臨床教師角色壓力感受量表、護理臨床教師組織支持感受量表和護理臨床教師使命感量表。以廣義估計方程式分析護理臨床教師感受到的角色壓力、組織支持及其使命感之變化趨勢以及彼此間之關係。
研究結果: 護理臨床教師於六個月期間，其組織支持感受顯著增加。研究對象為在職進修者、被指定擔任護理臨床教師的動機和有參加師資課程者的角色壓力感受較高。有教學經驗者的角色壓力則較低;非自願擔任護理臨床教師者的使命感較低。另外，本研究發現組織支持感受改變的重要預測因素為在職進修、擔任護理臨床教師的動機、被指導者的教育程度；在職進修、被指定擔任護理臨床教師的動機、被指導者是大學畢業以上者的護理臨床教師之組織支持感受變化較大。而護理臨床教師使命感的重要預測因素是組織支持感受及擔任護理臨床教師的動機；組織支持感受越高則護理臨床教師使命感也越高，擔任護理臨床教師的外因動機者相較於內在動機者使命感為低。同時，護理臨床教師使命感變化的重要預測因素是組織支持感受的改變和擔任護理臨床教師的意願；組織支持感受變化越大則使命感增加變化也越大；非自願擔任護理臨床教師者相較自願擔任者的護理臨床教師使命感變化也較大。
結論:護理臨床教師組織支持感受及其變化與護理臨床教師使命感及其變化有正向的關係，因此提供持續性的組織支持不但有助於提升護理臨床教師使命感，也會有長期的效應。本研究以重複測量和單一方向檢測護理臨床教師的屬性、角色壓力感受、組織支持感受對其使命感的影響。未來可以針對各變項間的相互影響，採用多方向性互動的研究設計，深入探究這些變項在不同時間的變化。

關鍵字

護理臨床教師 ； 角色壓力 ； 組織支持 ； 使命感 ； 重複性測量研究

並列摘要

Abstract
Background: Nurses face the pressure of workload and manpower issues. Thus, preceptors play key persons for new staffs recruitment and retention. However, preceptors suffer from role stress because they have to undertake both clinical workload and teaching responsibility. Although preceptors’ enthusiasm for clinical teaching is due to role commitment, different levels of role stress and organizational support perceived by preceptors will impact their role commitment. In addition, the preceptors’ role commitment might change because of their clinical experience over time. Studies with a cross-sectional design are limited to indicate the dynamic change patterns of preceptors’ role stress, organizational support and commitment during their mentoring period.
Purpose: The purpose of this study was to examine changes and relationships among new nursing preceptors’ perceived role stress, organizational support, and commitment to their role within six-month period while they first assumed the preceptor role.
Method: A longitudinal study with a single group and repeated measures were used in this study. With a convenient sampling, participants were recruited from a medical center in southern Taiwan. Inclusive criteria were nurses who worked in a teaching hospital and were candidates for nursing preceptor recommended by managers of the units. The study instruments included the demographic questionnaire, the Preceptor’s Perception of Stress Scale, the Preceptor’s Perception of Support Scale and the Commitment to the Preceptor Role Scale. Data were collected before a preceptor training program, and again after the training program in the second, fourth, and sixth months. Data were analyzed with generalized estimating equation to explore the trend of changes and relationships among the perceived role stress, organizational support and commitment to the preceptor role.
Results: Nursing preceptors’ perception of organizational support gradually increased significantly during the six-month period. The participants, who were on-job education, assigned as a nursing preceptor by managers of the unit, and who participated in the faculty development classes, perceived higher stress. Participants with teaching experience perceived lower stress and participants without intention to be a preceptor had lower commitment. In addition, the study indicated that predictors of changes in organizational support involved on-job education, assigned to be a nursing preceptor by managers of the unit and educational level of trainees. Preceptors who were on-job education, who were assigned to be a nursing preceptor by managers of the unit, and whose trainees were bachelor degree or above perceived higher change in organizational support. The important predictors of preceptor’s role commitment were organizational support and motivation to be a preceptor. Preceptors with higher perception of organizational support had higher sense of role commitment. Compared with internal motivation, preceptors with external motivation had lower role commitment. Meanwhile, the change of organizational support and intention to be a preceptor were predictors of changes in role commitment. The higher organizational support perceived, the stronger sense of role commitment was found. Compared with participants who had intention to be preceptors, participants who were without intention to be preceptors had higher change in role commitment.
Conclusion: A positive correlation between preceptors’ sense of role commitment and perceived organizational support, as well as the positive relationship for both changes in role commitment and organizational support. Thus, persistent organizational support not only facilitates preceptor’s role commitment but also has a long-term effectiveness. This study explored changes and relationships among new nursing preceptors’ role commitment and their demographic characteristics, role stress, and organizational support based on a repeated-measure study design over a six-month period. The future study would explore the interactions between different factors and the trend of their changes over a period of time.

並列關鍵字

Nursing preceptor ； role stress ； organizational support ； commitment ； repeated-measure study design

參考文獻

中文參考資料

王秀禾、葉美玲、鍾聿琳、楊千慧(2008)．應用耳穴貼壓改善睡眠之成效．實證護理，4 (3)，243-250。doi: 10.6225/jebn.4.3.243

尹裕君(2013)．二年期護理師(護士)訓練計畫實施之現況與我見．護理雜誌，60 (3)，11-16。doi:10.6224/JN.60.3.11

台灣護理學會(2001)．有關臨床「Preceptor」之中文名稱．取自http://www.twna.org.tw/frontend/un09_news/news_newsdetail.asp?t_id=3214§or=1

台灣護理學會(2012)．基層護理能力進階規劃指引．取自https://www.twna.org.tw/frontend/un10_open/welcome.asp#