Five factors exacerbate occupational alienation among nurses: development and application of Clinical Nurse Occupational Alienation Scale

ZHAO Ying; GU Ling; DONG Lei; SONG Caiping

doi:10.16016/j.2097-0927.202605039

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Five factors exacerbate occupational alienation among nurses: development and application of Clinical Nurse Occupational Alienation Scale

Medical Psychology | 更新时间：2026-07-15

- Five factors exacerbate occupational alienation among nurses: development and application of Clinical Nurse Occupational Alienation Scale
- Journal of Army Medical University Vol. 48, Issue 13, Pages: 1919-1929(2026)
- 作者机构：
  
  1.陆军军医大学（第三军医大学）第二附属医院：临床护理教研室，重庆
  2.陆军军医大学（第三军医大学）第二附属医院：护理处，重庆
  3.陆军军医大学（第三军医大学）第二附属医院：院办，重庆
- 作者简介：
  
  SONG Caiping， E-mail：scp1974@163.com
- 基金信息：
  
  the Medical Research Project of Chongqing Health Commission(2025WSJK023)
- DOI：10.16016/j.2097-0927.202605039
  CLC： R192.6;R195.1;R197.32
- Received：14 May 2026，
  
  Revised：2026-06-03，
  
  Accepted：03 June 2026，
  
  Published：15 July 2026
- 稿件说明：
移动端阅览
赵颖，顾玲，董蕾，等.五个方面因素加重护理职业疏离感：临床护士职业疏离感量表的编制及应用［J］.陆军军医大学学报，2026，48（13）：1919-1929.DOI：10.16016/j.2097-0927.202605039.

Z Y，GU L，DONG L，et al.Five factors exacerbate occupational alienation among nurses： development and application of Clinical Nurse Occupational Alienation Scale［J］.J Army Med Univ，2026，48（13）：1919-1929.DOI：10.16016/j.2097-0927.202605039.
赵颖，顾玲，董蕾，等.五个方面因素加重护理职业疏离感：临床护士职业疏离感量表的编制及应用［J］.陆军军医大学学报，2026，48（13）：1919-1929.DOI：10.16016/j.2097-0927.202605039. DOI：

Z Y，GU L，DONG L，et al.Five factors exacerbate occupational alienation among nurses： development and application of Clinical Nurse Occupational Alienation Scale［J］.J Army Med Univ，2026，48（13）：1919-1929.DOI：10.16016/j.2097-0927.202605039. DOI：

摘要

目的

在全球护理人力资源持续短缺、我国护士岗位压力与留任困难突出的背景下，部分护士虽留守岗位却出现心理疏远、投入下降的职业疏离现象，而现有测量工具在文化适配性与结构稳定性上存在局限。本研究旨在编制一份信效度良好、适用于我国文化背景的临床护士职业疏离感量表（nurse occupational alienation scale，NOAS），并开展初步应用研究，为评估与干预提供科学依据。

方法

本研究采用横断面研究设计，于2025年6月至10月，通过多阶段分层便利抽样方法，在重庆市6家医院招募临床注册护士。量表开发与验证阶段：基于文献回顾构建初始NOAS条目池，经德尔菲专家咨询、认知访谈及预调查后形成NOAS测试版；将样本分为A组（

=441）、B组（

=318），A组用于项目分析与探索性因子分析（exploratory factor analysis，EFA），B组用于验证性因子分析（confirmatory factor analysis，CFA）及信效度检验，C组（从B组中随机抽取研究对象，

=78）用于重测信度检验。量表应用阶段：使用一般资料调查表及最终版NOAS进行横断面现状调查，分析临床护士职业疏离感的现状及其相关影响因素。

结果

最终版NOAS包含工作超载感、权能缺失感、情感耗竭感、职业意义缺失感、关系隔离感、价值冲突感6个维度共53个条目。EFA提取6个公因子，累计方差解释率为69.45%，因子载荷范围0.69~0.81；CFA显示六因子模型拟合良好（

χ²

=2.27），比较拟合指数（comparative fit index，CFI）=0.92，塔克-刘易斯指数（Tucker-Lewis index，TLI）=0.92，近似误差均方根（root mean square error of approximation，RMSEA）=0.06，标准化残差均方根（standardized root mean square residual，SRMR）=0.06；各维度平均方差提取量（average variance extracted，AVE）范围为0.49~0.61，组合信度（composite reliability，CR）范围为0.88~0.92；NOAS总分与Maslach职业倦怠量表-服务行业版（Maslach burnout inventory-human services survey，MBI-HSS）情感耗竭维度呈显著正相关（

=0.74），与Utrecht工作投入量表（Utrecht work engagement scale，UWES-17）工作投入总分呈显著负相关（

=-0.69）；总量表Cronbach’s

系数为0.96，重测组内相关系数（intraclass correlation coefficient，ICC）=0.85；横断面调查发现，临床护士职业疏离感总分为（16.80±4.20）分，56.65%的临床护士职业疏离感总分超过理论中值，夜班频次对临床护士职业疏离感的影响最大（

=0.33），其次为科室类型（

=0.19）、月平均收入（

=-0.16）、医院等级（

=0.14）和性别（

=0.13），该模型共解释临床护士职业疏离感总变异的34.10%。

结论

本研究编制的六维NOAS具有良好信效度及本土适应性，可有效评估护士职业疏离感水平；高夜班频次、急危重症科室、三甲医院、男性及低收入是增加疏离感的风险因素，为护理管理干预提供了循证依据。

Abstract

Objective

Against the backdrop of a persistent global shortage of nursing human resources and prominent job stress and retention difficulties among Chinese nurses

some nurses have exhibited occupational alienation characterized by psychological detachment and decreased engagement despite remaining in their positions

while existing measurement tools have limitations in cultural adaptability and structural stability. This study aims to develop a reliable and valid Clinical Nurse Occupational Alienation Scale(NOAS) that is applicable to the Chinese cultural context

and to conduct preliminary application research to provide a scientific basis for assessment and intervention.

Methods

A cross-sectional study design was adopted. From June to October 2025

clinical registered nurses were recruited from 6 hospitals in Chongqing through multistage stratified convenience sampling. In the scale

development and validation phase

an initial NOAS item pool was constructed based on literature review

and a pilot version of the NOAS was formed after Delphi consultation

cognitive interviews

and a preliminary survey. The participants were divided into Group A(

=441) and Group B(

=318). Group A was used for item analysis and exploratory factor analysis(EFA)

and Group B was employed for confirmatory factor analysis(CFA) and reliability/validity testing. Group C(a random subsample from Group B

=78) was utilized for test-retest reliability testing. In the scale application phase

a general information questionnaire and the final version of the NOAS were used for cross-sectional status surveys to analyze the current status of occupational alienation among clinical nurses and its influencing factors.

Results

The final version of the NOAS consisted of 53 items across 6 dimensions: work overload

powerlessness

emotional exhaustion

loss of professional meaning

relational isolation

and value conflict. EFA extracted 6 common factors with a cumulative variance explanation rate of 69.45%

and factor loadings ranging from 0.69 to 0.81. CFA indicated good fit for the 6-factor model(

²/

=2.27)

with a comparative fit index(CFI) of 0.92

a Tucker-Lewis index(TLI) of 0.92

a root mean square error of approximation(RMSEA) of 0.06

and a standardized root mean square residual(SRMR) of 0.06. The average variance extracted(AVE) for each dimension ranged from 0.49 to 0.61

and composite reliability(CR) ranged from 0.88 to 0.92. The total NOAS score was significantly positively correlated with the emotional exhaustion dimension of the Maslach Burnout Inventory-Human Services Survey(MBI-HSS)(

=0.74) and significantly negatively correlated with the total score of the Utrecht Work Engagement Scale(UWES-17)(

=-0.69). The Cronbach’s α coefficient for the total scale was 0.96

and

the test-retest intraclass correlation coefficient(ICC) was 0.85. The cross-sectional survey revealed the total occupational alienation score of 16.80±4.20 among clinical nurses

and 56.65% of nurses had the total score exceeding the theoretical median. Night shift frequency had the greatest impact on occupational alienation(

=0.33)

followed by department type(

=0.19)

average monthly income(

0.16)

hospital grade(

=0.14)

and gender(

=0.13). The model explained 34.10% of the total variance in occupational alienation among clinical nurses.

Conclusion

The 6-dimensional NOAS developed in this study demonstrates good reliability

validity

and cultural adaptability

and can effectively assess the level of occupational alienation among nurses. High night shift frequency

working in acute/critical care departments

working in tertiary hospitals

being male

and low income are risk factors for increased alienation

providing evidence-based support for nursing management interventions.

关键词

Keywords

references

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Graduate School， Wannan Medical University

Department of Military Health Education， College of Military Preventive Medicine， Army Medical University （Third Military Medical University）

Department of Ophthalmology， First Affiliated Hospital， Army Medical University （Third Military Medical University）

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