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研究生:方楸淑
研究生(外文):FANG, CHIU-SHU
論文名稱:醫院護理人員護理照護品質與真誠領導、心理賦權、病人安全建言行為和工作倦怠之關係:職場不文明和韌性的調節效果
論文名稱(外文):The Relationships on Hospital Nurses among Nurses-Reported Quality of Nursing Care and Authentic Leadership, Psychological Empowerment, Patient Safety of Speaking Up Behavior and Burnout: The Moderating Effects of Workplace Incivility and Resilience
指導教授:周汎澔周汎澔引用關係
指導教授(外文):CHOU, FAN-HAO
口試委員:陳欽明李澄賢馬淑清劉怡
口試委員(外文):CHEN, CHIN-MINGLI, CHENG-HSIENMA, SHU-CHINGLIU, YI
口試日期:2023-03-31
學位類別:博士
校院名稱:高雄醫學大學
系所名稱:護理學系博士班
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2023
畢業學年度:111
語文別:中文
論文頁數:266
中文關鍵詞:護理照護品質護理人員真誠領導心理賦權病人安全建言行為工作倦怠職場不文明韌性
外文關鍵詞:quality of nursing carenursesauthentic leadershippsychological empowermentpatient safety of speaking up behaviorburnoutworkplace incivilityresilience
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本研究探討醫院護理人員的真誠領導感受、心理賦權、病人安全建言行為、工作倦怠與護理照護品質之模式關係,以及加入調節變項韌性和職場不文明對於整體模式之影響。本研究為橫斷式相關性研究設計,採結構式線上自填式問卷進行相關資料收集,以方便取樣,選取台南市三間醫院,分別為一間醫學中心、一家為區域醫院和一家地區醫院;有效樣本為944位護理人員(有效回收率65.42%)。使用真誠領導量表、心理賦權量表、病人安全建言行為量表、工作倦怠量表、韌性量表、職場不文明量表、護理照護品質量表和護理人員基本資料等研究工具收集資料。使用探索性和驗證性因素分析其因素效度,並利用SPSS和Mplus進行研究變項結構方程模式之分析。本研究結果顯示,真誠領導對心理賦權有顯著正向直接效果,對病人安全建言行為有負向顯著直接效果;心理賦權對病人安全建言行為和護理照護品質都有顯著正向直接效果,對工作倦怠有負向顯著效果。病人安全建言行為對工作倦怠有正向顯著效果,對護理照護品質沒有直接效果。心理賦權在真誠領導和護理照護品質之間具有完全中介效果,最終的護理照護品質模式可解釋變異量為38.3%。病人安全建言行為和工作倦怠在真誠領導和護理照護品質之間沒有中介效果。韌性對護理照護品質有正向顯著直接效果,職場不文明對護理照護品質沒有顯著直接效果,但韌性、職場不文明在護理人員病人安全建言行為、工作倦怠與護理照護品質之間沒有調節效果。心理賦權是影響護理照護品質的重要因素,本研究將依據研究結果提出具體可行之建議,期望能對護理實務有實質貢獻,進而達
到更好的護理照護品質。

This study examines the relationships between authentic leadership, psychological empowerment, speaking up for patient safety, burnout, and nursing care quality among hospital nurses. The study also examines the moderation of variables related to resilience and workplace incivility in the overall model.
This cross-sectional and correlational study included a convenience sample of 944 nurses from three hospitals in southern Taiwan. Data were collected through self-administered online questionnaires, which included the authentic leadership questionnaire (ALQ), the psychological empowerment scale, the speaking up of patient safety questionnaire (SUPS-Q), the Copenhagen burnout inventory (CBI), the workplace incivility scale (WIS), the Connor–Davidson resilience scale (CD-RISC 10), demographic characteristics, and the quality of nursing care scale.
The collected data were analyzed using exploratory, confirmatory factor analysis, and cross-validation to establish factor validity. Structural equation modeling (SEM) analysis using Mplus to confirm the variables’ relationship with the moderating effects of resilience and workplace incivility.
The results of this study showed that authentic leadership had a significant positive direct effect on psychological empowerment, and a significant negative direct effect on speaking up behavior for patient safety; psychological empowerment had a significant positive direct effect on patient safety of speaking up behavior and quality of nursing care, and a significant negative direct effect on job burnout; patient safety of speaking up behavior had a significant positive direct effect on job burnout, but didn’t have a direct effect on quality of nursing care. Psychological empowerment had a full mediating effect between authentic leadership and quality of nursing care, and the final quality of nursing care model accounted for 38.3% of the variance.
Patient safety of speaking up behavior and burnout showed no mediating effect on authentic leadership and quality of nursing care. Furthermore, resilience had a significant positive direct effect on the quality of nursing care, while workplace incivility didn’t directly affect the quality of nursing care. However, resilience and workplace incivility had no moderating effects on patient safety of speaking up behavior, job burnout, and quality of nursing care among nurses.
Psychological empowerment is an important factor that affects the quality of nursing care. Based on the research results, this study provides a better understanding of the relationships among authentic leadership, psychological empowerment, and the quality of nursing care. The findings can serve as a valuable reference for nursing leaders to cultivate nurses' psychological empowerment and ultimately improve the quality of nursing care.


中文摘要…………………………………………………………………………………………………… Ⅰ
英文摘要 …………………………………………………………………………………………………Ⅲ
致 謝 …………………………………………………………………………………………………………Ⅳ

第一章 緒論 …………………………………………………………………………………………1
第一節 問題背景及重要性 ……………………………………………………………1
第二節 問題陳述 ………………………………………………………………………………7
第三節 研究目的…………………………………………………………………………………8
第二章 文獻查證與概念架構…………………………………………………………9
第一節 文獻查證 ………………………………………………………………………………9
第二節 研究架構 ……………………………………………………………………………40
第三節 研究假設 ……………………………………………………………………………41
第四節 名詞定義 ……………………………………………………………………………42
第三章 研究方法 ……………………………………………………………………………45
第一節 研究設計 ……………………………………………………………………………45
第二節 研究場所與對象 ………………………………………………………………47
第三節 研究工具 ……………………………………………………………………………50
第四節 研究工具之效度與信度評估 ………………………………………55
第五節 資料收集 …………………………………………………………………………116
第六節 研究對象權益維護考量 ……………………………………………117
第七節 資料分析方法 ………………………………………………………………118
第四章 研究結果 …………………………………………………………………………125
第一節 研究對象基本屬性之描述 ………………………………………125
第二節 各研究變項與護理照護品質之關係分析……………147
第三節 護理照護品質結構方程模式之檢定…………………157
第五章 討論 ……………………………………………………………………………………181
第一節 研究對象的基本屬性 ……………………………………………181
第二節 醫院護理人員護理照護品質建構模式…………………183
第三節 研究限制 ……………………………………………………………………191
第六章 結論與建議 ……………………………………………………………………192
第一節 結論 ……………………………………………………………………………192
第二節 建議 ……………………………………………………………………………194
參考文獻 ……………………………………………………………………………………………196
附件 ………………………………………………………………………………………………………237
附錄一 問卷內容 ……………………………………………………………………………237
附錄二 研究工具使用同意書 ……………………………………………………238
附錄三 專家內容效度名單……………………………………………………………239
附錄四 人體試驗委員會同意書 ………………………………………………250
附錄五 研究說明書 ………………………………………………………………………252



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