大專校院護理師COVID-19防疫支援之探討

Abstract

背景：嚴重特殊傳染性肺炎（Coronavirus Disease-2019, COVID-19）於全世界大流行後，疫情下校園護理師（下稱校護）工作量及工時急遽增加，在長時間的高壓環境下會造成心理健康負面影響，若無良好支持系統，將產生職業倦怠；學校為人口密集場所，校園傳染病防治工作為校園護理師主要工作之一，國內外卻鮮少有研究關注校護所需的防疫支援以及造成職業倦怠的相關因素。檢視校護在面對傳染病時所獲得的防疫支援情形及會引發職業倦怠之相關因素，可為主管機關未來制定支援政策提供參考，以建立正向的執業環境，讓校護能夠在防疫工作中感受到其專業價值、被重視的需求和心靈上的關懷。 目的：本研究旨在探討大專校院護理師個人背景及經驗、學校工作現況、心理健康情形、COVID-19防疫經驗與自覺所獲得的防疫支援，其中防疫支援分別是從人力（staff）、用物設備（stuff）、空間（space）、系統（systems）四構面層面探討，同時探討職業倦怠情形與上述變項之相關性。 方法：本研究採橫斷式研究，以大專校院護理師為對象，使用結構式自填問卷，題項包括背景及經驗、學校特徵、COVID-19防疫經驗、心理健康、所獲得的防疫支援及職業倦怠。採用「廣泛性焦慮量表」（Generalized Anxiety Disorder 7–Item, GAD-7）、「病人健康問卷」（Patient Health Questionnaire-2, PHQ-2）評估心理健康狀況，職業倦怠評估工具則為「倦怠量表」（Maslach Burnout Inventory, MBI）；自覺獲得的防疫支援則以自擬之「因應COVID-19防疫護理師防疫支援查檢表」進行評估。 結果：本研究共收集223份問卷，其中215份為有效問卷，年齡最多是40-49歲、已婚有子女同居住者多、教育程度以大學畢業為主，且校護年資5年以下居多。在校護自覺獲得防疫支援中，認為較少得到的支援為「人力」、「自動化防疫設施」、「所需空間支援」、「地方機關即時提供協助」、「外語版本衛教資料」，心理健康情形以輕度焦慮程度者居多、憂鬱程度亦是無或輕微憂鬱程度為主，全體樣本中53%的校護自評達不同程度的職業倦怠，多元逐步羅吉斯迴歸發現職業倦怠風險因素共17項，模型之曲面下面積為0.969，具有充分之解釋力，大專校護職業倦怠與因應疫情之防疫支援有關，其中重要的防疫支援因素包含「地方機關適切且即時提供防疫需要的幫助或資訊」、「執行校園防疫所需要的自動化防疫設施能充分取得」及「執行校園防疫期間，其他常規業務被允許降載」等因素。 結論：在COVID-19疫情下重啟校園，大專校院護理人員工作量增加，易感人力不足，需延長工作時間或下班後仍需工作，當獲得的防疫支援不足時，容易導致職業倦怠感受。本研究發現防疫支援和同儕支持與職業倦怠呈顯著負相關，而焦慮和憂鬱情緒與職業倦怠呈顯著正相關，因此提供適切充裕的防疫支持至關重要；而防疫支援可從人力、物資、空間和系統四個構面來提供完整資源。

Background: After the global pandemic Coronavirus Disease 2019 (COVID-19), school nurses' workload and working hours have increased sharply under the epidemic, which will cause adverse mental health in a long-term high-pressure environment. Without a sound support system, burnout may occur. Schools are densely populated places, and the prevention and control of campus infectious diseases is one of the main tasks of school nurses. However, more domestic and international research should focus on the necessary epidemic prevention support for school nurses and the related factors contributing to professional burnout. Therefore, examining the support provided to school nurses in dealing with infectious diseases and identifying the factors that may lead to professional burnout can serve as a reference for future policy development. This can help establish a positive working environment where school nurses can feel their professional value, acknowledge their needs, and receive emotional support. Purposes: This study investigates the personal background and experiences, the current work situation, mental health status, COVID-19 prevention experiences, and perceived level of prevention support. The epidemic prevention support will be explored in four dimensions: Staff, Space, Stuff, and Systems. The study also aims to explore the correlation between professional burnout and the abovementioned variables. Method: This study utilizes a cross-sectional research design and targets nursing professionals in higher education institutions. A structured self-administered questionnaire is used. The questionnaire includes background and experiences, school characteristics, COVID-19 prevention experiences, mental health, perceived epidemic prevention support, and professional burnout. The Generalized Anxiety Disorder 7-Item (GAD-7) scale and the Patient Health Questionnaire-2 (PHQ-2) are used to assess mental health status. The Maslach Burnout Inventory (MBI) is employed to evaluate professional burnout. Perceived epidemic prevention support is set by the "COVID-19 Nursing Professional Epidemic Prevention Support Checklist." Results: The study collected 223 questionnaires, and 215 were valid. The participants were mostly 40-49 years old, married with children, and had a university degree. Additionally, most school nurses had less than five years of experience. Among the prevention support received by school nurses, the less supported aspects were "staffing," "automated epidemic prevention facilities," "required spatial support," "immediate assistance provided by local authorities," and "educational materials in foreign languages." The mental health situation was dominated by mild anxiety and no or mild depression, and 53% of the school nurses in the whole sample self-rated them as having varying degrees of burnout. Multiple stepwise logistic regression found 17 factors associated with burnout, and the area under the curve was 0.969, which had sufficient explanatory power. College nurses’ burnout was related to epidemic prevention support in response to the epidemic. Among the critical epidemic prevention support factors, such as "local authorities provide appropriate and real-time assistance or information for epidemic prevention,” "sufficient access to automated epidemic prevention facilities required for campus epidemic prevention,” and "other routines are allowed to be limited during the pandemic period.” Conclusions: In the context of the COVID-19 pandemic, the reopening of campuses has led to a rapid increase in workload for nursing professionals in higher education institutions. Many school nurses feel they must be more staffed and consistently face increased work demands due to the epidemic. This often requires them to extend or continue working after regular hours. Insufficient epidemic prevention support can easily contribute to professional burnout among most nursing professionals in higher education institutions. This study found a significant negative correlation between perceived epidemic prevention support, peer support, and professional burnout among school nurses. At the same time, there was a significant positive correlation between anxiety, depression, and professional burnout. Therefore, providing adequate and comprehensive epidemic prevention support is crucial. Such consent can be provided through staff, stuff, space, and systems, addressing all four dimensions. Ensuring appropriate and sufficient epidemic prevention support is vital in alleviating the burden on nursing professionals and mitigating the risk of professional burnout. By addressing the needs of school nurses and providing comprehensive support, including both resources and peer support, educational institutions can foster a positive work environment and enhance the well-being of nursing professionals in the face of ongoing pandemic challenges.