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Article(id=1220689484350411414, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1220689483859677846, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2025.19.001, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1729180800000, receivedDateStr=2024-10-18, revisedDate=1751990400000, revisedDateStr=2025-07-09, acceptedDate=null, acceptedDateStr=null, onlineDate=1768964652382, onlineDateStr=2026-01-21, pubDate=1760025600000, pubDateStr=2025-10-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1768964652382, onlineIssueDateStr=2026-01-21, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1768964652382, creator=13701087609, updateTime=1768964652382, updator=13701087609, issue=Issue{id=1220689483859677846, tenantId=1146029695717560320, journalId=1220038315760373764, year='2025', volume='39', issue='19', pageStart='3201', pageEnd='3376', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1768964652266, creator=13701087609, updateTime=1768965013333, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1220690998338961744, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1220689483859677846, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1220690998338961745, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1220689483859677846, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3201, endPage=3207, ext={EN=ArticleExt(id=1220689484610458264, articleId=1220689484350411414, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Latent profiles analysis and factors influencing vicarious trauma among pediatric critical care nurses, columnId=1220689484526572183, journalTitle=Chinese Nursing Research, columnName=Original Articles, runingTitle=null, highlight=null, articleAbstract=

Objective To explore the latent classification characteristics and their influencing factors of vicarious trauma among pediatric critical care nurses. Methods Using a convenience sampling method,a total of 319 pediatric critical care nurses from 12 hospitals in Shanxi province were selected from July to August 2024.General Information Questionnaire,Vicarious Trauma Scale for Medical Staff,Regulatory Emotional Self⁃Efficacy Scale,and Simplified Chinese Version of Event Related Rumination Inventory were used for the survey.The categories of pediatric critical care nurses' vicarious trauma were initially explored based on the latent profiles,and the influencing factors of the latent profiles were analyzed using unordered multinomial logistic regression. Results The score of Vicarious Trauma Scale for Medical Staff was 81.60±22.55.Vicarious trauma was divided into four latent profiles:mild trauma response group,emotionally dominant response group,significant negative trauma group,and balanced trauma response group.The regression analysis results showed that age,education level,years of working experience,reproductive status,death of a relative,rescuing a patient,death of a patient under care,regulatory emotional self-efficacy,and rumination were influencing factors of vicarious trauma among pediatric critical care nurses. Conclusions There is population heterogeneity among pediatric critical care nurses in vicarious trauma.Nursing managers can provide individualized interventions to nurses based on the influencing factors of different latent profiles to reduce the level of vicarious trauma among pediatric nurses.

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YANG Hui, E⁃mail:
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目的 探索儿科重症护士替代性创伤潜在分类特点及其影响因素。 方法 采用便利抽样法，于2024年7月—8月选取山西省12所医院的319名儿科重症护士为研究对象，采用一般资料调查表、医护人员替代性创伤量表、情绪调节自我效能感量表和简体中文版事件相关反刍性沉思问卷进行调查，基于潜在剖面初步探索儿科重症护士替代性创伤类别，采用无序多分类Logistic回归分析潜在剖面影响因素。 结果 儿科重症护士医护人员替代性创伤量表得分为（81.60±22.55）分。替代性创伤可分为4个潜在剖面：轻度创伤反应组、情感主导反应组、显著负性创伤组、均衡创伤反应组。回归分析结果显示，年龄、文化程度、工作年限、生育情况、亲人离世、参加抢救、照护过的患儿死亡、情绪调节自我效能感以及反刍性沉思是儿科重症护士替代性创伤的影响因素。 结论 儿科重症护士替代性创伤存在群体异质性，护理管理者可根据不同潜在剖面的影响因素对护士进行个体化干预，以降低儿科护士替代性创伤水平。

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杨辉，E⁃mail：
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薄恩惠，护士，硕士研究生在读

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薄恩惠，护士，硕士研究生在读

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薄恩惠，护士，硕士研究生在读

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China), AuthorCompanyExt(id=1220838931671732376, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689484350411414, companyId=1220838931650760853, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.山西医科大学护理学院，山西 030001)])])], keywords=[Keyword(id=1220838933613695207, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689484350411414, language=EN, orderNo=1, keyword=pediatrics), Keyword(id=1220838933680804075, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689484350411414, language=EN, orderNo=2, keyword=intensive care unit), Keyword(id=1220838933802438894, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689484350411414, language=EN, orderNo=3, keyword=nurse), Keyword(id=1220838933924073714, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689484350411414, language=EN, orderNo=4, keyword=vicarious trauma), Keyword(id=1220838934016348407, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689484350411414, language=EN, orderNo=5, keyword=latent profile analysis), Keyword(id=1220838934091845883, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689484350411414, language=EN, orderNo=6, keyword=influencing factors), Keyword(id=1220838934184120579, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689484350411414, language=CN, orderNo=1, keyword=儿科), Keyword(id=1220838934293172488, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689484350411414, language=CN, orderNo=2, keyword=重症监护室), Keyword(id=1220838934360281355, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689484350411414, language=CN, orderNo=3, keyword=护士), Keyword(id=1220838934444167440, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689484350411414, language=CN, orderNo=4, keyword=替代性创伤), Keyword(id=1220838935769567511, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689484350411414, language=CN, orderNo=5, keyword=潜在剖面), Keyword(id=1220838935887008025, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689484350411414, language=CN, orderNo=6, keyword=影响因素)], refs=[Reference(id=1220838937489232225, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689484350411414, doi=null, pmid=null, pmcid=null, year=2019, volume=51, issue=2, pageStart=72, pageEnd=83, url=null, language=null, rfNumber=[1], rfOrder=0, authorNames=DOR A, MASHIACH EIZENBERG M, HALPERIN O, journalName=Revue Canadienne de Recherche En Sciences Infirmieres, refType=null, unstructuredReference=DOR A, MASHIACH EIZENBERG M, HALPERIN O.Hospital nurses in comparison to community nurses:motivation,empathy,and the mediating role of burnout[J].Revue Canadienne de Recherche En Sciences 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articleId=1220689484350411414, language=CN, label=图 1, caption=儿科重症护士替代性创伤潜在剖面图, figureFileSmall=L3gpdK8vu4Iez+siffKvYg==, figureFileBig=E2tGCVJPcfcdlxoDTTq58w==, tableContent=null), ArticleFig(id=1220838936293855535, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689484350411414, language=EN, label=Table 1, caption=

Scores of Vicarious Trauma Scale for Medical Staff,Regulatory Emotional Self⁃Efficacy Scale,and Simplified Chinese Version of Event Related Rumination Inventory among pediatric critical care nurses（$\bar{x}\pm s$，n=319）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目得分
医护人员替代性创伤量表81.60±22.55
负性情感体验21.18±4.75
回避与躯体化反应27.06±10.45
负性认知与警觉33.36±11.26
情绪调节自我效能感量表40.49±7.43
调节积极情绪的自我效能感16.06±2.62
调节生气/愤怒情绪的自我效能感9.20±2.62
调节沮丧/痛苦情绪的自我效能感15.24±4.21
简体中文版事件相关反刍性沉思问卷46.99±12.02
侵入性反刍沉思23.34±6.59
目的性反刍沉思23.65±6.34
), ArticleFig(id=1220838936390324532, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689484350411414, language=CN, label=表1, caption=

儿科重症护士医护人员替代性创伤量表、情绪调节自我效能感量表及简体中文版事件相关反刍性沉思问卷得分（$\bar{x}\pm s$，n=319） (分)

, figureFileSmall=null, figureFileBig=null, tableContent=
项目得分
医护人员替代性创伤量表81.60±22.55
负性情感体验21.18±4.75
回避与躯体化反应27.06±10.45
负性认知与警觉33.36±11.26
情绪调节自我效能感量表40.49±7.43
调节积极情绪的自我效能感16.06±2.62
调节生气/愤怒情绪的自我效能感9.20±2.62
调节沮丧/痛苦情绪的自我效能感15.24±4.21
简体中文版事件相关反刍性沉思问卷46.99±12.02
侵入性反刍沉思23.34±6.59
目的性反刍沉思23.65±6.34
), ArticleFig(id=1220838936486793528, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689484350411414, language=EN, label=Table 2, caption=

Latent profile model fitting indicators for vicarious trauma in pediatric critical care nurses

, figureFileSmall=null, figureFileBig=null, tableContent=
模型AICBICaBICEntropyP类别概率
LMRTBLRT
模型16 761.0186 783.6096 764.578
模型26 531.3876 569.0396 537.3210.751<0.000 1<0.000 10.386/0.614
模型36 460.3786 513.0906 468.6850.7860.026 9<0.000 10.226/0.445/0.329
模型46 410.0006 480.0006 420.0000.8520.003 8<0.000 10.163/0.100/0.307/0.430
模型56 412.2386 491.0726 421.2920.7840.101 0<0.000 10.144/0.370/0.119/0.075/0.291
), ArticleFig(id=1220838936579068223, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689484350411414, language=CN, label=表2, caption=

儿科重症护士替代性创伤的潜在剖面模型拟合指标

, figureFileSmall=null, figureFileBig=null, tableContent=
模型AICBICaBICEntropyP类别概率
LMRTBLRT
模型16 761.0186 783.6096 764.578
模型26 531.3876 569.0396 537.3210.751<0.000 1<0.000 10.386/0.614
模型36 460.3786 513.0906 468.6850.7860.026 9<0.000 10.226/0.445/0.329
模型46 410.0006 480.0006 420.0000.8520.003 8<0.000 10.163/0.100/0.307/0.430
模型56 412.2386 491.0726 421.2920.7840.101 0<0.000 10.144/0.370/0.119/0.075/0.291
), ArticleFig(id=1220838936658760001, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689484350411414, language=EN, label=Table 3, caption=

Univariate analysis of factors influencing latent classification of vicarious trauma for pediatric critical care nurses

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类轻度创伤反应组（n=52）情感主导反应组（n=32）显著负性创伤组（n=98）均衡创伤反应组（n=137）χ2值P
性别女51(98.077)29(90.625)95(96.939)134(97.810)4.7600.190
男1(1.923)3(9.375)3(3.061)3(2.190)
年龄20~30岁37(71.154)3(9.375)15(15.306)27(19.708)74.518<0.01
31~40岁15(28.846)16(50.000)57(58.163)70(51.095)
≥41岁0(0.000)13(40.625)26(26.531)40(29.197)
文化程度专科11(21.154)12(37.500)2(2.041)2(1.460)78.773<0.01
本科41(78.846)18(56.250)63(64.286)102(74.452)
硕士研究生及以上0(0.000)2(6.250)33(33.673)33(24.088)
工作年限1~5年35(67.308)0(0.000)6(6.123)12(8.759)130.607<0.01
6~10年16(30.769)9(28.125)35(35.714)39(28.467)
11~15年0(0.000)8(25.000)22(22.449)32(23.358)
16~20年1(1.923)6(18.750)17(17.347)28(20.438)
≥21年0(0.000)9(28.125)18(18.367)26(18.978)
职称初级21(40.385)11(34.375)45(45.918)57(41.606)1.8020.937
中级29(55.769)19(59.375)48(48.980)72(52.555)
高级2(3.846)2(6.250)5(5.102)8(5.839)
婚姻状况已婚44(84.615)29(90.625)79(80.612)114(83.212)2.8830.823
未婚8(15.385)3(9.375)17(17.347)21(15.328)
离异或丧偶0(0.000)0(0.000)2(2.041)2(1.460)
生育情况已生育10(19.231)29(90.625)23(23.469)68(49.635)130.733<0.01
未生育31(59.615)2(6.250)6(6.123)34(24.818)
妊娠期11(21.154)1(3.125)69(70.408)35(25.547)
科室儿科重症19(36.538)5(15.625)29(29.592)34(24.818)5.1220.163
新生儿重症33(63.462)27(84.375)69(70.408)103(75.182)
周夜班数无1(1.923)4(12.500)12(12.245)11(8.029)9.9300.128
1~2个51(98.077)26(81.250)84(85.714)124(90.511)
>2个0(0.000)2(6.250)2(2.041)2(1.460)
有亲人离世否51(98.077)5(15.625)62(63.265)101(73.723)65.689<0.01
是1(1.923)27(84.375)36(36.735)36(26.277)
参加抢救否8(15.385)18(56.250)56(57.143)75(54.745)28.585<0.01
是44(84.615)14(43.750)42(42.857)62(45.255)
照护过的患儿死亡否49(94.231)18(56.250)38(38.776)69(50.365)43.865<0.01
是3(5.769)14(43.750)60(61.224)68(49.635)
), ArticleFig(id=1220838936738451782, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689484350411414, language=CN, label=表3, caption=

儿科重症护士替代性创伤潜在类别影响因素的单因素分析 (人（%）)

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类轻度创伤反应组（n=52）情感主导反应组（n=32）显著负性创伤组（n=98）均衡创伤反应组（n=137）χ2值P
性别女51(98.077)29(90.625)95(96.939)134(97.810)4.7600.190
男1(1.923)3(9.375)3(3.061)3(2.190)
年龄20~30岁37(71.154)3(9.375)15(15.306)27(19.708)74.518<0.01
31~40岁15(28.846)16(50.000)57(58.163)70(51.095)
≥41岁0(0.000)13(40.625)26(26.531)40(29.197)
文化程度专科11(21.154)12(37.500)2(2.041)2(1.460)78.773<0.01
本科41(78.846)18(56.250)63(64.286)102(74.452)
硕士研究生及以上0(0.000)2(6.250)33(33.673)33(24.088)
工作年限1~5年35(67.308)0(0.000)6(6.123)12(8.759)130.607<0.01
6~10年16(30.769)9(28.125)35(35.714)39(28.467)
11~15年0(0.000)8(25.000)22(22.449)32(23.358)
16~20年1(1.923)6(18.750)17(17.347)28(20.438)
≥21年0(0.000)9(28.125)18(18.367)26(18.978)
职称初级21(40.385)11(34.375)45(45.918)57(41.606)1.8020.937
中级29(55.769)19(59.375)48(48.980)72(52.555)
高级2(3.846)2(6.250)5(5.102)8(5.839)
婚姻状况已婚44(84.615)29(90.625)79(80.612)114(83.212)2.8830.823
未婚8(15.385)3(9.375)17(17.347)21(15.328)
离异或丧偶0(0.000)0(0.000)2(2.041)2(1.460)
生育情况已生育10(19.231)29(90.625)23(23.469)68(49.635)130.733<0.01
未生育31(59.615)2(6.250)6(6.123)34(24.818)
妊娠期11(21.154)1(3.125)69(70.408)35(25.547)
科室儿科重症19(36.538)5(15.625)29(29.592)34(24.818)5.1220.163
新生儿重症33(63.462)27(84.375)69(70.408)103(75.182)
周夜班数无1(1.923)4(12.500)12(12.245)11(8.029)9.9300.128
1~2个51(98.077)26(81.250)84(85.714)124(90.511)
>2个0(0.000)2(6.250)2(2.041)2(1.460)
有亲人离世否51(98.077)5(15.625)62(63.265)101(73.723)65.689<0.01
是1(1.923)27(84.375)36(36.735)36(26.277)
参加抢救否8(15.385)18(56.250)56(57.143)75(54.745)28.585<0.01
是44(84.615)14(43.750)42(42.857)62(45.255)
照护过的患儿死亡否49(94.231)18(56.250)38(38.776)69(50.365)43.865<0.01
是3(5.769)14(43.750)60(61.224)68(49.635)
), ArticleFig(id=1220838936847503690, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689484350411414, language=EN, label=Table 4, caption=

Variable assignment status

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变量赋值方式
年龄20~30岁=1，31~40岁=2，≥41岁=3
文化程度专科=1，本科=2，硕士研究生及以上=3
工作年限1~5年=1，6~10年=2，11~15年=3，16~20年=4，≥21年=5
生育情况已生育（Z1=0，Z2=0），未生育（Z1=1，Z2=0），妊娠期（Z1=0，Z2=1）
有亲人离世否=1，是=2
参加抢救否=1，是=2
照护过的患儿死亡否=1，是=2
情绪调节自我效能感原值输入
反刍性沉思原值输入
), ArticleFig(id=1220838936918806861, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689484350411414, language=CN, label=表4, caption=

变量赋值情况

, figureFileSmall=null, figureFileBig=null, tableContent=
变量赋值方式
年龄20~30岁=1，31~40岁=2，≥41岁=3
文化程度专科=1，本科=2，硕士研究生及以上=3
工作年限1~5年=1，6~10年=2，11~15年=3，16~20年=4，≥21年=5
生育情况已生育（Z1=0，Z2=0），未生育（Z1=1，Z2=0），妊娠期（Z1=0，Z2=1）
有亲人离世否=1，是=2
参加抢救否=1，是=2
照护过的患儿死亡否=1，是=2
情绪调节自我效能感原值输入
反刍性沉思原值输入
), ArticleFig(id=1220838936985915727, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689484350411414, language=EN, label=Table 5, caption=

Multivariate analysis of factors influencing latent profiles of vicarious trauma for pediatric critical care nurses

, figureFileSmall=null, figureFileBig=null, tableContent=
变量轻度创伤反应组情感主导反应组均衡创伤反应组
回归系数POR[95%CI]回归系数POR[95%CI]回归系数POR[95%CI]
年龄1.4590.0214.303[1.250，14.815]0.9180.3252.503[0.403，15.543]-0.2000.6220.819[0.369，1.815]
文化程度2.5440.0084.500[1.800，11.250]-2.2230.0590.108[0.010，1.164]0.0270.9341.028[0.538，1.961]
工作年限0.9530.0322.593[1.086，6.192]-0.0640.8940.938[0.363，2.423]0.4020.0641.494[0.977，2.287]
未生育2.2080.0079.101[1.836，45.119]-1.1020.3830.332[0.028，3.958]0.6700.2061.954[0.691，5.522]
妊娠期-1.1880.1160.305[0.069，1.339]-2.5720.0640.076[0.006，1.001]-1.940<0.0016.958[3.423,14.141]
亲人离世-0.5110.3120.607[0.254，1.503]0.5370.3201.643[0.316，6.189]-1.7920.0126.001[1.987,18.748]
参加抢救0.2320.6391.211[0.627，2.589]0.3650.5321.359[0.630，3.198]1.5190.0124.481[1.562，13.340]
照护过的患儿死亡-0.5430.3070.601[0.224，1.751]-0.3480.5180.741[0.341，1.774]-2.1530.0078.611[2.481，30.168]
情绪调节自我效能感-0.0450.1840.956[0.894，1.022]-0.2520.1410.777[0.588，1.028]-0.013<0.0010.987[0.980，0.994]
反刍性沉思-0.0380.1550.963[0.914，1.014]0.1550.0031.168[1.054，1.295]-0.0090.5200.991[0.964，1.019]
), ArticleFig(id=1220838937078190419, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1220689484350411414, language=CN, label=表5, caption=

儿科重症护士替代性创伤潜在剖面影响因素的多因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量轻度创伤反应组情感主导反应组均衡创伤反应组
回归系数POR[95%CI]回归系数POR[95%CI]回归系数POR[95%CI]
年龄1.4590.0214.303[1.250，14.815]0.9180.3252.503[0.403，15.543]-0.2000.6220.819[0.369，1.815]
文化程度2.5440.0084.500[1.800，11.250]-2.2230.0590.108[0.010，1.164]0.0270.9341.028[0.538，1.961]
工作年限0.9530.0322.593[1.086，6.192]-0.0640.8940.938[0.363，2.423]0.4020.0641.494[0.977，2.287]
未生育2.2080.0079.101[1.836，45.119]-1.1020.3830.332[0.028，3.958]0.6700.2061.954[0.691，5.522]
妊娠期-1.1880.1160.305[0.069，1.339]-2.5720.0640.076[0.006，1.001]-1.940<0.0016.958[3.423,14.141]
亲人离世-0.5110.3120.607[0.254，1.503]0.5370.3201.643[0.316，6.189]-1.7920.0126.001[1.987,18.748]
参加抢救0.2320.6391.211[0.627，2.589]0.3650.5321.359[0.630，3.198]1.5190.0124.481[1.562，13.340]
照护过的患儿死亡-0.5430.3070.601[0.224，1.751]-0.3480.5180.741[0.341，1.774]-2.1530.0078.611[2.481，30.168]
情绪调节自我效能感-0.0450.1840.956[0.894，1.022]-0.2520.1410.777[0.588，1.028]-0.013<0.0010.987[0.980，0.994]
反刍性沉思-0.0380.1550.963[0.914，1.014]0.1550.0031.168[1.054，1.295]-0.0090.5200.991[0.964，1.019]
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儿科重症护士替代性创伤潜在剖面分析及其影响因素
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薄恩惠 1 , 姜敏 2 , 吴燕铭 1 , 何兴月 1 , 杨二明 1 , 杨辉 1
护理研究 | 科研论著 2025,39(19): 3201-3207
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护理研究 | 科研论著 2025, 39(19): 3201-3207
儿科重症护士替代性创伤潜在剖面分析及其影响因素
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薄恩惠1, 姜敏2, 吴燕铭1, 何兴月1, 杨二明1, 杨辉1
作者信息
  • 1.山西医科大学护理学院，山西 030001
  • 2.山西省儿童医院

    • 薄恩惠，护士，硕士研究生在读

通讯作者:

杨辉，E⁃mail：
Latent profiles analysis and factors influencing vicarious trauma among pediatric critical care nurses
Enhui BO1, Min JIANG2, Yanming WU1, Xingyue HE1, Erming YANG1, Hui YANG1
Affiliations
  • 1.Nursing College of Shanxi Medical University, Shanxi 030001 China
  • 2.Shanxi Children's Hospital
出版时间: 2025-10-10 doi: 10.12102/j.issn.1009-6493.2025.19.001
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摘要
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目的 探索儿科重症护士替代性创伤潜在分类特点及其影响因素。 方法 采用便利抽样法，于2024年7月—8月选取山西省12所医院的319名儿科重症护士为研究对象，采用一般资料调查表、医护人员替代性创伤量表、情绪调节自我效能感量表和简体中文版事件相关反刍性沉思问卷进行调查，基于潜在剖面初步探索儿科重症护士替代性创伤类别，采用无序多分类Logistic回归分析潜在剖面影响因素。 结果 儿科重症护士医护人员替代性创伤量表得分为（81.60±22.55）分。替代性创伤可分为4个潜在剖面：轻度创伤反应组、情感主导反应组、显著负性创伤组、均衡创伤反应组。回归分析结果显示，年龄、文化程度、工作年限、生育情况、亲人离世、参加抢救、照护过的患儿死亡、情绪调节自我效能感以及反刍性沉思是儿科重症护士替代性创伤的影响因素。 结论 儿科重症护士替代性创伤存在群体异质性，护理管理者可根据不同潜在剖面的影响因素对护士进行个体化干预，以降低儿科护士替代性创伤水平。

儿科  /  重症监护室  /  护士  /  替代性创伤  /  潜在剖面  /  影响因素

Objective To explore the latent classification characteristics and their influencing factors of vicarious trauma among pediatric critical care nurses. Methods Using a convenience sampling method,a total of 319 pediatric critical care nurses from 12 hospitals in Shanxi province were selected from July to August 2024.General Information Questionnaire,Vicarious Trauma Scale for Medical Staff,Regulatory Emotional Self⁃Efficacy Scale,and Simplified Chinese Version of Event Related Rumination Inventory were used for the survey.The categories of pediatric critical care nurses' vicarious trauma were initially explored based on the latent profiles,and the influencing factors of the latent profiles were analyzed using unordered multinomial logistic regression. Results The score of Vicarious Trauma Scale for Medical Staff was 81.60±22.55.Vicarious trauma was divided into four latent profiles:mild trauma response group,emotionally dominant response group,significant negative trauma group,and balanced trauma response group.The regression analysis results showed that age,education level,years of working experience,reproductive status,death of a relative,rescuing a patient,death of a patient under care,regulatory emotional self-efficacy,and rumination were influencing factors of vicarious trauma among pediatric critical care nurses. Conclusions There is population heterogeneity among pediatric critical care nurses in vicarious trauma.Nursing managers can provide individualized interventions to nurses based on the influencing factors of different latent profiles to reduce the level of vicarious trauma among pediatric nurses.

pediatrics  /  intensive care unit  /  nurse  /  vicarious trauma  /  latent profile analysis  /  influencing factors
薄恩惠, 姜敏, 吴燕铭, 何兴月, 杨二明, 杨辉. 儿科重症护士替代性创伤潜在剖面分析及其影响因素. 护理研究, 2025 , 39 (19) : 3201 -3207 . DOI: 10.12102/j.issn.1009-6493.2025.19.001
Enhui BO, Min JIANG, Yanming WU, Xingyue HE, Erming YANG, Hui YANG. Latent profiles analysis and factors influencing vicarious trauma among pediatric critical care nurses[J]. Chinese Nursing Research, 2025 , 39 (19) : 3201 -3207 . DOI: 10.12102/j.issn.1009-6493.2025.19.001
正文
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在儿科重症护理中，护士通过同理心能够深入感知患儿及其家属的情绪状态与心理需求，提供更加贴心和个性化的照护服务，有效缓解患儿及其家属的心理压力，提升照护质量[1]。在护士同理病人的过程中，极易陷入病人及家庭的疾痛中，导致替代性创伤（vicarious trauma，VT）的发生[2]。替代性创伤是护士运用同理心深刻感受病人及家属的情绪和认知，但由于长期目睹病人及家属的身体或情感痛苦而导致护士生理、心理及行为等不同层面的受创，并对护士的内在认知和信念产生的负向影响[2]。替代性创伤为护士难以避免的职业创伤风险[3]，发生率为14.0%~57.8%[4⁃5]。不仅会对护士的身心健康造成负面影响，还会对照护质量、病人安全、医院人力资源管理造成负面影响[6]。儿科重症护士情感负荷大，离职率高，是替代性创伤的高危人群。深入探究儿科重症护士替代性创伤发生的影响因素并提升护士心理健康水平是亟待解决的问题。然而，当前研究对儿科重症护士的关注不足，已有的影响因素研究忽略了护士群体内部的异质性，不利于针对性、个体化干预措施的制定[7]。潜在剖面分析（latent profile analysis，LPA）遵循“个体中心”的理念，在个体水平基础上对人群特质做更细致的划分，有利于深入探究不同人群的特质[8]。本研究采用潜在剖面分析法探讨儿科重症护士替代性创伤的潜在类别，并分析不同特征儿科重症护士替代性创伤特点及影响因素，为精准干预方案的制定提供参考。
1 对象与方法
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1.1　研究对象
2024年7月—8月，采用便利抽样法，选取山西省12所医院儿科重症护士为研究对象。纳入标准：1）在儿科重症监护室或新生儿重症监护室工作1年及以上的注册护士；2）知情同意并自愿参与本研究。排除标准：1）进修护士、规培护士及实习护士；2）因休假、外出学习不能参加本研究者。参考相关文献，潜在剖面分析研究中样本量最小应为300例[9]。本研究已通过山西医科大学伦理委员会审批（批号：2024005）。
1.2　研究方法
1.2.1　调查工具
1.2.1.1　一般资料调查表
在查阅文献的基础上，由研究者自行设计，包括性别、年龄、文化程度、工作年限、职称、婚姻状况、生育情况、周夜班数等。
1.2.1.2　医护人员替代性创伤量表
医护人员替代性创伤量表由张青青[10]整合替代性创伤相关理论后，结合工作在临床一线的医护人员及专家进行访谈和问卷调查的基础上编制而成，包括回避与躯体化反应（12个条目）、负性认知与警觉（11个条目）、负性情感体验（6个条目）3个维度，共29个条目。各条目采用Likert 5级评分法，“非常不符合”计1分，“非常符合”计5分，量表总分29~145分，得分越高表示受试者替代性创伤越严重。本研究中该量表Cronbach's α系数为0.95。
1.2.1.3　情绪调节自我效能感量表
该量表由Caprara等[11]研制，我国学者文书锋等[12]对量表进行跨文化调试。该问卷主要包括调节积极情绪的自我效能感（4个条目）、调节生气/愤怒情绪的自我效能感（3个条目）和调节沮丧/痛苦情绪的自我效能感（5个条目）3个维度，共12个条目。各采用Likert 5级评分法，“非常不符合”计1分，“非常符合”计5分，总分12~60分，得分越高则表明受试者情绪调节自我效能感越强。本研究中该量表Cronbach's α系数为0.90。
1.2.1.4　简体中文版事件相关反刍性沉思问卷
该量表由美国学者Cann等[13]研制，我国学者董超群等[14]对相关问卷进行汉化。该问卷包含侵入性反刍性沉思（10个条目）和目的性反刍性沉思（10个条目）2个维度，共20个条目。各条目采用Likert 4级评分法，“从不”计0分，“经常”计3分，总分0~60分，得分越高表明受试者反刍性沉思频率越高，本研究中该量表的Cronbach's α系数为0.96。
1.2.2　调查方法
采用问卷调查法调查，问卷由4部分组成：第1部分为知情同意书，被试者阅读知情同意书，点击“同意”后方可进入问卷；第2部分为卷首语，向研究对象详细介绍本问卷的研究目的、填写方式及填写注意事项等；第3部分为问卷正文；第4部分为结束语，向被试者表达填写问卷、配合参与研究的感谢。将问卷内容上传至问卷星生成电子问卷，将问卷以二维码的形式发送至研究对象。问卷内容均被设为必答题，每个IP限填1次，调查遵循自愿原则，被试者匿名填写，确保其隐私安全。共有效调查319名儿科重症护士。
1.2.3　统计学方法
采用Mplus 8.3软件进行潜在剖面分析，以医护人员替代性创伤量表3个维度为外显变量，采用潜在剖面分析拟合替代性创伤的潜在类别，从初始模型（1个潜在类别）开始拟合，之后逐步增加模型中的类别数目。依据赤池信息准则（Akaike information criterion，AIC）、贝叶斯信息准则（Bayesian information criterion，BIC）、样本校正的贝叶斯信息准则（aBIC）、熵（Entropy）、罗·梦戴尔·鲁本校似然比（Lo⁃Mendell⁃Rubin test，LMRT）、基于Bootstrap的似然比检验（Bootstrapped likelihood ratio test，BLRT），并结合各类别意义及临床实际情况，选择最优模型。采用SPSS 25.0进行统计分析，符合正态分布的定量资料采用均数±标准差（$\bar{x}\pm s$）描述；不符合正态分布的定量资料采用中位数（四分位数）[M（P25,P75）]表示。定性资料采用频数、百分比（%）表示。采用χ2检验比较不同剖面儿科重症护士基线资料差别，筛选有统计学意义的变量进行无序多分类Logistic回归，分析儿科重症护士替代性创伤的独立影响因素。以P<0.05为差异有统计学意义。
2 结果
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2.1　儿科重症护士医护人员替代性创伤量表、情绪调节自我效能感量表及简体中文版事件相关反刍性沉思问卷得分情况
儿科重症护士医护人员替代性创伤量表得分为（81.60±22.55）分，情绪调节自我效能感量表的得分为（40.49±7.43）分，简体中文版事件相关反刍性沉思问卷得分为（46.99±12.02）分，详见表1。
2.2　儿科重症护士替代性创伤潜在剖面分析
使用医护人员替代性创伤量表的3个维度作为外显变量，拟合了5个潜在剖面模型。拟合指数见表2。模型4和模型5在AIC、BIC和aBIC指标上表现较佳，显示了良好的拟合度。模型4的Entropy最高，表明其分类结果最确定。同时，模型4在LMRT和BLRT检验中均有统计学意义。综合考虑，模型4因其在分类确定性和统计显著性上的优异表现，被选为最佳模型。
2.3　儿科重症护士替代性创伤潜在剖面的命名及特点
依据潜在剖面结果绘制潜在剖面图，见图1。类别1包含52名护士，占总体的16.30%。该群体在3个维度上均获得较低的得分，反映出他们在情绪体验和反应上相对稳定，替代性创伤程度较轻，将其命名为轻度创伤反应组；类别2有32名护士，占总体10.03%。此类别护士在负性情感体验维度上得分较高，主要面临强烈的情感波动，但在回避与躯体化反应和负性认知与警觉上相对较低，将其命名为情感主导反应组；类别3包括98名护士，占总体30.72%，这些护士在负性情感体验、回避与躯体化反应和负性认知与警觉上表现出较高的得分，显示出明显的负性反应，因此将其命名为显著负性创伤组；类别4有137名护士，占总体的42.95%，此类别的护士在3个维度上的得分均处于较高水平，将其命名为均衡创伤反应组。
2.4　儿科重症护士替代性创伤潜在剖面影响因素的单因素分析
结果显示，儿科重症护士4个替代性创伤潜在类别在年龄、文化程度、工作年限、生育情况、是否有亲人离世、是否参加抢救、照护过的患儿是否死亡方面差异有统计学意义（P<0.05）。详见表3。
2.5　儿科重症护士替代性创伤潜在剖面的多因素分析
以替代性创伤潜在类别为因变量（以显著负性创伤组为参考组），以单因素分析中有统计学意义的变量及情绪调节自我效能感、反刍性沉思为自变量，进行无序多分类Logistic回归分析，自变量赋值情况见表4。结果显示，年龄、文化程度、工作年限、生育情况、亲人离世、参加抢救、照护过的患儿死亡、情绪调节自我效能感以及反刍性沉思是儿科重症护士替代性创伤的影响因素。详见表5。
3 讨论
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3.1　儿科重症护士替代性创伤现状及群体异质性
本研究基于潜在剖面分析，将儿科重症护士的替代性创伤划分为4个不同表现形式的类别，证实儿科重症护士替代性创伤存在异质性。此外，轻度创伤反应组的护士替代性创伤得分均较低，表明其能够在面对病人及其家庭的情感压力时保持一定的心理界限，避免过度卷入。情感主导反应组即使在低创伤水平下也表现出较高的情绪困扰，可能与个人的情绪调节能力低、支持系统不足及工作环境中的高压力有关，管理者需要特别关注其情绪管理能力，提供个性化的心理支持和干预措施，提高其应对替代性创伤的能力。面对情感负荷时，显著负性创伤组的护士往往展现出明显的回避行为及高度警觉性。对此，可以通过认知行为疗法帮助其识别并修正导致这些过度警觉和回避行为的不合理信念；同时，也可以采用暴露疗法，逐步引导护士正面应对引发其回避反应的情境，从而改善其回避和警觉状态。均衡创伤反应组护士是替代性创伤风险较高的群体，其表现出明显的负性情感体验、回避与躯体化反应以及负性认知与警觉反应，深受患儿及家属疾痛的影响，难以摆脱负面情绪的困扰。医院应该重点关注该部分人群，建立如心理咨询、情绪疏导服务等心理支持体系，并为其提供放松休闲时机，减轻其心理压力。
3.2　儿科重症护士替代性创伤影响因素
3.2.1　年龄、文化程度、工作年限对儿科重症护士替代性创伤的影响
本研究结果显示，年轻、工作年限低的护士更容易发生替代性创伤，年轻护士工作年限短，与郑改改等[15]的研究结果相同。这可能是由于工作年限较短的护士在感知患儿感受、察觉患儿真实需求方面有所欠缺，而需要密切观察病情发展快的患儿增加其心理压力，从而加剧替代性创伤的产生发展，这提示管理者要关注新手护士的心理健康，可以在入职培训中增设自我觉察与情绪管理项目，帮助新手护士识别自身心理状态的微妙变化，平稳地度过职业生涯的初期适应阶段。此外，文化程度较低的护士更容易受到替代性创伤的影响，与既往研究结果相似[16]。
3.2.2　生育及特殊经历对儿科重症护士替代性创伤的影响
本研究结果显示，未生育的儿科重症护士被归为轻度创伤反应组的概率大，妊娠期的儿科重症护士被归于显著负性创伤反应组的概率大，揭示了不同生育情况的女性发生替代性创伤的风险存在较大差异。由于尚未经历母亲角色的转变，未经历过生育的儿科重症护士对患儿的痛苦和病情发展能够保持心理界限，一定程度上降低了替代性创伤的风险；而社会角色的增加[2]以及对胎儿健康的担忧使得妊娠期儿科重症护士敏感且脆弱[17]，更容易过度沉溺在患儿的痛苦中；此外，体力下降、疲劳感增加等生理变化导致妊娠期护士工作效率和应对能力下降，也会增加替代性创伤发生风险。因此，建议管理者应根据女性生育情况，制定个性化的管理与支持策略，构建全面的心理支持系统，包括定期举办心理健康教育讲座，定期开展团队建设活动，促进护士间的情感交流与协作，提升其应对替代性创伤的能力；针对妊娠期护士实施更为人性化的管理：合理调整其工作安排，适度减轻工作负担；设立休息室，提供温馨舒适的环境，为其提供一个放松的避风港。此外，组织生育经验分享会，邀请已生育的同事分享心得，为妊娠期护士提供情感上的支持与心理上的慰藉，缓解其焦虑情绪，确保她们在关爱患儿的同时，也能得到应有的关怀与支持。
与既往研究[18]相似，本研究发现有亲人离世、照顾过的患儿死亡以及频繁参加抢救经历的儿科重症护士更容易产生均衡创伤反应。Hancock等[19]认为护士的心理状态可能同时受到多种创伤因素的影响，意味着护士所经历的创伤不是由单一原因造成的，而是多种因素共同作用的结果，这与本研究结果相符。首先，儿科重症护士在工作中承担着救治病患的责任，同时也面临着病人及其家庭复杂的情感需求[20]。这种双重角色使他们在遇到创伤性事件时心理负担更重。此外，高强度的工作节奏、紧急的抢救任务以及持续的情感输出，都进一步加剧了他们的心理压力，使他们更容易陷入高创伤反应的状态。在面对患儿离世等创伤性事件时，由于过度同情，护士会产生强烈的情感反应[21]，进而诱发替代性创伤。而在抢救过程中，护士需要迅速做出决策并执行操作，承受巨大的心理压力。这种高压环境会削弱护士的心理韧性，使得他们在面对创伤性事件时更加难以应对，从而加剧了替代性创伤的产生。因此，建议管理者关注高压环境中工作的护士、有创伤经历或正处于创伤体验中的护士。
3.2.3　情绪调节自我效能感和反刍性沉思对儿科重症护士替代性创伤的影响
回归分析结果显示，情绪调节自我效能感低的护士被归为显著负性创伤反应组的概率大；低水平反刍的护士被归为显著负性创伤组的概率大。目的性反刍是个体主动进行自我反省、思考未来的适应性认知加工方式[13]。在这种思维模式下，护士会主动思索创伤经历中蕴藏的能量及自己的感受，有助于护士提升职业认同感，实现替代性创伤后成长[22⁃23]，但低水平目的性反刍的护士多集中注意创伤事件的疾苦，或常以逃避的方式面对，促使出现回避与警觉。可采用以反刍性沉思为中心的正念认知疗法、接纳与承诺疗法、认知控制训练、表达性写作等多种有效措施干预反刍性沉思[24]，降低护士替代性创伤。情绪调节自我效能感是个体对能否有效调节自身情绪状态的自信程度，得分低说明护士在面对创伤时表现强烈的消极情绪体验且困于不良情绪中，可能会经历更大的压力和焦虑，从而加剧替代性创伤，可以借助改善绩效系统，开展心理辅导，利用合理情绪疗法等方式干预护士情绪调节自我效能感[25]，从而降低替代性创伤。
4 小结
收起
本研究结果显示，儿科重症护士是替代性创伤的高发人群，且存在群体异质性。年龄、文化程度、工作年限、生育情况、亲人离世、参加抢救、照护过的患儿死亡、情绪调节自我效能感以及反刍性沉思是儿科重症护士替代性创伤的影响因素，提示管理者应该重点关注高危人群心理健康，采取针对性措施缓解替代性创伤。然而本研究的研究对象仅限于山西省内，可能会产生一定的地域局限性，而横断面的设计无法追踪个体的心理变化过程，难以揭示替代性创伤的发展趋势和动态变化，未来研究应扩大样本范围至不同地区，以提升研究结果的可推广性。
基金
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  • 山西省2024年度研究生教育创新计划研究生实践创新项目(2024SJ199)
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2025年第39卷第19期
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doi: 10.12102/j.issn.1009-6493.2025.19.001
  • 接收时间：2024-10-18
  • 首发时间：2026-01-21
  • 出版时间：2025-10-10
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  • 收稿日期：2024-10-18
  • 修回日期：2025-07-09
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山西省2024年度研究生教育创新计划研究生实践创新项目(2024SJ199)
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    1.山西医科大学护理学院，山西 030001
    2.山西省儿童医院

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
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