护理管理风格对护士职业健康影响的范围综述

A Scoping Review of the Impact of Nursing Management Styles on Nurses’ Occupational Health

摘要: 目的：护士职业健康问题日益严峻，现有干预多聚焦个体层面，而作为组织层面关键变量的护理管理风格尚未得到系统性整合。本研究旨在系统归纳护理管理风格类型、总结护士职业健康结局指标、分析二者关系及作用机制。方法：采用范围综述，遵循JBI指南，系统检索PubMed、Web of Science、CINAHL、CNKI及万方数据库。纳入以护士为研究对象、探讨护理管理风格与职业健康关系的原始研究及系统综述/Meta分析。结果：共纳入33篇文献，识别出16种管理风格(包括变革型、真诚型、交易型、授权型、参与型、伦理型、权威型、放任型、官僚–控制型、支持–创新型、多元领导风格、护士长领导行为/领导力、领导信任等)及16项职业健康结局(工作满意度、职业倦怠、工作投入、敬业度、组织承诺、工作绩效、离职意愿、留任率、出勤主义、工作压力、心理困扰、抗逆力、幸福感、护理质量、心理健康、一般健康)。主要发现：① 积极领导风格(特别是变革型与真诚型)通过心理授权、组织氛围、工作环境、患者安全文化等中介机制，稳健正向促进护士工作满意度、工作投入、工作绩效、留任率及抗逆力，并抑制职业倦怠与离职意愿；② 交易型领导的积极效应显著弱于变革型领导，而放任型、权威型、官僚–控制型等消极风格则持续损害护士健康；③ 授权型领导与伦理型领导对特定结局具有独特保护作用，前者显著提升护士抗逆力，后者通过降低工作不安全感减少出勤主义。系统综述与Meta分析一致支持上述结论。结论：本研究系统构建了护理管理风格与多维度职业健康结局的关系框架，明确了变革型与真诚型领导作为首要干预靶点的高证据等级，并揭示了消极领导风格的系统性危害。该成果为护理管理实践提供了从个体干预向组织系统变革转型的理论依据，建议医院管理层优先培养积极领导风格、建立识别与消除消极领导行为的机制，并开展纵向及跨文化研究以验证因果关系与文化调节效应。

Abstract: Objective: The issue of nurses’ occupational health is becoming increasingly serious. Existing interventions predominantly focus on the individual level, whereas nursing management styles, as key organizational-level variables, have not been systematically synthesized. This study aims to systematically categorize nursing management styles, summarize nurses’ occupational health outcome indicators, and analyze the relationships and underlying mechanisms between the two. Methods: A scoping review was conducted following the JBI guidelines. Systematic searches were performed in PubMed, Web of Science, CINAHL, CNKI, and Wanfang Database. Original studies and systematic reviews/meta-analyses that focused on nurses as participants and examined the relationship between nursing management styles and occupational health were included. Results: A total of 33 articles were included, identifying 16 management styles (including transformational, authentic, transactional, empowering, participative, ethical, authoritarian, laissez-faire, bureaucratic-controlling, supportive-innovative, multiple leadership styles, head nurses’ leadership behaviors/leadership, trust in leadership, etc.) and 16 occupational health outcomes (job satisfaction, burnout, work engagement, dedication, organizational commitment, job performance, turnover intention, retention rate, presenteeism, work stress, psychological distress, resilience, well-being, quality of care, mental health, and general health). Key findings: ① Positive leadership styles (particularly transformational and authentic leadership) robustly and positively promote job satisfaction, work engagement, job performance, retention, and resilience, while suppressing burnout and turnover intention, through mediating mechanisms such as psychological empowerment, organizational climate, work environment, and patient safety culture; ② The positive effects of transactional leadership are significantly weaker than those of transformational leadership, whereas negative styles such as laissez-faire, authoritarian, and bureaucratic-controlling leadership consistently impair nurses’ health; ③ Empowering and ethical leadership confer unique protective effects on specific outcomes—the former significantly enhances nurses’ resilience, while the latter reduces presenteeism by decreasing job insecurity. Systematic reviews and meta-analyses consistently support the above conclusions. Conclusion: This study systematically constructs a framework of the relationships between nursing management styles and multidimensional occupational health outcomes, identifies transformational and authentic leadership as high-evidence-level priority intervention targets, and reveals the systematic harms of negative leadership styles. These findings provide a theoretical basis for shifting nursing management practice from individual-level interventions to organizational-level systemic change. It is recommended that hospital administrators prioritize cultivating positive leadership styles, establish mechanisms for identifying and eliminating negative leadership behaviors, and conduct longitudinal and cross-cultural studies to verify causal relationships and cultural moderating effects.