Zhang Xiujuan, Chen Qiong, Hu Yanling, Zhao Xiufang, Huang Xi
Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
J Nurs Manag. 2025 Mar 24;2025:8175652. doi: 10.1155/jonm/8175652. eCollection 2025.
Voice behavior refers to nurses' proactive actions in offering constructive suggestions, providing feedback, or raising concerns in the workplace, which are crucial for enhancing care quality and improving the work environment. This study aims to investigate the current status and influencing factors of voice behavior among nurses in neonatal intensive care units (NICUs) in tertiary hospitals in Sichuan Province, providing empirical evidence for improved nursing management and hospital administration. A multicenter, crosssectional survey. From January to June 2023, 422 neonatal nurses from tertiary hospitals in Sichuan Province were selected through stratified random sampling. Data were collected through self-reported questionnaires, including a general information questionnaire and a voice behavior scale. The voice behavior scale consists of 10 items, divided into promotive and prohibitive behavior dimensions, using a five-point Likert scale (1 = "" and 5 = ""). The scale has been widely used among Chinese nurses and demonstrates good internal consistency (Cronbach's α = 0.951). Data analysis was conducted using SPSS Version 26.0. Structural validity was assessed through exploratory factor analysis (KMO > 0.8, Bartlett's test < 0.05), followed by confirmatory factor analysis using AMOS. For group comparisons, independent -tests and analysis of variance (ANOVA) were used, with Welch's test for unequal variances. Post hoc multiple comparisons were performed using Tamhane's T2 for unequal variances and LSD for equal variances. A -value < 0.05 was considered statistically significant. Age, marital status, and number of children significantly influenced voice behavior. Voice behavior increased with age up to 50 years, unmarried individuals exhibited less voice behavior than married or divorced ones, and more children correlated with more voice behavior. Job title, position, and years of experience in the neonatal department also significantly impacted voice behavior. Higher positions and more than 15 years of experience were associated with increased voice behavior. Senior titles correlated with higher prohibitive voice behavior. The voice behavior of NICU nurses is influenced by various factors, including age, marital status, number of children, job title, position, and years of experience in the neonatal department. As age increases, the number of children grows, work experience accumulates, and nurses' voice behavior tends to intensify. In particular, for senior nurses, managers should pay attention to their prohibitive voice behavior and encourage their active involvement in decision-making processes to enhance the quality of care. Nursing managers should tailor management strategies based on these individual characteristics, providing customized support for nurses at different experience levels. At the same time, emphasis should be placed on creating a psychologically safe work environment to stimulate nurses' initiative and creativity, thereby improving team communication and collaboration. This approach will contribute to ensure the quality of care and patient safety in NICUs. Understanding the factors influencing voice behavior helps nursing managers to enhance nurse participation and care quality. Nursing managers can implement the following strategies: (1) create a psychologically safe environment: encourage open communication by ensuring nurses feel their opinions are valued, with clear channels for feedback and action, (2) address senior nurses' prohibitive voice behavior: provide leadership training to senior nurses to transform negative feedback into constructive suggestions, promoting collaboration and work improvement, (3) tailor strategies based on experience: offer support and mentorship to new nurses, while encouraging experienced nurses to take leadership roles and contribute to decision-making, (4) incentivize contributions: develop reward systems to recognize nurses' involvement in improving patient care, such as acknowledging innovative ideas and active participation.
建言行为是指护士在工作场所主动提出建设性意见、提供反馈或表达关切的行为，这对于提高护理质量和改善工作环境至关重要。本研究旨在调查四川省三级医院新生儿重症监护病房（NICU）护士建言行为的现状及其影响因素，为改进护理管理和医院管理提供实证依据。一项多中心横断面调查。2023年1月至6月，通过分层随机抽样选取了四川省三级医院的422名新生儿护士。通过自填式问卷收集数据，包括一般信息问卷和建言行为量表。建言行为量表由10个项目组成，分为促进性和禁止性两个行为维度，采用五点李克特量表（1 =“从不”，5 =“总是”）。该量表已在中国护士中广泛使用，并具有良好的内部一致性（Cronbach's α = 0.951）。使用SPSS 26.0版进行数据分析。通过探索性因子分析（KMO > 0.8，Bartlett检验 < 0.05）评估结构效度，随后使用AMOS进行验证性因子分析。对于组间比较，使用独立样本t检验和方差分析（ANOVA），方差不等时使用Welch检验。方差不等时使用Tamhane's T2进行事后多重比较，方差相等时使用LSD进行事后多重比较。P值 < 0.05被认为具有统计学意义。年龄、婚姻状况和子女数量对建言行为有显著影响。建言行为在50岁之前随年龄增长而增加，未婚者的建言行为少于已婚或离异者，子女数量越多，建言行为越多。职称、职位和新生儿科室工作年限也对建言行为有显著影响。职位较高和工作年限超过15年与建言行为增加有关。高级职称与较高的禁止性建言行为相关。NICU护士的建言行为受到多种因素影响，包括年龄、婚姻状况、子女数量、职称、职位和新生儿科室工作年限。随着年龄增长、子女数量增加和工作经验积累，护士的建言行为趋于增强。特别是对于资深护士，管理者应关注其禁止性建言行为，鼓励他们积极参与决策过程以提高护理质量。护理管理者应根据这些个体特征制定管理策略，为不同经验水平的护士提供定制化支持。同时，应强调营造心理安全的工作环境，以激发护士的主动性和创造力，从而改善团队沟通与协作。这种方法将有助于确保NICU的护理质量和患者安全。了解影响建言行为的因素有助于护理管理者提高护士的参与度和护理质量。护理管理者可实施以下策略：（1）营造心理安全的环境：通过确保护士感到自己的意见受到重视，鼓励开放沟通，建立明确的反馈和行动渠道；（2）解决资深护士的禁止性建言行为：为资深护士提供领导力培训，将负面反馈转化为建设性意见，促进协作和工作改进；（3）根据经验量身定制策略：为新护士提供支持和指导，同时鼓励经验丰富的护士担任领导角色并参与决策；（4）激励贡献：制定奖励制度，认可护士在改善患者护理方面的参与，如认可创新想法和积极参与。
