The Study Of Nurses' Risk Perception Influencing Factors And Risk Response Behavior Based On Structural Equation Modeling

Nursing is a service occupation with high risks and responsibility.Owing to particularity of the occupation,nurses are faced with risks spreading everywhere.Besides causing physical damage or economic loss to nurses,these risks can also lead to a series of psychological and behavioral response.Although there are many researches about the nursing occupation safety at home and abroad,most of the researchers focus on the analysis of risks from an objective aspect,ignoring the subjective factors of nurses.However,nurses' perception about risks is the key that influences their psychology and behavior.Nursing risk perception refers to the subjective feeling and understanding of nurses about crisis events in working conditions.In nursing practice,there are still lack of systematic and scientific researches about nurses' cognition of occupation risks,factors that influence the risk perception,and responses in face of risks.Therefore investigation explored the risks perception and responses to risks of nurses have significant research value.In this study we chose nurses as the research object,“risk perception” and “responses to risks” as the cut-in point,and discussed characteristics and influencing factors of risk perception.On this basis,taking risk perception as the core variability,we combined direct influencing factors of risk perception and mechanism of risk perception on responses through structural equation model to clarify the internal logical relationship between the variables.The results are helpful for nurses to judge accurately,understand various risks in the nursing occupation,and improve the effectiveness of decision-making under the circumstances of risks.Objective1.To test the validity and reliability of nurses' risk perception questionnaire;2.To clarify the relationship between risk perception,resilience and social support;3.To construct the theoretical model of nurses' risk perception,and to explore the relationship between risk perception and responses to risks.Methods1.On the basis of previous research,336 nurses in Xi'an were investigated.They were required to fill in the “nurses' risk perception questionnaire”.With the methods of internal consistency check,split-half reliability,test-retest reliability,and confirmatory analysis,et al,we verified the reliability and validity of the questionnaire.2.With “nurses' risk perception questionnaire”,“resilience scale of Chinese version”,and “SSRS”,we carried out our research on 466 nurses in Xi'an.We used descriptive analysis,T test,variance analysis and person correlation analysis to explore the correlation between nurses' risk perception,resilience and social support.3.With “risk perception” and “risk response behavior” as cut-in point,resilience and social support as the antecedent variables and risk response behaviors as outcome variables,we conducted an assumed model of nurses' risk perception,and used structural equation model analysis to verify the hypothetical model and research hypotheses.Results1.The validity and reliability of “nurses' risk perception questionnaire”1.1 Reliability AnalysisInternal consistency check: The Cronbach's ? coefficient of the nurse risk perception questionnaire was 0.840,personal security risk was 0.745,physical function risk was 0.756,occupational exposure risk was 0.751,social mentality risk was 0.774,organizational factor risk was 0.765,and time risk was 0.748.The results indicated good internal consistency of the questionnaire.Split-half reliability: The split-half reliability was 0.873,personal security risk was 0.854,physical function risk was 0.813,occupational exposure risk was 0.861,social mentality risk was 0.824,organizational factor risk was 0.792,and time risk was 0.883.The results suggested good split-half reliability of the questionnaire.Retest reliability: The retest reliability of the nurse risk perception questionnaire was 0.846(p<0.001),which suggested good time stability of the questionnaire.1.2 Validity AnalysisThe confirmatory factor analysis results showed that each indexes of the structural model are in the standard range(==3.644,RMSEA=0.071,AGFI=0.912,GFI=0.945,CFI=0.919).2.The correlation between risk perception,resilience and social support2.1 The current status of nurses' risk perceptionIn this research,total score of the risk perception is78.82±19.44,scoring average is 56.30%,and the nurses' risk perception is on intermediate level.According to the results,top three risk perceptions are: physical function risk(63.40%),occupational exposure risk(59.40%)and time risk(58.00%).2.2 The current status of resilience and social supportResilience: The total score of the resilience is 69.22±14.68,significantly higher than the stander score 65.4±13.9(t=7.918,p<0.001).Social support: The total score of the social support is 39.15±7.43,which is intermediate level.2.3 The influence factors of nurses' risk perceptionWe found that the differences of different genders,hospital levels,and service years were of statistical significance(p<0.05),while differences of ages,education backgrounds,departments,academic titles and marital status were of no significance(p>0.05).Gender: The risk perception level of female nurses was significantly higher than that of male nurses.Hospital level: There was a significant difference in the score of risk perception among nurses in different hospital levels(p<0.05),nurses in first level hospitals had a low risk perception score than those in other hospitals.Service years: Nurses' risk perception level of nurse working 10~14 years was higher than nurses who work less than 5 years or more than 15 years.2.4 The negative correlation of resilience,social support and risk perceptionResilience and risk perception: There was a negative correlation between psychological resilience and the overall level of risk perception(r=-0.103,p<0.05);dimensions of resilience were negatively correlated with dimensions of perceived risk(p<0.05).Social support and risk perception: There was a negative correlation between social support and the overall level of risk perception(r=-0.205,p<0.05);the dimensions of social support were negatively correlated with dimensions of perceived risk(p<0.05).3.Risk perception and responses to risks based on structural equation model.Based on previous studies,considering clinical practice,we established a theoretical model of nurses' risk perception to directly clarify the influencing factors of nurses' risk perception,and the logical relationship between risk perception and responses to risks:(1)The resilience level has a negative impact on nurses' risk perception;(2)The resilience level has a positive impact on nurses' responses to risks;(3)The social support level has a negative impact on nurses' risk perception;(4)The social support level has a positive impact on nurses' responses to risks;(5)Risk perception level has a positive impact on nurses' responses to risks.Conclusion1.“Nurses' risk perception questionnaire” had good reliability and validity;it can measure the nurse's risk perception.2.The nurses' risk perception is in the middle level,the related influencing factors were gender,hospital level,service years,resilience and social support.3.Nurses' risk perception level was negatively correlated with the nurses' resilience and social support level;the nurses' resilience and social support level positively influenced their responses to risks;The higher the nurses' risk perception level in the occupation,the better coping behavior they performance;and vice versa.