心理幸福感作為壓力因應策略與留任意願之中介變項：以臨床護理人員進行探討

背景：護理人力短缺易造成工作壓力與病人安全問題，凍結護理人力流失、增強留任意願為長期努力目標。目的：了解護理人員工作壓力源、壓力因應策略使用、心理幸福感與留任意願間的關係。方法：以科技部計畫「北部某醫學中心護理師心理幸福感、壓力因應策略、病人安全態度與護理工作環境指標之研究探討」進行二手資料庫分析，該計畫執行期間為103年12月1日至104年11月30日，研究工具採(1) Bryan Sexton (2006)病人安全態度量表(SAQ)、(2)Carver (1989)壓力因應策略量表(Brief COPE)、(3)Ryff (1989)心理幸福感量表(PWB)、(4)蔡淑妙與盧美秀（1998）留任意願量表；以自填式問卷於北部某醫學中心臨床護理人員以分層隨機抽樣進行資料收集，共發放501份問卷。統計方式採線性迴歸分析(Linear regression)、單因子變異數分析(ANOVA)，及結構方程式(SEM)路徑分析進行。結果：該計畫有效問卷回收474份（有效回收率94.8%），各量表具良好信度（Cronbach’s α .83~ .94）及良好效度。研究結果顯示：「積極的問題聚焦」因應策略和留任意願有顯著正相關（β= .13, p < .01），「消極的情緒聚焦」因應策略和留任意願有顯著負相關（β = -.18, p < .001）；具高度心理幸福感之護理人員，留任意願顯著高於中度及低度者（p <.001）；因應策略與留任意願間呈負向關係（β = -.15, p < .01），心理幸福感與留任意願呈正向關係（β = .25, p < .001），因應策略可藉由心理幸福感作為中介與留任意願產生正向關係（Sobel test Z=4.83, β =.10, p < .001）。結論／實務應用：高度工作壓力會使留任意願降低，經由因應策略的使用，能使心理幸福感獲得提升，進而增進護理人員的留任意願。研究者建議可為新進人員進行壓力因應教育訓練課程，並由行政主管提供支持性的工作環境，主動營造正向工作氛圍。

關鍵字

心理幸福感；壓力因應策略；留任；護理人員

並列摘要

Background: Nursing staff shortage can easily lead to patient safety problems and induce more job stress, freeze the loss of nursing staff, enhance the willingness of retention is a long-term goal. Objectives: To understand the relation between job stress, coping strategy, psychological well-being and nurses’ retention. Method: In this study, we conducted a second-hand database analysis on the topic of “Impacts of psychological well-being, stress coping and practice environment of nursing work, safety attitude among nurses of medical center in North Taiwan”, which is collected from 2014/12/1 to 2015/11/30, and included a random sample of 501 clinical nurses from a medical center in Northern Taiwan, the instrument was using (1) Bryan Sexton (2006) Safety Attitude Questionnaire (SAQ)、(2)Carver (1989) Brief COPE、(3)Ryff (1989) Psychological well-being scale (PWB)、(4)Tsay and Lu (1998) intent-to-stay scale. And use Linear regression, ANOVA, SEM path analysis for statistics. Results: A total of 474 responses (response rate 94.8%) were received, All scales have good reliability (Cronbach's α.83 ~ .94) and good validity. the findings were: (1) “active problem-focused coping” is positively correlated with nurses’ retention (β= .13, p < .01), “passive emotional-focused coping” is negatively correlated with nurse’ retention (β = -.18, p < .001); (2) nurses with higher PWB had significantly higher retention (p <.001); (3) coping strategy has negatively association with retention(β = -.15, p < .01), PWB is positively associate with retention(β = .25, p < .001), PWB has found to be a positively mediator of coping strategy and retention(Sobel test z=4.83, β =.10, p < .001). Conclusions: Job stress can reduce retention, but through the use of coping strategies, PWB can be improved, thereby enhancing the retention of nursing staff. we suggest to provide stress coping training courses for nursing new staff, and build up a supportive and positively workplace by nursing supervisors.