Lees S, Ellis N
Department of Psychology, University College of North Wales, Bangor, Wales.
J Adv Nurs. 1990 Aug;15(8):946-61. doi: 10.1111/j.1365-2648.1990.tb01951.x.
This study identifies the stressors and coping strategies of nursing staff (students, trained staff and those who had left the profession before qualification) in a variety of ward specialisms. The research instruments included an open-ended interview concerning pre-nursing experience, perceived stressors and satisfactions, and ways of coping, and psychometric tests of self-esteem, assertion, ways of coping and personality. The five most frequently cited stressors were understaffing, conflict with nurses, dealing with death and dying, overwork and conflict with doctors. Experience of stressors was related to role and seniority of respondents, with different aspects of the same stressor differentially affecting nurses at different levels of experience. Coping strategies also depended on experience. Trained staff showed more use of problem-focused ways of coping, whilst students and leavers relied more on emotion-focused strategies to deal with stressful situations. These differences were related to personality characteristics of respondents and to self-esteem as well as to situational characteristics of the stressful episode. Social support was important in times of work-related stress, with students in particular making good use of peer group support. Respondents were generally lacking in assertiveness and high in anxiety. Although self-esteem was generally high, leavers scored markedly less than other subject groups in the areas of personal and social self-esteem. Leavers had little prior knowledge or experience of nursing before entering training and knew few nurses or doctors: consequently, nursing failed to meet their expectations. Stress was identified as the major cause of attrition and the sources of stress are identified. This study informed a major programme of stress-management training for student nurses which began in 1988 at the North Wales School of Nursing and which is currently under evaluation. It includes relaxation therapy, assertiveness training, and on-going group discussions which foster peer-group support and which explore the stressors and coping strategies relevant to different stages of training and ward specialisms.
本研究确定了不同病房专科护理人员（学生、受过培训的人员以及在取得资格前就已离开该职业的人员）面临的压力源和应对策略。研究工具包括一次关于护理前经历、感知到的压力源与满意度以及应对方式的开放式访谈，以及自尊、自信、应对方式和个性的心理测试。最常被提及的五个压力源是人员配备不足、与护士的冲突、处理死亡事宜、工作过度以及与医生的冲突。压力源的经历与受访者的角色和资历有关，同一压力源的不同方面对不同经验水平的护士有不同影响。应对策略也取决于经验。受过培训的人员更多地采用以问题为中心的应对方式，而学生和离职人员在应对压力情况时更多地依赖以情绪为中心的策略。这些差异与受访者的个性特征、自尊以及压力事件的情境特征有关。在工作相关压力时期，社会支持很重要，尤其是学生充分利用了同伴群体的支持。受访者普遍缺乏自信且焦虑程度较高。尽管总体自尊水平较高，但离职人员在个人自尊和社会自尊方面的得分明显低于其他受试群体。离职人员在进入培训前对护理几乎没有先验知识或经验，认识的护士或医生也很少：因此，护理未能达到他们的期望。压力被确定为人员流失的主要原因，并确定了压力源。本研究为1988年在北威尔士护理学院开始的一项针对学生护士的压力管理培训主要项目提供了依据，该项目目前正在评估中。它包括放松疗法、自信训练以及持续的小组讨论，这些讨论促进同伴群体的支持，并探讨与培训不同阶段和病房专科相关的压力源和应对策略。
