手术室护士离职意愿影响因素的路径分析 [中文引用][英文引用]

目的 应用结构方程模型探讨手术室护士离职意愿的影响路径，以期为深入探讨其影响机制及制定管理措施提供依据。方法 2024 年 2 月—3 月采用便利抽样法，选择湖北省 5 家三级甲等综合医院的 336 名手术室护士作为研究对象，以计划行为理论为框架建立研究假设，采用一般资料问卷、离职意愿量表（turnover intention questionnaire，TIQ）、职业污名感知量表（occupational stigma perception scale，OSPS）、护士心理资本量表（psychological capital scale for nurses，PCSN）、护士组织支持感问卷（survey of nurse perceived organizational support，SNPOS）、护士职业认同评定量表（professional identity scale for nurses，PISN）进行调查，采用 Pearson 相关性分析各变量间的相关性，并采用 Amos 27.0 建立结构方程模型并验证拟合性能，计算路径系数。结果 312 名护士完成研究，手术室护士离职意愿得分为（14.9±4.2）分，其中 53.8% 手术室护士有较高的离职意愿、14.7% 手术室护士有很高的离职意愿。离职意愿与职业污名感知呈正相关（r=0.362），与心理资本（r=-0.253）、组织支持感（r=-0.274）、职业认同（r=-0.271）呈负相关（均 P<0.001）。构建的手术室护士离职意愿影响因素结构方程模型拟合较好，手术室护士职业污名感知、心理资本、组织支持感、职业认同对离职意愿均产生直接效应，标准化路径系数分别为 0.336、-0.180、-0.272、-0.263（均P<0.05），同时，心理资本在组织支持和离职意愿中发挥间接中介作用，中介效应占总效应的 48.04%，职业认同分别在组织支持和离职意愿、职业污名感知和离职意愿、心理资本和离职意愿中发挥部分中介作用，中介效应分别占总效应的 25.72%、10.25%、89.57%。结论 职业污名感知、心理资本、职业认同、组织支持感是手术室护士离职意愿的影响因素，均可对离职意愿产生直接影响，同时，心理资本和职业认同也是重要的中介变量，介导了职业污名感知和组织支持对离职意愿的影响路径。护理管理者可帮助手术室护士建立正确的职业认知、提供心理支持、塑造职业价值观、营造良好组织氛围，降低其离职意愿。

Objective To investigate the factors that influenceturnover intention among the nurses of operating theatre with a structural equation model，and elucidate the underlying mechanisms，thereby informing evidence-based management strategies. Methods From February to March 2024，a convenience sample of 336 operating theatre nurses was recruited from five Tier-IIIA hospitals in Hubei Province. Guided by planned behaviour theory，data were collected using a general demographic questionnaire，the turnover intention questionnaire（TIQ），occupational stigma perception scale（OSPS），psychological capital scale for nurses（PCSN）， survey of nurse perceived organisational support（SNPOS）and the professional identity scale for nurses（PISN）. Pearson’s correlation analysis was used to examine the correlations among variables. Amos 27.0 was used to construct the structural equation model， evaluate model fit and calculate path coefficient. Results A total of 312 nurses completed the survey. Overall，53.8% of operating theatre nurses exhibited moderate-to-high intention of turnover with 14.7% of high intention. Turnover intention of operating theatre nurses was positively correlated with occupational stigma perception（r=0.362，P<0.001）and negatively correlated with psychological capital（r=-0.253，P<0.001），perceived organisational support（r=-0.274，P<0.001），professional identity（r=-0.271，P<0.001）. The structural equation model demonstrated good fit. Occupational stigma perception，psychological capital，perceived organisational support，and professional identity all directly impacted turnover intention，with standardised path coefficients of 0.336，-0.180，-0.272， or -0.263，respectively（all P<0.05）. Psychological capital served as an indirect mediator between organisational support and turnover intention，with the medicating effect accounting for 48.04% of the total effect. Professional identity partially mediated the relationships between organisational support and turnover intention，between occupational stigma perception and turnover intention，and between psychological capital and turnover intention，with the mediating effects accounting for 25.72%，10.25%，89.57% of the total effect， respectively. Conclusion Occupational stigma perception，psychological capital，professional identity and organisational support are factors influencing turnover intention among the nurses of operating theatre，each exerting a direct effect. Psychological capital and professional identity serve as important mediating variables，mediating the pathways through which occupational stigma perception and organisational support affect turnover intention. Nursing managers can reduce turnover intention among the nurses of operating theatre by enhancing occupational cognition，providing psychological support，reshaping professional values and creating a favourable organisational atmosphere.