社區醫院護理主管工作壓力與因應策略之關係研究

The Study on the Relationships between Job Stress and Coping Strategies of Nursing Managers among Community Hospitals

駱昭芬(Chao-Fen Lo)

指導教授 ： 馬震中 ； 郭光明

義守大學/醫學院/醫務管理學系/碩士(2015年)

https://doi.org/10.6343/ISU.2015.00112

摘要

背景與目的：社區醫院護理主管扮演複雜角色，面對外在工作要求及內在自我期許，護理主管承受極大工作壓力。護理主管工作壓力需關注，也須有適當因應策略，才能協助個人或組織有效因應醫院經營危機。然造成醫院護理主管工作壓力因素相當複雜，加上全國護理人力不足，執業環境不佳，社區醫院在新人招募日漸困難，更突顯護理主管承受極大壓力，因此，本研究主要目的為探討社區醫院護理主管所面臨工作壓力及其因應策略之關係，及各自包含哪些因素。
材料與方法：本研究採調查法，首先經文獻找出護理人員所面臨10個不同工作壓力來源與8個因應策略因素，以經驗證量表設計問卷初稿，並經三位專家(2位實務界1位學界)檢視/修訂問卷以提升內容效度，再以修訂後問卷進行小樣本前測及再修訂產生正式問卷，之後本研究取得南部某醫學中心人體試驗委員會核可(編號：10403-007)。研究樣本為高雄市及屏東縣市46家社區醫院護理主管，共發出302份問卷，回收231份有效問卷，有效問卷回收率76.5%。問卷回收後採用驗證性因素分析與典型相關分析來進一步分析，結果顯示各因素信度均符合Cronbach’s α > 0.7標準，且個別問項之交叉負荷量均高於0.7；而驗證性因素分析亦顯示本研究問卷具備足夠建構效度(各因素平均變異萃取量均大於0.7且各因素平均變異萃取量開根號值亦大於因素間相關係數)。
結果與結論：典型相關分析結果顯示主要典型函數(重疊百分比為59.08%)之典型相關係數為0.73，Wilk’s lambda = 0.17 (p<0.001)，而工作壓力來源與因應策略各因素顯著性則依據典型相關負荷量絕對值高於0.45標準判斷，在工作壓力來源方面顯著因素及其重要順序為不適當的情緒準備、死亡與臨終、工作量、病人及家屬、護理人力短缺、同儕支持、歧視、與醫師溝通、與上司的互動；而在因應策略方面顯著因素及其重要順序為自力更生、宿命、對抗性、支持、樂觀、姑息、情緒。此研究結果可反映出社區醫院護理主管面對工作壓力時情緒糾結與工作矛盾的內心感受大於生理負荷的血汗工作量；因應策略中以自力更生拔得頭籌，顯示護理主管在傳統體制苦行僧的勇敢面對。護理主管的心理與靈性關懷需被關注，面對挫折與失敗亦需協助。面對工作壓力時，應有良好因應策略，促進自我成長及帶領護理同仁邁向護理專業的康莊大道。

關鍵字

社區醫院 ； 因應策略 ； 護理主管 ； 工作壓力

並列摘要

Background and Purpose: Nursing managers play a complicated role in community hospitals. Facing external work requirements and internal self-expectations, nursing managers are under considerable job stress. The job stress of nursing managers demands attention, and appropriate coping strategies are required to help individuals or organizations cope with hospital management crises effectively. However, the factors resulting in job stress for hospital nursing managers are extremely complex. In addition, Taiwan has a shortage of nurses, and the working environment at hospitals is poor,thuscommunity hospitals are finding it increasingly difficult to recruit new nursing staff. This further highlights the incredible stress that nursing managers bear. Therefore, the main purpose of this study was to investigate the relationship between the job stress faced by community hospital nursing managers and their coping strategies as well as which factors are contained within these elements.
Materials and Methods:We adopted a survey methodology for this study. First, ten different sources of job stress and eight coping strategy factors for nurses were collected from the literature. We used a validated scale to craft the draft questionnaire. Three experts (two practitioners and one scholar) reviewed and revised the questionnaire to enhance its content validity. We then performed a small-sample pretest using the revised questionnaire before revising it further to create the final questionnaire. This study received ethics approval from an institutional review board of a medical center in southern Taiwan (Number: 10403-007). The sample for this study comprised the nursing managers of 46 community hospitals in Kaohsiung City, Pingtung County, and Pingtung City. A total of 302 questionnaires were issued and 231 valid questionnaires were recovered for a valid response rate of 76.5%. We used confirmatory factor analysis and canonical correlation analysis for analyzing the collected data. The results indicated that the reliability of each factor met the Cronbach standard of α > 0.7. Each of the individual items had cross loading higher than 0.7 criteria. Confirmatory factor analysis also revealed that our questionnaire had sufficient construct validity (the average variance extracted of each factor was higher than 0.7 and the square roots of the average variance extracted of each factor were also greater than the correlation coefficients between factors).
Results and Conclusions:The results of canonical correlation analysis indicate that the canonical correlation coefficient of the canonical function (the proportion of redundancy was 59.08%) was 0.73 and Wilk’s lambda = 0.17 (p < 0.001). The significance of the factors of sources of job stress and coping strategies all had absolute canonical correlation loadings higher than the judgment criteria of 0.45. Among the sources of job stress, the significant factors in order of importance were inadequate emotional preparation, death and dying, workload, patients and families, nursing manpower shortages, problems with peer support, discrimination, conflict with physicians, and problems with supervisors. Among coping strategies, the significant factors in order of importance were self-reliant, fatalistic, confrontational,supportive, optimistic, palliative, and emotive. The results of this study reflect that the job stress faced by community hospital nursing managers originates more from their inner feelings of emotional entanglement and work conflicts than it does from the physical stress of the effort demanded by workloads. Among the coping strategies, self-reliance came out on top, showing the ascetic courage of nursing managers when facing traditional hospital systems. The psychological and spiritual care for nursing managers demands attention. They also require assistance when facing frustration and failure. When facing job stress, nursing managers must have strong coping strategies to promote personal growth and to lead their nursing colleagues in stepping forward on the grand path of the nursing profession.

並列關鍵字

Community hospital ； Coping strategies ； Nursing manager ； Job stress

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