护士长多元领导风格对ICU护士安全行为影响机制的混合性研究

doi:10.3761/j.issn.2096-7446.2026.07.014

摘要/Abstract

摘要：

目的基于社会情境理论探讨护士长多元领导风格对ICU护士安全行为的影响机制，为护理安全管理提供科学依据。方法采用聚敛式混合研究设计。便利抽样调查浙江省14所三级甲等医院的446名ICU护士，使用一般情况调查表、多元领导风格量表、差错管理氛围量表、差错压力取向量表及护士安全行为量表，采用多重线性回归和结构方程模型分析作用路径。目的抽样15名ICU护士进行质性访谈，并进行内容分析。结果量性研究显示，护士长多元领导风格是ICU护士安全行为的重要影响因素，差错管理氛围和差错压力取向在其中发挥链式中介作用。质性研究提炼出领导风格的作用、组织氛围的影响、不安全事件反应及个体内在驱动4个主题。混合研究补充揭示工作负荷、团队协作及风险益处认知对安全行为的影响。结论护士长多元领导风格可直接影响ICU护士安全行为，并通过“差错管理氛围→差错压力取向”的链式中介作用间接影响ICU护士安全行为。护士长在管理实践中应兼顾多元领导风格建设、差错管理氛围营造及差错压力干预，以促进护士主动安全行为。

关键词: ICU护士, 多元领导风格, 差错管理氛围, 差错压力取向, 安全行为, 聚敛式混合研究

Abstract:

Objective Based on the social context theory，this study explored the influence and mechanism of the multiple leadership styles of head nurses on the safety behaviors of ICU nurses，providing a scientific basis for nursing safety management. Methods A convergent mixed-methods design was adopted. Using convenience sampling，446 ICU nurses from 14 tertiary hospitals in Zhejiang Province were surveyed with the general data questionnaire，Multifactor Leadership Questionnaire，Error Management Climate Scale，Error Strain Orientation Questionnaire and Nurse Safety Behavior Questionnaire. Multiple linear regression and structural equation modeling were conducted to analyze the pathways of influence. In addition，purposive sampling was used to conduct qualitative interviews with 15 ICU nurses，and data were analyzed using content analysis. Results Quantitative findings indicated that nurse managers’ multiple leadership style was a significant predictor of ICU nurses’ safety behaviors，with error management climate and error strain orientation playing a chain mediating role. Qualitative analysis identified four themes，including roles of leadership style，influence of organizational atmosphere，responses to unsafe events，and individual intrinsic drivers. The mixed-methods integration further revealed the roles of perceived workload，team collaboration，and error-benefit cognition in shaping safety behaviors. Conclusion Head nurses’ multiple leadership styles directly influence ICU nurses’ safety behaviors and exert an indirect influence through the serial mediating effect of error management climate and error strain orientation. In management practice，head nurses should take into account the construction of multiple leadership styles，the creation of an error management climate，and the intervention of error stress to promote nurses’ proactive safety behaviors.

Key words: ICU Nurses, Multiple Leadership Styles, Error Management Climate, Error Strain Orientation, Nurse Safety Behavior, Convergent Mixed Study

柯喻, 张玉萍, 姚梅琪, 华婧, 张若林, 金静芬. 护士长多元领导风格对ICU护士安全行为影响机制的混合性研究[J]. 中华急危重症护理杂志, 2026, 7(7): 856-863.

KE Yu, ZHANG Yuping, YAO Meiqi, HUA Jing, ZHANG Ruolin, JIN Jingfen. Mechanisms of influence of head nurses’ multiple leadership styles on ICU nurses’ safety behaviors：a mixed-method study[J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(7): 856-863.

图/表 6

表1

表2

图1

表3

表4

表5

参考文献 28

[1]	国家卫生健康委办公厅. 患者安全专项行动方案(2023-2025年)[EB/OL].(2023-09-27)[2025-02-03]. https://www.gov.cn/zhengce/zhengceku/202310/content_6908044.htm.
	Office of the National Health Commission. 患者安全专项行动方案(2023-2025年)[EB/OL].(2023-09-27)[2025-02-03]. https://www.gov.cn/zhengce/zhengceku/202310/content_6908044.htm.
[2]	Lesny M, Conrad M, Latarche C, et al. Adverse events during nursing care procedure in intensive care unit:the prevenir study[J]. Intensive Crit Care Nurs, 2020, 60:102881. doi: 10.1016/j.iccn.2020.102881
[3]	Ferris GR, Arthur MM, Berkson HM, et al. Toward a social context theory of the human resource management-organization effectiveness relationship[J]. Hum Resour Manag Rev, 1998, 8(3):235-264.
[4]	柯喻, 金静芬, 张玉萍, 等. 差错管理氛围在护士长多元领导风格与护士安全行为间的中介作用[J]. 中国护理管理, 2025, 25(9):1400-1404.
	Ke Y, Jin JF, Zhang YP, et al. Effects of error management climate on mediating head nurses’ multiple leadership styles and nurses’ safety behaviors[J]. Chin Nurs Manag, 2025, 25(9):1400-1404.
[5]	邰春玲, 陈冬, 李新雨, 等. 心理安全感与主动性行为在差错管理氛围与患者安全胜任力间的中介作用[J]. 护理学杂志, 2023, 38(6):72-75,79.
	Tai CL, Chen D, Li XY, et al. Mediating effects of psycholo-gical security and proactive behavior on the relationship bet-ween error management climate and patient safety competency[J]. J Nurs Sci, 2023, 38(6):72-75,79.
[6]	Farnese ML, Fida R, Picoco M. Error orientation at work:di-mensionality and relationships with errors and organizational cultural factors[J]. Curr Psychol, 2022, 41(2):970-989. doi: 10.1007/s12144-020-00639-x
[7]	苏文君. 差错压力取向对员工创新行为的影响研究:情绪劳动的中介作用和核心自我评价的调节作用[D]. 合肥: 安徽大学, 2018.
	Su WJ. A study on the influence of error stress orientation on employees’ innovative behavior:the mediating role of emotional labor and the moderating role of core self-evaluation[D]. Hefei: Anhui University, 2018.
[8]	Bass BM, Avolio BJ. Multifactor leadership questionnaire[M]. Palo Alto: Mind Garden, 2004:29.
[9]	潘慧. 护士长领导行为与护士工作满意度、组织承诺的相关性研究[D]. 延吉: 延边大学, 2008.
	Pan H. The relationship among leadership behaviors of nurse managers,and job satisfaction,orgnizational commitment of staff nurses[D]. Yanji: Yanbian University, 2008.
[10]	马靓. 中国文化背景下不同领导风格对护士工作绩效的影响研究[D]. 南京: 南京中医药大学, 2017.
	Ma L. Research on the influence of head nurses’ leadership styles on job performance of staff nurses in Chinese culture[D]. Nanjing: Nanjing University of Chinese Medicine, 2017.
[11]	Tao J, Liu Y, Su D. The effect of ambidextrous leadership on knowledge sharing behavior among nurse specialists:a chain mediation role of perceived organizational support and organi-zational commitment[J]. BMC Nurs, 2025, 24(1):181. doi: 10.1186/s12912-025-02808-4
[12]	Cigularov KP, Chen PY, Rosecrance J. The effects of error ma-nagement climate and safety communication on safety:a multi-level study[J]. Accid Anal Prev, 2010, 42(5):1498-1506. doi: 10.1016/j.aap.2010.01.003
[13]	van Dyck C, Frese M, Baer M, et al. Organizational error mana-gement culture and its impact on performance:a two-study replication[J]. J Appl Psychol, 2005, 90(6):1228-1240. doi: 10.1037/0021-9010.90.6.1228
[14]	杜鹏程, 贾玉立, 倪清. 差错能成为创新之源吗:基于差错管理文化对员工创造力影响的跨层次分析[J]. 科技管理研究, 2015, 35(9):161-166.
	Du PC, Jia YL, Ni Q. Can error become the source of innovation:an analysis on the cross-level model based on the effect of error management culture on employees’ creativity[J]. Sci Technol Manag Res, 2015, 35(9):161-166.
[15]	Rybowiak V, Garst H, Frese M, et al. Error orientation ques-tionnaire(EOQ):reliability,validity,and different language equi-valence[J]. J Organiz Behav, 1999, 20(4):527-547. doi: 10.1002/(ISSN)1099-1379
[16]	Shih CP, Chang LY, Chen JC, et al. The factors influencing safety behavior of medical staffs in emergency room of a medical center in taiwan[J]. Chin J Manag, 2008, 25(4):451-465.
[17]	戎晏甫. 病人安全文化与安全行为间关系之探讨[D]. 台北市: 慈济大学, 2010.
	Rong YF. An exploration of the relationship between patient safety culture and safe behaviors[D]. Taipei: Tzu Chi Univer-sity, 2010.
[18]	Creswell JW, Creswell JD. Research design:qualitative,quanti-tative,and mixed methods approaches[M]. Sage publications, 2017.
[19]	刘满, 马凤艳, 刘陆, 等. 肿瘤科护士安全行为的影响因素及其与自我意识的相关性分析[J]. 中国肿瘤临床与康复, 2024, 31(3):187-194.
	Liu M, Ma FY, Liu L, et al. Influencing factors of safety behaviors of oncology nurses and their correlations with self-awareness[J]. Chin J Clin Oncol Rehabil, 2024, 31(3):187-194.
[20]	储雪琴, 李惠萍, 丁晓彤, 等. 护士安全行为与护士长多元领导行为、患者安全文化感知的关系研究[J]. 中国卫生事业管理, 2019, 36(1):17-19,49.
	Chu XQ, Li HP, Ding XT, et al. Studying on the relationship among nurses’ safe behaviors,head nurses’ diversified leading behaviors and patients’ safety culture perception[J]. Chin Health Serv Manag, 2019, 36(1):17-19,49.
[21]	Alrabae YMA, Aboshaiqah AE, Tumala RB. The association bet-ween self-reported workload and perceptions of patient safety culture:a study of intensive care unit nurses[J]. J Clin Nurs, 2021, 30(7/8):1003-1017. doi: 10.1111/jocn.v30.7-8
[22]	Mathew M, John A, Vazhakkalayil Ramachandran R. Nurse stress and patient safety in the ICU:physician-led observational mixed-methods study[J]. BMJ Open Qual, 2025, 14(2):e003109.
[23]	Wudarczyk B, Krupa-Nurcek S, Czapla M, et al. Factors influ-encing burnout,stress levels,and coping strategies among nursing staff in intensive care units[J]. Front Public Health, 2025, 13:1530353.
[24]	于淼, 王建辉, 赵彩杰, 等. 领导-成员交换关系在变革型领导与护理差错管理氛围间的中介作用[J]. 护理学杂志, 2020, 35(2):9-11.
	Yu M, Wang JH, Zhao CJ, et al. The influence of transforma-tional leadership on the error management climate:mediating role of leader-member exchange[J]. J Nurs Sci, 2020, 35(2):9-11.
[25]	陈华仲, 刘素霞, 梅强. 安全领导力对员工安全行为影响的元分析[J]. 中国安全科学学报, 2020, 30(5):7-13. doi: 10.16265/j.cnki.issn1003-3033.2020.05.002
	Chen HZ, Liu SX, Mei Q. Meta-analysis on impact of safety leadership on employees’ safety behavior[J]. China Saf Sci J, 2020, 30(5):7-13.
[26]	侯梦园, 魏万宏, 杨帆, 等. 职场精神力在低年资护士双元工作压力与安全行为间的调节效应[J]. 护理学杂志, 2025, 40(11):67-71.
	Hou MY, Wei WH, Yang F, et al. Moderating effect of work-place spirituality between challenge-hindrance stressors and safety behavior among junior nurses[J]. J Nurs Sci, 2025, 40(11):67-71.
[27]	Reason J. Managing the risks of organizational accidents[M]. London:Routledge, 2016.
[28]	李传圣, 迟俊涛, 方晓明, 等. ICU护士经历护理缺失事件真实体验的质性研究[J]. 中华急危重症护理杂志, 2024, 5(4):352-358.
	Li CS, Chi JT, Fang XM, et al. A qualitative study of the experiences of nurses experiencing missed nursing care events in the ICU[J]. Chin J Emerg Crit Care Nurs, 2024, 5(4):352-358.