Professor, Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan.
Lambda Beta, Associate Professor, School of Nursing, National Defense Medical Center, Taipei, Taiwan.
J Nurs Scholarsh. 2019 Mar;51(2):195-204. doi: 10.1111/jnu.12467. Epub 2019 Feb 25.
To examine the mechanisms of coping strategies on nurses' psychological well-being, practice environments and safety attitudes.
A cross-sectional study design was used. Structural equation modeling was performed to analyze the results. Five hundred clinical nurses were randomly selected from a large group of 1,500 from a medical center with 1,350 beds in Taipei, Taiwan, from July to October 2015. Self-report questionnaires were administered to measure coping strategies (Brief COPE), psychological well-being (Ryff's Psychological Well-being Scale), nurses' practice environments (Practice Environment Scale of the Nursing Work Index), and safety attitudes (Safety Attitudes Questionnaire).
Of the 500 participants who gave written consent, 474 (94.8%) filled out the questionnaire. Results showed that using more approach-oriented coping strategies and fewer avoidant coping strategies was associated with greater psychological well-being. Psychological well-being was directly associated with quality of nurses' practice environments and safety attitudes. The impact of psychological well-being on safety attitudes was mediated significantly by the quality of the practice environment. The use of approach-oriented coping strategies was significantly predictive of positive psychological well-being, a good practice environment, and good safety attitudes.
This study found a distinct pathway for the relationships between clinical nurses' psychological well-being, practice environment, and safety attitudes. Psychological well-being in clinical nurses was higher for those with more approach-oriented coping strategies. Psychological well-being directly impacted safety attitudes, which mediated nurses' practice environments. The practical implications of the results suggest that interventions designed to promote positive psychological well-being may help improve nurses' practice environments, which, in turn, may result in better safety attitudes and nursing care outcomes.
探讨应对策略对护士心理幸福感、实践环境和安全态度的作用机制。
采用横断面研究设计。使用结构方程模型进行分析。2015 年 7 月至 10 月，从台湾台北市一家拥有 1350 张床位的 1500 张床位的医疗中心的一大组人群中，随机抽取了 500 名临床护士作为研究对象。采用自报式问卷测量应对策略（简要应对方式问卷）、心理幸福感（Ryff 心理幸福感量表）、护士实践环境（护理工作环境量表）和安全态度（安全态度问卷）。
在 500 名同意书面同意的参与者中，有 474 名（94.8%）填写了问卷。结果表明，采用更多的应对策略和更少的回避应对策略与更高的心理幸福感相关。心理幸福感与护士实践环境和安全态度的质量直接相关。实践环境质量显著中介了心理幸福感对安全态度的影响。采用应对策略与积极的心理幸福感、良好的实践环境和良好的安全态度显著相关。
本研究发现临床护士的心理幸福感、实践环境和安全态度之间存在明确的关系途径。采用应对策略的临床护士心理幸福感更高。心理幸福感直接影响安全态度，而护士实践环境则在其中起到中介作用。研究结果的实际意义表明，旨在促进积极心理幸福感的干预措施可能有助于改善护士的实践环境，从而提高安全态度和护理服务质量。
