加護病房護理師工作壓力、心理韌性、留任意願之相關性研究

研究背景： 加護病房護理師長期處於高壓、高風險且高度專業的工作環境，除需面對重症病人照護、病情快速變化及繁重工作負荷外，亦須承受輪班制度及情緒勞動等壓力，可能影響其心理韌性及留任意願。心理韌性被視為個體面對壓力與逆境時的重要保護因子，然而國內針對加護病房護理師工作壓力、心理韌性與留任意願三者關係及心理韌性是否為中介效果之研究仍相對有限。研究目的： 本研究探討加護病房護理師之工作壓力、心理韌性與留任意願之現況及其相關性，並進一步檢驗心理韌性對工作壓力與留任意願關係之中介效果。研究方法： 本研究採橫斷式相關性研究設計，以中部某醫學中心成人加護病房護理師為研究對象，採方便取樣進行問卷調查，研究工具包括基本資料問卷、護理工作壓力源量表（Nurse Occupational Stressor Scale-2, NOSS-2）、醫療人員心理韌性量表及留任意願量表。資料分析採描述性統計、獨立樣本t檢定、單因子變異數分析、Pearson積差相關分析及Hayes PROCESS Macro Version 4.2 Model 4，以Bootstrap 5,000次重抽樣檢驗中介效果。研究結果： 有本研究有249位加護病房護理師參與，年齡以30-39歲為多數（38.2 %）。他們的工作壓力總平均為70.85 ± 10.71分；心理韌性總平均為24.41 ± 5.99分；留任意願總平均為13.35 ± 3.78分。不同年齡、教育程度及加護病房年資之護理師，其留任意願具有顯著差異；其中年齡較高（50–59歲）、專科學歷及加護病房年資20年以上之護理師，其留任意願顯著較高，而年資6–10年護理師之留任意願相對較低。整體工作壓力與心理韌性呈顯著負相關（r ＝ -.181，p ＝ .004），工作壓力與留任意願呈顯著負相關（r ＝ -.381，p＜.001），心理韌性與留任意願呈顯著正相關（r ＝ .238，p＜.001）。中介效果分析顯示，工作壓力對心理韌性具有顯著負向影響（B ＝ -0.0999，p＝.005），心理韌性對留任意願具有顯著正向影響（B ＝ 0.1099，p＝.004），工作壓力對留任意願仍具有顯著直接效果（B ＝ -0.1223，p＜.001）。此外，工作壓力經由心理韌性影響留任意願之間接效果為-0.0110，95% Bootstrap信賴區間為-0.0254～-0.0009，未包含0，顯示心理韌性在工作壓力與留任意願間具有顯著部分中介效果。研究結論： 本研究發現工作壓力會直接及間接影響加護病房護理師之留任意願，而心理韌性為重要之心理保護因子。建議醫療機構除持續改善工作環境及合理配置護理人力外，亦應強化心理支持及心理韌性培育措施，以提升護理師之心理調適能力及留任意願，作為護理管理及人力政策之參考。

Background:Intensive care unit (ICU) nurses work in a highly stressful, high-risk, and specialized clinical environment. In addition to providing care for critically ill patients, responding to rapidly changing patient conditions, and managing heavy workloads, they are also exposed to the demands of shift work and emotional labor. These stressors can adversely affect their resilience and retention intention. Resilience has been recognized as an important protective factor that enables individuals to cope with stress and adversity. However, studies that examine the relationships between work stress, resilience, and retention intention among ICU nurses, as well as the mediating role of resilience, remain limited in Taiwan.Purpose:This study aimed to investigate the current state of work stress, resilience, and retention intention among nurses in the intensive care unit (ICU), examine the relationships between these variables, and further explore the mediating effect of resilience on the relationship between work stress and retention intention.Methods: A cross-sectional correlational research design was adopted. The participants were adult ICU nurses recruited by convenience sampling from a medical center in central Taiwan. Research instruments included a demographic questionnaire, the Nurse Occupational Stressor Scale-2 (NOSS-2), the Healthcare Professional Resilience Scale, and the Retention Intention Scale. Data were analyzed using descriptive statistics, independent samples t tests, one-way analysis of variance (ANOVA), Pearson’s correlation analysis, and Hayes PROCESS Macro Version 4.2 Model 4. The mediating effect was examined using 5,000 bootstrap resamples.Results: A total of 249 nurses from the ICU participated in this study, with the majority aged 30 to 39 years (38.2%). The mean scores for work stress, resilience, and retention intention were 70.85 ± 10.71, 24.41 ± 5.99, and 13.35 ± 3.78, respectively. Significant differences in retention intention were found between nurses with different ages, educational levels, and years of ICU experience. Nurses aged 50 to 59 years, those with a junior college education, and those with more than 20 years of ICU experience reported significantly higher retention intention, while nurses with 6–10 years of ICU experience demonstrated relatively lower retention intention. Work stress was significantly negatively correlated with resilience (r = -.181, p = .004) and retention intention (r = -.381, p < .001), while resilience was significantly positively correlated with retention intention (r = .238, p < .001). Mediation analysis revealed that work stress had a significant negative effect on resilience (B = -0.0999, p = .005), and resilience had a significant positive effect on retention intention (B = 0.1099, p = .004). Work stress also exerted a significant direct effect on retention intention (B = -0.1223, p < .001). Furthermore, the indirect effect of work stress on retention intention through resilience was -0.0110, with a 95% bootstrap confidence interval ranging from -0.0254 to -0.0009, excluding zero. These findings indicate that resilience partially mediated the relationship between work stress and retention intention.Conclusions: This study found that work stress had direct and indirect effects on the retention intention of nurses in the intensive care unit (ICU) and that resilience served as an important protective factor. Healthcare institutions are encouraged to continue improving the work environment and ensuring appropriate nurse staffing while strengthening psychological support and resilience-building interventions. These efforts can improve nurses' psychological adaptation and retention intention, providing evidence to inform nursing management and healthcare workforce policy.