手术室护生实习压力源调查及ESPCS干预方法的效果研究
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摘要
目的调查护生手术室实习期间的压力源及焦虑状况,探讨ESPCS(讲解-模拟-练习-沟通-支持)干预方法在手术室临床教学中的效果及可行性。
方法质性研究:采取立意取样方法,按照纳入标准和排除标准,选取2009年9月至11月在手术室实习的15名护生为研究对象,由专业人员应用半结构式深入访谈和现场观察法对其进行访谈,通过内容分析法对原始资料进行整理分析。
横断面调查:根据质性研究结果及文献分析、专家咨询,设计的手术室护生实习压力源量表,于2010年01月至2010年12月对手术室实习的281名护生进行实习压力源调查和焦虑状况的评定。调查数据采用SPSS13.0软件包进行统计分析,应用均数、标准差描述手术室护生前十位压力源,应用独立样本t检验分析男女护生焦虑状况与全国青年常模的差异及应用t检验和方差分析比较不同人口学特征的护生焦虑状况的差异。护生焦虑状况与压力源之间的相关性用Pearson相关来进行分析。
实验研究:选取2010年12月至2011年07月在手术室实习的168名护生为研究对象,采用类随机实验方法将其分为干预组和对照组,其中干预组84人(男生14人,女生70人),对照组84人(男生12人,女生72人)。两组护生在年龄、性别构成比、学历、家庭所在地、志愿选择等方面经统计学检验,无显著性差异(P>0.05),均衡可比。干预组采用ESPCS干预方法带教,对照组采用传统的带教法,进行干预效果评估。采用配对t检验比较干预前后干预组和对照组焦虑、自我效能评分和应对方式评分的变化;采用独立样本t检验比较两组护生干预后焦虑状态、一般自我效能感、应对方式及理论操作考试成绩的差异。
结果质性研究结果表明,护生在手术室实习期间压力源可以概括为以下五个方面主题:手术室特殊的环境,手术室学习和工作方面的压力,情感方面的压力,社会偏见压力,职业危害压力。
横断面调查结果显示:(1)手术室实习护生所感受到的压力源较多,位于前10位的压力源依次排序:第一次洗手上手术台、手术室专科知识缺乏、手术室工作节奏快、注意力高度集中、害怕出错和事故、接触病人血液、分泌物等被感染几率增加、带教老师的态度严厉、手术室陌生的环境、与多科室的医生合作而工作紧张、工作时间无规律(如不能按时吃饭、上夜班等)、患者和家属的不理解。(2)不同群体的手术室实习护生焦虑状况分析结果:①总体状态焦虑量表(S-AI)评分高于同年龄常模(P<0.01)②S-AI评分独生子女与非独生子女组间差异无统计学意义(P>0.05);来自农村的护生高于城市护生(P<0.01);中专组护生高于大专及本科组(P<0.01,P<0.01);调剂生高于自愿选择护理和受别人影响的护生(P<0.01,P <0.05)。
实验研究结果表明,评估调查时干预组焦虑状态、消极应对方式评分明显低于对照组(P<0.01);一般自我效能感和积极应对方式评分明显高于对照组(P<0.01)。干预组干预前后焦虑状态评分分别为44.24±3.36和40.04±3.53(P<0.01)。一般自我效能感评分分别为2.42±0.24和2.57±0.34(P<0.01)。积极应对方式评分分别为1.83±0.27和1.92±0.19(P<0.05);消极应对方式评分分别为1.63±0.24和1.52±0.1(6P<0.01)。而对照组干预前后焦虑状态评分分别为44.93±2.11和44.89±2.12(P>0.05),一般自我效能感评分分别为2.41±0.30和2.40±0.18(P>0.05)。积极应对方式评分分别为1.82±0.30和1.84±0.20(P>0.05);消极应对方式评分分别为1.62±0.22和1.61±0.18(P>0.05)。
结论手术室实习护生所感受到的压力源较多,男女护生的焦虑状态评分均高于常模,存在较为严重的焦虑情绪。运用讲解-模拟-练习-沟通-支持(ESPCS)干预方法可有效缓解护生焦虑情绪,促进身心健康,提高实习质量。
Objective To investigate the stress source and anxiety of nursing students in operating room during internship, to explore the effectiveness and feasibility of Explain-Simulate-Practice-Communication-Support (ESPCS) intervention method used in the operating room clinical teaching.
Methods Qualitative research: The 15 nursing students practicing in operating room in The Third People’s Hospital of HeFei from September to November, 2009 were selected as subjects by using purposive sampling method in accordance with inclusion and exlcusion criteria and then interviewed using semi-structured deep interviews and site investigation by professionals. The orginal doucuments are classified and analyzed by using content analysis.
Cross section survey: According to the results of qualiatiative study, literature analysis, expert consulting and designed surgery stress source scale, 218 nursing student practicing in operating room in the Third people’s hospital of HeFei city from January 2010 to December 2010 were selected as study objects to study and evaluate the stress source and anxiety. The obtained data is statictically analyzed using SPSS13.0 software package, the main stress source of surgery nursing student is described by applying percentage, the difference of anxiety state between male and female nursing students and national youth normal model is tested and analyzed by dependent sample t, and the difference of anxiety state of nursing student with different demographic characteristics is compared by using t and variance analysis. The correlation between the anixety state and stress source of nursing students was analyzed with Pearson correlation.
Experiment research: selecting the nursing student practicing in operating room in the Third people’s hospital of HeFei city from December 2010 to July 2011 as subjects, totally 168 persons including 26 male and 142 female students. They were divided into intervention group with 84 persons (14 male, and 70 female) and control group with 84 students (12 male, 72 female) according random experiment method. There is no obvious difference (P> 0.05) in age, sex, education, home address and interesting between two groups determined by statistics, they are comparble. The intervention group was taught by ESPCS method and the control group use traditional method, and then the questionnaire survey and effectiveness evaluation were done for both two group, respectively before and after intervention. We use paired t to check and compare the anxiety, coping self-efficacy scores of the intervention and control groups as well as the change of coping scores and comparison; use dependent sample t to test and compare the difference of anxiety, general self-efficacy, coping and score of theory and operating examination between two group after intervention.
Results The results of qualitative interview indicated that the stress source of nursing student in operating room can be summarized as: special environment in operating room, study and work stress in operating room, emotion pressure, social bias pressures and stress of occupational hazards.
Cross-sectional survey shows that: (1) the stress source of surgery nursing student is pretty much, the top ten followed by sorting: the first hands on the operating table, lack of specialty knowledge of the operating room, fast-paced, high concentration of attention, fears of mistakes and accident, increase of probability of being infected due to contacting with patient blood, secretions, etc, acrimony of teacher, unfamiliar environment in operating room, intense work and irregular office time due to the cooperation with multi-department doctors (without eating and sleep on time) and the misunderstand of patients and their families. (2) The analysis results of anxiety status for surgery nursing student in different groups indicate that:①the score of general state anxiety scale (S-AI) is higher than the normal model (P<0.01) for the same age②the difference of the S-AI score between only child and siblings was not statistically significant (P>0.05); the S-AI score of nursing student from countryside is higher than that of one from city (P<0.01); the S-AI score of secondary group is higher than that of college and university group (P<0.01, P<0.01); the S-AI score of the transfers is higher that of voluntary care and the one influenced by others (P<0.01, P<0.05).
Experiment results indicate that the score of the anxiety state and negative coping score of the intervention group in the assessment survey is much less than that of the control group (P<0.01), but the general self-efficacy and positive coping score is much higher that of control group (P<0.01). The score of the anxiety state of the intervention group before and after intervention is 44.24±3.36 and 40.04±3.53 (P<0.01), respectively; the score of the general self-efficacy is 2.42±0.24 and 2.57±0.34 (P<0.01), respectively; the positive coping score is 1.83±0.27and 1.92±0.19 (P<0.05), respectively; the negative coping score is 1.63±0.24 and 1.52±0.16 (P<0.01), respectively. However, for the control group: the score of the anxiety state before and after intervention is 44.93±2.11 and 44.89±2.12 (P>0.05), respectively; the score of the general self-efficacy is 2.41±0.30 and 2.40±0.18 (P>0.05), respectively. The positive coping score is 1.82±0.30 and 1.84±0.20 (P>0.05), respectively; the negative coping score is 1.62±0.22 and 1.61±0.18 (P>0.05), respectively.
Conclusion Operating room nursing students are more sources of stress experienced, the S-AI score of both male and female nursing students is higher than that of normal model. They have more serious anxiety. The ESPCS intervention method can effectively alleviate the anxiety, promoting health, improving the quality of practice of nursing students.
方法质性研究:采取立意取样方法,按照纳入标准和排除标准,选取2009年9月至11月在手术室实习的15名护生为研究对象,由专业人员应用半结构式深入访谈和现场观察法对其进行访谈,通过内容分析法对原始资料进行整理分析。
横断面调查:根据质性研究结果及文献分析、专家咨询,设计的手术室护生实习压力源量表,于2010年01月至2010年12月对手术室实习的281名护生进行实习压力源调查和焦虑状况的评定。调查数据采用SPSS13.0软件包进行统计分析,应用均数、标准差描述手术室护生前十位压力源,应用独立样本t检验分析男女护生焦虑状况与全国青年常模的差异及应用t检验和方差分析比较不同人口学特征的护生焦虑状况的差异。护生焦虑状况与压力源之间的相关性用Pearson相关来进行分析。
实验研究:选取2010年12月至2011年07月在手术室实习的168名护生为研究对象,采用类随机实验方法将其分为干预组和对照组,其中干预组84人(男生14人,女生70人),对照组84人(男生12人,女生72人)。两组护生在年龄、性别构成比、学历、家庭所在地、志愿选择等方面经统计学检验,无显著性差异(P>0.05),均衡可比。干预组采用ESPCS干预方法带教,对照组采用传统的带教法,进行干预效果评估。采用配对t检验比较干预前后干预组和对照组焦虑、自我效能评分和应对方式评分的变化;采用独立样本t检验比较两组护生干预后焦虑状态、一般自我效能感、应对方式及理论操作考试成绩的差异。
结果质性研究结果表明,护生在手术室实习期间压力源可以概括为以下五个方面主题:手术室特殊的环境,手术室学习和工作方面的压力,情感方面的压力,社会偏见压力,职业危害压力。
横断面调查结果显示:(1)手术室实习护生所感受到的压力源较多,位于前10位的压力源依次排序:第一次洗手上手术台、手术室专科知识缺乏、手术室工作节奏快、注意力高度集中、害怕出错和事故、接触病人血液、分泌物等被感染几率增加、带教老师的态度严厉、手术室陌生的环境、与多科室的医生合作而工作紧张、工作时间无规律(如不能按时吃饭、上夜班等)、患者和家属的不理解。(2)不同群体的手术室实习护生焦虑状况分析结果:①总体状态焦虑量表(S-AI)评分高于同年龄常模(P<0.01)②S-AI评分独生子女与非独生子女组间差异无统计学意义(P>0.05);来自农村的护生高于城市护生(P<0.01);中专组护生高于大专及本科组(P<0.01,P<0.01);调剂生高于自愿选择护理和受别人影响的护生(P<0.01,P <0.05)。
实验研究结果表明,评估调查时干预组焦虑状态、消极应对方式评分明显低于对照组(P<0.01);一般自我效能感和积极应对方式评分明显高于对照组(P<0.01)。干预组干预前后焦虑状态评分分别为44.24±3.36和40.04±3.53(P<0.01)。一般自我效能感评分分别为2.42±0.24和2.57±0.34(P<0.01)。积极应对方式评分分别为1.83±0.27和1.92±0.19(P<0.05);消极应对方式评分分别为1.63±0.24和1.52±0.1(6P<0.01)。而对照组干预前后焦虑状态评分分别为44.93±2.11和44.89±2.12(P>0.05),一般自我效能感评分分别为2.41±0.30和2.40±0.18(P>0.05)。积极应对方式评分分别为1.82±0.30和1.84±0.20(P>0.05);消极应对方式评分分别为1.62±0.22和1.61±0.18(P>0.05)。
结论手术室实习护生所感受到的压力源较多,男女护生的焦虑状态评分均高于常模,存在较为严重的焦虑情绪。运用讲解-模拟-练习-沟通-支持(ESPCS)干预方法可有效缓解护生焦虑情绪,促进身心健康,提高实习质量。
Objective To investigate the stress source and anxiety of nursing students in operating room during internship, to explore the effectiveness and feasibility of Explain-Simulate-Practice-Communication-Support (ESPCS) intervention method used in the operating room clinical teaching.
Methods Qualitative research: The 15 nursing students practicing in operating room in The Third People’s Hospital of HeFei from September to November, 2009 were selected as subjects by using purposive sampling method in accordance with inclusion and exlcusion criteria and then interviewed using semi-structured deep interviews and site investigation by professionals. The orginal doucuments are classified and analyzed by using content analysis.
Cross section survey: According to the results of qualiatiative study, literature analysis, expert consulting and designed surgery stress source scale, 218 nursing student practicing in operating room in the Third people’s hospital of HeFei city from January 2010 to December 2010 were selected as study objects to study and evaluate the stress source and anxiety. The obtained data is statictically analyzed using SPSS13.0 software package, the main stress source of surgery nursing student is described by applying percentage, the difference of anxiety state between male and female nursing students and national youth normal model is tested and analyzed by dependent sample t, and the difference of anxiety state of nursing student with different demographic characteristics is compared by using t and variance analysis. The correlation between the anixety state and stress source of nursing students was analyzed with Pearson correlation.
Experiment research: selecting the nursing student practicing in operating room in the Third people’s hospital of HeFei city from December 2010 to July 2011 as subjects, totally 168 persons including 26 male and 142 female students. They were divided into intervention group with 84 persons (14 male, and 70 female) and control group with 84 students (12 male, 72 female) according random experiment method. There is no obvious difference (P> 0.05) in age, sex, education, home address and interesting between two groups determined by statistics, they are comparble. The intervention group was taught by ESPCS method and the control group use traditional method, and then the questionnaire survey and effectiveness evaluation were done for both two group, respectively before and after intervention. We use paired t to check and compare the anxiety, coping self-efficacy scores of the intervention and control groups as well as the change of coping scores and comparison; use dependent sample t to test and compare the difference of anxiety, general self-efficacy, coping and score of theory and operating examination between two group after intervention.
Results The results of qualitative interview indicated that the stress source of nursing student in operating room can be summarized as: special environment in operating room, study and work stress in operating room, emotion pressure, social bias pressures and stress of occupational hazards.
Cross-sectional survey shows that: (1) the stress source of surgery nursing student is pretty much, the top ten followed by sorting: the first hands on the operating table, lack of specialty knowledge of the operating room, fast-paced, high concentration of attention, fears of mistakes and accident, increase of probability of being infected due to contacting with patient blood, secretions, etc, acrimony of teacher, unfamiliar environment in operating room, intense work and irregular office time due to the cooperation with multi-department doctors (without eating and sleep on time) and the misunderstand of patients and their families. (2) The analysis results of anxiety status for surgery nursing student in different groups indicate that:①the score of general state anxiety scale (S-AI) is higher than the normal model (P<0.01) for the same age②the difference of the S-AI score between only child and siblings was not statistically significant (P>0.05); the S-AI score of nursing student from countryside is higher than that of one from city (P<0.01); the S-AI score of secondary group is higher than that of college and university group (P<0.01, P<0.01); the S-AI score of the transfers is higher that of voluntary care and the one influenced by others (P<0.01, P<0.05).
Experiment results indicate that the score of the anxiety state and negative coping score of the intervention group in the assessment survey is much less than that of the control group (P<0.01), but the general self-efficacy and positive coping score is much higher that of control group (P<0.01). The score of the anxiety state of the intervention group before and after intervention is 44.24±3.36 and 40.04±3.53 (P<0.01), respectively; the score of the general self-efficacy is 2.42±0.24 and 2.57±0.34 (P<0.01), respectively; the positive coping score is 1.83±0.27and 1.92±0.19 (P<0.05), respectively; the negative coping score is 1.63±0.24 and 1.52±0.16 (P<0.01), respectively. However, for the control group: the score of the anxiety state before and after intervention is 44.93±2.11 and 44.89±2.12 (P>0.05), respectively; the score of the general self-efficacy is 2.41±0.30 and 2.40±0.18 (P>0.05), respectively. The positive coping score is 1.82±0.30 and 1.84±0.20 (P>0.05), respectively; the negative coping score is 1.62±0.22 and 1.61±0.18 (P>0.05), respectively.
Conclusion Operating room nursing students are more sources of stress experienced, the S-AI score of both male and female nursing students is higher than that of normal model. They have more serious anxiety. The ESPCS intervention method can effectively alleviate the anxiety, promoting health, improving the quality of practice of nursing students.
引文
1. Oermann MH,standfest KM.Differences in stresses and challenge in c1inical practice among AND and BSN students in varying clinical courses[J].Journal of Nursing Education,l997,36(5):228-233.
2.曹颖,戴舒霞,于艳秋.护理本科生的压力及应对方式的调查分析[J].护理学杂志,2000,15(3):166-168.
3. Jones MC,Johnston DW.Distress,stress and coping in first-year student nurses[J].Journal of Advanced Nursing,1997,26(3):475-482.
4. Evans W,Kelly B.Pre-registration diploma student nurse stress and coping measures[J].Nurse Education Today,2004,24(6):473-482.
5. Tully A.Stress,sources of stress and ways of coping among psychiatric nursing students[J].Journal of Psychiatric Mental Health Nursing,2004,11(1):43-47.
6.朱秀勤,邱晓钰,张雪花.定向实习护生临床实习期间压力源调查[J].现代护理,2007,13(28):2686-2688.
7.张玉萍,李惠玲,邓火琼,等.临床实习护生状态焦虑的调查分析[J].护理研究, 2007,21(8):2178.
8.马艳涛,任海兰.手术室护生实习带教方法的改进和应用[J].护理研究,2005,7(22):1964-1965.
9.张晓妹.手术室护士的心理压力源分析与对策[J].解放军护理杂志,2005,22(4):36-37.
10.刘秋秋,曹畅,刘敬利.以问题为基础的教学法在手术室临床中的应用[J].护理管理杂志,2005,5(3):34-36.
11.池金风,赵秀芹,周爱霞.讲解-模拟-练习-实践-评价教学方法在手术室带教中的应用[J].中华护理教育,2006,6(3):70-71.
12. Farrington A. Stress and nursing[J].British Journal of Nursing,1995,4(10):574-578.
13.李小妹.护理学导论[M].长沙:湖南科学技术出版社,2001:103-121.
14.宋晨,钟凯.综合性医院护士焦虑调查与分析[J].临床论著,2005,12(4):30-32.
15.姜乾金.医学心理学[M].北京:人民卫生出版社,2005:80-95.
16.袁碧,张盼盼,魏林娜.新疆民汉班学生临床护理课程成绩分析[J].护理学杂志,2008,15(3):19-20.
17.葛明贵.大学生一般自我效能感、学习厌倦感与抑郁的关系[J].重庆师范大学学报,2006,23:190-192.
18.马伟娜,徐华.中学生生活事件、自我效能与焦虑抑郁情绪的关系[J].中国临床心理学杂志,2006,14:303-305.
19.景学安,张旺信,王华义,等.日常生活事件对学习成绩影响的研究[J].中华医学教育杂志,2007,27(6):50-52.
20.戴晓阳.护理心理学[M].北京:人民卫生出版社,1998:48.
21. Dewe PJ. Identifying the cause of nurses' stress: a survey of New Zealand nurses[J]. Work and Stress,1987,1(1):15-24.
22. Demerouti E,Bakker AB,Nachreiner F,et al. A model of burnout and life satisfaction amongst nurses[J].Journal of Advanced Nursing,2000,32:454-464.
23. Stordeur S,D'Hoore W,Vandenberghe C.Leadership,organizational stress and emotional exhaustion among hospital nursing staff[J].Journal Advanced Nursing,2001,35:533-542.
24. Bianchi ER. Stress and coping among Cardivascular nurses:a survey in Brazil[J]. Issues in Mental Health Nursing,2004,25(7):737-745.
25. Rhead M. Stress among student nurses:is it practical or academic?[J].Journal of Clinical Nursing,1995,4(6):369-376.
26.曾迎春,易礼兰,蒋乐龙.护理专业学生压力源及压力管理的研究进展.中华护理教育,2009,6(3):132-134.
27. Streubert HJ,Carpenter DR.Qualitative research in nursing[J].Philadelphia: Lippincott,1995:48-51.
28. JANICE M.Qualitative research methods for health professionals[M].Thousand0aks,CA:Sage Publications,1995:24.
29.王斌,熊晓美.质性研究的方法及其在护理专业的应用及展望[J].护理学报,2008,15(3):25-27.
30.陈向明.在行动中学做质的研究[M].北京:教育科学出版社,2003:324-325.
31. Colaizzi P. Psychological research as the phenomenologists view it[M].New York:Oxford University Press.1978:48-71.
32.李心天.医学心理学[M].北京:中国协和医科大学出版社,1998:297-396.
33.李映兰.美国护士预防血液传播疾病的意识和措施[J].中华护理杂志,2002,37(8):633.
34.黄金银,费素定,吴晓琴.高职护生实习前临床护理技能强化培训尝试[J].护理学,2006,13(7):77-79.
35.沈叙英,朱明亚.影响护生手术室临床实习效果的原因及对策[J].解放军护理杂志,2009,26(1):51-52.
36.沈宁.护理专业教学改革研究报告[M].北京:高等教育出版社,2000:28.
37.雷鹤.美育在护理教学中的应用[J].实用护理杂志,2002,18(10):210.
38.陈炼红.卫校护理职业防护教育现状调查[J].实用预防医学,2004,11(2):406-407.
39.周惠,宫玉花,郭莉.手术室护士工作压力与亚健康状况研究[J].中国护理管理,2009,9(4):53-55.
40.蔡桂芬.手术室护士工作压力源调查分析[J].护理学杂志,2009,24(16):30-31.
41.严玮,李惠萍.手术室护生实习压力源的质性研究[J].中华现代护理杂志,2011,17(17):2067-2069.
42.汪向东,王希村,马弘.心理卫生评定量表手册[J].中国心理卫生杂志,1999,13(S1):238-241.
43.郑晓华,舒良,张艾琳,等.状态-特质焦虑问题在长春的测试报告[J].中国心理卫生杂志,1993,7(2):60-62.
44.曹颖,向虹,于艳秋.护理本科生临床实习期间压力源与应对方式的调查研究[J].中华护理杂志,2001,36(7):491-494.
45.蔡兰妹,林剑珊.实习学生压力源的调查分析[J].中华护理教育,2009,6(8):378-380.
46.沈叙英,朱明亚.影响护生手术室临床实习效果的原因及对策[J].解放军护理杂志,2009,26(1):328-330.
47.陈沽冰,王永霞,庞聪磊,等.男护生54名妇科实习压力因素调查及应对措施分析[J].齐鲁护理杂志,2010,l6(1):16-19.
48.姜德才,张展.护理实训基地规范化建设探析.职业教育研究,2011,3:122-123.
49.薄建柱,杨绍清,崔向军,等.不同家庭所在地大学生心理健康状况分析[J].中国健康心理学杂志,2009,17(5):615-617.
50.谢方瑜,王玉玲,李娜.工作流程图在心外科带教中的应用[J].中国实用护理杂志,2004,20(7):69-70.
51.刘秋秋,曹畅,刘敬利.以问题为基础的教学法在手术室临床中的应用[J].护理管理杂志,2005,5(3):34-36.
52. Zhang JX,Schwarzer R.Messuring optimistic self-efficacy construct[J].Scholarly Inquiry for Nursing Practice,2001,15(3):189-207.
53.王才康,胡中锋,刘勇.一般自我效能感量表的信度和效度研究[J].应用心理学,2001,7(1):37-40.
54.解亚宁.简易应对方式量表信度和效度的初步研究[J].中国临床心理学杂志,1998(2):114-115.
55.郑晓华,舒良,张艾琳,等.状态-特质焦虑问题在长春的测试报告[J].中国心理卫生杂志,1993,7(2):60-62.
56.郭本禹.当代心理学的新进展[M].济南:山东教育出版社,2003.
57. Lazarus RS.Coping theory and research:Past,present,and future[J].Psychosom Med.1993,55:234-247.
58.刘丽丽,李秋洁,崔丹.临床实习护理本科生自我效能感与应对方式的相关研究[J].护理研究,2007,21(28):2571-2573.
59.李小宁,李小燕,强水云,等.临床护士心理压力源及应对方式调查[J].护理学杂志,2004,19(12):67-69.
60. McCrace RR.Methological challenges, teoretical advances and clinical applications [J]. American Pschologist,2000, 55(6):620-622.
61. Choudhyry UK.新护理教师职能发展中的核心能力[J].国外医学:医学教育分册,1994,15(1):27.
62.何惠燕,陈丽莉,李丽娇.主带教老师模式在手术室带教中的应用[J].中华护理教育,2009,6(8):360-362.
1 0ermann M H, standfest K M. Differences in stresses and challenge in c1inical practice among AND and BSN students invarying clinical courses[J]. J Nurs Educ,l997, 36(5):228-233
2朱秀勤,邱晓钰,张雪花.定向实习护生临床实习期间压力源调查[J].现代护理,2007,13(28):2686-2688.
3 Farrington A.Stress and nursing[J].British Journal of Nursing,1995,4(10):574-578
4李小妹.护理学导论[M].长沙:湖南科学技术出版社,2001,103-121
5 Beck D L,Hackett M B,Srivastava R,et a1.Perceived level and sources of stress in university professional schools[J].Journal of Nursing Education,1997,36(4):180-186.
6 Kleehammer K H,Hart A L,Keck J F.Nursing students’perceptions of anxiety producing situations in the clinical setting[J].Journal of Nursing Education,1990, 29(5): l83-187.
7 AdmiH.Nursing students' stress during the initial clinical experience[J].Journal of Nursing Education,1997, 36(7):323-327
8 Pagana KD. Stresses and threats reported by baccalaureate students in relation to an initial clinical experience [J]. Jounral of Nursing Education,1988, 7(9):418-424
9曹颖,向虹,于艳秋.护理本科生临床实习期间压力源与应对方式的调查研究[J].中华护理杂志,2001,36(7): 491-494.
10杨永丽,赵秋利.不同临床实习期护理本科生压力源及压力程度的研究[J].中国实用护理杂志,2007,23(1): 67-68.
11 Jones MC,Johnston DW.Distress,stress and coping in first-year student nurses[J].Journal of Advanced Nursing,1997, 26(3): 475-482.
12 Evans W,Kelly B.Pre-registration diploma student nurse stress and coping measures[J].Nurse Education Today,2004, 24(6): 473-482.
13 Tully A.Stress,sources of stress and ways of coping among psychiatric nursing students s[J].Journal of Psychiatric Mental Health Nursing,2004,11(1): 43-47.
14冯卫红,王爱英,王辉,等.护理专业学生实习压力来源调查分析[J].中国护理管理,2006,6(7): 45-47.
15李爱华,刘晓英.护理本科生临床实践体验的质性研究[J].中华护理教育,2009,6(6): 257-260.
16 Mahat G.Stress and coping:first-year Nepalese nursing students in clinical settings[J].Journal of Nursing Education,1996,35(4): 163-169.
17 Rosenstein AH.Nurse physician relationship:impact on nurse satisfaction and retention[J].Am J Nurs,2002,102(6): 26.
18 Makoul G,Schofield T.Communication teaching and assessment in medical education:an international consensus statement[J].Patient Educ Couns,1999, 3:191-195.
19 Maguire P,Pitceathly C.Key communication skills and how to acquire them[J].BMJ,2002, 9(28): 697-700.
20 Marita P,Leenal Tarjak,Nurses self-reflection via video taping to improve communication skills in health counseling[J].Patient Educ Couns,1999,36(1): 3-11.
21 Amos MA, Hu J, Herrick CA.The Impact of team building on communication and job satisfaction of nursing staff[J]. JNSD,2005,21(1):10-16.
22黄希庭,杨雄.中学生自我价值感量表的编制[J].心理科学,1998,21(4):289-292.
23袁华,李小妹.压力管理训练对护理本科生压力水平的影响[J].护理学杂志,2004,19(1): 9-11
24李艳,王井霞,陶新陆.中国国内护生的人格特征研究进展[J].现代护理,2007,13(28): 2708-2709.
25 Lazarus RS.Coping theory and research:Past,present,and future[J].Psychosom Med,1993,55:234-247.
26 Dunn,Sandra V,Ehrich L.Students' Perceptions of filed experience in professional development:a comparative study[J].Journal of Nursing Education,2000,(39):393-400.
27梁小芹,绳宇.实习护生对临床学习环境态度的调查[J].护理管理杂志,2010,10(2):102-106.
28蔡兰妹,林剑珊.实习学生压力源的调查分析[J].中华护理教育,2009,6(8): 378-380
2.曹颖,戴舒霞,于艳秋.护理本科生的压力及应对方式的调查分析[J].护理学杂志,2000,15(3):166-168.
3. Jones MC,Johnston DW.Distress,stress and coping in first-year student nurses[J].Journal of Advanced Nursing,1997,26(3):475-482.
4. Evans W,Kelly B.Pre-registration diploma student nurse stress and coping measures[J].Nurse Education Today,2004,24(6):473-482.
5. Tully A.Stress,sources of stress and ways of coping among psychiatric nursing students[J].Journal of Psychiatric Mental Health Nursing,2004,11(1):43-47.
6.朱秀勤,邱晓钰,张雪花.定向实习护生临床实习期间压力源调查[J].现代护理,2007,13(28):2686-2688.
7.张玉萍,李惠玲,邓火琼,等.临床实习护生状态焦虑的调查分析[J].护理研究, 2007,21(8):2178.
8.马艳涛,任海兰.手术室护生实习带教方法的改进和应用[J].护理研究,2005,7(22):1964-1965.
9.张晓妹.手术室护士的心理压力源分析与对策[J].解放军护理杂志,2005,22(4):36-37.
10.刘秋秋,曹畅,刘敬利.以问题为基础的教学法在手术室临床中的应用[J].护理管理杂志,2005,5(3):34-36.
11.池金风,赵秀芹,周爱霞.讲解-模拟-练习-实践-评价教学方法在手术室带教中的应用[J].中华护理教育,2006,6(3):70-71.
12. Farrington A. Stress and nursing[J].British Journal of Nursing,1995,4(10):574-578.
13.李小妹.护理学导论[M].长沙:湖南科学技术出版社,2001:103-121.
14.宋晨,钟凯.综合性医院护士焦虑调查与分析[J].临床论著,2005,12(4):30-32.
15.姜乾金.医学心理学[M].北京:人民卫生出版社,2005:80-95.
16.袁碧,张盼盼,魏林娜.新疆民汉班学生临床护理课程成绩分析[J].护理学杂志,2008,15(3):19-20.
17.葛明贵.大学生一般自我效能感、学习厌倦感与抑郁的关系[J].重庆师范大学学报,2006,23:190-192.
18.马伟娜,徐华.中学生生活事件、自我效能与焦虑抑郁情绪的关系[J].中国临床心理学杂志,2006,14:303-305.
19.景学安,张旺信,王华义,等.日常生活事件对学习成绩影响的研究[J].中华医学教育杂志,2007,27(6):50-52.
20.戴晓阳.护理心理学[M].北京:人民卫生出版社,1998:48.
21. Dewe PJ. Identifying the cause of nurses' stress: a survey of New Zealand nurses[J]. Work and Stress,1987,1(1):15-24.
22. Demerouti E,Bakker AB,Nachreiner F,et al. A model of burnout and life satisfaction amongst nurses[J].Journal of Advanced Nursing,2000,32:454-464.
23. Stordeur S,D'Hoore W,Vandenberghe C.Leadership,organizational stress and emotional exhaustion among hospital nursing staff[J].Journal Advanced Nursing,2001,35:533-542.
24. Bianchi ER. Stress and coping among Cardivascular nurses:a survey in Brazil[J]. Issues in Mental Health Nursing,2004,25(7):737-745.
25. Rhead M. Stress among student nurses:is it practical or academic?[J].Journal of Clinical Nursing,1995,4(6):369-376.
26.曾迎春,易礼兰,蒋乐龙.护理专业学生压力源及压力管理的研究进展.中华护理教育,2009,6(3):132-134.
27. Streubert HJ,Carpenter DR.Qualitative research in nursing[J].Philadelphia: Lippincott,1995:48-51.
28. JANICE M.Qualitative research methods for health professionals[M].Thousand0aks,CA:Sage Publications,1995:24.
29.王斌,熊晓美.质性研究的方法及其在护理专业的应用及展望[J].护理学报,2008,15(3):25-27.
30.陈向明.在行动中学做质的研究[M].北京:教育科学出版社,2003:324-325.
31. Colaizzi P. Psychological research as the phenomenologists view it[M].New York:Oxford University Press.1978:48-71.
32.李心天.医学心理学[M].北京:中国协和医科大学出版社,1998:297-396.
33.李映兰.美国护士预防血液传播疾病的意识和措施[J].中华护理杂志,2002,37(8):633.
34.黄金银,费素定,吴晓琴.高职护生实习前临床护理技能强化培训尝试[J].护理学,2006,13(7):77-79.
35.沈叙英,朱明亚.影响护生手术室临床实习效果的原因及对策[J].解放军护理杂志,2009,26(1):51-52.
36.沈宁.护理专业教学改革研究报告[M].北京:高等教育出版社,2000:28.
37.雷鹤.美育在护理教学中的应用[J].实用护理杂志,2002,18(10):210.
38.陈炼红.卫校护理职业防护教育现状调查[J].实用预防医学,2004,11(2):406-407.
39.周惠,宫玉花,郭莉.手术室护士工作压力与亚健康状况研究[J].中国护理管理,2009,9(4):53-55.
40.蔡桂芬.手术室护士工作压力源调查分析[J].护理学杂志,2009,24(16):30-31.
41.严玮,李惠萍.手术室护生实习压力源的质性研究[J].中华现代护理杂志,2011,17(17):2067-2069.
42.汪向东,王希村,马弘.心理卫生评定量表手册[J].中国心理卫生杂志,1999,13(S1):238-241.
43.郑晓华,舒良,张艾琳,等.状态-特质焦虑问题在长春的测试报告[J].中国心理卫生杂志,1993,7(2):60-62.
44.曹颖,向虹,于艳秋.护理本科生临床实习期间压力源与应对方式的调查研究[J].中华护理杂志,2001,36(7):491-494.
45.蔡兰妹,林剑珊.实习学生压力源的调查分析[J].中华护理教育,2009,6(8):378-380.
46.沈叙英,朱明亚.影响护生手术室临床实习效果的原因及对策[J].解放军护理杂志,2009,26(1):328-330.
47.陈沽冰,王永霞,庞聪磊,等.男护生54名妇科实习压力因素调查及应对措施分析[J].齐鲁护理杂志,2010,l6(1):16-19.
48.姜德才,张展.护理实训基地规范化建设探析.职业教育研究,2011,3:122-123.
49.薄建柱,杨绍清,崔向军,等.不同家庭所在地大学生心理健康状况分析[J].中国健康心理学杂志,2009,17(5):615-617.
50.谢方瑜,王玉玲,李娜.工作流程图在心外科带教中的应用[J].中国实用护理杂志,2004,20(7):69-70.
51.刘秋秋,曹畅,刘敬利.以问题为基础的教学法在手术室临床中的应用[J].护理管理杂志,2005,5(3):34-36.
52. Zhang JX,Schwarzer R.Messuring optimistic self-efficacy construct[J].Scholarly Inquiry for Nursing Practice,2001,15(3):189-207.
53.王才康,胡中锋,刘勇.一般自我效能感量表的信度和效度研究[J].应用心理学,2001,7(1):37-40.
54.解亚宁.简易应对方式量表信度和效度的初步研究[J].中国临床心理学杂志,1998(2):114-115.
55.郑晓华,舒良,张艾琳,等.状态-特质焦虑问题在长春的测试报告[J].中国心理卫生杂志,1993,7(2):60-62.
56.郭本禹.当代心理学的新进展[M].济南:山东教育出版社,2003.
57. Lazarus RS.Coping theory and research:Past,present,and future[J].Psychosom Med.1993,55:234-247.
58.刘丽丽,李秋洁,崔丹.临床实习护理本科生自我效能感与应对方式的相关研究[J].护理研究,2007,21(28):2571-2573.
59.李小宁,李小燕,强水云,等.临床护士心理压力源及应对方式调查[J].护理学杂志,2004,19(12):67-69.
60. McCrace RR.Methological challenges, teoretical advances and clinical applications [J]. American Pschologist,2000, 55(6):620-622.
61. Choudhyry UK.新护理教师职能发展中的核心能力[J].国外医学:医学教育分册,1994,15(1):27.
62.何惠燕,陈丽莉,李丽娇.主带教老师模式在手术室带教中的应用[J].中华护理教育,2009,6(8):360-362.
1 0ermann M H, standfest K M. Differences in stresses and challenge in c1inical practice among AND and BSN students invarying clinical courses[J]. J Nurs Educ,l997, 36(5):228-233
2朱秀勤,邱晓钰,张雪花.定向实习护生临床实习期间压力源调查[J].现代护理,2007,13(28):2686-2688.
3 Farrington A.Stress and nursing[J].British Journal of Nursing,1995,4(10):574-578
4李小妹.护理学导论[M].长沙:湖南科学技术出版社,2001,103-121
5 Beck D L,Hackett M B,Srivastava R,et a1.Perceived level and sources of stress in university professional schools[J].Journal of Nursing Education,1997,36(4):180-186.
6 Kleehammer K H,Hart A L,Keck J F.Nursing students’perceptions of anxiety producing situations in the clinical setting[J].Journal of Nursing Education,1990, 29(5): l83-187.
7 AdmiH.Nursing students' stress during the initial clinical experience[J].Journal of Nursing Education,1997, 36(7):323-327
8 Pagana KD. Stresses and threats reported by baccalaureate students in relation to an initial clinical experience [J]. Jounral of Nursing Education,1988, 7(9):418-424
9曹颖,向虹,于艳秋.护理本科生临床实习期间压力源与应对方式的调查研究[J].中华护理杂志,2001,36(7): 491-494.
10杨永丽,赵秋利.不同临床实习期护理本科生压力源及压力程度的研究[J].中国实用护理杂志,2007,23(1): 67-68.
11 Jones MC,Johnston DW.Distress,stress and coping in first-year student nurses[J].Journal of Advanced Nursing,1997, 26(3): 475-482.
12 Evans W,Kelly B.Pre-registration diploma student nurse stress and coping measures[J].Nurse Education Today,2004, 24(6): 473-482.
13 Tully A.Stress,sources of stress and ways of coping among psychiatric nursing students s[J].Journal of Psychiatric Mental Health Nursing,2004,11(1): 43-47.
14冯卫红,王爱英,王辉,等.护理专业学生实习压力来源调查分析[J].中国护理管理,2006,6(7): 45-47.
15李爱华,刘晓英.护理本科生临床实践体验的质性研究[J].中华护理教育,2009,6(6): 257-260.
16 Mahat G.Stress and coping:first-year Nepalese nursing students in clinical settings[J].Journal of Nursing Education,1996,35(4): 163-169.
17 Rosenstein AH.Nurse physician relationship:impact on nurse satisfaction and retention[J].Am J Nurs,2002,102(6): 26.
18 Makoul G,Schofield T.Communication teaching and assessment in medical education:an international consensus statement[J].Patient Educ Couns,1999, 3:191-195.
19 Maguire P,Pitceathly C.Key communication skills and how to acquire them[J].BMJ,2002, 9(28): 697-700.
20 Marita P,Leenal Tarjak,Nurses self-reflection via video taping to improve communication skills in health counseling[J].Patient Educ Couns,1999,36(1): 3-11.
21 Amos MA, Hu J, Herrick CA.The Impact of team building on communication and job satisfaction of nursing staff[J]. JNSD,2005,21(1):10-16.
22黄希庭,杨雄.中学生自我价值感量表的编制[J].心理科学,1998,21(4):289-292.
23袁华,李小妹.压力管理训练对护理本科生压力水平的影响[J].护理学杂志,2004,19(1): 9-11
24李艳,王井霞,陶新陆.中国国内护生的人格特征研究进展[J].现代护理,2007,13(28): 2708-2709.
25 Lazarus RS.Coping theory and research:Past,present,and future[J].Psychosom Med,1993,55:234-247.
26 Dunn,Sandra V,Ehrich L.Students' Perceptions of filed experience in professional development:a comparative study[J].Journal of Nursing Education,2000,(39):393-400.
27梁小芹,绳宇.实习护生对临床学习环境态度的调查[J].护理管理杂志,2010,10(2):102-106.
28蔡兰妹,林剑珊.实习学生压力源的调查分析[J].中华护理教育,2009,6(8): 378-380