女性護理人員工作條件、組織社會心理對職業健康危害之影響

Abstract

研究目的：本研究目的主要以組織工作環境及組織社會心理層面，來探討女性護理人員發生職業健康危害（意外、針扎及割刺傷）之相關因素，並使用「付出回饋失衡模式」（Effort-reward imbalance）作為組織社會心理的評估工具。 研究方法：使用勞委會之「女性作業員工健康危害調查研究-醫護人員」以及國建局「臨床醫護人員工作健康危害調查」之部分調查資料，進行次級資料分析。研究對象為工作於區域醫院以上具有執照且從事臨床工作之護理人員，樣本共有12,990人。本研究先以兩階段的對數迴歸分析（two-stage logistic regression），用以探討組織制度環境、工作特性以及組織社會心理因素，對護理人員發生意外傷害與針扎及割刺傷的影響，再佐以路徑分析（path analysis）驗證「付出回饋失衡模式」（Effort-reward imbalance）中的中介效果，以及其他因素對職業健康危害的綜合影響程度。 結果：（一）影響意外傷害發生的因素，在迴歸分析的結果中，除了護理人員知覺的組織社會心理因素外，尚有作業環境不安全的組織環境、工作負荷重、工作控制低等。此外，在路徑分析的結果顯示，績效考核不適當的組織環境、工作負荷重、工作控制低等因素，亦會透過知覺的組織社會心理的作用，使護理人員發生意外傷害的機會較高。（二）影響針扎及割刺傷發生的因素，在迴歸分析的結果中，除了知覺的組織社會心理因素外，尚有作業環境不安全、績效考核制度不適當的組織環境、工作控制低等，此外，在路徑分析的結果顯示，績效考核不適當的組織環境、工作負荷重、工作控制低等因素，亦會透過知覺的組織社會心理因素的作用，使護理人員發生針扎及割刺傷的機會較高。（三）「付出回饋失衡」會對職業健康危害產生負面影響，且與「工作過度投入」存在交互作用。利用路徑分析的方式，所得到的結果可驗證「工作過度投入」在「付出回饋失衡」對職業健康危害的影響中具有中介效果。 結論與建議：影響護理人員發生職業健康危害的原因，除了常被提及的物理環境或器材設備因素外，其工作的組織制度環境、工作條件以及知覺的組織社會心理狀態亦會對職業健康危害造成影響，因此建議應定期監測工作場所安全，並檢視護理人員的工作內容與評估工作負荷量，加強注重護理人員心理層面的需求。

Objectives：This study is aiming at the causes for occupational hazards among female nurses: accidents, needle stick and cutting injuries, with focusing on the aspects of work conditions and psychosocial environment. The “Effort-reward imbalance” model and its questionnaire were used for evaluating the psychosocial environment. Method:A secondary data consists of a national survey on nurses, conducted by the Commission on Labors, and a national survey on clinical professionals was used for analysis. The target population is clinical nurses who work in regional hospitals or medical centers. There was a total of 12,990 respondents completed the questionnaire. The author used two-stage logistic regression to investigate the impact from organizational environment, work characteristics, as well as psychosocial environment to the causes for accidents, needle stick or cutting injuries. A path analysis was adopted for testing the mediating effect from “Effort-reward imbalance” and to verify the combined impact from other occupational hazard factors. Result：According to the result of regression analysis, “psychosocial environment”, “unsafe work environment”, “heavy work loadings”, and ”lower work controls” are found to be related with the causes for accidents. Besides, the result of path analysis shows that through the effect of psychosocial environment, nurses who answered “working in hospitals with improper performance evaluation”, “heavy work loadings” , and ”lower work controls” tend to have higher chances in occurrence of accidents. “Psychosocial environment”, “unsafe work environment”, “improper performance evaluation”, and ”lower work controls” are found to be related with the causes for needle stick or cutting injuries. Through the effect of psychosocial environment, nurses who answered” working in hospitals with improper performance evaluation”, “heavy work loadings” , and ”lower work controls” tend to have higher risk in experiencing needle stick or cutting injuries. Nurses who suffered from “Effort-reward imbalance” have higher risk in experiencing occupational hazards than others, and an interaction between “Effort-reward imbalance” and “Over commitment” exists. Through path analysis, the result shows that “Over commitment” has a mediating effect on the impact of occupational hazard from “Effort-reward imbalance”. Conclusion：Except well-known factors such as physical environment and facilities, the organizational environment, work conditions, and psychosocial environment are all factors related to the causes of occupational hazards. Thus, hospitals are suggested to monitor their workplace safety regularly, to re-evaluation work contents and work loading for nurses, and to give more attention on responding nurses’ psychological needs.