探討初階專科護理師職場壓力與教學行為之中介影響－以專業承諾為中介變項

The Mediating Role of Novice Nurse Practitioner Professional Commitment on Workplace Stress and Teaching Behaviors

10.6224/JN.202202_69(1).07

蕭棨文(Chi-Wen SHIAU)；童恒新(Heng-Hsin TUNG)；劉介宇(Chieh-Yu LIU)；鄭夙芬(Su-Fen CHENG)

專科護理師 ； 職場壓力 ； 專業承諾 ； 教學行為 ； nurse practitioner ； workplace stress ； professional commitment ； teaching behaviors

護理雜誌

69卷1期（2022 / 02 / 01）

41 - 50

繁體中文

背景：初階專科護理師的教學行為是影響訓練中專科護理師轉任成功與否之關鍵，研究顯示教學行為、職場壓力及專業承諾之間有相關，卻極少有文獻驗證專業承諾是否為職場壓力與教學之中介效果。目的：探討初階專科護理師職場壓力、教學行為、專業承諾之相關性預測因子及中介效果。方法：採橫斷面式研究設計，共有79位初階專科護理師參與。研究工具包含：專科護理師基本屬性表、職場壓力量表、專業承諾量表、教學行為量表。結果：研究結果顯示「職場壓力」與「專業承諾」、「教學行為」呈負相關（r = -.37, p ＜ .01; r = -.27, p ＜ .05）。「專業承諾」與「教學行為」呈正相關（r = .61, p ＜ .001）。「專業承諾」為「教學行為」之預測因子（β = .59, R^2 = .38, p ＜ .001），「專業承諾」為「職場壓力」、「教學行為」之中介變項（Z = -3.11, p ＜ .001）。結論／實務應用：研究結果證實初階專科護理師專業承諾為職場壓力與教學行為之中介變項。並提供提升專業承諾在職教育之參考依據。

Background: Teaching is a vital competency for nurse practitioners (NP). Correlations among teaching behaviors, workplace stress, and professional commitment in novice NPs have been identified in previous research. However, the mediating effect of professional commitment on workplace stress and teaching behaviors is an issue that has been investigated in only a few studies. Purpose: To explore the relationships among workplace stress, teaching behaviors, and professional commitment in novice NPs and to identify the predictors and mediators of teaching behaviors. Methods: This cross-sectional study used a sample of 79 novice NPs. The research instruments used were the Nurse Workplace Stress Scale, Nurse Professional Commitment Questionnaire, and Clinical Teaching Behavior Inventory. Results: Negative correlations were found between workplace stress and professional commitment (r = -.37, p ＜ .01) and between workplace stress and teaching behavior (r = -.27, p ＜ .05). A positive correlation was found between professional commitment and teaching behaviors (r = .61, p ＜ .001). Professional commitment was identified as a predictor of teaching behaviors (β = .59, R^2 = .38, p ＜ .001) and as a mediator of workplace stress and teaching behaviors (Z = -3.11, p ＜ .001). Conclusions/Implications for Practice: The findings verified professional commitment in novice NPs to be a moderator of workplace stress and teaching behaviors. The results of this study may be used to facilitate growth in professional commitment in healthcare practice settings.

1. Wang, W.-F.,Hung, C.-H.,Li, C.-Y.(2018).Development trajectories and predictors of the role commitment of nursing preceptors.The Journal of Nursing Research,26(3),168-176.
   連結：
2. 王采芷, T.-J.,郭裴翎, P.-L.(2019)。進階護理的發展與現況。源遠護理，13(1)，5-13。
   連結：
3. 伍碧琦, P.-C.,周汎澔, F.-H.,李碧娥, B.-O.(2016)。臨床護理教育的挑戰與省思。長庚護理，27(1)，26-33。
   連結：
4. 邱慧洳, H.-J.,蔡秀鸞, S.-L.,童恒新, H.-H.(2017)。專科護理師的新時代。護理雜誌，64(1)，11-16。
   連結：
5. 洪翠蓮, T.-L.,齊偉先, W.-H.(2019)。臺灣專科護理師在臨床實務上面臨的困境與挑戰。台灣專科護理師學刊，6(1)，12-21。
   連結：
6. 張煥禎, H.-C.,劉佩瑜, P.-Y.,何國章, K.-C.,陳淑怡, S.-I.,張玲華, L.-H.(2017)。台灣專科護理師服務現況調查～2014年結果。台灣專科護理師學刊，3(1)，5-14。
   連結：
7. 陳齡芳, L.-F.,陳小蓮, H.-L.(2019)。臺灣專科護理師進階制度推動現況與未來。源遠護理，13(1)，22-28。
   連結：
8. 謝美玲, M.-L.(2019)。專科護理師臨床批判思考能力之培養。台灣專科護理師學刊，6(2)，11-16。
   連結：
9. 專科護理師分科及甄審辦法，衛生福利部衛部照字第1091561294號令修正（2020，9月26日）。[Regulations Governing Specialties and Examination of Nurse Practitioner, Ministry of Health and Welfare, Taiwan, ROC, WeiBu-Zhao-Zi No. 1091561294 amended (2020, September 26).] https://law.moj.gov.tw/LawClass/LawHistory.aspx?pcode=L0020081
10. Baron, R. M.,Kenny, D. A.(1986).The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations.Journal of Personality and Social Psychology,51(6),1173-1182.
11. Beck Dallaghan, G. L.,Alerte, A. M.,Ryan, M. S.,Patterson, P. B.,Petershack, J.,Christy, C.,Mills, W. A., Jr.,Paul, C. R.,Peltier, C.,Stamos, J. K.,Tenney-Soeiro, R.,Vercio, C.(2017).Recruiting and retaining community-based preceptors: A multicenter qualitative action study of pediatric preceptors.Academic Medicine,92(8),1168-1174.
12. Borimnejad, L.,Valizadeh, S.,Rahmani, A.,Whitehead, B.,Shahbazi, S.(2018).Attributes of Iranian new nurse preceptors: A phenomenological study.Nurse Education in Practice,28,121-126.
13. Brom, H. M.,Melnyk, B. M.,Szalacha, L. A.,Graham, M.(2016).Nurse practitioners’ role perception, stress, satisfaction, and intent to stay at a Midwestern academic medical center.Journal of the American Association of Nurse Practitioners,28(5),269-276.
14. Chang, H.-Y.,Shyu, Y.-I. L.,Wong, M.-K.,Chu, T.-L.,Lo, Y.-Y.,Teng, C.-I.(2017).How does burnout impact the three components of nursing professional commitment?.Scandinavian Journal of Caring Sciences,31(4),1003-1011.
15. Davis, L.,Fathman, A.(2018).Clinical education of nurse practitioner students: Identifying incentives, barriers, and working models to develop sustainable preceptorships.Journal of Nursing Education and Practice,8(9),18-24.
16. Davis, L.,Fathman, A.,Colella, C.(2021).An immersive clinical experience to create sustainable clinical learning opportunities for nurse practitioner students.Journal of the American Association of Nurse Practitioners,33(1),66-76.
17. Elder, E.,Johnston, A. N. B.,Wallis, M.,Greenslade, J. H.,Crilly, J.(2019).Emergency clinician perceptions of occupational stressors and coping strategies: A multi-site study.International Emergency Nursing,45,17-24.
18. Faraz, A.(2019).Facilitators and barriers to the novice nurse practitioner workforce transition in primary care.Journal of the American Association of Nurse Practitioners,31(6),364-370.
19. Lee, M.-H.,Holzemer, W. L.,Faucett, J.(2007).Psychometric evaluation of the Nursing Stress Scale (NSS) among Chinese nurses in Taiwan.Journal of Nursing Measurement,15(2),133-144.
20. Lee-Hsieh, J.,O’Brien, A.,Liu, C.-Y.,Cheng, S.-F.,Lee, Y.-W.,Kao, Y.-H.(2016).The development and validation of the Clinical Teaching Behavior Inventory (CTBI-23): Nurse preceptors’ and new graduate nurses’ perceptions of precepting.Nurse Education Today,38,107-114.
21. Li, L.,Ai, H.,Gao, L.,Zhou, H.,Liu, X.,Zhang, Z.,Sun, T.,Fan, L.(2017).Moderating effects of coping on work stress and job performance for nurses in tertiary hospitals: A cross- sectional survey in China.BMC Health Services Research,17(1),Article 401.
22. Lu, K.-Y.,Chiou, S.-L.,Chang, Y.-Y.(2000).A study of the professional commitment changes from nursing students to registered nurses.The Kaohsiung Journal of Medical Sciences,16(1),39-46.
23. Morgan, M.,Brewer, M.,Buchhalter, F.,Collette, C.,Parrott, D.(2018).Sustaining regional preceptor partnerships: Preceptor incentive survey.The Journal for Nurse Practitioners,14(1),E1-E4.
24. Roberts, M. E.,Wheeler, K. J.,Tyler, D. O.,Padden, D. L.(2017).Precepting nurse practitioner students: A new view-Results of two national surveys of nurse practitioner preceptors.Journal of the American Association of Nurse Practitioners,29(8),484-491.
25. Smith, J. H.,Sweet, L.(2019).Becoming a nurse preceptor, the challenges and rewards of novice registered nurses in high acuity hospital environments.Nurse Education in Practice,36,101-107.
26. Sobel, M. E.(1982).Asymptotic confidence intervals for indirect effects in structural equation models.Sociological Methodology,13,290-312.
27. Webb, J.,Lopez, R. P.,Guarino, A. J.(2015).Incentives and barriers to precepting nurse practitioner students.The Journal for Nurse Practitioners,11(8),782-789.
28. 台灣專科護理師學會（2020，10月16日）．進階制度及認證辦法。http://www.tnpa.org.tw/advanced/rules.asp [Taiwan of Association of Nursing Practitioners. (2020, October 16). The career ladder system and related certification regulations. http://www.tnpa.org.tw/advanced/rules.asp]
29. 韓惠君, H.-C.,許麗齡, L.-L.(2014)。專科護理師參與培訓課程之學習經驗。護理雜誌，61(1)，54-63。
30. 簡如君, J.-C.,吳明芳, M.-F.,吳姵賢, P.-X.,施乃云, N.-Y.,謝欣妤, X.-Y.,陳淑芬, S.-F.(2010)。繁體中文版護理壓力量表修訂之心理計量評估與適用性探討。第八屆東亞健康促進會議，上海，中國=Shanghai, China: