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Article(id=1322929478179103001, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322929431592972373, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.15.027, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1766678400000, receivedDateStr=2025-12-26, revisedDate=1783094400000, revisedDateStr=2026-07-04, acceptedDate=null, acceptedDateStr=null, onlineDate=1793340566439, onlineDateStr=2026-10-30, pubDate=1786291200000, pubDateStr=2026-08-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793340566439, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793340566439, creator=13701087609, updateTime=1793340566439, updator=13701087609, issue=Issue{id=1322929431592972373, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='15', pageStart='2577', pageEnd='2768', issueExtLink='null', onlineDate='null', pubDate='1786291200000', pubDateStr='2026-08-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793340555332, creator='13701087609', updateTime=1793343107287, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322940135335145743, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322929431592972373, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322940135335145744, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322929431592972373, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2764, endPage=2768, ext={EN=ArticleExt(id=1322929480066539803, articleId=1322929478179103001, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Research progress on workplace cognitive failures in clinical nurses, columnId=1220689485315101342, journalTitle=Chinese Nursing Research, columnName=Review Articles, runingTitle=null, highlight=null, articleAbstract=

This study reviewed the concept,theoretical models,measurement tools,research status quo,and influencing factors related to cognitive failure in the workplace for clinical nurses,aiming to enhance nursing managers' awareness of cognitive failure among nurses and provide reference for developing targeted interventions.

, authors=Yang ZHOU, Liangyan HU, Xiaoli LIU, Zhenyu SONG, authorsList=Yang ZHOU, Liangyan HU, Xiaoli LIU, Zhenyu SONG, authorCompany=null, correspAuthors=Zhenyu SONG, authorNote=null, correspAuthorsNote=null, 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=1322929480657936668, articleId=1322929478179103001, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=临床护士工作场所认知失败的研究进展, columnId=1220689485482873504, journalTitle=护理研究, columnName=科研综述, runingTitle=null, highlight=null, articleAbstract=

对临床护士工作场所认知失败的概念、理论模型、测量工具、研究现状及影响因素进行综述，旨在促进护理管理者关注护士工作场所认知失败，为其制定针对性干预措施提供参考。

, authors=周洋, 胡良燕, 刘晓黎, 宋振玉*, *, authorsList=周洋, 胡良燕, 刘晓黎, 宋振玉, authorCompany=null, correspAuthors=宋振玉, authorNote=

周洋，护师，硕士研究生

, correspAuthorsNote=
宋振玉，E-mail：
SONG Zhenyu, E-mail:
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周洋，护师，硕士研究生

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临床护士工作场所认知失败的研究进展
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周洋 , 胡良燕 , 刘晓黎 , 宋振玉 *, *
护理研究 | 科研综述 2026,40(15): 2764-2768
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护理研究 |科研综述 2026 , 40 (15) : 2764 -2768
临床护士工作场所认知失败的研究进展
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周洋，护师，硕士研究生

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周洋, 胡良燕, 刘晓黎, 宋振玉*, *
作者信息
  • 1山东第一医科大学附属省立医院，山东 250021
通讯作者:
宋振玉，E-mail：
SONG Zhenyu, E-mail:
作者简介:

周洋，护师，硕士研究生

Research progress on workplace cognitive failures in clinical nurses
Yang ZHOU, Liangyan HU, Xiaoli LIU, Zhenyu SONG
Affiliations
  • 1Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong 250021 China
出版时间: 2026-08-10 doi: 10.12102/j.issn.1009-6493.2026.15.027
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摘要
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对临床护士工作场所认知失败的概念、理论模型、测量工具、研究现状及影响因素进行综述，旨在促进护理管理者关注护士工作场所认知失败，为其制定针对性干预措施提供参考。

护士  /  工作场所认知失败  /  认知资源理论  /  护理管理  /  综述

This study reviewed the concept,theoretical models,measurement tools,research status quo,and influencing factors related to cognitive failure in the workplace for clinical nurses,aiming to enhance nursing managers' awareness of cognitive failure among nurses and provide reference for developing targeted interventions.

nurse  /  workplace cognitive failures,WCF  /  cognitive resource theory  /  nursing management  /  review
周洋, 胡良燕, 刘晓黎, 宋振玉. 临床护士工作场所认知失败的研究进展. 护理研究, 2026 , 40 (15) : 2764 -2768 . DOI: 10.12102/j.issn.1009-6493.2026.15.027
Yang ZHOU, Liangyan HU, Xiaoli LIU, Zhenyu SONG. Research progress on workplace cognitive failures in clinical nurses[J]. Chinese Nursing Research, 2026 , 40 (15) : 2764 -2768 . DOI: 10.12102/j.issn.1009-6493.2026.15.027
正文
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适应工作环境的护士通过专注于任务以减少工作错误的发生,但由于护理工作具有非线性、碎片化的特点，护士执行常规任务时常受时间和频繁且不可预测的中断限制[1-2]。此外，夜班、长时间轮班、职场压力等都会显著增加护士疲劳，降低他们的认知表现和体能[3]。在这些限制下，认知失败在某种程度上是不可避免的。工作场所认知失败（workplace cognitive failures，WCF）指个人在本应能够完成的任务中，由于感知、记忆和行动机能的中断而导致的行为过失[4]。护士工作场所认知失败行为不仅会损害其身心健康，还会拉低工作效率与护理质量，进而严重威胁病人健康安全，给组织造成生产力与经济层面的重大损失[5-7]。因此，为促进国内护士工作场所认知失败的评估与干预，提高护理质量，促进病人健康结局，本研究对护士工作场所认知失败的概念、现状、理论模型、评估工具及影响因素进行综述，现报道如下。
1　工作场所认知失败的概念
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认知失败的概念雏形源于1977年Reason[8]的研究，其认为人类在执行工作和日常任务中会出现不可避免的无意识行为偏差。其核心观念在于失误行为并非个人的能力缺陷，而是由组织深层存在的潜在失效与个人主动失效所造成的。1982年，英国心理学家Broadbent等[9]首次系统提出了认知失败的概念，将其定义为个体在执行生活中的简单或单一任务时，发生了认知的错误，致使其在完成任务过程中出现失误，并强调其与短时记忆过载、注意力分散以及警觉性下降等认知机制相关。这一概念超越了传统认知障碍的范畴，更侧重描述在日常情景下认知功能的暂时性失调。至此，认知失败研究逐渐从关注个体特质（如神经质）转向对认知过程和工作失误的考察[10]。后来，Wallace等[4]认为以往研究将认知失败视为一种日常情景中表现出来的个体差异特质过于宽泛，重新从工作情景角度对认知失败的概念进行了解析，即员工在工作过程中由于注意力、记忆和行动机能失败而导致的行为过失，并对3个核心维度做了进一步的补充：1）记忆维度，无法提取与工作相关且熟悉的信息；2）注意力维度，工作时无法将注意力集中于任务相关信息；3）行动机能维度，在工作过程中未能以预期或有意识的方式执行适当行为。其核心理论转变在于认为认知失败并非全是稳定特质，工作场所中的认知失败很大程度是由特定情景因素（如职业压力、工作中断）所诱发的。总而言之，认知失败的现代定义已脱离“认知障碍”的旧标签，转而将其视为个人-任务-环境系统交互失调的信号。这一定义将工作失误的关注点从责备个体，转向了如何通过优化任务设计、改善工作环境和增强个体认知资源管理系统性风险，这在医疗行业的安全管理中具有核心实践价值。
2　工作场所认知失败的相关理论模型
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工作场所认知失败的相关理论模型主要包括认知资源理论和警戒唤醒理论。认知资源理论认为个体在执行认知任务时所能调动的心理资源是有限的[11]。当工作环境中的多任务要求、频繁中断或高强度压力导致认知资源被过度消耗或分配不当时，用于执行常规任务的资源便显不足，从而引发记忆遗漏、注意力分散或行动失误等认知失败。警戒唤醒理论则聚焦唤醒水平对警戒绩效的调控作用。相关研究指出，个体唤醒水平与任务绩效呈倒U型关系，适中唤醒水平对应最佳警戒绩效，过高（如过度紧张）或过低（如困倦、注意力涣散）都会使信号检测能力下降[12]。当护士处于长时间需要保持警戒的任务中（如危重病人的生命体征监测），个体的唤醒水平会逐渐降低，直至低于完成任务所需的临界唤醒阈值[13]。唤醒水平不足时，个体对信号敏感度下降、注意力难以维持，进而出现警戒衰退（表现为信号漏检、反应时延长等）。以上理论为理解临床工作中认知失败如何演变为严重临床不良事件提供了清晰的理论路径。
3　工作场所认知失败的测量工具
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3.1　认知失败问卷（Cognitive Failure Questionnaire，CFQ）
CFQ是由Broadbent等[9]开发的单维度结构问卷，包括注意力、记忆（一般的记忆因素和人名记忆因素）以及行动机能3方面的过失，共25个条目，各条目采用Likert 5级计分法，经验证其信效度较好，其Cronbach's α系数为0.96。但该工具维度结构单一，忽略了具体情景因素（如疲劳、工作压力及中断）对认知失败的诱发作用，无法解释同一人在不同环境下的表现波动。国内学者周扬等[14]对该量表进行了汉化和修订，形成了多维度的中文版CFQ，包括干扰（条目1~10）、记忆（条目11~16）、人际失误（条目17~20）、运动协调（条目21~23）和人名记忆（条目24~25）5个维度。各条目采用Likert 5级计分法，“从不”计1分，“总是”计5分，得分越高表示个体认知失败的严重性越高。中文版CFQ信效度良好，其Cronbach's α系数为0.86。中文版CFQ的多维结构与国外学者Wallace等[15-16]观点一致，通过适当的维度划分有助于增强问卷的外部标准，认知失败概念的界定会更加清晰，利于辨别认知失败的不同类型，现已被广泛应用于普通人群的实证研究。
3.2　工作场所认知失败问卷（Workplace Cognitive Failure Scale，WCFS）
WCFS由Wallace等[4]于2005年编制，该量表包含注意力失败、记忆失败、行动失败3个维度，共15个条目（每个维度均包含5个条目）。各条目采用Likert 5级评分法，“从不”至“通常”分别计为1~5分，总分为15~75分，得分越高表示研究对象的工作场所认知失败水平越高。经验证，该问卷的信效度较好，其Cronbach's α系数为0.91，该工具专门针对工作情景开发，聚焦工作相关的认知失败，现已被国内外学者广泛应用在护士群体认知失败行为的测量中。
3.3　职业认知失败问卷（Occupational Cognitive Failures Questionnaire，OCFQ)
该问卷由Hassanzadeh等[17]于2012年开发，用于评估个人的注意力、记忆力以及行动等相关的问题，比如忘记工作相关的电话号码或姓名以及在工作任务中犯错。问卷共30个条目，各条目采用Likert 5级计分法，从“我强烈不同意”到“我完全同意”依次计1~5分。得分越高表明个体工作认知失败水平越高。经验证该问卷的信效度较好，内容效度为0.70，其Cronbach's α系数为0.96。
4　护士工作场所认知失败现状
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护士工作场所认知失败的发生率较高，在不同国家、地区和科室间存在差异。一项在美国护理人员中进行的横断面调查显示，护士工作场所认知失败的发生率高达74%[10]。Abbasi等[18]对在急诊、重症监护室以及冠心病监护病房工作的750名护士进行了调查，结果显示，急诊科护士认知失败发生风险得分最高，为（48.44±10.40）分。Park等[5]根据过去6个月内有无发生病人安全事件对护士进行分组，结果显示事件组认知失败水平显著高于无事件组（P<0.001），且事件组认知失败3个核心维度得分均高于无事件组。一项针对伊朗急诊科护士的研究指出，急诊护士认知失败处于中等水平，并揭示了其与工作倦怠、心理负荷的正向关联性[3]。秦一心等[19]对我国山东省6所三级公立综合医院的重症监护室护士进行了调查，结果显示，重症监护室护士工作场所认知失败得分较高，92.52%的重症监护室护士报告了至少1项认知失败体验。
5　护士工作场所认知失败的影响因素
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5.1　个人因素
5.1.1　人口学特征
认知失败风险随年龄和工作年限的增加而降低，高学历护士，值白班护士较低学历及倒夜班护士发生认知失败的风险更低。高年资护士报告的记忆相关认知失败较年轻护士更少[20]，这可能归因于高年资护士护理经验水平和常规操作水平较高。倒夜班护士昼夜颠倒，更容易缺少休息和睡眠，影响注意力和记忆力，从而比白班护士更容易发生认知失误[21-22]。高学历护士在工作相关知识、能力与素养方面的掌握程度较高，其临床决策与思维能力也更为突出，在高负荷环境下，能够更有效地分配认知资源，筛选关键信息、排除认知干扰并进行正确的临床决策[19,23]。
5.1.2　心理弹性
心理弹性被定义为个人在面对危险环境时维持生物、心理和精神平衡的能力，是认知失败的重要保护因素[24-25]。研究表明，心理弹性与护士的认知失败呈负相关[19]。高水平的心理弹性可促进临床护士实现自我控制，有效调整处理面对压力事件时的认知、心理和情绪，灵活改变思维方式以执行恰当的临床决策。
5.1.3　工作-家庭不平衡
护理工作因具有工作压力大、频繁倒夜班等特点，是工作-家庭不平衡的高危职业[26]。当工作-家庭不平衡时，护士的精神和情感可能无法专注于工作，直接导致认知失败[18]。
5.1.4　数字疲劳
医疗服务中数字技术的日益广泛应用直接改变了护士的工作模式和职业动态。护士在护理工作中需要不断地与健康记录系统、数字通信工具及其他信息技术进行互动，长时间接触数字设备和屏幕最终会引发护士的数字疲劳[27]。数字疲劳不仅会直接增加护理人员的认知负荷，还会削弱其对工作相关信息的感知和记忆，增加护理操作失误，影响病人健康结局。
5.2　工作环境因素
5.2.1　职业压力
职业压力是导致护士认知失败的一个重要因素[28]。研究指出，护士的职业压力处于高度水平，显著高于其他职业[29]。在高压环境下，护士往往需要将有限的认知资源聚焦于核心压力源，进而导致认知资源赤字，造成警觉性下降，出现认知失败。
5.2.2　工作流程中断
工作流程中断是导致护士工作场所认知失败最显著的环境因素之一。瑞士的一项研究表明，工作流程中断会严重影响护士的认知功能，显著增加不良事件的发生风险[30]。医疗环境中的中断来源多样，包括同事咨询、电话铃声和病人家属的询问等[31-32]，这些工作中断不仅占用了护士大量的工作时间，还会迫使护士频繁切换任务，导致其认知资源分散和“重启成本”增加，每次中断后重新回到原任务都需要花费额外的认知努力，这会导致护士认知资源的进一步消耗，使个体陷入资源匮乏的恶性循环[33]。
5.2.3　物理环境
重症监护室护士长期暴露于噪声环境中，具体包括仪器运转和报警声，医护人员交谈声以及病人疼痛呻吟声。研究指出，暴露于环境刺激可能对人们的认知表现产生不利影响，包括注意力、记忆力和反应时间[34]。有研究显示，工作绩效质量与声音暴露呈负相关[35]，具体表现为声音暴露会导致个体内部认知状态的改变，包括注意力变化、压力水平波动及脑力负荷增加。提示持续声音暴露可能会降低护士的警觉度和注意力水平，增加其操作失误与疲劳风险。
5.3　组织因素
5.3.1　职场暴力
职场暴力是影响护士认知失败的因素之一[36]。受我国传统文化中“服从权威”“等级制度”等观念的影响，我国的欺凌行为具有周期性、持久性、隐蔽性等特点[37]，护理人员在遭受职场欺凌后，往往会将其视为一种工作常态，持久的心理压力会导致其对于认知资源的掌控能力进一步下降，变得难以专注于工作、清晰思考和集中注意力，会无法控制地进行回忆，最终引发医疗差错事故[38-39]。
5.3.2　健康干预项目
耳穴按压被认为是改善护士认知行为的干预手段，可以积极地减少护士认知失败行为的发生[40]。研究表明，耳穴按压可以改变大脑活动模式，从而提升记忆力和注意力，同时降低背内侧前额叶皮层的神经活动水平[41]。
6　护士工作场所认知失败的干预对策
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6.1　护士应强化自身认知管理与健康素养
护理人员应继续深化学习临床知识与技能，增加认知资源储备，提升认知韧性，即识别、抵御并从认知失败风险中恢复的能力，以适应护理工作的高要求和压力。在临床工作中还可以使用个人化的思维辅助工具（如口袋检查单、电子提醒），将复杂流程外化为可视化步骤，减少工作记忆负荷。心理环境的健康状态是保持个体正常认知的基础。因此，护理人员应重视自身的心理问题，采取正念、压力管理等健康促进行为维护自身心理健康，避免或减少认知失败。
6.2　管理者应优化职场软环境，建立动态工作负荷调控机制
6.2.1　积极加强防范欺凌教育，开展职场暴力模拟培训课程，缓解职场欺凌带来的不良影响
护理管理者应积极倡导公平公正文化，以身作则，将防范欺凌教育与理论学习、专业技能培养置于同等重要的地位。通过科室例会、岗前培训等渠道，常态化传递心理安全氛围的重要性，强调护理人员的专业尊严与职业平等，破除高年资护士对新入职护士的压制性管理以及工作高压下情绪宣泄等错误认知。其次，设计并实施职场暴力模拟培训课程，协助护理人员识别职场暴力的特征和风险，掌握对应的应对策略，引导团体形成主动抵制职场欺凌的行为共识。
6.2.2　优化信息工作流程，建立动态工作负荷调控机制
电子健康记录系统的结构化录入等要求，常使护士陷入重复性文书工作，这实质上是一种认知过载的非增值工作，直接挤占了直接的护理时间，还会持续消耗护士有限的认知资源。因此，护理管理者可采取智能化简化文档录入流程[42]、简化文书书写[43]、简化系统信息显示[44]等措施，优化护理工作流程，减少无关的信息交互，避免护士认知资源的过度消耗。此外，还应依据病人数量、病情危重程度进行科学的人力资源配置，制定弹性排班表，开展“滴滴护士”项目[45]，若遇紧急事件或人力严重短缺等特殊情况，呼叫“滴滴护士”进行协助，最大限度避免占用上班护士的常规认知资源，改善护理质量。在日常工作中，推广结构化“微休息”制度，协助护士通过深呼吸、简单拉伸等方式恢复认知资源，避免因长时间工作导致注意力下降[46]。
6.3　组织应改善物理环境，开展健康促进项目
6.3.1　工作环境优化是减少认知失败的基础策略
组织应建立安全的警报管理环境，减少非必要的环境噪声以降低护士的认知负荷。更根本的是，组织要减少工作中的非必要中断和低效环节，针对护理中断频发事务精准干预与强化培训，打造“无中断事件”病房[47]，减少外界信息对护理人员认知资源的过度消耗。
6.3.2　关注护士健康
研究指出，耳穴按压、虚拟现实锻炼等技术可以改善个体的认知状态，促进健康[40,48]。因此，相关组织应建立认知资源动态保护系统，创建休息和运动空间，定期开展健康促进项目，促进护士认知恢复，减少工作场所认知失败的发生。
7　小结与展望
收起
近年来，关于护士工作场所认知失败的研究呈上升趋势，已经成为护理职业安全领域的热点。国内外关于护士工作场所认知失败的研究设计多局限于横断面研究，建议未来可构建包含客观指标的工作场所认知失败测量问卷；构建护士工作场所认知失败的风险模型与实证研究；进行护士工作场所认知失败的纵向研究，开发精准干预模式，以期促进我国护理人员的职业健康，打造更安全、更高效的医疗系统。

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doi: 10.12102/j.issn.1009-6493.2026.15.027
  • 接收时间：2025-12-26
  • 首发时间：2026-10-30
  • 出版时间：2026-08-10
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  • 收稿日期：2025-12-26
  • 修回日期：2026-07-04
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    1山东第一医科大学附属省立医院，山东 250021

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宋振玉，E-mail：
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2种不同金属材料的力学参数
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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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