链式中介作用下助产士心理弹性对创伤后成长的影响研究

doi:10.3761/j.issn.1672-9234.2024.04.012

摘要/Abstract

摘要：

目的探讨压力知觉和积极应对方式在助产士心理弹性和创伤后成长间的链式中介作用。方法于2023年4月—7月，采用便利抽样法，选取四川省24所三级甲等医院2年内参与或目睹过创伤性分娩事件的349名助产士作为调查对象，应用一般资料调查表、简体中文版创伤后成长评定量表、心理弹性量表、中文版压力知觉量表、简易应对方式问卷对其进行调查。结果共回收有效问卷320份。320名助产士心理弹性得分为（87.18±7.35）分，压力知觉得分为（20.31±3.12）分，积极应对方式得分为（28.64±3.93）分，创伤后成长得分为（76.09±9.42）分。助产士心理弹性、压力知觉、积极应对方式、创伤后成长4个变量两两间具有相关性（均P<0.05）。中介效应分析结果显示，助产士心理弹性对创伤后成长的直接效应显著，效应值为0.341；压力知觉和积极应对方式不仅分别在助产士心理弹性和创伤后成长之间起中介作用（效应值分别为0.103、0.122），还在两者间起链式中介作用（效应值为0.037），中介效应占总效应的43.4%。结论心理弹性可直接影响助产士的创伤后成长，也可分别通过压力知觉、积极应对方式的中介作用及两者间的链式中介作用间接影响助产士的创伤后成长。护理管理者应助力助产士增强心理弹性、降低压力知觉水平、培养积极应对方式，从而促进其实现创伤后成长。

关键词: 助产士, 韧性, 心理, 创伤后成长, 压力知觉, 应对方式, 中介效应分析

Abstract:

Objective To explore the chain mediating effect of perceived stress and positive coping strategies on the psychological resilience and post-traumatic growth of midwives. Methods Convenience sampling method was used with 349 midwives surveyed from 24 tertiary hospitals in Sichuan Province. General information questionnaire，Simplified Chinese version of Posttraumatic Growth Inventory，Chinese version of Connor Davidson Resilience Scale，Chinese version of Perceived Stress Scale，and Simplified Coping Style Questionnaire were employed in investigation. Results A total of 320 midwives were finally included. The midwives’ psychological resilience score（87.18±7.35），perceived stress score（20.31±3.12），positive coping style score（28.64±3.93），and post-traumatic growth score（76.09±9.42） were all correlated to each other（all P<0.05）. The mediation effect results showed that psychological resilience has a significant direct effect on post-traumatic growth，with an effect value of 0.341. Besides，stress perception and positive coping styles not only played a significant individual mediating role between psychological resilience and post-traumatic growth，with effect values of 0.103 and 0.122，respectively，but also played a significant chain mediating role. The effect value was 0.037，and the mediating effect accounted for 43.4% of the total effect. Conclusion The psychological resilience of midwives can directly affect post-traumatic growth，and also indirectly affect post-traumatic growth through the individual and chain mediating effects of stress perception and positive coping strategies. Nursing managers should help to improve the psychological resilience of midwives and to reduce individual stress perception，enhance coping abilities to achieve positive growth.

Key words: Midwifery, Resilience, Psychological, Posttraumatic growth, Stress perception, Coping behavior, Mediation analysis

郑瑜, 王鑫, 邓媛, 王佳. 链式中介作用下助产士心理弹性对创伤后成长的影响研究[J]. 中华护理教育, 2024, 21(4): 454-460.

ZHENG Yu, WANG Xin, DENG Yuan, WANG Jia. The influence of resilience on posttraumatic growth of midwives via the chain mediating effects[J]. Chinese Journal of Nursing Education, 2024, 21(4): 454-460.

图/表 5

表1

表2

表3

图1

表4

参考文献 28

[1]	Beck CT. Birth trauma:in the eye of the beholder[J]. Nurs Res, 2004, 53(1):28-35. doi: 10.1097/00006199-200401000-00005
[2]	梁欣, 周红, 孙鑫章, 等. 不同地区助产士共情疲劳现状及其影响因素的研究[J]. 中华护理杂志, 2020, 55(7):1060-1066. doi: 10.3761/j.issn.0254-1769.2020.07.019
[3]	Sheen K, Spiby H, Slade P. The experience and impact of traumatic perinatal event experiences in midwives:a qualitative investigation[J]. Int J Nurs Stud, 2016, 53:61-72. doi: 10.1016/j.ijnurstu.2015.10.003
[4]	Tedeschi RG, Calhoun LG. TARGET ARTICLE:“posttraumatic growth:conceptual foundations and empirical evidence”[J]. Psychol Inq, 2004, 15(1):1-18. doi: 10.1207/s15327965pli1501_01
[5]	Beck CT, Eaton CM, Gable RK. Vicarious posttraumatic growth in labor and delivery nurses[J]. J Obstet Gynecol Neonatal Nurs, 2016, 45(6):801-812. doi: 10.1016/j.jogn.2016.07.008
[6]	Connor KM, Davidson JRT. Development of a new resilience scale:the Connor-Davidson Resilience Scale(CD-RISC)[J]. Depress Anxiety, 2003, 18(2):76-82. doi: 10.1002/(ISSN)1520-6394
[7]	邢蝶, 肖爱祥, 叶君荣, 等. 精神科护士遭受工作场所暴力后心理弹性对创伤后成长的影响[J]. 循证护理, 2023, 9(14):2616-2619.
[8]	Liu XX, Ju XX, Liu XH. The relationship between resilience and intent to stay among Chinese nurses to support Wuhan in managing COVID-19:the serial mediation effect of post-traumatic growth and perceived professional benefits[J]. Nurs Open, 2021, 8(5):2866-2876. doi: 10.1002/nop2.v8.5
[9]	杨廷忠, 黄汉腾. 社会转型中城市居民心理压力的流行病学研究[J]. 中华流行病学杂志, 2003, 24(9):11-15.
[10]	解亚宁. 简易应对方式量表信度和效度的初步研究[J]. 中国临床心理学杂志, 1998, 6(2):53-54.
[11]	Lazarus R, Folkman S. Stress,appraisal and the coping process[M]. New York: Springer, 1984.
[12]	梁宝勇. 心理健康素质测评系统·基本概念、理论与编制构思[J]. 心理与行为研究, 2012, 10(4):241-247.
[13]	Tedeschi RG, Calhoun LG. The Posttraumatic Growth Inventory:measuring the positive legacy of trauma[J]. J Trauma Stress, 1996, 9(3):455-471. doi: 10.1007/BF02103658 pmid: 8827649
[14]	汪际. 创伤后成长评定量表及其意外创伤者常模的研制[D]. 上海: 第二军医大学, 2011.
[15]	Yu XN, Zhang JX. Factor analysis and psychometric evaluation of the Connor-Davidson Resilience Scale(CD-RISC) with Chinese people[J]. Soc Behav Pers, 2007, 35(1):19-30. doi: 10.2224/sbp.2007.35.1.19
[16]	Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress[J]. J Health Soc Behav, 1983, 24(4):385-396. pmid: 6668417
[17]	Folkman S, Lazarus RS. An analysis of coping in a middle-aged community sample[J]. J Health Soc Behav, 1980, 21(3):219. pmid: 7410799
[18]	周浩, 龙立荣. 共同方法偏差的统计检验与控制方法[J]. 心理科学进展, 2004, 12(6):942-950.
[19]	温涵, 梁韵斯. 结构方程模型常用拟合指数检验的实质[J]. 心理科学, 2015, 38(4):987-994.
[20]	赵慧, 沈亚红, 张婷. 助产士职业性肌肉骨骼疾患影响因素分析及其与职业紧张、心理弹性的关系[J]. 中国优生与遗传杂志, 2022, 30(7):1220-1224.
[21]	王抒情. 助产士共情能力与心理弹性、希望特质的相关性研究[D]. 合肥: 安徽医科大学, 2021.
[22]	赵聪聪, 程相红, 刘利, 等. 低生育水平时期助产士职业压力现状及影响因素分析[J]. 临床护理杂志, 2023, 22(5):2-6.
[23]	冯凯娜. 助产士职业倦怠、抗逆力与应对方式的关系研究[D]. 南昌: 南昌大学, 2021.
[24]	陈琪, 朱波, 张青. 临床护士组织支持感和积极应对方式在主动性人格与创新行为间的链式中介效应[J]. 护理学报, 2023, 30(21):1-6.
[25]	Hooper LM, Marotta SA, Lanthier RP. Predictors of growth and distress following childhood parentification:a retrospective exploratory study[J]. J Child Fam Stud, 2008, 17(5):693-705. doi: 10.1007/s10826-007-9184-8
[26]	姚立超. 大学生心理弹性与压力后成长的关系:压力知觉和积极应对方式的链式中介作用[D]. 沈阳: 沈阳师范大学, 2022.
[27]	黄晶, 伍玉琴, 陈凌, 等. 广东省心血管专业护士压力知觉及应对方式现况分析[J]. 职业与健康, 2023, 39(12):1649-1653.
[28]	王明明, 张亚云, 孙铮. 护士知觉压力及其应对方式的相关研究[J]. 泰山医学院学报, 2017, 38(5):488-490.