| Objective:Based on the perspective of resilience,this study investigated the status of maladjustment in clinical practice of undergraduate nursing students,analyzed the influencing factors,and constructed a risk prediction model,in order to predict the risk of maladjustment in clinical practice of undergraduate nursing students before they practice,so as to provide guidance for nursing teachers and managers to develop personalized preventive interventions and help nursing students better transition from school studying to clinical practice.Methods:Cluster sampling method was adopted to select 2017 and 2018 full-time undergraduate nursing students in a university in Guangdong Province.In the second semester of junior year(before clinical practice),all participants were investigated with the questionnaire of general characteristics,the Connor-Davidson Resilience Scale(CD-RISC),the Chinese Big Five Personality Inventory Brief Version(CBF-PI-B),the Critical Thinking Dispositions Inventory-Chinese Version(CTDI-CV),the General SelfEfficacy Scale(GESE),the Family APGAR Index(APGAR)to know the influencing factors of maladjustment in clinical practice.The Maladjustment Scale in Clinical Practice was used to investigate the status of maladjustment in clinical practice during three months of practice.SPSS26.0 software was used for descriptive statistics,univariate analysis and multivariate logistic regression analysis for prediction model construction.R software 4.1.0 and R studio 1.3.1093 was used to present,evaluate,and verify the prediction model.Nomogram was used to represent the model.Area under ROC curve(AUC)and calibration graph were used to evaluate the discrimination and calibration of the model respectively.Bootstrap method was used to verify the model internally.All tests were statistically significant with P<0.05(twotailed).Results:(1)The status of maladjustment in clinical practice of undergraduate nursing students:The score of maladjustment in clinical practice of undergraduate nursing students was(92.33±15.87).249 nursing students(56.2%)was in maladjustment,including 179(40.4%)mild maladjustment,70(15.8%)moderate and severe maladjustment.The mean scores of each dimension from high to low were interpersonal relationship and social interaction(3.66±0.60),cognition(3.37±0.70),behavior(3.08±0.69),emotion(2.96±0.71).(2)The univariate analysis of maladjustment in clinical practice of undergraduate nursing students:①In the demographic characteristics,there were significant differences of maladjustment scores in gender.Compared with male students,female students had lower maladjustment scores in practice(t=3.038,P<0.05).There were no significant differences in the only child,hometown,class leader experience(P>0.05).②In family characteristics,there was significant difference of maladjustment score in nursing students with different family monthly income(F=4.230,P<0.05).Whereas there were no significant differences in family structure,parental education level and parental occupation(P>0.05).③In professional attitude,there was significant differences of maladjustment score in nursing students attitude towards nursing profession(t=2.822,P<0.05)and their employment prospect(t=3.381,P<0.05).There was no significant difference in whether nursing major was their first choice when admitting into university(t=0.044,P>0.05).④ There was significant difference of maladjustment score in nursing students with different family function(F=6.869,P<0.05).(3)The correlation analysis of maladjustment in clinical practice of undergraduate nursing students:①There was a positive correlation between maladjustment and resilience(r=0.208,P<0.05).The higher resilience of nursing students,the better adjustment in clinical practice.In all dimensions,toughness(r=0.188,P<0.05),strength(r=0.190,P<0.05),and optimism(r=0.166,P<0.05)were positively correlated with maladjustment in clinical practice.② The maladjustment in clinical practice was positively correlated with conscientiousness(r=0.128,P<0.05),agreeableness(r=0.197,P<0.05),openness(r=0.125,P<0.05)and extraversion(r=0.281,P<0.05),and negatively correlated with neuroticism(r=-0.339,P<0.05).The higher conscientiousness,agreeableness,openness and extraversion of nursing students,the better adjustment in clinical practice,while the neuroticism was on the contrary.③ There was a positive correlation between maladjustment and selfefficacy(r=0.182,P<0.05).The higher self-efficacy of nursing students,the better adjustment in clinical practice.④ The maladjustment in clinical practice was positively correlated with critical thinking(r=0.251,P<0.05).The higher critical thinking was,the better adjustment in clinical practice was.Among all dimensions,truthseeking,open-mindedness,systematicity,critical thinking self-confidence and inquisitiveness are positively correlated with maladjustment in clinical practice(P<0.05),while analyticity,cognitive maturity are not significant with maladjustment(P>0.05).(4)The logistic analysis on maladjustment in clinical practice of undergraduate nursing students:①Gender,family monthly income,attitude towards to nursing profession and their employment prospect,open-mindedness,inquisitiveness,neuroticism and extraversion were the independent factors of maladjustment in clinical practice(P<0.05).②Female(OR=2.207,95%CI:1.222～3.984),dislike nursing(OR=1.680,95%CI:1.024-2.755),pessimistic about their employment prospects(OR=2.199,95%CI:1.017-4.758)and neuroticism(OR=1.079,95%CI:1.037-1.124)were risk factors of maladjustment in clinical practice.③ Compared with family monthly income<1000 (?),family monthly income 1000-2999 (?)(OR=0.333,95%CI:0.144-0.770),3000-4999(?)(OR=0.307,95%CI:0.130-0.728),≥5000 (?)(OR=0.246,95%CI:0.1020.594),open mind(OR=0.943,95%CI:0.897-0.992),inquisitiveness(OR=0.944,95%CI:0.903-0.986)and extraversion(OR=0.936,95%CI:0.902-0.907)were protective factors for maladjustment in clinical practice.(5)The expression of maladjustment risk prediction model for undergraduate nursing students in clinical practice was:Y=0.792 ×(Gender)-1.101 ×(Family monthly income 1000-2999 (?))1.181×(Family monthly income 2000～4999 (?))-1.402 ×(Family monthly income≥5000 (?))+0.519 ×(Attitude towards to nursing profession)+0.788 ×(Employment prospects)-0.059 ×(openmindedness)-0.058 ×(inquisitiveness)+0.076×(neuroticism)-0.066×(extraversion).(6)The evaluation of maladjustment risk prediction model for undergraduate nursing students in clinical practice:The AUC of the risk prediction model for maladjustment in clinical practice of undergraduate nursing students was 0.765(95%CI:0.721-0.810),and the calibration curves of the original data set and Bootstrap resampling data set were basically overlapped with the 45° oblique line.Conclusions:(1)It was found that there were many undergraduate nursing students with maladjustment in clinical practice.Therefore,nursing educators in schools and nursing administrators in hospitals should pay attention to this problem.(2)The risk factors for maladjustment in clinical practice were female students,dislike of nursing profession,pessimism about employment prospects and neuroticism.Medical colleges should focus on such nursing students and reduce the adverse impact of risk factors.For example,they can help undergraduate nursing students to understand nursing profession correctly and establish confidence through professional identity and nursing values education.(3)The protective factors for maladjustment in clinical practice were good family economic status,open-mindedness and inquisitiveness,and extraversion.Nursing educators should strengthen the positive effect of protective factors to reduce the risk of maladjustment in clinical practice and help nursing students to shape their positive personality and cultivate their critical thinking ability.For students with poor family economic conditions,teachers and hospital administers should not only support with money,but also improve students’ mental health.(4)The risk prediction model of maladjustment in clinical practice of undergraduate nursing students was with good discrimination and calibration,can accurately and conveniently predict the risk of maladjustment in clinical practice.Teachers in medical colleges and administers in hospital can use the risk prediction model to predict the risk of maladjustment in clinical practice of undergraduate nursing students,so as to identify high-risk students as soon as possible and reduce the adverse effects of maladjustment on nursing students,which may give nursing students more satisfactions about nursing profession in clinical practice. |
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