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ICU护士群体心理韧性与PTSD的关系
其他题名The Relationship between Resilience and PTSD of ICU Nurses
张晶
导师陈祉妍
2020-01
摘要ICU作为救治危重患者的工作场所,经常出现各种应激事件,例如急迫而高强度的抢救、心肺复苏、处理患者死亡、处理激烈的医患冲突等。一线的ICU护士常常是亲历者和目击者,因此时常暴露于具有创伤性的应激事件之中。研究发现,ICU护士已经成为创伤后应激障碍(post-traumatic stress disorder ,PTSD)的高发群体。国外研究报道,ICU护士创伤应激障碍日益增加,发病率可达29.0%。PTSD危害已成共识,可严重影响受害者的工作能力,持续时间可达数年之久,具有一定的致残率,并造成护士职业疲溃和离职的发生,严重影响医疗质量。心理韧性、社会支持及自尊等因具有良好的保护性在PTSD的研究中受到人们关注。2012年,Mealer等学者发现,在美国心理韧性良好的ICU护士具有更强工作适应能力和较低的PTSD发生率。目前国内尚缺少整合性的相关研究和数据支持,本研究旨在调查心理韧性与PSTD的关系,并分析社会支持与自尊的潜在中介效应。本研究基于既往的研究结果,对ICU执业护理人员进行便利抽样,对其中717份有效问卷进行分析。PTSD、心理韧性、社会支持和自尊均采用问卷形式进行自评。采用结构方程进行建模,用AMOS软件中的Bootstrap进行中介效应检验。考察心理韧性与PTSD的关系以及社会支持与自尊在其中的中介作用。研究的主要结果表明:性别与护理职务的交互作用能显著预测PTSD,职称与健康状况的交互作用能显著预测PTSD。心理韧性与PTSD显著负相关,社会支持及自尊与PTSD显著负相关。心理韧性与社会支持及自尊呈现显著正相关的关系,与此同时,社会支持又与自尊呈现出正性相关的关系。首先使用AMOS模型拟合分析。结果显示,拟合良好。Bootstrap法中介效应统计分析后显示平均中介效应为-0.17,置信区间为[-0.25,-0.08],社会支持与自尊在心理韧性与PTSD之间起链式中介作用。结论: ICU护士的心理韧性可以影响PTSD,心理韧性越高,PTSD分数水平越低。 社会支持在心理韧性和PTSD之间起中介作用。社会支持和自尊在心理韧性和PTSD间存在链式中介效应,心理韧性可以直接预测PTSD也可以通过社会支持和自尊影响PTSD。
其他摘要As a workplace for treating critically ill patients, ICU often has various stress events, such as urgent and high-intensity rescue, cardiopulmonary resuscitation, treatment of patient death, and treatment of conflicts between doctors and patients. First-line ICU nurses are often experienced and witnesses and are therefore often exposed to traumatic stress events. The study found that ICU nurses have become a high-risk group of post-traumatic stress disorder (PTSD). Foreign studies have reported that ICU nurses have an increasing incidence of traumatic stress disorder, with an incidence rate of 29.0%. The PTSD hazard has become a consensus, which can seriously affect the ability of the victim to work. It lasts for several years, has a certain disability rate, and causes the occupational fatigue and turnover of nurses, which seriously affects the quality of medical care. Resilience, social support and self-esteem have attracted attention in the research of PTSD because of their good protection. Mealer and other scholars found that ICU nurses with good psychological resilience in the United States have stronger work adaptability and lower incidence of PTSD. At present, there is a lack of integrated research and data support in China. This study aims to investigate the relationship between resilience and PSTD, and analyze the potential mediating effects of social support and self-esteem.Based on previous studies, 717 valid questionnaires were analyzed by convenience sampling for ICU practicing nurses. PTSD, resilience, social support and self-esteem were assessed by questionnaire. Structural equation was used to model and Bootstrap in AMOS software was used to test the mediation effect. To investigate the relationship between resilience and PTSD and the mediating role of social support and self-esteem.The main results show that the interaction between gender and nursing position can significantly predict PTSD, and the interaction between professional title and health status can significantly predict PTSD. Resilience is negatively correlated with PTSD, while social support and self-esteem are negatively correlated with PTSD. Resilience is positively correlated with social support, and social support is positively correlated with self-esteem. Resilience is positively correlated with self-esteem. AMOS is used to fit and analyze the data of the model, and the fitting index is good. Bootstrap method was used to analyze the mediating effect. The results showed that the average mediating effect was -0.17 and the confidence interval was [-0.25, -0.08]. Social support and self-esteem had a chain mediating effect between resilience and PTSD.Conclusion: The resilience of ICU nurses can affect PTSD. The higher the resilience, the lower the PTSD score level. Social support plays a mediating role between resilience and PTSD. Social support and self-esteem have a chain mediating effect between resilience and PTSD. Resilience can directly predict PTSD and can also influence PTSD through social support and self-esteem.
关键词ICU护士 心理韧性 PTSD 多重中介
学位类型硕士
语种中文
学位名称理学硕士(同等学力硕士)
学位专业健康心理学
学位授予单位中国科学院心理研究所
学位授予地点中国科学院心理研究所
文献类型学位论文
条目标识符https://ir.psych.ac.cn/handle/311026/41643
专题健康与遗传心理学研究室
推荐引用方式
GB/T 7714
张晶. ICU护士群体心理韧性与PTSD的关系[D]. 中国科学院心理研究所. 中国科学院心理研究所,2020.
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