| Background:Humanistic care is the essential requirement of nursing service.One of the fundamental features of modern nursing practice is to establish a caring relationship that is needed to promote health and rehabilitation.The reports of National Nursing Career Development Plan(2016-2020)and Notice on guidance on Promoting the Reform and Development of Nursing Services all clearly put forward that nursing humanistic care and professional quality education should be strengthened to improve the humanistic care ability of nurses.The condition of nurses’humanistic care in Chinese hospitals is unoptimistic.Study shows that the total score and score rate of humanistic care practice of hospital nurses in China are at a low level.The insufficiency of nurses’humanistic care behavior has adverse effects on both sides of nurses and patients such as the rehabilitation process of patients,bad experience of medical treatment,bad nurse-patient relationship and medical disputes.The disharmonious nurse-patient relationship will also affect the humanistic care behavior output of nurses.To improve and enhance nurses’humanistic care behavior as soon as possible is the realistic requirement and inevitable choice to promote patients’health,reduce doctor-patient disputes and deepen the quality and connotation of nursing service.Nursing practice and researches have shown that nurses’humanistic care behavior is affected by many factors.It is of great theoretical and practical significance to clarify the influencing factors and their internal mechanism of nurses’humanistic care behavior for deepening the connotation of nursing service effectively.At present,the research methods of influencing factors of nurses’humanistic care behavior at home and abroad are single,mostly based on quantitative cross-sectional survey,with small sample size,and the research objects are mostly limited in a hospital,which limits the extrapolation of research conclusions;the research contents are mostly to explore the influence of nurses’general information on their humanistic care behavior,and lack the essence of the phenomenon of nurses’lack of humanistic care.The existing researches still have gaps in revealing the influencing factors of nurses’humanistic care behavior and their mechanism,which make hard to guide the continuous improvement and enhancement of nurses’humanistic care.Under the guidance of social cognitive theory,this study intends to use mixed methods to understand the current situation of nurses’humanistic care behavior,systematically explore the mechanism of individual and the environment factors on hospital nurses’humanistic care behavior,and build a model,so as to provide a theoretical framework and new key breakthrough points for the improvement of humanistic care practice of nurses effectively in hospitals of China.Objective:To explore the influencing factors and their internal mechanism of nurses’humanistic care behavior,and to provide a theoretical framework for improving the humanistic care service practice of nurses effectively in hospitals of China,and to seek new breakthrough points and acting points.(1)To describe the structure and the current situation of humanistic care behavior of nurses;(2)To identify the influencing factors of the nurses’humanistic care behavior;(3)To construct and validate a structural equation model of influencing factors of nurses’humanistic care behavior,and to reveal the action mechanism of these factors.Objects and Methods:This study was designed as the qualitative-quantitative sequential mixed method in four stages.The research methods mainly included literature review method,phenomenological research,expert consultation method,questionnaire survey method.Statistical analyses were conducted using NVivo12.0,SPSS16.0 and Amos23.0.Phase Ⅰ Preliminarily constructing the framework of influencing factors of nurses’humanistic care behaviorThe interview outline was formed on the basis of literature review and theoretical research,guided by the social cognitive theory.Semi-structured in-depth interviews on the experience of humanistic care behavior of nurses were conducted in nurses,inpatients and doctors.The data were analyzed according to Colaizzi’s analysis method,and initially formed the structure connotation of the nurses’humanistic care behavior and the conceptual framework of influencing factors.Phase Ⅱ Improving the framework through Delphi expert consultationDelphi expert consultation was used to improve the conceptual framework of influencing factors of nurses’humanistic care behavior formed in Phase I to provide support for the subsequent quantitative study.Phase Ⅲ Establishing a hypothetical mechanism model of the influencing factors of nurses’humanistic care behaviorBased on the framework in Phase I and Phase II,Care Behavior Inventory,Nursing Work Environment scale,Psychological Capital Questionnaire,Professional Identity Scale,General Self-efficacy Scale and a self-made questionnaire were used to collect data.A stratified sampling method was used to recruit 15 tertiary Grade A hospitals involving 3,583 officially registered nurses to describe the current situation of the nurses’humanistic care behavior,and establish a hypothetical mechanism model of the influencing factors of nurses’humanistic care behavior.Phase Ⅳ Validating the mechanism model of the influencing factors of nurses’humanistic care behaviorThe hypothetical model was distinguished,corrected and explained using Amos23.0 software and the qualitative and quantitative research results were integrated.Results:PhaseⅠThe conceptual framework of the influencing factors of nurses’humanistic care behavior was constructed preliminarilyInterviews were conducted in 35 personnel.Four patient opinion reports were also collected.The connotation of humanistic care behavior of nurses was divided into 5 topics and 10 categories:(1)respect for patients(equal treatment,protection of privacy);(2)empathy(transposition thinking,clarifying patient background and needs);(3)professional basic requirements(nurses professional quality,with the corresponding professional standards and norms);(4)assist to meet the individual reasonable needs of patients(psychological needs and physiological needs);(5)promote patient health(achieve good therapeutic purpose and promote patient growth).The influencing factors of the nurses’humanistic care behavior were extracted from 2 categories of 10 subjects:(1)personal factors(attitude,personality,personal basic quality,family factors,age,self-efficacy);(2)environmental factors(human resource allocation,social recognition,work atmosphere,remuneration).PhaseⅡThe conceptual framework of influencing factors of nurses’humanistic care behavior was improved by Delphi methodTwo rounds of consultation were conducted with 17 experts.The authoritative coefficient of the group of experts was 0.91,the recovery rates of the questionnaire were 94.44%,100%,the Kendall coefficient was 0.38,0.45,and the opinion of the two rounds of survey experts tended to converge.The nurses’humanistic care behavior included five elements:respect for patients,empathy,professional basic requirements,assistance to patients to meet reasonable individual needs and promote patient health.The main factors affecting the nurses’humanistic care behavior were personal factors(psychological capital,professional identity,general self-efficacy)and environmental factors(nursing work environment).Phase Ⅲ A hypothesis model of the influencing factors of nurses’humanistic care behavior was constructed(1)A total of 3,583 nurses participated in this survey.The age ranged from 19 to58 years old,and the nursing service years ranged from 1 to 38 years.Nurses with college degree or above were 3,543(98.88%).Nurses with junior title were 2,657(74.16%).(2)The Care Behavior Inventory score was 114.70±15.43,of which the score of“respect and connection”dimension was the lowest(4.34±0.75);the Nursing Work Environment scale score was 114.52±18.78,of which the score of“sufficient manpower”dimension was the lowest(3.87±1.02);the Occupational identity scale score was 109.31±16.75(score range 30-150 points),of which the score of“professional social skills”and“professional cognitive evaluation”dimensions were the lowest,respectively for 3.50±0.61,3.50±0.68,and the psychological Capital Queationnaire score was 4.46±0.71,of which the score of“hope”dimension was the lowest(4.32±0.83);and the general self-efficacy score was 26.71±6.30,which was lower than the international and domestic norm.(3)Single factor analysis found that age,working life,professional title,the nurses’children’s condition,working department,care knowledge,whether receiving the care training,whether there were care standards and norms have impacts on the nurses’caring behavior(P<0.001).Factors such as gender,education level,marital status,position,employment form,religious belief and whether the only child have no effect on the nurses’caring behavior total(P>0.05);multiple comparison found that that nurses with more than 11 years of working life have higher total scores of caring behavior than those with working life of 5 years or less(P<0.001),there was no difference in the total score of caring behavior between nurses with 6-10 years of working life and other groups(P>0.05);and the caring behavior of nurses in emergency department was lower than other departments(P<0.05).(4)Spearman correlation analysis found that humanistic care behavior was correlated with the nursing work environment,psychological capital,occupational identity and general self-efficacy(r=0.456,0.439,0.408,0.282,P<0.001).Nursing work environment was correlated with the psychological capital,occupational identity and general self-efficacy(r=0.720,0.695,0.397,P<0.001).The psychological capital was correlated with occupational identity and general self-efficacy(r=0.728,0.539,P<0.001).There was a correlation between the occupational identity and general self-efficacy(r=0.556,P<0.001).(5)Multiple linear regression analysis showed the influencing factors of the nurses’humanistic care behavior included the nursing work environment,the psychological capital,the professional identity,working years employment form,the general self-efficacy,department and the care knowledge(R~2=0.264,F=79.867,P<0.001).The influencing factors of the dimension of“respect and connection”included the nursing work environment,care knowledge,the psychological capital,the professional identity,whether there were care standards and norms,whether receiving the care training and department(R~2=0.277,F=91.037,P<0.001).The influencing factors of the dimension of“knowledge and skills”included the psychological capital,the nursing work environment,working years,the general self-efficacy,department and employment form(R~2=0.156,F=47.070,P<0.001).The influencing factors of the dimension of“support and guarantee”included the nursing work environment,the psychological capital,the occupational identity,employment form,working years and department(R~2=0.177,F=54.640,P<0.001).(6)A hypothesis model of the influencing factors of nurses’humanistic care behavior was constructed.Phase Ⅳ The model of influencing factors of nurses’humanistic care behavior was verified(1)The factor load between the potential variable and its measurement index was between 0.72 and 0.96;the combination reliability of potential variables was0.86～0.96,and the average variance extraction was 0.65～0.80;The estimation values of each path coefficient were statistically significant(P<0.05);x~2/df=26.824,PGFI=0.799,PNFI=0.797,GFI=0.880,AGFI=0.846,RMSEA=0.085,NFI=0.929,CFI=0.931,IFI=0.931,RFI=0.917,TLI=0.920.(2)The results of the structural equation model effect analysis:The standardized direct effects of nursing working environment,psychological capital and professional identity on nurses’humanistic care behavior were 0.26,0.21 and 0.07,respectively,and the general self-efficacy had no direct effect on the humanistic care behavior.The standardized indirect effect value of nursing working environment on nurses’humanistic care behavior was 0.217 through psychological capital,professional identity and general self-efficacy,and the standardized total effect value of nursing working environment on nurses’humanistic care behavior was 0.477.(3)By integrating the quantitative and qualitative research results,the action mechanism of influencing factors of nurses’humanistic care behavior was constructed.Conclusion:(1)The nurses’humanistic care behavior in Sichuan province contains five structures:respect for patients,empathy,following the basic professional requirements,assisting in meeting reasonable needs of patients and promote health of patients.(2)The humanistic care behavior of nurses is at a moderate level and there is still a large room for improvement.Special attention should be paid to the respect and connection to patients in the cultivation of nurses’humanistic care behavior.(3)The humanistic care behavior of nurses is mainly affected by individual and environmental factors.The nursing work environment,psychological capital,professional identity,general self-efficacy,working years,employment form,department,care knowledge,whether receiving the care training and whether there are care standards and norms are the influencing factors of the nurses’humanistic care behavior.Nursing work environment has a direct positive effect on the nurses’humanistic care behavior,and indirect positive effects on the nurses’humanistic care behavior through psychological capital,professional identity and general self-efficacy,and among them,psychological capital plays the biggest role of mediation,and psychological capital is the most important individual factor affecting nurses’humanistic care behavior.The improvement of nursing working environment and the promotion of nurses’psychological capital level can be taken as a new breakthrough and action point to effectively enhance the humanistic care behavior level of nurses.(4)The established model of influencing factors of nurses’humanistic care behavior can provide theoretical framework and scientific basis for follow-up intervention research. |
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