汕头大学医学院学报

目的：调查实习护生临床决策能力、临床实习适应状况及一般自我效能感的现状，并检验自我效能感在临床适应与决策能力之间的中介效应。方法：采用横断面调查设计，于2023年11月至2024年1月便利抽取深圳市与汕头市4所三甲医院的221名本科护理实习生。采用护理临床决策能力量表、一般自我效能感量表及护理学生临床实习适应不良量表进行调查。运用SPSS 25.0进行相关与回归分析，使用Amos 24.0构建结构方程模型，并采用Bootstrap法检验中介效应。结果：实习护生临床决策能力总分为(128±15)分，处于中等水平。临床实习适应状况、一般自我效能感均与临床决策能力呈正相关(r值分别为0.242、0.360，均P<0.001)。多元线性回归分析显示，理论知识很好(β=0.269,P=0.010)以及更高的自我效能感水平(中等水平：β=0.276,P=0.001；高水平：β=0.363,P<0.001)是临床决策能力的独立相关因素。结构方程模型拟合良好(χ²/df=2.185,RMSEA=0.073,CFI=0.925,TLI=0.914)。Bootstrap检验显示，临床实习适应状况对临床决策能力的总效应为0.271(95%CI:0.045～0.448,P<0.05)，其中通过自我效能感产生的间接效应为0.143(95%CI:0.076～0.227,P<0.001)，占总效应的52.8%，而直接效应不显著。结论：实习护生临床决策能力有待提升。自我效能感在临床实习适应与临床决策能力的关系中起关键中介作用。提升实习护生的自我效能感可能有助于提升其临床决策能力。

Objective: To investigate the current status of clinical decision-making ability, clinical internship adaptation, and general self-efficacy among nursing interns, and to examine the mediating effect of self-efficacy between clinical adaptation and decision-making ability. Methods: A cross-sectional survey was conducted from November 2023 to January 2024. A total of 221 undergraduate nursing interns were conveniently sampled from four tertiary grade A hospitals in Shenzhen and Shantou. The Nursing Clinical Decision-Making Scale, the General Self-Efficacy Scale, and the Clinical Practice Adaptation Scale for Nursing Students were used for data collection. SPSS 25.0 was used for correlation and regression analyses. Amos 24.0 was employed to construct a structural equation model, and the Bootstrap method was used to test the mediating effect. Results: The total score of clinical decision-making ability among the nursing interns was(128±15), indicating a moderate level. Both clinical internship adaptation and general self-efficacy were positively correlated with clinical decision-making ability(r=0.242 and 0.360, respectively, both P<0.001). Multiple linear regression analysis showed that strong theoretical knowledge(β=0.269, P=0.010) and a higher level of self-efficacy(moderate level: β=0.276, P=0.001;high level: β=0.363, P<0.001) were independently correlated with clinical decision-making ability. The structural equation model demonstrated a good fit(χ²/df=2.185, RMSEA=0.073, CFI=0.925, TLI=0.914). Bootstrap analysis revealed that the total effect of clinical internship adaptation on clinical decision-making ability was 0.271(95%CI: 0.045-0.448, P<0.05). The indirect effect through self-efficacy was 0.143(95%CI: 0.076-0.227, P<0.001),accounting for 52.8% of the total effect, while the direct effect was not significant. Conclusion: The clinical decision-making ability of nursing interns needs improvement. Self-efficacy plays a key mediating role in the relationship between clinical internship adaptation and clinical decision-making ability. Enhancing the self-efficacy of nursing interns may be an effective approach to improving their clinical decision-making ability.