醫療機構倫理氛圍與醫療人員過勞的關係

Abstract

簡介：組織倫理氛圍定義為：「組織內部成員所共同感受到在組織內可接受的行為、關係、權力及倫理準則。」組織倫理氛圍也意指：「受雇者所感受的在其公司內對或錯的覺察，而不是寫成文字的條文。」本研究的目標在於測試以下4個假設：(1) 健康照護機構的組織倫理氛圍與個人過勞有關；(2) 健康照護機構的組織倫理氛圍與工作相關的過勞有關；(3) 健康照護機構的組織倫理氛圍與委託人相關的過勞有關；(4) 健康照護機構的組織倫理氛圍與過度承諾的過勞有關。

研究方法與研究素材：本研究是一個多中心研究。招募了5個醫療機構的內科部的主治醫師、住院醫師及護理師參與本研究。只要願意參與本研究，由研究倫理委員會審查通過的研究參與知情同意書、倫理氛圍問卷、哥本哈根過勞問卷及資料蒐集問卷即給參與者填寫。所有資料將被輸入於Excel檔案中，資料輸入的正確性也被驗證。採用探索式因素分析對兩份問卷進行分析，用Pearson’s correlation coefficient or Spearman’s correlation coefficient統計方式量測兩個變數之間的線性關係。採用多變數線性迴歸分析以量測5種組織倫理氛圍與4種過勞的關係。

結果：本研究呈現了健康照護人員所感受到關懷組織倫理氛圍統計上相關於較少的個人的過勞 (coefficient = -0.1604, p value = 0.012)、較少的工作相關的過勞 (coefficient = -0.1604, p value = 0.012) 及較少的過度承諾相關的過勞 (coefficient = -0.1540, p value = 0.018)。健康照護人員所感受到功利主義組織倫理氛圍統計上相關於較多的個人的過勞 (coefficient = 0.1158, p value = 0.035)、較多的工作相關的過勞 (coefficient = 0.1173, p value = 0.031) 及較多委託人相關的過勞 (coefficient = 0.1425, p value = 0.002)。健康照護人員所感受到監管組織倫理氛圍統計上相關於較少的工作相關的過勞 (coefficient = -0.1919, p value = 0.020) 及較少的委託人相關的過勞 (coefficient = -0.2371, p value = 0.001)。

結論：培養適切、正向組織倫理氛圍的策略對於消弭健康照護人員的過勞有所助益。健康照護機構的領導者應該要透過培養關懷、監管組織倫理氛圍，避免培養功利主義組織倫理氛圍，以降低健康照護人員的過勞。

Introduction

Organizational ethical climate is defined as “a shared perception by operational officers of acceptable behavior, relationships, use of power, and ethical standards within an organization, without a written announcement.” It also implies “a state where employees possess a sense of what is right and wrong in their company without an expressed order or a written set of rules.” The objectives of this study were to test the following four hypotheses: (1) Healthcare organizational ethical climate is significantly associated with personal burnout; (2) Healthcare organizational ethical climate is significantly associated with work—related burnout; (3) Healthcare organizational ethical climate is significantly associated with client—related burnout; and (4) Healthcare organizational ethical climate is significantly associated with over—commitment burnout.

Materials and Methods

This was a multi-center study. Attending physicians, house officers and practicing nurses of Department of Internal Medicine from five healthcare organizations were purposefully recruited. As long as they agreed to participate in this study, an informed consent form approved by research ethical committees, the Ethical Climate Questionnaire, the Copenhagen Burnout Inventory, and data collection form were distributed to them, and returned after completely filled out to the local co-principal investigators and the principal investigator for data entry. All data entry was done by entering to an excel file. Those excel files were verified for its accuracy. Exploring factor analysis was conducted to validate the two questionnaires. The relationship between two variables was examined using Pearson’s correlation coefficient or Spearman’s correlation coefficient depending upon the scale of the two variables. Multivariate linear regression analysis was applied to explore the relationship between the independent variables of interest (the five organizational ethical climates) and the dependent variables (the four types of burnouts) after controlling for other confounding variables.

Results

This study showed that: the organizational ethical climate of Caring perceived by the healthcare workers was significantly associated with less Personal Burnout (coefficient = -0.1604, p value = 0.012), less Work-related Burnout (coefficient = -0.1604, p value = 0.012), and less Over-commitment Burnout (coefficient = -0.1540, p value = 0.018); the Instrumental organizational ethical climate perceived by the healthcare workers was significantly associated with more Personal Burnout (coefficient = 0.1158, p value = 0.035), more Work-related Burnout (coefficient = 0.1173, p value = 0.031), and Client-related Burnout (coefficient = 0.1425, p value = 0.002); and the organizational ethical climate of Laws and Codes perceived by the healthcare workers was significantly associated with less Work-related Burnout (coefficient = -0.1919, p value = 0.020) and less Client-related Burnout (coefficient = -0.2371, p value = 0.001).

Conclusion

The strategies to cultivate appropriate organizational ethical climates, i.e. the organizational ethical climate of Caring, and the organizational ethical climate of Laws and Codes, contribute to relieving the healthcare workers’ various burnouts. The leading authorities of a healthcare organization should take care of the organization’s healthcare workers by getting rid of cultivating the Instrumental organizational ethical climate, and enhancing the positive organizational ethical environment by cultivating the organizational ethical climates of Caring, and Laws and Codes, which motivate the healthcare workers to stay within the organization without burnout.