急诊护理人员同情心疲乏风险模型构建及多维叙事支持系统的探索性研究

Nowadays, the rapid development of national healthcare services and public health requires a stable nursing team. However, owing to the features of emergency nursing care, a part of the emergency nurses show a strong turnover intention. One reason that could lead to the situation is that emergency nurses may suffer from “compassion fatigue” after a long period of emotional engagement at work. As a state of emotional exhaustion, compassion fatigue could exert a negative effect on individual’s physical and mental health of emergency nurses as well as their caring quality. In spite of this, this area has not aroused sufficient attention from those nursing managers at home and abroad. Consequently, this study keeps focused on the emergency nursing professionals and attempts to complete three parts of research contents. Firstly, by comprehensive literature review and qualitative interviews, the draft of Compassion Fatigue Risk Model for emergency nursing professionals will be proposed based on the existing compassion fatigue theories. Secondly, by survey research and regression statistical analyses, the prevalence and potential influencing factors of compassion fatigue among emergency nursing professionals will be explored, and using these quantitative data and structural equation model, the Compassion Fatigue Risk Model for emergency nursing professionals will be verified and established. Lastly, taking the Risk Model as a reference and the healing power of narrative writing as the entry point, a multidimensional narration support system will be developed to facilitate the emergency nursing professionals to cope with their feelings of compassion fatigue; an action research will be carried out to explore the feasibility and effectiveness of the system. This study aims to direct the emergency nursing professionals to recognize and identify their occupationally emotional stress and introduce a professional support system with distinctive features and strong practicability to the nursing managers. All expected outcomes of this study can help to promote the physical and mental health of emergency nursing professionals and maintain the long-term and stable development of this special group of helpers.

目前，我国卫生事业发展及全民健康需要一支稳定的护理队伍，但因工作性质特殊，急诊护士反映出较强的离职意向。导致此问题的原因之一可能是急诊护理人员在工作中因高强度情感投入出现的一种情感耗竭状态——同情心疲乏对其身心健康及照护质量产生了负面影响。但该领域尚未引起护理管理者充分关注。因此，本研究聚焦急诊护理人员，首先通过文献回顾及质性访谈，基于相关理论，构建急诊护理人员同情心疲乏风险模型初稿；进而通过调查研究与统计建模，了解该群体同情心疲乏现状，探究潜在影响因素，验证风险模型；最后以此模型为基础，以叙事写作疗愈作用为切入点，开发帮助急诊护理人员应对同情心疲乏体验的多维叙事支持系统，并通过行动研究探究该系统的应用效果。该研究旨在指导我国急诊护理人员正确认识可能遭受的职业情感应激，帮助护理管理者探索一套特色鲜明、实用性强的支持系统，从而维护这一特殊助人群体的身心健康，保持急诊护理队伍长久稳定发展。

目前，我国卫生事业发展及全民健康需要一支稳定的护理队伍，但因工作性质特殊，急诊护士反映出较强的离职意向。导致此问题的原因之一可能是急诊护理人员在工作中因高强度情感投入出现的一种情感耗竭状态——同情心疲乏，对其身心健康及照护质量产生了负面影响。因此，本研究聚焦急诊护理人员，首先通过质性访谈，提炼出有关急诊护理人员同情心疲乏体验的4个主题，包括同情心疲乏体验复杂多样、同情心疲乏与多种因素相关、同情心疲乏可产生负性影响、采取多种同情心疲乏应对策略，共包含12个类属。然后基于文献回顾、理论研究及质性访谈结果，构建急诊护理人员同情心疲乏风险模型初稿，并开展调查研究与统计分析优化风险模型。第一阶段采用便利抽样选取来自全国多家医院的急诊科护士进行调查，进行单因素分析，并根据分析结果进一步开展多元线性回归分析。第二阶段采用便利抽样选取上海市若干医院急诊科护士为研究对象，使用AMOS软件进行路径分析。根据调查研究及统计分析结果，优化同情心疲乏风险模型，具体如下：急诊护理人员的工作相关因素及个人与生活相关因素会对其同情心疲乏和同情心满足水平产生影响。同情心疲乏与同情心满足可能同时存在，并直接或通过工作倦怠间接影响其健康状态，最终决定是否出现离职意向。最后以风险模型为基础，以叙事写作为切入点，开发帮助急诊护理人员应对同情心疲乏体验的多维叙事支持系统，包括情绪管理和叙事写作讲座、叙事写作与访谈、重构故事及分享与交流、团队活动与座谈等。行动研究结果证明该支持系统会对急诊科护士的同情心疲乏、工作倦怠、同情心满足、自我同情、工作相关生活质量等产生影响。急诊科护士普遍表示支持系统中各环节设计合理，满意度较高，收获较多，包括加深对同情心疲乏认识、关注并反思情绪问题、收获人生感悟及治愈感、学会分析工作问题、培养对科研兴趣、实现综合能力提升等。

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