患者安全文化在护士长多元领导风格与护士职业倦怠间的中介作用

张雨健; 许文雪; 王丽君; 刘亚东; 王倩; 曹英娟

doi:10.16766/j.cnki.issn.1674-4152.004392

患者安全文化在护士长多元领导风格与护士职业倦怠间的中介作用

doi: 10.16766/j.cnki.issn.1674-4152.004392

张雨健^{1, 2, 3},
许文雪^{2, 3},
王丽君⁴,
刘亚东⁵,
王倩⁶,
曹英娟^{1, 2, 7, ,}

1.
山东大学齐鲁医院护理部，山东济南 250012
2.
山东大学护理理论与实践创新研究中心，山东济南 250012
3.
山东大学齐鲁医院全科医学科
4.
山东中医药大学卫生管理学院，山东济南 250000
5.
山东省公共卫生临床中心护理部，山东济南 250132
6.
山东第一医科大学附属肿瘤医院，山东济南 250117
7.
山东大学护理与康复学院，山东济南 250012

基金项目:

山东省自然基金项目 ZR2022MG039

详细信息

通讯作者:
曹英娟，E-mail: caoyingjuan@hotmail.com

中图分类号: R471
计量
- 文章访问数: 3
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- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2025-04-11
- 网络出版日期: 2026-04-11

The mediating effect of patient safety culture between head nurses' multiple leadership styles and nurses' occupational burnout

ZHANG Yujian^{1, 2, 3},
XU Wenxue^{2, 3},
WANG Lijun⁴,
LIU Yadong⁵,
WANG Qian⁶,
CAO Yingjuan^{1, 2, 7
, ,}

1.
Nursing Department of Qilu Hospital, Shandong University, Jinan, Shandong 250012, China

摘要

摘要: 目的探讨患者安全文化在护士长多元领导风格与护士职业倦怠之间的中介效应，以期为国内护士职业倦怠的干预提供新视角、新路径。方法采用分层便利抽样法，于2024年8—10月选取山东省不同地市10所三级综合医院的1 673名注册护士作为调查对象，采用一般资料调查表、多元领导风格量表、马氏职业倦怠量表-服务行业版以及患者安全文化测评问卷进行调查。运用SPSS 25.0统计学软件分析数据，采用Pearson相关性分析探究变量间关联，通过Bootstrap法分析中介效应，剖析护士长多元领导风格与护士职业倦怠现状相关性，探究患者安全文化于两者间的中介效应。结果护士长多元领导风格、护士职业倦怠、患者安全文化得分分别为(33.59±22.87)分、(56.78±20.34)分、(103.74±15.78)分，护士职业倦怠的阳性率为39.7%(664人)，护士职业倦怠与变革型领导风格(r=-0.542，P＜0.01)呈负相关关系，与交易型领导风格(r=0.321，P＜0.01)呈正相关关系，而患者安全文化在交易型领导风格和变革型领导风格对职业倦怠的影响中均起到显著中介效应。结论护士职业倦怠程度较为严重，变革型领导风格可以直接影响或通过患者安全文化的中介作用来抑制护士的职业倦怠，提升患者安全文化水平。
- 多元领导风格 /
- 护士 /
- 职业倦怠 /
- 患者安全文化 /
- 中介效应
Abstract: Objective To explore the mediating role of patient safety culture in the relationship between head nurses' multiple leadership styles and nurses' occupational burnout, in order to provide a new perspective and a new path for the intervention of nurses' occupational burnout. Methods Using stratified convenience sampling, 1 673 registered nurses from 10 tertiary general hospitals in different prefecture-level cities of Shandong Province were selected as subjects for the survey from August to October 2024. The survey utilized the general information questionnaire (GIQ), multiple leadership styles scale (MLSS), Maslach burnout inventory-human service survey (MBI-HSS), and patient safety culture assessment questionnaire (PSCAQ). Statistical analysis was performed using SPSS 25.0 software. Pearson correlation analysis was employed to explore the associations between variables, and the Bootstrap method was used to analyze the mediating effect. This study examined the correlation between head nurses' multiple leadership styles and nurses' current state of job burnout, and explored the mediating effect of patient safety culture between the two. Results The scores for head nurses' multiple leadership styles, nurses' occupational burnout, and patient safety culture were 33.59±22.87, 56.78±20.34, and 103.74±15.78, respectively. The positive rate of nurses' occupational burnout was 39.7% (664 nurses). The total score of occupational burnout was negatively correlated with transformational leadership style (r=-0.542, P < 0.01) and positively correlated with transactional leadership style (r=0.321, P < 0.01). Patient safety culture played a significant mediating role in the effects of both transactional and transformational leadership styles on occupational burnout. Conclusion The degree of nurses' occupational burnout is relatively severe. The transformational leadership style can directly or indirectly reduce nurses' occupational burnout through the mediating effect of patient safety culture, enhancing the level of patient safety culture.
- Multiple leadership style /
- Nurse /
- Occupational burnout /
- Patient safety culture /
- Mediating effect

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图 1 护士职业倦怠与一般资料相关性分析

注：a为情绪耗竭，b为情绪耗竭倦怠，c为去人格化，d为去人格化倦怠，e为个人成就感，f为个人成就感倦怠，g为职业倦怠总分，h为性别，i为年龄，j为工作年限，k为职称，l为最高学历，m为任职方式，n为科室，o为婚姻状况，p为在过去一年内是否参加过至少一次由专业机构或认证专家组织的心理学相关培训课程，q为月总收入；^*P＜0.05，^**P＜0.01。

Figure 1. Correlation analysis between nurses' professional burnout and general demographic data

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图 2 多元领导风格与护士职业倦怠和患者安全文化的相关性分析

注：a为情绪耗竭，b为情绪耗竭倦怠，c为去人格化，d为去人格化倦怠，e为个人成就感，f为个人成就感倦怠，g为职业倦怠总分，h为团队氛围，i为对工作的满意，j为对压力的认知，k为单位安全的氛围，l为对管理的感受，m为安全文化总分，n为变革型，o为领导魅力，p为感召力，q为个性化关怀，r为智力激发，s为交易型，t为权变奖励，u为积极例外管理，v为消极例外管理；^**P＜0.01。

Figure 2. Correlation analysis of pluralistic leadership styles with nurse burnout and patient safety culture

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图 3 安全文化中介效应

Figure 3. Mediating effect of safety culture

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表 1 护士一般资料情况

Table 1. General information of nurses

项目	类别	人数(%)
性别	男性	105(6.3)
	女性	1 568(93.7)
年龄(岁)	18~22	51(3.0)
	23~27	490(29.3)
	28~36	724(43.3)
	≥37	408(24.4)
工作年限(年)	1~4	550(32.9)
	5~9	392(23.4)
	10~19	546(32.6)
	≥20	185(11.1)
职称	护士	379(22.7)
	护师	501(29.9)
	主管护师及以上	793(47.4)
最高学历	专科	88(5.3)
	本科	1 563(93.4)
	硕士研究生及以上	22(1.3)
任职方式	正式编制	472(28.2)
	合同制	1 201(71.8)
科室	内科	679(40.6)
	外科	509(30.4)
	妇产科	214(12.8)
	儿科	39(2.3)
	急诊科	28(1.7)
	ICU	148(8.8)
	手术室	56(3.3)
婚姻状况	未婚	511(30.5)
	已婚	1 145(68.4)
	离异	15(0.9)
	丧偶	2(0.1)
在过去一年内是否参加过至少一次由专业机构或认证专家组织的心理学相关培训课程	是	536(32.0)
在过去一年内是否参加过至少一次由专业机构或认证专家组织的心理学相关培训课程	否	1 137(68.0)
月总收入(元)	≤5 000	395(23.6)
	5 001~10 000	1 062(63.5)
	10 001~15 000	198(11.8)
	15 001~20 000	18(1.1)

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表 2 护士长多元领导风格、护士职业倦怠及患者安全文化得分

Table 2. Head nurses' multiple leadership styles, nurses' professional burnout, and patient safety culture scores

项目	得分范围(分)	得分(x±s，分)
多元领导风格总分	0~128	33.59±22.87
变革型领导风格	0~80	25.13±13.75
领导魅力	0~12	4.47±2.47
感召力	0~20	4.78±4.29
个性化关怀	0~16	5.12±2.91
智力激发	0~32	10.76±5.85
交易型领导风格	0~48	8.46±10.34
权变奖励	0~16	2.75±3.51
积极例外管理	0~16	3.08±3.62
消极例外管理	0~16	2.64±3.56
职业倦怠总分	0~132	56.78±20.34
情绪耗竭	0~54	16.99±12.57
去人格化	0~30	5.47±6.19
个人成就感降低	0~48	34.32±12.52
安全文化总分	33~117	103.74±15.78
团队氛围	7~35	32.29±5.92
对工作的满意	6~30	26.26±5.52
对压力的认知	4~20	14.85±4.82
单位安全的氛围	4~20	18.33±3.29
对管理的感受	12~15	12.00±0.07

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表 3 护士职业倦怠阳性检出情况

Table 3. Positive detection result of nurse burnout

项目	人数(%)
护士职业倦怠	664(39.7)
情绪耗竭倦怠	411(24.6)
去人格化倦怠	383(22.9)
个人成就感倦怠	124(7.4)
职业倦怠严重程度分级
无	1 009(60.3)
轻度	414(24.7)
中度	246(14.7)
重度	4(0.2)

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表 4 安全文化在领导风格对职业倦怠影响中的中介效应分析

Table 4. Analysis of the mediating effect of safety culture on the influence of leadership style on job burnout

项目	Effect	se	t	LLCI	ULCI	c_cs
X1对Y总效应	0.64	0.05	14.03	0.55	0.73	0.32
X1对Y直接效应	0.46	0.05	9.32	0.36	0.56	0.23
X1对Y间接效应	0.18	0.03^a	0.13^b	0.23^c
X2对Y总效应	-0.80	0.03	-26.31	-0.86	-0.74	-0.54
X2对Y直接效应	-0.73	0.03	-22.73	-0.79	-0.66	-0.49
X2对Y间接效应	-0.07	0.01^a	-0.10^b	-0.05^c
注：^a为BootSE, ^b为BootLLCI，^c为BootULCI。X1为交易型领导风格，X2为变革型领导风格，Y为职业倦怠，中介变量为安全文化，置信区间不包含0代表效应值具有统计学意义。

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