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Article(id=1322168273395888215, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322168262247432815, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.05.002, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1751817600000, receivedDateStr=2025-07-07, revisedDate=1768838400000, revisedDateStr=2026-01-20, acceptedDate=null, acceptedDateStr=null, onlineDate=1793159081076, onlineDateStr=2026-10-28, pubDate=1773072000000, pubDateStr=2026-03-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793159081076, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793159081076, creator=13701087609, updateTime=1793159081076, updator=13701087609, issue=Issue{id=1322168262247432815, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='5', pageStart='705', pageEnd='880', issueExtLink='null', onlineDate='null', pubDate='1773072000000', pubDateStr='2026-03-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793159078418, creator='13701087609', updateTime=1793159078418, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=713, endPage=724, ext={EN=ArticleExt(id=1322168273639157848, articleId=1322168273395888215, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Construction and validation of risk prediction model for workplace bullying among nurses based on the Chinese Nurses' Health Cohort Study（TARGET）, columnId=1220689484526572183, journalTitle=Chinese Nursing Research, columnName=Original Articles, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the influencing factors of workplace bullying among nurses and construct risk prediction model to assist hospital administrators in developing targeted preventive measures and reducing the incidence of workplace bullying in this population.

Methods

Based on data from the Chinese Nurses' Health Cohort Study(TARGET) covering 46 790 nurses from February 2021 to February 2024,surveys were conducted using the General Information Questionnaire,the Chinese version of the Negative Acts Questionnaire,the Generalized Anxiety Disorder Questionnaire,the Patient Health Questionnaire,the Chinese version of the Ten-Item Big Five Inventory,the Trait Coping Style Questionnaire,and the Chinese version of the Perceived Stress Scale.Participants were randomly divided into a modeling group(32 752 individuals) and a validation group(14 038 individuals) at a ratio of 7∶3.Univariate and logistic regression analyses were used to screen the influencing factors of workplace bullying among nurses and establish a risk prediction model.The Bootstrap method was employed for internal validation of the prediction model,and external validation was performed using the validation group data.The calibration curve was used to evaluate the predictive performance of the model.

Results

Among the 46 790 nurses,9 274 experienced workplace bullying,with an incidence rate of 19.82%.Logistic regression analysis showed that age,gender,position,years of work experience,anxiety level,depression level,perceived stress score,positive coping score,negative coping score,Big Five personality traits(extraversion,agreeableness,emotional stability,openness),education level,department,and employment type were influencing factors for workplace bullying among nurses(P<0.05).The areas under the receiver operating characteristic curve for the modeling group and validation group were 0.729[95%CI(0.723,0.736)] and 0.728[95%CI(0.718,0.738)],respectively,with specificity of 0.664 and 0.631 and sensitivity of 0.683 and 0.718.The calibration curve indicated a good fit.

Conclusions

Based on the TARGET cohort data,this study screened the relevant influencing factors of workplace bullying among Chinese nurses,constructed and validated risk prediction model for bullying in this population.The model can help identify high-risk individuals early and provide a reference for targeted preventive interventions and the optimization of clinical management practices.

, authors=Guanglin LIU1, Na WEI1, Xinyue ZHANG2, Li LI3, 4, Huihui ZHANG3, 4, Yingjuan CAO1, 3, 4, authorsList=Guanglin LIU, Na WEI, Xinyue ZHANG, Li LI, Huihui ZHANG, Yingjuan CAO, authorCompany=null, correspAuthors=Yingjuan CAO, authorNote=null, correspAuthorsNote=
CAO Yingjuan, E-mail:
, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322168275040055395, articleId=1322168273395888215, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=基于中国护士健康队列（TARGET）的护士工作场所欺凌风险预测模型构建与验证, columnId=1220689484681761433, journalTitle=护理研究, columnName=科研论著, runingTitle=null, highlight=null, articleAbstract=
目的

分析护士工作场所欺凌发生的影响因素并构建风险预测模型，协助医院管理者制定针对性预防措施，降低该人群工作场所欺凌的发生率。

方法

基于中国护士健康队列（TARGET）研究数据，涵盖2021年2月—2024年2月的46 790名护士。采用一般资料调查表、中文版负性行为问卷、广泛性焦虑障碍问卷、病人健康问卷、中文版10项目大五人格量表、特质应对方式量表及中文版感知压力量表进行调查。按7∶3的比例随机分为建模组32 752人和验证组14 038人。采用单因素和Logistic回归分析筛选护士工作场所欺凌的影响因素并建立风险预测模型。采用Bootstrap法进行预测模型内部验证，以验证组数据进行外部验证，采用校准曲线评价模型的预测性能。

结果

46 790名护士中，9 274人发生工作场所欺凌，发生率为19.82%。Logistic回归分析显示，年龄、性别、职务、工作年限、焦虑程度、抑郁程度、感知压力得分、积极应对得分、消极应对得分、大五人格（外向性、宜人性、情绪稳定性、开放性）、学历、科室、聘任类型为护士工作场所欺凌发生的影响因素（P<0.05）。建模组和验证组的受试者工作特征曲线下面积分别为0.729［95%CI（0.723，0.736）］和0.728［95%CI（0.718，0.738）］，特异度分别为0.664和0.631，灵敏度分别为0.683和0.718。校准曲线显示拟合良好。

结论

本研究基于TARGET队列数据，筛选了中国护士工作场所欺凌发生的相关影响因素，构建并验证了该人群欺凌风险预测模型，有助于早期识别高风险个体，为开展针对性预防干预及优化临床管理实践提供参考依据。

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刘广林，硕士研究生在读

, correspAuthorsNote=
曹英娟，E-mail:
CAO Yingjuan, E-mail:
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Univariate analysis of influencing factors of workplace bullying among nurses(n=32 752)

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项目分类未遭受工作场所欺凌(n=26 300)遭受工作场所欺凌(n=6 452)统计值P
性别[人(%)]男1 319(5.0)404(6.3)χ2=16.150<0.001
女24 981(95.0)6 048(93.7)
学历[人(%)]专科及以下2 675(10.2)540(8.4)χ2=36.931<0.001
本科23 267(88.5)5 776(89.5)
硕士研究生及以上358(1.4)136(2.1)
婚姻状况[人(%)]未婚6 841(26.0)1 547(24.0)χ2=13.6200.003
已婚19 026(72.3)4 778(74.1)
离婚394(1.5)116(1.8)
丧偶39(0.1)11(0.2)
科室[人(%)]内科7 813(29.7)1 902(29.5)χ2=30.921<0.001
外科5 281(20.1)1 341(20.8)
急诊科1 425(5.4)403(6.2)
妇产科2 031(7.7)425(6.6)
儿科1 767(6.7)376(5.8)
手术室1 555(5.9)411(6.4)
ICU1 814(6.9)487(7.5)
门诊1 224(4.7)317(4.9)
行政科室174(0.7)35(0.5)
其他3 216(12.2)755(11.7)
聘任类型[人(%)]在编5 372(20.4)1 529(23.7)χ2=50.485<0.001
合同制14 774(56.2)3 394(52.6)
人事代理2 806(10.7)744(11.5)
备案制1 631(6.2)414(6.4)
劳务派遣1 507(5.7)312(4.8)
其他210(0.8)59(0.9)
职称[人(%)]初级4 956(18.8)992(15.4)χ2=43.653<0.001
中级19 740(75.1)5 046(78.2)
高级1 574(6.0)410(6.4)
其他30(0.1)4(0.1)
职务[人(%)]护士23 476(89.3)5 651(87.6)χ2=14.832<0.001
护士长及以上2 565(9.8)729(11.3)
其他259(1.0)72(1.1)
月收入[人(%)]<3 000元2005(7.6)427(6.6)χ2=44.460<0.001
3 000~6 000元12 304(46.8)2 798(43.4)
>6 000~9 000元8 387(31.9)2 212(34.3)
>9 000元3 604(13.7)1 015(15.7)
排班方式 [人(%)]仅白班9 363(35.6)2 100(32.5)χ2=21.223<0.001
仅夜班183(0.7)47(0.7)
倒班16 754(63.7)4 305(66.7)
焦虑程度[人(%)]正常13 085(49.8)1 273(19.7)χ2=2 454.529<0.001
轻度9 985(38.0)3 123(48.4)
中度2 236(8.5)1 332(20.6)
重度994(3.8)724(11.2)
抑郁程度[人(%)]正常12 491(47.5)1 172(18.2)χ2=2 505.299<0.001
轻度9 844(37.4)2 905(45.0)
中度1 830(7.0)868(13.5)
中重度1 450(5.5)954(14.8)
重度685(2.6)553(8.6)
夜班年限[人(%)]0~5年15 247(58.0)3 380(52.4)χ2=80.908<0.001
>5~10年5 850(22.2)1 529(23.7)
>10~15年3 793(14.4)1 114(17.3)
>15~20年1 022(3.9)290(4.5)
>20年388(1.5)139(2.2)
PSS-10得分(分)16.67±4.7719.46±4.78t=-42.053<0.001
PSSS得分(分)56.62±23.6454.24±17.42t=9.125<0.001
积极应对得分(分)31.98±8.6930.58±7.18t=13.424<0.001
消极应对得分(分)25.66±8.3628.91±7.09t=-31.811<0.001
年龄(岁)33.22±7.2633.99±7.11t=-7.743<0.001
工作年限(年)10.53±7.8111.13±7.82t=-5.470<0.001
外向性(分)8.40±2.477.91±2.25t=15.363<0.001
宜人性(分)10.38±2.169.55±1.92t=30.160<0.001
尽责性(分)9.96±2.329.34±2.09t=20.939<0.001
情绪稳定性(分)9.49±2.318.48±1.91t=36.377<0.001
开放性(分)8.85±2.068.46±1.74t=15.670<0.001
), ArticleFig(id=1322530461855891746, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168273395888215, language=CN, label=表1, caption=

建模组护士遭受工作场所欺凌影响因素的单因素分析(n=32 752)

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类未遭受工作场所欺凌(n=26 300)遭受工作场所欺凌(n=6 452)统计值P
性别[人(%)]男1 319(5.0)404(6.3)χ2=16.150<0.001
女24 981(95.0)6 048(93.7)
学历[人(%)]专科及以下2 675(10.2)540(8.4)χ2=36.931<0.001
本科23 267(88.5)5 776(89.5)
硕士研究生及以上358(1.4)136(2.1)
婚姻状况[人(%)]未婚6 841(26.0)1 547(24.0)χ2=13.6200.003
已婚19 026(72.3)4 778(74.1)
离婚394(1.5)116(1.8)
丧偶39(0.1)11(0.2)
科室[人(%)]内科7 813(29.7)1 902(29.5)χ2=30.921<0.001
外科5 281(20.1)1 341(20.8)
急诊科1 425(5.4)403(6.2)
妇产科2 031(7.7)425(6.6)
儿科1 767(6.7)376(5.8)
手术室1 555(5.9)411(6.4)
ICU1 814(6.9)487(7.5)
门诊1 224(4.7)317(4.9)
行政科室174(0.7)35(0.5)
其他3 216(12.2)755(11.7)
聘任类型[人(%)]在编5 372(20.4)1 529(23.7)χ2=50.485<0.001
合同制14 774(56.2)3 394(52.6)
人事代理2 806(10.7)744(11.5)
备案制1 631(6.2)414(6.4)
劳务派遣1 507(5.7)312(4.8)
其他210(0.8)59(0.9)
职称[人(%)]初级4 956(18.8)992(15.4)χ2=43.653<0.001
中级19 740(75.1)5 046(78.2)
高级1 574(6.0)410(6.4)
其他30(0.1)4(0.1)
职务[人(%)]护士23 476(89.3)5 651(87.6)χ2=14.832<0.001
护士长及以上2 565(9.8)729(11.3)
其他259(1.0)72(1.1)
月收入[人(%)]<3 000元2005(7.6)427(6.6)χ2=44.460<0.001
3 000~6 000元12 304(46.8)2 798(43.4)
>6 000~9 000元8 387(31.9)2 212(34.3)
>9 000元3 604(13.7)1 015(15.7)
排班方式 [人(%)]仅白班9 363(35.6)2 100(32.5)χ2=21.223<0.001
仅夜班183(0.7)47(0.7)
倒班16 754(63.7)4 305(66.7)
焦虑程度[人(%)]正常13 085(49.8)1 273(19.7)χ2=2 454.529<0.001
轻度9 985(38.0)3 123(48.4)
中度2 236(8.5)1 332(20.6)
重度994(3.8)724(11.2)
抑郁程度[人(%)]正常12 491(47.5)1 172(18.2)χ2=2 505.299<0.001
轻度9 844(37.4)2 905(45.0)
中度1 830(7.0)868(13.5)
中重度1 450(5.5)954(14.8)
重度685(2.6)553(8.6)
夜班年限[人(%)]0~5年15 247(58.0)3 380(52.4)χ2=80.908<0.001
>5~10年5 850(22.2)1 529(23.7)
>10~15年3 793(14.4)1 114(17.3)
>15~20年1 022(3.9)290(4.5)
>20年388(1.5)139(2.2)
PSS-10得分(分)16.67±4.7719.46±4.78t=-42.053<0.001
PSSS得分(分)56.62±23.6454.24±17.42t=9.125<0.001
积极应对得分(分)31.98±8.6930.58±7.18t=13.424<0.001
消极应对得分(分)25.66±8.3628.91±7.09t=-31.811<0.001
年龄(岁)33.22±7.2633.99±7.11t=-7.743<0.001
工作年限(年)10.53±7.8111.13±7.82t=-5.470<0.001
外向性(分)8.40±2.477.91±2.25t=15.363<0.001
宜人性(分)10.38±2.169.55±1.92t=30.160<0.001
尽责性(分)9.96±2.329.34±2.09t=20.939<0.001
情绪稳定性(分)9.49±2.318.48±1.91t=36.377<0.001
开放性(分)8.85±2.068.46±1.74t=15.670<0.001
), ArticleFig(id=1322530461939777827, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168273395888215, language=EN, label=Table 2, caption=

Variable assignment

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自变量赋值
性别男=1，女=2
职务护士（0,0），护士长及以上（1,0），其他（0,1）
焦虑程度正常（0,0,0），轻度（1,0,0），中度（0,1,0），重度（0,0,1）
抑郁程度正常（0,0,0，0），轻度（1,0,0，0），中度（0,1,0，0），中重度（0,0,1,0），重度（0,0,0，1）
学历专科及以下（0,0），本科（1,0），硕士研究生及以上（0,1）
科室内科（0，0，0，0，0，0，0，0，0），外科（1，0，0，0，0，0，0，0，0），急诊科（0，1，0，0，0，0，0，0，0），妇产科（0，0，1，0，0，0，0，0，0），儿科（0，0，0，1，0，0，0，0，0），手术室（0，0，0，0，1，0，0，0，0），ICU（0，0，0，0，0，1，0，0，0），门诊（0，0，0，0，0，0，1，0，0），行政科室（0，0，0，0，0，0，0，1，0），其他（0，0，0，0，0，0，0，0，1）
聘任类型在编（0，0，0，0，0），合同制（1，0，0，0，0），人事代理（0，1，0，0，0），备案制（0，0，1，0，0），劳务派遣（0，0，0，1，0），其他（0，0，0，0，1）
), ArticleFig(id=1322530462023663908, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168273395888215, language=CN, label=表2, caption=

变量赋值

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量赋值
性别男=1，女=2
职务护士（0,0），护士长及以上（1,0），其他（0,1）
焦虑程度正常（0,0,0），轻度（1,0,0），中度（0,1,0），重度（0,0,1）
抑郁程度正常（0,0,0，0），轻度（1,0,0，0），中度（0,1,0，0），中重度（0,0,1,0），重度（0,0,0，1）
学历专科及以下（0,0），本科（1,0），硕士研究生及以上（0,1）
科室内科（0，0，0，0，0，0，0，0，0），外科（1，0，0，0，0，0，0，0，0），急诊科（0，1，0，0，0，0，0，0，0），妇产科（0，0，1，0，0，0，0，0，0），儿科（0，0，0，1，0，0，0，0，0），手术室（0，0，0，0，1，0，0，0，0），ICU（0，0，0，0，0，1，0，0，0），门诊（0，0，0，0，0，0，1，0，0），行政科室（0，0，0，0，0，0，0，1，0），其他（0，0，0，0，0，0，0，0，1）
聘任类型在编（0，0，0，0，0），合同制（1，0，0，0，0），人事代理（0，1，0，0，0），备案制（0，0，1，0，0），劳务派遣（0，0，0，1，0），其他（0，0，0，0，1）
), ArticleFig(id=1322530462094967077, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168273395888215, language=EN, label=Table 3, caption=

Logistic regression analysis of influencing factors of workplace bullying among nurses

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变量分类回归系数标准误Wald χ2值POR值95%CI
性别女-0.1690.0676.3550.0120.845[0.741,0.963]
职务护士长及以上0.1480.0576.6340.0101.159[1.036,1.298]
其他0.2130.1442.1840.1391.237[0.933,1.640]
焦虑程度轻度0.5530.049124.939<0.0011.738[1.578,1.915]
中度0.7980.069134.280<0.0012.222[1.941,2.543]
重度0.7470.09462.727<0.0012.111[1.755,2.540]
抑郁程度轻度0.4850.05190.189<0.0011.625[1.470,1.796]
中度0.6640.06991.747<0.0011.943[1.696,2.226]
中重度0.7780.07997.113<0.0012.178[1.866,2.543]
重度0.8240.10759.494<0.0012.279[1.849,2.810]
科室外科0.0520.0421.4860.2231.053[0.969,1.144]
急诊科0.0750.0671.2690.2601.078[0.946,1.229]
妇产科-0.1130.0633.2310.0720.893[0.790,1.010]
儿科-0.1540.0665.4690.0190.857[0.753,0.975]
手术室0.1230.0663.4610.0631.131[0.993,1.287]
ICU-0.0690.0621.2380.2660.933[0.826,1.054]
门诊0.1680.0764.9010.0271.183[1.019,1.372]
行政科室-0.2000.2000.9960.3180.819[0.553,1.212]
其他0.0240.0520.2080.6481.024[0.925,1.133]
学历本科0.0490.0570.7460.3881.050[0.940,1.174]
硕士研究生及以上0.3470.1257.7280.0051.415[1.108,1.807]
聘任类型合同制-0.1200.0466.7160.0100.887[0.810,0.971]
人事代理-0.0500.0590.7330.3920.951[0.848,1.067]
备案制-0.0840.0721.3720.2410.919[0.798,1.058]
劳务派遣-0.1060.0801.7610.1840.899[0.769,1.052]
其他0.0670.1630.1660.6831.069[0.776,1.472]
年龄0.0490.00756.033<0.0011.050[1.037,1.064]
工作年限-0.0210.00614.481<0.0010.979[0.968,0.990]
PSS-10得分0.0240.00527.374<0.0011.025[1.015,1.034]
积极应对得分-0.0170.00333.499<0.0010.984[0.978,0.989]
消极应对得分0.0250.00381.394<0.0011.025[1.020,1.031]
PSSS得分-0.0000.0010.0690.7931.000[0.998,1.001]
外向性得分-0.0240.00711.3440.0010.976[0.962,0.990]
宜人性得分-0.0990.010103.966<0.0010.906[0.889,0.923]
尽责性得分0.0050.0090.3310.5651.005[0.988,1.023]
开放性得分0.0600.01036.749<0.0011.062[1.042,1.083]
情绪稳定性得分-0.0280.0107.2810.0070.973[0.953,0.992]
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护士遭受工作场所欺凌影响因素的Logistic回归分析

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变量分类回归系数标准误Wald χ2值POR值95%CI
性别女-0.1690.0676.3550.0120.845[0.741,0.963]
职务护士长及以上0.1480.0576.6340.0101.159[1.036,1.298]
其他0.2130.1442.1840.1391.237[0.933,1.640]
焦虑程度轻度0.5530.049124.939<0.0011.738[1.578,1.915]
中度0.7980.069134.280<0.0012.222[1.941,2.543]
重度0.7470.09462.727<0.0012.111[1.755,2.540]
抑郁程度轻度0.4850.05190.189<0.0011.625[1.470,1.796]
中度0.6640.06991.747<0.0011.943[1.696,2.226]
中重度0.7780.07997.113<0.0012.178[1.866,2.543]
重度0.8240.10759.494<0.0012.279[1.849,2.810]
科室外科0.0520.0421.4860.2231.053[0.969,1.144]
急诊科0.0750.0671.2690.2601.078[0.946,1.229]
妇产科-0.1130.0633.2310.0720.893[0.790,1.010]
儿科-0.1540.0665.4690.0190.857[0.753,0.975]
手术室0.1230.0663.4610.0631.131[0.993,1.287]
ICU-0.0690.0621.2380.2660.933[0.826,1.054]
门诊0.1680.0764.9010.0271.183[1.019,1.372]
行政科室-0.2000.2000.9960.3180.819[0.553,1.212]
其他0.0240.0520.2080.6481.024[0.925,1.133]
学历本科0.0490.0570.7460.3881.050[0.940,1.174]
硕士研究生及以上0.3470.1257.7280.0051.415[1.108,1.807]
聘任类型合同制-0.1200.0466.7160.0100.887[0.810,0.971]
人事代理-0.0500.0590.7330.3920.951[0.848,1.067]
备案制-0.0840.0721.3720.2410.919[0.798,1.058]
劳务派遣-0.1060.0801.7610.1840.899[0.769,1.052]
其他0.0670.1630.1660.6831.069[0.776,1.472]
年龄0.0490.00756.033<0.0011.050[1.037,1.064]
工作年限-0.0210.00614.481<0.0010.979[0.968,0.990]
PSS-10得分0.0240.00527.374<0.0011.025[1.015,1.034]
积极应对得分-0.0170.00333.499<0.0010.984[0.978,0.989]
消极应对得分0.0250.00381.394<0.0011.025[1.020,1.031]
PSSS得分-0.0000.0010.0690.7931.000[0.998,1.001]
外向性得分-0.0240.00711.3440.0010.976[0.962,0.990]
宜人性得分-0.0990.010103.966<0.0010.906[0.889,0.923]
尽责性得分0.0050.0090.3310.5651.005[0.988,1.023]
开放性得分0.0600.01036.749<0.0011.062[1.042,1.083]
情绪稳定性得分-0.0280.0107.2810.0070.973[0.953,0.992]
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基于中国护士健康队列（TARGET）的护士工作场所欺凌风险预测模型构建与验证
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刘广林 1 , 魏娜 1 , 张心悦 2 , 李黎 3, 4 , 张会会 3, 4 , 曹英娟 1, 3, 4, *, *
护理研究 | 科研论著 2026,40(5): 713-724
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护理研究 |科研论著 2026 , 40 (5) : 713 -724
基于中国护士健康队列（TARGET）的护士工作场所欺凌风险预测模型构建与验证
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刘广林1, 魏娜1, 张心悦2, 李黎3, 4, 张会会3, 4, 曹英娟1, 3, 4, *, *
作者信息
  • 1山东大学护理与康复学院，山东 250012
  • 2山东第一医科大学第一附属医院（山东省千佛山医院）
  • 3山东大学齐鲁医院
  • 4山东大学护理理论与实践创新研究中心
通讯作者:
曹英娟，E-mail:
CAO Yingjuan, E-mail:
作者简介:

刘广林，硕士研究生在读

Construction and validation of risk prediction model for workplace bullying among nurses based on the Chinese Nurses' Health Cohort Study（TARGET）
Guanglin LIU1, Na WEI1, Xinyue ZHANG2, Li LI3, 4, Huihui ZHANG3, 4, Yingjuan CAO1, 3, 4
Affiliations
  • 1School of Nursing and Rehabilitation,Shandong University,Shandong 250012 China
  • 2The First Affiliated Hospital of Shandong First Medical University/Shandong Qianfoshan Hospital
  • 3Qilu Hospital of Shandong University
  • 4Nursing Theory and Practice Innovation Research Center of Shandong University
    • Corresponding Author:
    CAO Yingjuan, E-mail:
出版时间: 2026-03-10 doi: 10.12102/j.issn.1009-6493.2026.05.002
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摘要
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目的

分析护士工作场所欺凌发生的影响因素并构建风险预测模型，协助医院管理者制定针对性预防措施，降低该人群工作场所欺凌的发生率。

方法

基于中国护士健康队列（TARGET）研究数据，涵盖2021年2月—2024年2月的46 790名护士。采用一般资料调查表、中文版负性行为问卷、广泛性焦虑障碍问卷、病人健康问卷、中文版10项目大五人格量表、特质应对方式量表及中文版感知压力量表进行调查。按7∶3的比例随机分为建模组32 752人和验证组14 038人。采用单因素和Logistic回归分析筛选护士工作场所欺凌的影响因素并建立风险预测模型。采用Bootstrap法进行预测模型内部验证，以验证组数据进行外部验证，采用校准曲线评价模型的预测性能。

结果

46 790名护士中，9 274人发生工作场所欺凌，发生率为19.82%。Logistic回归分析显示，年龄、性别、职务、工作年限、焦虑程度、抑郁程度、感知压力得分、积极应对得分、消极应对得分、大五人格（外向性、宜人性、情绪稳定性、开放性）、学历、科室、聘任类型为护士工作场所欺凌发生的影响因素（P<0.05）。建模组和验证组的受试者工作特征曲线下面积分别为0.729［95%CI（0.723，0.736）］和0.728［95%CI（0.718，0.738）］，特异度分别为0.664和0.631，灵敏度分别为0.683和0.718。校准曲线显示拟合良好。

结论

本研究基于TARGET队列数据，筛选了中国护士工作场所欺凌发生的相关影响因素，构建并验证了该人群欺凌风险预测模型，有助于早期识别高风险个体，为开展针对性预防干预及优化临床管理实践提供参考依据。

护士  /  工作场所欺凌  /  预测模型  /  影响因素  /  压力  /  焦虑  /  抑郁
Objective

To analyze the influencing factors of workplace bullying among nurses and construct risk prediction model to assist hospital administrators in developing targeted preventive measures and reducing the incidence of workplace bullying in this population.

Methods

Based on data from the Chinese Nurses' Health Cohort Study(TARGET) covering 46 790 nurses from February 2021 to February 2024,surveys were conducted using the General Information Questionnaire,the Chinese version of the Negative Acts Questionnaire,the Generalized Anxiety Disorder Questionnaire,the Patient Health Questionnaire,the Chinese version of the Ten-Item Big Five Inventory,the Trait Coping Style Questionnaire,and the Chinese version of the Perceived Stress Scale.Participants were randomly divided into a modeling group(32 752 individuals) and a validation group(14 038 individuals) at a ratio of 7∶3.Univariate and logistic regression analyses were used to screen the influencing factors of workplace bullying among nurses and establish a risk prediction model.The Bootstrap method was employed for internal validation of the prediction model,and external validation was performed using the validation group data.The calibration curve was used to evaluate the predictive performance of the model.

Results

Among the 46 790 nurses,9 274 experienced workplace bullying,with an incidence rate of 19.82%.Logistic regression analysis showed that age,gender,position,years of work experience,anxiety level,depression level,perceived stress score,positive coping score,negative coping score,Big Five personality traits(extraversion,agreeableness,emotional stability,openness),education level,department,and employment type were influencing factors for workplace bullying among nurses(P<0.05).The areas under the receiver operating characteristic curve for the modeling group and validation group were 0.729[95%CI(0.723,0.736)] and 0.728[95%CI(0.718,0.738)],respectively,with specificity of 0.664 and 0.631 and sensitivity of 0.683 and 0.718.The calibration curve indicated a good fit.

Conclusions

Based on the TARGET cohort data,this study screened the relevant influencing factors of workplace bullying among Chinese nurses,constructed and validated risk prediction model for bullying in this population.The model can help identify high-risk individuals early and provide a reference for targeted preventive interventions and the optimization of clinical management practices.

nurses  /  workplace bullying  /  prediction model  /  influencing factors  /  stress  /  anxiety  /  depression
刘广林, 魏娜, 张心悦, 李黎, 张会会, 曹英娟. 基于中国护士健康队列（TARGET）的护士工作场所欺凌风险预测模型构建与验证. 护理研究, 2026 , 40 (5) : 713 -724 . DOI: 10.12102/j.issn.1009-6493.2026.05.002
Guanglin LIU, Na WEI, Xinyue ZHANG, Li LI, Huihui ZHANG, Yingjuan CAO. Construction and validation of risk prediction model for workplace bullying among nurses based on the Chinese Nurses' Health Cohort Study（TARGET）[J]. Chinese Nursing Research, 2026 , 40 (5) : 713 -724 . DOI: 10.12102/j.issn.1009-6493.2026.05.002
正文
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工作场所欺凌（workplace bullying,WPB）现已成为护士群体的重大职业危害[1]。中华人民共和国国家卫生健康委员会将工作场所欺凌定义为“工作场所中来自他人持续存在的造成伤害的虐待，包括语言和非语言的、心理和躯体的虐待和侮辱”。研究表明，护士遭受工作场所欺凌的比例很高[2]。Hong等[3]针对233名注册护士研究表明，37%的人认为自己同时是工作场所欺凌的受害者和证人。Amini等[4]针对伊朗184名护士的研究发现，75.5%的护士面临职场霸凌。Liu等[5]对我国东部、中部和西部4个省（市）的9所公立三级医院的调查显示，在过去12个月中，针对护士的身体暴力和心理暴力的发生率分别为9.60%和59.64%。
工作场所欺凌会造成多方面的影响。于护士而言，持续暴露在由工作场所欺凌引起的压力环境中，可能会给护士造成躯体健康问题（睡眠质量差、心血管疾病等）[6-7]，还有可能造成心理健康问题（如情绪耗竭、焦虑、影响自尊）[8-10]。于病人而言，工作场所欺凌可能会导致护士共情疲劳、损害工作质量[11-12]，进而导致护理质量降低，并威胁病人的安全。于医院而言，工作场所欺凌可能会影响护士的工作参与度、离职意愿[13]。因此，工作场所欺凌可能对护士群体造成很大影响，甚至损害护理质量，危及患者健康，应格外引起重视。护士群体工作场所欺凌的发生与多种因素密切相关。在年龄方面，一项研究表明，暴力事件发生的相关因素包括年龄、婚姻状况、工作经验、感知压力等[14]；而Assadpour等[15]的研究显示，性别、婚姻状况、年龄并不是感知工作场所欺凌的预测因素。在科室方面，有研究显示，急诊、重症监护室（ICU）护士更容易遭受工作场所欺凌[16]。另有研究表明，暴力事件暴露最多的科室是急诊和门诊[17]。在性别方面，Obeidat等[18]认为男性更有可能报告工作场所欺凌感知，而Al-Surimi等[19]发现工作场所欺凌在女性医疗保健从业者更普遍。虽然已有多项研究讨论了工作场所欺凌发生风险与其他因素的关联，但结果存在分歧。综上，在护士群体中识别与工作场所欺凌相关的个人、心理以及职业因素可能会大大提高护士对预防控制工作场所欺凌重要性的认识水平。因此，本研究基于中国护士健康队列（TARGET）研究评估中国护士工作场所欺凌的发生率和相关危险因素，构建工作场所欺凌发生风险的预测模型，旨在为识别和干预工作场所欺凌提供依据。
1　对象与方法
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1.1　研究对象
数据来源于中国护士健康队列研究（TARGET）[20]的基线横断面数据，涵盖2021年2月—2024年2月全国105所医院的46 790名护士。TARGET评估中国护士的健康状况，探讨工作压力、工作环境和生活方式等因素对其健康状况的影响。研究对象纳入标准：1)18~65岁的执业注册护士；2)知情同意且自愿参与者。排除标准：1)进修或轮转护士；2)调查期间休假者。采用R软件将所有样本按7∶3的比例分别建模组(32 752人)和验证组(14 038人)。本研究已通过山东大学齐鲁医院伦理委员会审批(KYLL-202210-060-1)，并符合《赫尔辛基宣言》相关伦理准则。
1.2　调查工具
1.2.1　一般资料调查表
由研究团队自行设计，包括性别、年龄、婚姻状况、学历、工作年限、夜班年限、聘任类型、科室、职称、职务和月收入等。
1.2.2　中文版负性行为问卷(Negative Acts Questionnaire-Revised,NAQ-R)
本研究使用NAQ-R调查护士遭受工作场所欺凌的发生情况。该问卷由Einarsen等[21]开发，荀洪景等[22]汉化修订，共计23个条目。前22个条目包含个人相关负性行为、工作相关负性行为及组织不公3个维度，每个条目均采用Likert 5级评分法，“从来没有”计1分，“每天都有”计5分，得分越高表示欺凌越严重。根据第23个条目“过去6个月中您是否在工作场所受过欺负 ”明确护士是否遭受欺凌及遭受欺凌的程度。本研究中问卷的Cronbach's α系数为0.984。
1.2.3　广泛性焦虑障碍问卷(Generalized Anxiety Disorder-7,GAD-7)
本研究使用GAD-7评估护士的焦虑症状。量表由Spitzer等[23]于2006年按照焦虑障碍的诊断标准编制而成，共7个条目，采用Likert 4级评分法，“完全没有”计0分，“几乎每天”计3分，总分0~21分，得分越高说明个体焦虑症状越严重。以GAD-7总得分为等级判断标准，将焦虑程度划分为正常（0~4分）、轻度（5~9分）、中度（10~14分）和重度（15~21分）。本研究中量表的Cronbach's α系数为0.966。
1.2.4　病人健康问卷 (Patient Health Questionnaire-9,PHQ-9)
PHQ-9由Kroenke等[24]于2001年编制，被用于评估护士的抑郁症状。问卷共9个条目，采用Likert 4级评分法，“从来没有”计0分，“几乎每天”计3分，总分0~27分，得分越高表示个体抑郁症状越严重。根据总分将抑郁程度分为正常（0~4分）、轻度（5~9分）、中度（10~14分）、中重度（15~19分）和重度（20~27分）。本研究中问卷的Cronbach's α系数为0.958。
1.2.5　中文版10项目大五人格量表(Ten-Item Personality Inventory-Chinese version,TIPI-C)
本研究使用TIPI-C评估护士的人格特质。量表由Gosling等[25]编制，包含宜人性、外向性、尽责性、开放性和情绪稳定性5个维度，共10个条目，每个条目采用Likert 7级评分法，绝对不同意计1分，绝对同意计7分，哪个维度得分越高表示越偏向哪个维度的人格特质。2013年，中国学者李金德[26]对量表进行翻译修订及信效度检验，中文版TIPI具有较好的信效度。本研究中量表的Cronbach's α系数为0.805。
1.2.6　特质应对方式量表(Trait Coping Styles Questionnaire,CSQ)
PSS最初由姜乾金等[27]于1993年编制，最初为16个条目，1999年修订为20个条目[28]，用于探讨个人在面对事件时的应对策略。量表分为积极应对方式（positive coping,PC）和消极应对方式（negative coping,NC）2个维度，每个条目采用Likert 5级评分法，肯定不是计1分，肯定是计5分。积极应对方式得分越高反映受试者在应对应激时采用更多的积极态度和行为特征；消极应对方式得分越高反映受试者在应对应激时采用更多的消极态度和行为特征。积极应对方式和消极应对方式的 Cronbach's α系数分别为0.70和0.69，表明具有较好的信度。本研究中量表的Cronbach's α系数为0.916，其中积极应对方式的Cronbach'sα系数0.929，消极应对方式的Cronbach'sα系数为0.918。
1.2.7　中文版感知压力量表（Perceived Stress Scale-10,PSS-10）
PSS最初由Cohen等[29]开发，用于评估个人在日常生活中的感知压力水平。Leung等[30]分别比较了包括4个、10个、14个条目的3个版本量表，发现PSS-10与PSS-14的Cronbach's α系数分别为0.83和0.85，均较PSS-4有更好的信度。鉴于PSS-10条目数适中、信度良好、适用于医护群体，故本研究选用该量表。PSS-10采用Likert 5级评分法，从不计0分，总是计4分，总分0~40分，得分越高代表感知压力水平越高。本研究中量表的Cronbach's α系数为0.940。
1.2.8　中文版领悟社会支持量表(Perceived Social Support Scale,PSSS)
PSSS由Zimet等[31]编制，姜乾金等于2001年引入并汉化，中文版PSSS的信效度良好。该量表用于评估护士来自家庭、朋友和他人的感知支持情况，共包括家庭内支持、朋友支持和他人支持3个维度，12个条目，各条目采用Likert 7级评分法，总分为12~84分，得分越高说明个体感知支持水平越高。本研究中该量表的Cronbach's α系数为0.989。
1.3　资料收集与质量控制方法
研究团队以线上线下相结合的形式开展项目宣讲，与参与医院签署合作协议书并获得各参与者的知情同意后，通过本团队开发的中国护士健康队列微信公众号平台向各位参与者发放电子问卷。在数据收集过程中，研究团队建立了独立的云服务器和MySQL数据库集群，数据管理人员可以通过认证机制访问TARGET 项目的数据平台，进行数据接口调用、数据维护和数据状态监控，只有签署了相关协议的专业人员才能直接访问[20]。
为保障数据质量，问卷采用逻辑控制设计，每个IP地址仅能作答1次。项目组成员负责各联盟医院微信群，向各单位传达问卷填写要求及注意事项，并与联络员协同督促问卷填写进度，解答填写过程中遇到的问题。此外，填写时间过短、填写逻辑错误(量表含正反向计分条目、工作年限大于年龄)、选项重复率超过80%、存在异常值的问卷将被视为无效并予以剔除。
1.4　统计学方法
使用SPSS 26.0和R 4.1.2软件进行统计分析，定性资料以频数、百分比（%）表示，组间比较采用χ2检验；定量资料符合正态分布的以均数±标准差（x±s）表示，偏态分布的以中位数和四分位数[M(P25,P75)]表示，组间比较采用两独立样本t检验。将单因素分析中有统计学意义的变量纳入Logistic回归分析，基于“rms包”构建列线图模型，并通过受试者工作特征（receiver operator characteristic，ROC）曲线下面积（AUC）、Calibration校准曲线、Hosmer-Lemeshow检验评估模型的性能。以P<0.05为差异有统计学意义。
2　结果
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2.1　护士工作场所欺凌发生情况及影响因素的单因素分析
本研究共纳入46 790名护士，其中建模组纳入32 752人，验证组纳入14 038人。建模组工作场所欺凌发生率19.70%(6 452/32 752)，验证组工作场所欺凌发生率为20.10%(2 822/14 038)，总体样本工作场所欺凌发生率为19.82%(9 274/46 790)。单因素分析结果见表1。
2.2　护士发生工作场所欺凌影响因素的多因素分析
将单因素分析中P<0.05的变量分别纳入模型中作为自变量，将是否发生工作场所欺凌作为因变量（否=0，是=1），对自变量进行赋值（见表2），定量资料以原值输入。Logistic回归分析结果显示，年龄、性别、职务、工作年限、焦虑程度、抑郁程度、感知压力得分、积极应对得分、消极应对得分、大五人格（外向性、宜人性、情绪稳定性、开放性）、学历、科室、聘任类型是护士发生工作场所欺凌的影响因素，见表3。
2.3　护士发生工作场所欺凌风险预测模型的构建与验证
基于多因素分析明确的16个预测变量建立护士遭受工作场所欺凌风险预测模型并绘制列线图，见图1。构建的预测模型在建模组中受试者工作特征曲线下面积为0.729[95%CI（0.723,0.736）]，最佳截断值为0.216，其对应的特异度和灵敏度为0.664，0.683，见图2；验证组受试者工作特征曲线下面积为0.728[95%CI（0.718,0.738）]，最佳截断值为0.186，其特异度与灵敏度分别为0.631，0.718，见图3。通过Bootstrap法自抽样1 000次进行内部验证，建模组和验证组的平均绝对误差(mean absolute error,MAE)分别为0.002和0.022，表明模型预测工作场所欺凌发生风险较可靠，见图4和图5。
在模型构建与验证中均通过Hosmer-Lemeshow拟合优度检验，χ2值分别为11.561，7.563（均>0.05），说明构建的预测模型对工作场所欺凌的预测概率与实际概率相近，具有较高的准确度。
3　讨论
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3.1　护士工作场所欺凌发生率
本研究结果显示，中国护士工作场所欺凌的发生率为19.82%，与Kabir等[32]报道的孟加拉国护士工作场所欺凌的发生率(19.3%)相近，这可能与护士在两国中社会地位相近及工作量均较大有关。一项横断面研究发现，护士在过去6个月内工作场所欺凌的发生率为30.75%[33]。一项对2023年美国注册护士的调查研究发现，43.4%护士报告在过去12个月遭受了工作场所虐待或暴力[34]。此外，一项系统综述的结果显示，在32个国家中，ICU医护人员遭受暴力行为的总体中位频率为51%[35]。这可能是由于各国在工作场所欺凌法律、社会文化背景、医疗保健政策等方面不同。此外，各国对工作场所欺凌一词的表述也不同，这使得对比具有挑战性。
3.2　护士工作场所欺凌发生的影响因素
3.2.1　性别
本研究发现，女性是保护因素。有研究发现，性别是影响医患互动和工作场所暴力发生的众多因素之一[36]。另有研究人员认为，与女护士相比，男护士更经常受到来自其他工作人员的工作场所暴力[37]。结合样本结构分析，本研究中女性护士占绝对多数，而男护士比例相对较低。在此背景下，男护士作为相对少数群体，可能在团队协作、角色分工及同事互动过程中更易暴露在负面互动情境中，从而增加其遭受同事欺凌的风险。此外，男护士在临床工作中往往承担更多体力性或应急性任务，其工作强度及跨岗位协作频率较高，也可能在一定程度上增加其遭受工作场所欺凌的可能性。因此，本研究中观察到的性别差异更可能反映护理队伍性别结构及工作情境差异的影响，而非性别本身的直接作用。在工作场所欺凌防控中，应关注护理队伍性别结构差异，针对可能面临较高风险的群体制定更具针对性的管理与支持措施。
3.2.2　焦虑和抑郁
本研究发现，焦虑、抑郁是护士遭受工作场所欺凌的危险因素。这与Alfredo等[38-39]的研究相似。然而，目前没有研究明确说明焦虑、抑郁的直接作用机制。这可能是由于焦虑、抑郁者对于工作场所欺凌的敏感度和容忍度与其他人不同，他们更容易回忆并报告发生过工作场所欺凌或更容易将其他人的言行解读为具有欺凌性质；也可能是焦虑、抑郁者的行为模式更容易使其成为欺凌的目标。因此，应提升医院心理健康服务可及性，帮助护士调节情绪，改善护士的心理健康状态，建立有效的支持与预防措施，营造更健康的工作环境。
3.2.3　感知压力水平
本研究发现，感知压力水平是遭受工作场所欺凌的危险因素。这与Szusecki等[40]的研究一致，他们认为较高的感知压力水平与遭受欺凌相关。这可能是由于高压力导致护士的情绪调节能力下降，难以有效应对冲突，对自身能力产生怀疑，自身更容易情绪外显或工作失误频繁，成为被边缘化或指责的对象。因此，建议为有较高压力的护士提供压力管理培训，帮助其建立良好心理健康支持系统，形成安全的心理氛围。
3.2.4　工作科室
本研究发现，与Li等[41]的研究结果不同，相较于内科，儿科是影响工作场所欺凌的保护因素，门诊是危险因素。这可能是由于儿科护理工作以儿童及其家属为主要服务对象，护理过程中更强调团队协作、沟通与情绪支持，科室整体工作氛围相对注重互助与包容。此外，儿科护士在临床工作中通常形成较为稳定的团队结构，同事间合作密切，这在一定程度上有助于减少同事间冲突的发生，从而降低工作场所欺凌风险。相较之下，门诊护理工作节奏快、病人流动性大，日常工作中需频繁应对高强度服务需求及多岗位协作，工作压力和人际接触频率均较高。在此情境下，护士之间用于沟通和协调的时间有限，误解或冲突等负性事件更易发生。有研究显示，门诊服务环境的护士表现出较高的工作场所暴力的暴露率[41-42]，提示门诊工作环境可能是工作场所欺凌的重要高风险情境。本研究结果在一定程度上支持了上述研究结论。综上，不同科室护士工作场所欺凌风险存在差异，在防控干预中应重点关注门诊等高风险岗位，并借鉴儿科相对支持性的团队管理经验，以改善整体工作环境。
3.2.5　职务
本研究发现，职务为护士长及以上是危险因素。尽管有研究表明，新入职护士的暴力事件发生率高于有经验的护士[43]，但也有研究表明医生和病房管理人员中工作场所欺凌的发生率较高[44]。这提示在不同研究对象和研究情境下，护理人员工作场所负性事件的发生情况有所不同。原因可能是：一线护士更多面临来自病人或家属的外源性暴力，而护理管理人员则可能在组织内部互动中承担更高的欺凌风险。此外，一项关于护士工作场所暴力的多层文本挖掘分析表明，社交媒体出现的与工作场所暴力紧密联系的高频关键词为“护士长”“领导”等[45]，进一步提示护理管理岗位在工作场所负性事件中的重要性。因此，在制定工作场所暴力和欺凌防控策略时，应根据不同岗位特点实施分层管理措施。一方面，应加强对一线护士的安全防护与暴力应对培训；另一方面，也应为护理管理人员提供必要的组织支持、沟通培训和心理支持，降低其在履职过程中遭受负性事件的风险。
3.2.6　工作性质
本研究发现，相较于有编制的护士，合同制是工作场所欺凌发生的保护因素，这与既往研究[46]不尽相同。这可能是由于相对于在编护士，合同制护士工作性质更为灵活，社会保障和福利待遇可能相对较少，同时合同期满后可能面临失去工作的风险。因此，相较于在编护士，合同制护士可能会加强工作强度，提高工作警觉性，通过提升自己的工作能力、展现自己积极的工作态度，保障自己的工作稳定性，从而降低遭受工作场所欺凌的风险。因此，医院应关注各种护士的福利，实施合理的薪酬和绩效激励制度，同时应加强对于在编护士的奖惩制度，对于工作懈怠者应及时给予警告及相应处分，同时应关注并积极对待护士间的矛盾，增强其凝聚力，还应关注护士的专业发展，为其提供更多的发展平台。
3.2.7　工作年限
本研究发现，工作年限为保护因素。这与Petit等[47]的研究结果一致，但与陈洁等[46]的研究相反。这可能是由于低工作年限护士临床经验相对不足，在护理操作过程中难以及时、独立地判断操作规范，操作表现不够熟练，因而更容易被指责存在操作失误，尤其在急救等高压力情境中，易被贴上“能力不足”的标签，进而导致其容易遭受与能力相关的负面评价或不当对待。
3.2.8　年龄
本研究发现高龄是危险因素，与Njaka等[48]的研究恰好相反。分析原因为：第一，相较于年龄较高的护士，年龄较低的护士一般刚进入临床工作，对于工作场所欺凌的认知不足，不能清晰辨认，常常遭受工作场所欺凌而不自知；第二，较高年龄的护士在医疗工作期间一般是责任的主要承担者，与重病病人或其家属接触的频率较高。因此，当他们的护理效果达不到病人和家属的期望水平时，当事人责怪护士的可能性较高，从而导致工作场所欺凌发生较多。因此，医院应为高龄护士提供积极的支持措施，给予尊重、福利支持和实际支持。护理管理者应形成合理的排班安排，避免高龄护士长时间负责同一病人，加强护士的流动性，并营造一个支持性的组织氛围，提高他们的工作满意度。
3.2.9　学历
本研究发现学历为硕士研究生及以上是危险因素。这与Szusecki等[40,49]的结论相同，与Petit等[47]的结论不一致。这可能是由于高学历的护士容易因学术任务渐渐脱离临床工作，短期内难以适应临床节奏和任务；此外，由于硕士研究生护士的就业前景更广，容易被认为“干几年就转行”，导致其职业合法性被削弱。因此，医院可以在高学历护士入职时为其提供1名搭档，帮助其重新适应临床工作，快速融入临床生活；此外，可通过制度化、规范化的流动安排，使硕士研究生学历的护士的职业发展路径更加清晰和可预期，从而增强其职业选择的合理性与认可度，避免被解读为短期从业或频繁转向其他职业。
3.2.10　应对方式
本研究发现，消极应对方式是危险因素，积极应对方式是保护因素。Yoo等[50]研究发现，采取积极应对方式的护士不太可能遭受工作场所欺凌。同时，Li等[41]认为，积极应对有助于增强护士承受和应对压力的能力，还可以预防威胁；消极应对会加剧工作倦怠、不良情绪状态，还会导致各种心理问题。相较于积极应对方式，采取消极应对方式的护士似乎更难采取有效措施预防或抵抗工作场所欺凌的发生。因此，护理管理者需要制定合理的预防计划，提升护士压力管理能力和积极心理资源，使其能够采用积极的方式应对，减少工作场所欺凌的发生。
3.2.11　人格特质
本研究发现，大五人格中外向性、宜人性、情绪稳定性（神经质，部分文献使用其对立面神经质代替）是保护因素，而开放性是危险因素。既往研究表明，病人的性格特质为宜人性在护患纠纷中起到了负向预测作用，而神经质起到了正向预测作用[51]。还有研究表明，工作场所欺凌发生风险与责任心、宜人性和外向性等人格特质呈负相关，而与开放性、神经质的人格特质呈正相关[52]。此外，相关研究表明，工作场所骚扰与神经质呈正相关，与宜人性呈负相关，与本研究结果一致。然而，工作场所骚扰与开放性呈负相关[53]，这与本研究结果不一致。根据上述文献可以发现，本研究结果与大部分研究较为一致，但关于开放性这一人格特质的结果得出了不同的结论。开放性涉及个体对新思想、新经验的接受程度，然而过高的开放性可能导致护士在进行护理工作时因追求效率或效果而忽视既定规则（如无菌操作、用药流程），增加操作风险；在日常工作时可能更倾向于提出改变护理流程或质疑现有做法，引起同事或上级的不满，因而更容易遭受工作场所欺凌。因此，重视护士的人格特质有助于评估其遭受工作场所欺凌的风险，尤其是对于高开放性的护士可以进行沟通方式及冲突化解的相关培训，避免激化矛盾，降低工作场所欺凌的发生风险。
3.3　构建的预测模型效能
本研究基于单因素及多因素Logistic回归分析得到16个影响因素，基于以上因素构建了预测该人群发生风险的风险预测模型。通过Hosmer-Lemeshow拟合度检验显示回归方程拟合度高，预测能力较强；其次，通过1 000次bootstrap自抽样绘制Calibration校准曲线，显示校准曲线与理想预测情况基本接近，提示列线图模型预测中国护士工作场所欺凌的发生与内部抽样的相关性较好，证实了本研究预测模型的效能良好。构建的预测模型具有个性化、直观的优点，还有较好的区分度和准确度，有助于中国护士判断工作场所欺凌发生风险，并制定针对性的预防措施，降低该人群工作场所欺凌的发生率。在临床应用中，可个性化计算对应于每个影响因素的得分，以及计算总分并显示对应于总分的预测值，从而预测中国护士工作场所欺凌的发生率。
4　本研究的局限性
收起
首先，本研究采用多中心横断面设计，无法推断因果关系。因此，未来需要继续收集纵向数据，以深入探讨工作场所欺凌及其影响因素之间的因果关系。其次，本研究仅纳入全国105所医院，结果的外推性受到一定的限制。最后，本研究采用自评量表而非临床标准诊断，未应用客观指标，因此存在一定的回忆偏倚。
5　小结
收起
本研究基于中国护士健康队列（TARGET）项目数据，筛选了中国护士工作场所欺凌发生的影响因素，并构建了对应的风险预测模型，有助于高风险人群早期识别，制定有针对性的预防措施，为相关研究及临床实践提供借鉴。

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2026年第40卷第5期
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doi: 10.12102/j.issn.1009-6493.2026.05.002
  • 接收时间：2025-07-07
  • 首发时间：2026-10-28
  • 出版时间：2026-03-10
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  • 收稿日期：2025-07-07
  • 修回日期：2026-01-20
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    1山东大学护理与康复学院，山东 250012
    2山东第一医科大学第一附属医院（山东省千佛山医院）
    3山东大学齐鲁医院
    4山东大学护理理论与实践创新研究中心

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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