健康与遗传心理学研究室知识库

临床实习是护生理论联系实际的重要阶段。临床实习环境、作息时间、学习方式，人际关系都不同于学校，护生的知识储备、护理技能水平、医患沟通能力尚不足以应对实习中可能遇到的突发事件和不确定性。这不仅削弱了护生的控制感还影响到护生的心理健康，使护生产生焦虑、恐惧、担忧等负面情绪。有研究显示，我国医学生的焦虑水平高于普通院校大学生。焦虑不仅会影响护生的护理行为能力，增加工作失误的可能性，还会对临床实践的顺利实施产生负面影响。良好的实习氛围可以缓解实习压力，减少职业倦怠，增进护生对护理职业的认同感。如何提升护生对医院关怀氛围的感知，从而减轻护生实习焦虑是本研究关注 的重点。以往研究显示，主动控制感与个体健康水平、学业成就、焦虑水平、责任感密切相关，在人类心理健康中发挥着重要作用。且有研究证实，主动控制感与焦虑、环境等因素密切相关，自我效能感可能在其中起着调节作用。医院关怀氛围是实习环境的重要组成部分，本研究检验了“医院关怀氛围感知→ 主动控制感→ 实习焦虑”的中介模型，以及自我效能感在这个路径中的调节作用。通过半结构访谈等质性研究方法探讨了护生对实习环境的体验，进一步探寻影响护生实习焦虑的因素。

研究一 主要探讨医院关怀氛围感知、主动控制感、一般自我效能感和护生实习焦虑的关系及作用机制。方法：选取河北省 4 所医学院校 592 名正在医院实 习的护生为研究对象，通过问卷星发放问卷调查。结果表明：1）医院关怀氛围 感知、主动控制感、一般自我效能感和护生实习焦虑之间两两相关显著。2）主 动控制感在医院关怀氛围感知和实习焦虑间起部分中介作用，中介效应占比51.51%。3）一般自我效能感对“医院关怀氛围感知→ 主动控制感→实习焦虑”这一路径的后半段和直接路径有调节作用：拥有高水平主动控制感的护生，医院关怀氛围感知对实习焦虑的负向预测作用较强；主动控制感对实习焦虑的负向预测作用也较强。

研究二 主要探讨实习护生对所在教学医院实习环境的内心感受，进一步验证实习环境中影响护生实习焦虑的因素，为改善教学医院实习环境提供理论依据。选取实习医院内、外、妇、儿、重症医学等不同科室实习的护生为研究对象，设立访谈提纲进行访谈，并收集资料。结果：提取 4 个主题。主题 1：对临床带教的体验；主题 2：对科室关怀氛围的体验；主题 3：对自我实践能力的体验；主题 4：对患者意见反馈的体验。通过对主题的分析发现，教师的教学能力是影响护生实习焦虑的重要因素；感知医院关怀氛围可以减轻护生实习焦虑；理论与实践的差距是护生实习焦虑的主要来源。

总之，个体与环境之间是相互影响的，主动控制感在医院关怀氛围感知和实习焦虑间起部分中介作用，并受到自我效能感的调节。同时，教师职业素养是影响护生实习环境体验的重要因素，加强教师队伍建设，创建利于护生工作学习的 实习环境是教学管理者的重要责任。

The clinical internship is a crucial phase for nursing students to bridge the gap between theory and practice. During this period, they encounter an environment, work schedule, learning methods, and interpersonal dynamics that differ significantly from those experienced in school. Often, nursing students may find their theoretical knowledge, practical nursing skills, and ability to communicate with patients and healthcare teams insufficient to handle the emergencies and uncertainties encountered during their internships. This situation not only diminishes their sense of agency but also negatively impacts their mental health, leading to anxiety, fear, and worry. Research indicates that medical students in China exhibit higher levels of anxiety compared to their non-medical college peers. Anxiety not only hampers the students’ nursing performance and increases the likelihood of errors, but it also hinders the smooth progress of clinical practice. However, a supportive internship environment can help alleviate the stress, reduce professional burnout, and foster a stronger sense of identity with the nursing profession. This research focuses on how to enhance the students' perception of a caring environment and, consequently, reduce their anxiety during internships. A growing body of evidence suggests that a sense of agency is closely linked to individual health, academic performance, anxiety levels, and a sense of responsibility, playing a significant role in mental well-being. Moreover, studies have confirmed that factors like anxiety and environment are strongly related to one’s sense of agency, with self-efficacy potentially moderating this relationship. Given that the hospital’s caring atmosphere is a key component of the internship environment, this study investigates the mediating model involving "perception of the hospital’s caring atmosphere, sense of agency, and internship-related anxiety." It also examines the moderating role of self-efficacy in this process. Through the analysis of the theme, it is found that teachers 'teaching ability is an important factor affecting the anxiety of nursing students; perceiving the hospital care atmosphere can reduce nursing students' anxiety; the gap between theory and practice is the main source of nursing students' anxiety.

Study One：To investigate the relationship and underlying mechanisms between nursing students' perceptions of hospital care atmosphere, sense of active control, self-efficacy, and internship-related anxiety. The study involved 592 nursing students who were undergoing hospital internships. The following key findings emerged: There was a significant correlation between perceptions of the hospital care atmosphere, sense of active control, general self-efficacy, and internship anxiety. The sense of active control partially mediated the relationship between the perception of hospital care atmosphere and internship anxiety, with the mediating effect accounting for 51.51%. General self-efficacy moderated the latter part of the pathway "hospital care atmosphere perception → active control → internship anxiety." Specifically, nursing students with higher levels of self-efficacy showed a stronger negative predictive effect of hospital care atmosphere perception on internship anxiety. Similarly, the negative predictive effect of the sense of active control on internship anxiety was more pronounced. The relationship between individuals and their environment is mutually influential. The sense of active control plays a partial mediating role in the link between perceptions of the hospital care atmosphere and internship anxiety, with this mediation being moderated by self-efficacy.

Study Two. It mainly discusses the inner feelings of the nursing students on the practice environment in the hospital, further verifies the factors affecting the anxiety of nursing students in the practice environment and provide a theoretical basis for improving this environment. Nursing students interning in various hospital departments—including internal medicine, surgery, gynecology, pediatrics, and intensive care—were selected as participants. Structured interviews were conducted using a pre-established interview guide, and the collected data were analyzed. Four main themes emerged from the analysis: Theme 1: Experience of clinical teaching; Theme 2: Experience the caring atmosphere of the department; Theme 3: Experience of self-practice; Topic 4: Experience with Patient Feedback. Through the analysis of the theme, it is found that teachers 'teaching ability is an important factor affecting the anxiety of nursing students; perceiving the hospital care atmosphere can reduce nursing students' anxiety; the gap between theory and practice is the main source of nursing students' anxiety.

In short, the relationship between the individual and the environment is mutually influential, and the sense of active control plays a partial mediating role in the perception of hospital care atmosphere and internship anxiety, and is moderated by self-efficacy. At the same time, the professional quality of teachers affects the experience of nursing students in the internship environment, and it is an important responsibility of teaching managers to strengthen the construction of teachers and create an internship environment conducive to the work and learning of nursing students.