長期照顧機構護理人員之賦權、個人效應及留職意願模式之建構

近年來國內長期照護的需求隨著人口老化、疾病型態的改變、社會環境變遷而日益增多。護理人員是長期照顧機構主要服務提供者。本研究的目的為建構長期照顧機構護理人員賦權、個人效應及留職意願的因果模式，主要以Kanter組織權力理論為架構，探討長期照顧機構護理人員對組織賦權、心理賦權、組織承諾、工作滿足感、倦怠的感受及留職意願。本研究為橫斷性研究，採調查法，以高雄縣市護理之家與安養護機構的326位護理人員為研究對象。研究工具包括：人口學資料、組織賦權量表、心理賦權量表、組織承諾量表-價值承諾次量表、工作滿足感量表-外在滿足次量表、職業倦怠量表-情緒耗竭次量表及留職意願量表。統計方法採用百分比、平均值與皮爾森積差相關分析，以及驗證性因素分析與結構方程模式，最後建立長期照顧機構護理人員留職意願因果模式。研究結果得知，長期照顧機構護理人員賦權、個人效應與留職意願因果模式的χ2=553.233，df=287，p<0.01，CFI=0.949、RMSEA=0.053、SRMR=0.059，整個模式的適配度均達可以接受的標準，顯示此模式是適當的。由模式中得知，「組織承諾」（β=0.366, p<0.01）及「工作滿足感」（β=0.304, p<0.05）對「留職意願」有顯著的正向直接效果，而「倦怠」（β=-0.254, p<0.001）對「留職意願」有顯著的負向直接效果。「心理賦權」對「組織承諾」（β=0.205, p<0.01）與「工作滿足感」（β=0.201, p<0.05）有正向直接效果，但「心理賦權」對「倦怠」未有顯著的效果（β=-0.132, p>0.05）。「組織賦權」對「心理賦權」（β=0.728, p<0.001）、「組織承諾」（β=0.180, p<0.05）與「工作滿足感」（β=0.534, p<0.001）皆有正向直接效果，「組織賦權」對「倦怠」則未達顯著效果（β=-0.187, p>0.05）；「工作滿足感」對「組織承諾」有顯著正向直接效果（β=0.631, p<0.001）。「組織賦權」對「留職意願」的總間接效果為0.556；「心理賦權」對「留職意願」的總間接效果為0.216。模式中所有的變項能解釋56.1%留職意願的變異量。本研究結果將可做為提升長期照顧機構護理人員留任措施之參考。

關鍵字

長期照護；護理人員；留職意願；組織賦權；心理賦權；組織承諾；工作滿足感；倦怠

並列摘要

A Model of Nurses’ Empowerment, Personal Impacts and Intention to Stay in the Long-Term Care Institution The purpose of this study was to model nurses’ empowerment, personal impacts and intention to stay in the long-term care institution. The hypothesized theory was adapted from Kanter’s structural power theory, and to investigate structural empowerment, psychological empowerment, burnout, job satisfaction, organizational commitment and intention to stay of long-term care institution nurses. This research was conducted using a cross-sectional survey on long-term care institution nurses of Kaohsiung area. A total of 326 nurses were comprised in our study samples. The structured questionnaires included demographic data, structural empowerment scale, psychological empowerment scale, emotional exhaustion subscale of burnout scale, extrinsic satisfaction subscale of job satisfaction scale, value commitment subscale of organizational commitment scale and intention to stay scale. The statistical package SPSS 15.0 was employed for the descriptive data analyses. Confirmatory factor analysis was used to test the validity of each scale. And the hypothesized causal model was tested by the structural equation modeling using Mplus 5.1 software. We found that organizational commitment (β=0.366, p<0.01), job satisfaction(β=0.304, p<0.05) and burnout (β=-0.254, p<0.001) had significant direct effect on intention to stay. Psychological empowerment had significant direct effect on organizational commitment (β=0.205, p<0.01) and job satisfaction(β=0.201, p<0.05), however, psychological empowerment had not significant direct effect on burnout (β=-0.132, p>0.05). Structural empowerment had significant direct effect on psychological empowerment (β=0.728, p<0.001), organizational commitment (β=0.180, p<0.05) and job satisfaction (β=0.534, p<0.001), but structural empowerment had not significant direct effect on burnout (β=-0.187, p>0.05). Job satisfaction had significant direct effect on organizational commitment (β=0.631, p<0.001). Structural empowerment (0.556, p<0.001) and psychological empowerment (0.216, p<0.001) had significant indirect effect on intention to stay. The goodness-of-fit indices indicated the model best fit and the constructs included in the model accounted for 56.1% variance of intention to stay. The findings of this study provide a reference and guildlines for intervention program to promote nurses retain in long-term care institutions.

並列關鍵字

long-term care ； nurse ； intention to stay ； structural empowerment ； psychological empowerment ； burnout ； job satisfaction ； organizational commitment