基于叙事地图探索文化差异对护生职业认同影响的质性研究

曹春艳

doi:10.3760/cma.j.cn116021-20250826-02174

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基于叙事地图探索文化差异对护生职业认同影响的质性研究

更新时间：2025-11-21

- 基于叙事地图探索文化差异对护生职业认同影响的质性研究
- A qualitative study of the impact of cultural differences on the professional identity of nursing students based on narrative maps
- 中华医学教育探索杂志 2025年页码：1-6
- 作者机构：
  
  上海市浦东新区东明社区卫生服务中心，上海 200123
- 作者简介：
  
  Email：ccycaocao@sina.com
- 基金信息：
- DOI：10.3760/cma.j.cn116021-20250826-02174
  中图分类号： R471
- 收稿：2025-08-26，
  
  网络出版：2025-11-21，
- 稿件说明：
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曹春艳. 基于叙事地图探索文化差异对护生职业认同影响的质性研究[J/OL]. 中华医学教育探索杂志, 2025,1-6.

Cao Chunyan. A qualitative study of the impact of cultural differences on the professional identity of nursing students based on narrative maps[J/OL]. Chinese Journal of Medical Education Research, 2025, 1-6.
曹春艳. 基于叙事地图探索文化差异对护生职业认同影响的质性研究[J/OL]. 中华医学教育探索杂志, 2025,1-6. DOI： 10.3760/cma.j.cn116021-20250826-02174.

Cao Chunyan. A qualitative study of the impact of cultural differences on the professional identity of nursing students based on narrative maps[J/OL]. Chinese Journal of Medical Education Research, 2025, 1-6. DOI： 10.3760/cma.j.cn116021-20250826-02174.

摘要

目的

采用叙事地图的方式，还原护生的临床职业认同故事，从文化差异视角深入探究护生职业认同的变化情况，进而为提升护生职业认同感提供临床护理教学策略。

方法

选取2020年入科实习的上海市中医药大学2018级专升本护生30人，将其随机分为5组。每2周由科室专职带教主持开展半结构式焦点小组访谈。对护生访谈录音内容采用Colaizzi 7步分析法分析后，绘制时间-心理过程叙事地图；采用Nvivo14.0软件对护生叙事内容进行主题编码聚焦分析。

结果

提炼出9个典型案例，分别为不起作用的滴速调节器、应得权利的认知差异、生死取向的冲突、患者眼中的医护地位、过度防御对沟通的阻碍、情绪劳动与职业角色冲突、高知家属的挑战与沟通困境、感性决策与理性决策的冲突、职业情绪的内耗；4个共性主题，分别为医护患关系中的社会权责分离、医疗情境中医护患信任困境、医疗情境下的决策“两难”、刻板印象引发的职业歧视。

结论

主体间距离、防御性避免、独白式应对、社会歧视这4类文化差异，对护生临床实践阶段的职业认同产生深刻影响。临床护理教育者可尝试运用对话式教学法，提升实习护士的职业认同。

Abstract

Objective

To restore the story of the clinical professional identity of nursing students using the method of narrative mapping

deeply explore the changes of professional identity of nursing students from the perspective of cultural differences

and thereby provide clinical nursing teaching strategies to improve the professional identity of nursing students.

Methods

Thirty nursing students enrolled in a junior college-to-bachelor program in 2018 at Shanghai University of Traditional Chinese Medicine who began internship in 2020 were randomly divided into five groups. Semi-structured focus group interviews were conducted every two weeks under the guidance of dedicated clinical instructors. Interview recordings were analyzed using Colaizzi's 7-step method to construct time-psychological process narrative maps. NVivo 14.0 software was used for thematic coding and focused analysis of the narrative data.

Results

Nine representative cases were identified

including non-functional drip rate regulator

cognitive differences in entitlement

conflict between life and death orientation

the status of medical staff in the eyes of patients

barriers to communication caused by excessive defense

conflict between emotional labor and professional role

challenges and communication dilemmas regarding highly educated family members

conflict between emotional and rational decision-making

and internal friction of professional emotions. Four common themes were extracted

including separation of social rights and responsibilities in doctor-nurse-patient relationships

trust dilemmas among doctors

nurses

and patients in clinical contexts

decision-making dilemmas in medical settings

and stereotype triggering professional discrimination.

Conclusions

Four types of cultural differences

including intersubjective distance

defensive avoidance

monologue coping

and social discrimination

have a profound impact on the professional identity of nursing students during clinical practice. Clinical nursing educators may consider adopting dialogic teaching methods to improve the professional identity of nursing interns.

关键词

Keywords

references

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