臺灣不同層級醫院之臨床護理人員其工作壓力源及心理健康之探討

Abstract

研究目的：了解臺灣臨床護理人員工作壓力源現況、比較不同層級醫院之臨床護理人員工作壓力源差異、比較不同層級醫院之臨床護理人員心理健康程度的差異。 研究方法：本研究以衛生福利部 2010-2013 年「新制醫院評鑑合格之醫院(含精神科)」為抽樣母群體，以內政部公布之全國北、中、南、東分區，以系統抽樣方式於各區有執業登記之全職臨床護理人員進行問卷發放。收案對象包含：醫學中心、區域醫院、地區醫院及精神科專科醫院之全職臨床護理人員。使用工具包含：護理工作壓力源量表、職場疲勞量表、簡式健康量表及個人基本資料等四大部份，以JMP 10.0 統計軟體進行資料分析。 研究結果：本研究共有 3,786 份問卷。參與研究之護理人員平均年齡為32.7歲(標準差7.3)，平均護理工作總年資為10.2 (標準差7.2)。近三個月班別以白班為主，班別制度以8 小時制為眾；平均每日工作9.1 小時(標準差1.2)，平均一週工作46.3 小時(標準差8.5)；8 小時班制者平均每日工作9 小時(標準差1.0)，平均每週工作46 小時；12 小時班制者平均每日工作12.7 小時，平均每週工作57.8 小時。護理工作壓力源總分平均值為63.3(標準差14.1)。以醫院層級分析量表各題項，發現各層級醫院之主要壓力源不盡相同，整體來看以「若同事間沒有良好的互動關係，我會很有壓力」、「病人可能有感染性疾病時(如SARS，AIDS 等)，我會很有壓力」、「必須承受病人或家屬的負向情緒讓我很有壓力」、「若須支援其他專科病房、我會很有壓力」、「工作帶來的相關責任，使我必須改變家庭活動的安排」等為百分比最高的五項，多屬於「職業危害」分量表之題項。參與研究的護理人員有34.8%身心狀況適應良好、33.4%有輕度心理困擾、24.8%有中度心理困擾、7%有重度心理困擾。有65.2%達常見精神疾患(如：失眠、焦慮症與憂鬱症等)篩檢之切割點。 結論與建議：高強度護理工作壓力源(壓力源總分≥72 分)於高個人疲勞、高對服務對象疲勞、常自覺壓力大及工作滿意度差等預測模式中皆達統計顯著差異。然各層級醫院之壓力源不盡相同，建議各級醫療院所可定期使用護理工作壓力源量表做為評估壓力源的工具，進而做為改善職場環境的參考依據。

Objective: The purpose of this study was to investigate general occupational stressor in nurses, and variation of occupational stressors and mental health status among nurses working in different level of hospitals. Methods: The study population was from all qualified hospitals of New Hospital Accreditation between 2010 and 2013. A cross-sectional questionnaire survey using systematic sampling method was performed in North, Central, South and East Taiwan. The participants were full-time nurses working in medical centers, reginal hospitals, district hospitals and psychiatry hospitals. The questionnaires included the following contents: The Nurses Occupational Stressor Scale (NOSS), occupational burnout inventory, Brief Symptom Rating Scale (BSRS-5) and demographics. The JMP version 10.0 statistical software was used for data analysis. Results: A total of 3,297 questionnaires were eligible for final analysis, response rate was 75.8%. The mean age was 32.7 years (SD 7.3), and the average work tenure was 10.2 years (SD 7.2). Most of them were on day shifts(8 hours). The mean working hour was 9.1 hours per day and 46.3 hours per week. For 8-hour shifts, the actual mean working hour was 9 hours per day and 46 hours per week, whereas for 12- hour shifts, the mean working hour was 12.7 hours per day and 57.8 hours per week. The mean NOSS score was 63.3 (SD 14.1). The major occupational stressors were different across hospitals, overall“poor workplace relationships with colleagues”,“the patient might have contagious disease, such as SARS and AIDS”,“having to bear negative sentiments of patients and/or of their relatives”,“having to be a substitute for other specialized units,”and“compulsory alteration of family activities due to work responsibilities,” were the most common occupational stressors, and most of them were classified as “Occupational Hazards” subscale of NOSS. Of all participants, 34.8% reported to be in good mental health, 34.3% reported to have minor mental disorders, 24.8% in moderate mental disorders and 7% in severe conditions. Nearly 2/3 (65.2%) of participants reached the cutpoint (BSRS-5 score≥6) for common mental disorders. Conclusions and Recommendations: This study identified that nurses with mean NOSS score of 25% tile (NOSS score≥72) were more likely to have personal burnout, client burnout, stress and job dissatisfaction. In summary, stressors are different across hispitals, periodically identify nusing stressors using NOSS and to improve working environment for nurses are warranted.