【作者】 龚艳艳；

【导师】 王惠珍；

【作者基本信息】 南方医科大学 ， 护理学， 2011， 硕士

【摘要】 研究背景职业决策(career decision-making)源于英国经济学家Keynesian的经济学理论,逐步被引用到职业心理学中。职业心理学家从不同的理论角度对职业决策的概念进行了探讨。目前职业决策研究领域中广泛认同的是,职业决策是一个过程,而不单单是一种结果。职业决策是决策者在职业选择过程中,参照外在环境的现状与发展趋势,依据自身的特性,对预期目标实现可能的判断分析,并作出合理取舍的过程；这个过程受个体自身特点、环境限制等众多因素影响,伴随个体职业发展全过程,并且不同阶段会有不同任务。影响职业决策的因素是复杂的、变化的。对个人来说,职业生活是个人生活保障的来源,是个人实现自我价值和社会价值的重要舞台；对社会而言,个人从事合适的职业,是保证社会稳定、提高社会运行效率的前提。近年来,高校扩招使精英教育成为大众化教育,护理人员学历层次普遍提高的同时,高校护生的就业问题也日益凸显。一方面是临床高素质护理人才的流失给护理质量造成了一定的消极影响；另一方面是高校护生为求不到理想的职位而焦虑。如何引导高校护生找到合适的职位,使其人尽其才,并成为护理队伍中稳定的一员,是各级卫生行政部门、学校和医院管理部门近年来研究的热点之一。现有的西方研究源于西方的理论和实践,由于中西方经济和文化差异,西方的研究成果对指导我国护生职业决策缺乏有效帮助。国内现有的对护生职业决策的研究还不够深入,大多是对国外相关理论的验证性研究。目前,尽管市场经济引导中国就业市场,但是这种就业市场的自由度并不明朗。家庭因素、社会因素等个体外在因素影响甚至左右求职者的职业选择结果。对我国护生职业决策的研究,还有待进一步结合我国国情,选择本土化的视角进行研究。研究目的：1揭示广州市护理本科生职业决策过程中的影响因素；2探讨相关因素在广州市护理本科生职业决策过程中的作用。研究意义：1为广州市高校对护理本科生进行职业决策指导提供参考依据；2为解决高级护理人才的供需矛盾提供参考依据；3为社会相关部门解决大学生就业问题提供参考依据。研究对象研究对象的纳入标准：(1)广州市高校的全国统招全日制护理专业本科生；(2)高中阶段为普通全日制高中；(3)目前在校正常就读；(4)自愿参加本课题研究。研究对象的排除标准：(1)定向生,委培生,专升本学生；(2)在就读本科护理学专业前已经定好工作单位的其他情况。研究步骤及方法：本研究采用质性与量性相结合的研究方法,对广州市护理本科生职业决策的影响因素进行探讨。第一部分内容采用质性研究,运用目的抽样法,抽取广州市四所院校的应届护理本科毕业生,进行深入访谈(in depth interview),及时将访谈录音逐字、逐句地记录下来,并记录接受访谈毕业生的非语言行为及其所提供的个人基本资料,依次给每位毕业生的访谈记录编序并建立各自独立的文档。资料分析分3个步骤进行。首先在收集资料的过程中聆听并分析上一次访谈的内容,反思访谈中存在的问题,以期在下一次访谈中能够避免。其次研究者多次集中聆听录音,并阅读每一位毕业生的访谈记录,力求对受访者的谈话内容有一个梗概的了解。最后寻找并提炼毕业生表述中与本研究有关的地方,尽量使用毕业生自己的语言(即本土语言)标记这些地方,设立编码。将这些编码进行归类,升华出护理本科毕业生职业决策影响因素的主题概念。第二部分内容采用量性分析。根据第一部分内容的研究结果,拟订《广州市护理本科生职业决策影响因素的调查问卷》,对广州市五所院校的护理本科生按年级分层便利抽样,使样本尽可能的具有代表性。所得数据资料均采用SPSS13.0统计软件进行录入和分析,采用描述性统计分析、两个和多个独立样本非参数检验、两个独立样本t检验、单因素方差分析、双变量Spearman相关分析等统计学分析方法,所有结果以P<0.05为差异有统计学意义。质性研究结果1经济收入水平的高低是影响护理本科生职业决策的最重要因素；2社会对护理职业的认可重视是影响护理本科生职业决策的重要因素之一；3作为社会的细胞,家庭因素对护生职业决策也具有一定的影响作用；4受访者表示在职业决策时会考虑地域因素；5教育和实习因素为促使护生转变对护理职业的看法发挥了一定作用；6生源地的地方职能部门对护生职业决策具有一定的影响作用。量性研究结果1、护生对护理专业的态度变化除大三和大四的男生对护理专业的态度与刚入校时的差异无统计学意义(Z =-1.134,P=0.257:Z=-0.276,P=0.783),其他护生对护理专业好感增强(P<0.05)。2护生从事护理职业的意愿情况1171名护生中,有229人(19.56%)打算长期从事护理职业；541人(46.20%)打算先从事护理职业,看情况未必改行；262人(22.37%)打算先从事护理职业,找机会改行；139人(11.87%)打算毕业后立即改行。男女护生从事护理职业意愿的年级差异均无统计学意义(χ2=0.111,P=0.990；χ2=6.607,P=0.086),各年级护生从事护理职业意愿的性别差异亦无统计学意义(Z=-1.391,P=0.164；Z=一1.008,P=0.313；Z=-0.599,P=0.549；Z=-0.194,P=0.846).3护生城乡选择的意愿情况1171名护生中,有665人(56.79%)选择大城市,390人(33.30%)选择中小城市。不同年级的女生在城乡区域选择上的差异存在统计学意义(χ2=10.420,P=0.015),随着年级的增高,女生选择大城市的人数比例有下降趋势,选择中小城市的人数比例有增高趋势。4护生单位所有制选择的意愿情况1171名护生中,889人(75.92%)选择公立单位,51人(4.36%)选择非公立单位,231人(19.72%)选择无所谓。不同年级的女生对单位所有制性质选择的差异存在统计学意义(χ2=11.924,P=0.008),随着年级的增高,选择公立单位的女生人数比例有增高趋势。大一和大二护生单位所有制性质选择情况的性别差异有统计学意义(Z=-2.129,P=0.033；Z=-2.732,P=0.006),大一、大二的女生选择公立单位的人数比例呈现高于男生的趋势,选择非公立单位或者无所谓的人数比例呈现低于男生的趋势。5护生岗位种类选择的意愿情况1171名护生中,626人(53.46%)选择临床护理岗位,153人(13.07%)选择护理教育岗位,169人(14.43%)选择护理管理岗位,113人(9.65%)选择其他岗位,110人(9.39%)选择无所谓。大一和大二护生岗位种类选择情况的性别差异有统计学意义(Z=-3.483,P=0.000；Z=-2.604,P=0.009),大一、大二的女生选择临床护理、护理教育岗位的人数比例呈现高于男生的趋势,选择其他岗位和无所谓的人数比例呈现低于男生的趋势。6影响因素对护生职业决策的影响作用相关因素对护生职业决策影响力大小的差异有统计学意义(P<0.05)。护士职业价值观水平、中小城市吸引力和人事编制吸引力3项因素对男生职业决策影响力大小的年级差异有统计学意义(F=4.652,P=0.004；F=3.011,P= 0.033；F=4.562,P=0.009)；除了家庭支持、县城吸引力和公立单位吸引力外,其他因素对女生职业决策影响力大小的年级差异均有统计学意义(P<0.05)。护士职业价值观水平在二年级和四年级护生中的性别差异有统计学意义(t=-2.563,P=0.011；t=2.439,P=0.016)。家庭支持因素、中小城市吸引力和护理教育岗位的吸引力在一年级和二年级护生中的性别差异有统计学意义(t=-3.479,P=0.001；t=-2.355,P=0.019；t=-2.248,P=0.025；t=-2.778,P=0.006；t=-2.169,P=0.003；t=-2.153,P=0.032)。社会对护理职业的认可重视因素和非公立单位吸引力对四年级护生职业决策影响力的性别差异有统计学意义(t= 2.426,P=0.016；t=1.980,P=0.049)。县城和乡镇吸引力对一年级护生职业决策影响力的性别差异有统计学意义(t=-2.575,P=0.010；t=-2.598,P=0.010).临床护理岗位吸引力对一年级和四年级护生职业决策影响力的性别差异有统计学意义(t=-2.453,P=0.015；t=2.010,P=0.046).7影响因素与护生从事护理职业意愿的相关关系大一男生从事护理职业的意愿与人事编制弱正相关(r=0.278,P<0.05),与家庭支持因素显著正相关(r=0.627,P<0.001)。大一女生从事护理职业的意愿与社会对护理职业的认可重视和家庭支持因素均弱正相关(r=0.204,P<0.001；r =0.232,P<0.001).大二男生从事护理职业的意愿与家庭支持因素弱正相关(r=0.443,P<0.01)。大二女生从事护理职业的意愿与社会对护理职业的认可重视、临床护理岗位吸引力、家庭支持因素弱正相关(r=0.256,P<0.001；r=0.148, P<0:01；r=0.251,P<0.001).大四男生从事护理职业的意愿与非公立单位吸引力显著负相关(r=-0.619,P<0.05)。大四女生从事护理职业的意愿与社会对护理职业的认可重视及临床护理岗位吸引力弱正相关(r=0.207,P<0.01；r=0.200, P<0.01).结论1.广州市护理本科生的职业决策过程是一个动态变化的过程,各因素对护生职业决策的影响力大小不同,作用不同。2.学校教育因素对提升护生的护士职业价值观成效显著,学校教育因素和护生的护士职业价值观因素对促进护生从事护理职业的作用力还显单薄。3.家庭支持因素对促进低年级护生从事护理职业有一定的正向推动作用。4.护生对地域的选择与其是否从事护理职业无关；地域发展的差距使大部分护理本科生流向城市和经济发达地区,可能加剧城乡和区域护理事业发展的差距。5.公有制单位和人事编制的岗位稳定性较好,但广州市高校的护理本科生不是为了求稳而选择护理职业,一部分护生有可能会因为非公立单位的某些优势岗位而放弃护理岗位。6.如果提升社会对护理职业的认可重视程度,女护生选择护理职业的倾向性就可能增大。7.增强护生对临床护理岗位的了解和理解,对促进护生从事临床护理工作有一定的积极意义。8.生源地城镇政府职能部门对大学生的支持和重视,对于吸引毕业生为家乡做贡献起到重要的作用。9.本研究编译的中文版NPVS-R对测量广州市护理本科生的护士职业价值观是适用的。更多还原

【Abstract】 BackgroundThe concept of Career Decision-Making came from the economic theory brought up by Keynesian, the British economist, and was taken up gradually to occupational psychology. Occupational psychologists have studied it in different theoretical perspective. Now, it is recognized widely in the field of Career Decision-Making that career decision-making is a process, not just a result. Career Decision-Making is a process, during which the decision makers judge whether the expected objective could be achieved and make a reasonable choice, with reference to the external environment, situation and development trend, based on its own characteristics; this process is influenced by the individual’s own characteristics and much environment restrictions, with the whole process of individual career development, and the different stages have different tasks. Factors that affect career decisions are complex and changeable.For individuals, professional life is a source of personal security and an important stage where a personal self-worth and social value can be achieved; for society, it is the prerequisite to ensure social stability and improve the efficiency of social operation that individuals engaged in the right career. In recent years, elite education has become popular education because of increased enrollment, and nursing education levels have been generally improved, while the employment of college nursing students become increasingly visible:one problem is the loss of clinical nurses, with negative effect to the clinical nursing quality; the other problem is that college nursing students worry about the ideal position. How to guide nursing students in looking for suitable jobs and love the job as a nurse is one of the focuses in the recent researches of the administration departments, schools and the hospital management organizations. Most of the existing western studies come from western theories and practices, and the investigation and analysis of nursing students are lack of effective to guide the home students in career decision-making because of the difference between home and abroad. The existing home studies are lack of thorough and most of them are the copy of western ones. Now, market economy guide the home employs, however, it is not free enough. The factors affect the employees such as family factor and social factors. It is expected to make a deep study in home college nursing students according to home fact.Objective1 To know the influence factors in the career decision-making of the undergraduate nursing students in Guangzhou city.2 To know the functions of the influence factors in the career decision-making of the undergraduate nursing students in Guangzhou city.Significance1 To provide something useful to help the undergraduate nursing students in Guangzhou city to make a career decision.2 To provide something useful to solve the contradiction between the supply and requirement of advanced nurses.3 To provide something useful to solve the employment problem of college students for relevant sectors of society. Object of studyStudy inclusion criteria:1 full-time undergraduate nursing student passed nationwide entrance examination; 2 high schools full-time as an ordinary high school; 3 currently enrolled in normal schools; 4 volunteered to participate in this research Study exclusion criteria:1 one whose job had been appointed or specialty student before undergraduate; 2 one whose job had been appointed before being an undergraduate nursing student in other cases.MethodsQualitative research and quantitative study were used in the research of the Influence factors in the career decision-making of the undergraduate nursing students in Guangzhou city.The first part was qualitative research, and the responders were chosen from 4 universities in Guangzhou city in purpose sampling way, and in a depth interview. Listened to the tape again and again, made a record word for word timely, including the nonverbal behavior and personal information, and then set up interviews record document.Data analysis was carried out in 3 steps. Firstly, listened to tape and tried to find the problem so that it would be solved in the next interview. Secondly, read all the records and tried to make an abstract. Finally, looked for the points related to the study and mark these points in the responder’s words, then established the encoding. These codes are classified, and the general idea could be got about the influence factors.The second part was quantitative analysis. According to the first part of the research results, made the questionnaire named the questionnaire of the factors of career decision-making of the graduate nursing students in Guangzhou city, and the responders were chosen form 5 universities in Guangzhou city stratified by grade in convenience sample survey, so that the sample was as representative as possible. The data were entering and analyzed in SPSS 13.0 software, with descriptive statistics,2 or k independent samples nonparametric test, independent-samples t test, one-way ANOVA, bivariate Spearman correlation, etc. All of the results was considered statistically significant at the level P<0.05.Results of qualitative research1. The level of income was the most important factor in the responders’ career decision-making.2. How much respect did the public show to nursing was one of the important factors in the responders’career decision-making.3. As a cell of society, family factors on the career decision of nursing students also had some influence.4. Respondents said they would consider geographical factors in the career decision-making.5. Educational and training factors played a role to promote the responders’view on nursing profession.6. The local functions department of the responder’s hometown had a certain influence on their career decision-making.Quantitative results1. The attitude change on nursing of the respondersAll the responders love nursing better (P< 0.05) except the boy students in Grade 3 or Grade 4 (Z=-1.134, P= 0.257; Z=-0.276, P=0.783).2. The situation of the responders engaging in nursing profession229 (19.56%) of the responders would engage in nursing profession for a long term; 541 (46.20%) would engage in nursing profession for a certain time and then decide whether continue it; 262 (22.37%) would engage in nursing profession while trying to find another job; 139 (11.87%) would abandon nursing as soon as graduate. There was no difference between boys and girls in the will of being a nurse (Z=-1.391, P= 0.164; Z=-1.008, P= 0.313; Z=-0.599, P= 0.549; Z=-0.194, P= 0.846); there was no difference in different grades, either (χ2=0.111, P=0.990;%= 6.607,P=0.086). 3. How the responders chose urban and rural665 (56.79%) of the responders would choose big city,390 (33.30%) would choose medium or small city。It was different in grades in girl responders (χ2=10.420, P=0.015). As the grade increased, the proportion of girls choosing big city was in the downward trend and the proportion of girls choosing medium or small city was in an increasing trend.4. How the responders chose the ownership of the units889 (75.92%) of the responders chose public ownership,51 (4.36%) chose non-public ownership,231 (19.72%) considered it no significant。It was different in grades in girl responders (χ2= 11.924, P=0.008). As the grade increased, the proportion of girls choosing public ownership was in an increasing trend. It was different between boys and girls in Grade 1 and Grade 2 (Z=-2.129, P=0.033; Z=-2.732, P=0.006), the proportion of girls choosing public ownership was bigger than boys in an increasing trend, while non-public ownership was opposite.5. How the responders chose the post626 (53.46%) of the responders chose clinical nursing,153 (13.07%) chose nursing education,169 (14.43%) chose nursing management,113 (9.65%) chose other post,110 (9.39%) considered it no significant。It was different between boys and girls in Grade 1 and Grade 2 (Z=-3.483, P=0.000; Z=-2.604, P=0.009), the proportion of girls choosing clinical nursing and nursing education were bigger than boys in an increasing trend, while other post and no significant were opposite.6. The impact of the influence factors on career decision-makingThese influence factors were different in impact on career decision-making (P< 0.05). The impact of the nursing professional values (NPV), attraction of medium or small city, attraction of the establishment were different on boys in different grades (F= 4.652, P= 0.004; F= 3.011, P= 0.033; F= 4.562, P= 0.009). The impact of all the factors were different on girl in different grades except family factor, attraction of country seat or public ownership unit (P< 0.05). It was different between boys and girls in NPV in Grade 2 and Grade 4 (t=-2.563, P=0.011; t=2.439, P=0.016). It was different between boys and girls in Grade lor Grade 2, in family factor’s impact, attraction of medium or small city, nursing education (t=-3.479, P=0.001; t=-2.355, P=0.019; t=-2.248, P=0.025; t=-2.778, P=0.006;t=-2.169, P=0.003; t =-2.153, P=0.032). The impact on career decision-making of how much respect the public show to nursing and attraction of non-public ownership unit was different between boys and girls in Grade 4 (t=2.426, P=0.016; t=1.980, P=0.049). The impact on career decision-making of the attraction of country seat and town was different between boys and girls in Grade 1 (t=-2.575, P=0.010; t=-2.598, P= 0.010). The impact on career decision-making of the attraction of clinical nursing was different between boys and girls in Grade 1 and Grade 4 (t=-2.453, P=0.015; t= 2.010, P=0.046).7. The relationship between factors and wills of responders choosing nursing professionThere was a weak positive correlation between establishment and wills of choosing nursing (r=0.278, P< 0.05) and a positive correlation between family factor and wills of choosing nursing (r=0.627, P< 0.001) in the boys in Grade 1. Either public’s respect to nursing or family factor had a weak positive correlation with the wills of choosing nursing in the girls in Grade 1 (r=0.204, P< 0.001; r= 0.232, P< 0.001).Family factor had a weak positive correlation with the wills of choosing nursing in the boys in Grade 2 (r=0.443, P<0.01). Each of the factor of public’s respect to nursing, attraction of clinical nursing and family factor had a weak correlation with the wills of choosing nursing in the girls in Grade 2 (r=0.256,P< 0.001; r=0.148, P<0.01; r=0.251, P<0.001). Attraction of non-public ownership unit had a significant negative correlation with the wills of choosing nursing in the boys in Grade 4(r=-0.619, P<0.05). Any of the factors of public’s respect to nursing or attraction of clinical nursing had a weak correlation with the wills of choosing nursing in the girls in Grade 4(r=0.207, P< 0.01; r=0.200, P< 0.01).Conclusions 1. The career decision-making of the graduate nursing students in Guangzhou city is a dynamic process, and the impact of all the factors are in different sizes or different functions.2. Universities play a positive role to improve the nursing professional values of the graduate nursing students. Universities and nursing professional values don’t work well on encouraging graduate nursing students to engage in nursing profession.3. Family support factors have a certain positive role in encouraging junior graduate nursing students to engage in nursing profession.4. The area choice has nothing to do with the students’will of choosing nursing professional. Regional development gap makes most nursing undergraduate flow to the city and developed areas, so the nursing gap between urban and rural and regions may be exacerbated.5. The Public ownership units and the establishment post are thought stabile, but the reason of the nursing graduates in the universities in Guangzhou city choosing them is not for stability and part of the students maybe prefer some advantage position in non-public ownership units to nursing posts.6. If public show much respect to nursing, girl nursing graduates maybe more likely to choose nursing profession.7. It has certain positive significance to encourage nursing graduates to choose nursing profession that making nursing graduates know nursing much.8. The local functions department of the responder’s hometown has a certain influence on their career decision-making.9. The Chinese version of NPVS-R developed in the research is suitable to the nursing graduates in Guangzhou city.更多还原