臺灣不同科別之臨床護理人員其工作壓力源與心理健康探討

The relationship between occupational stress and mental health among nurses working in different hospital units

陳宜傳(Yi-Chuan Chen)

指導教授 ： 蕭淑銖

國立臺灣大學/醫學院/護理學研究所/碩士(2015年)

https://doi.org/10.6342/NTU.2015.00935

摘要

研究目的：了解臺灣臨床護理人員工作壓力現況，分析不同科別的臨床護理人員工作壓力源差異，並比較不同科別臨床護理人員的心理健康程度差異。

研究方法：本研究以衛生福利部2010-2013年「新制醫院評鑑合格之醫院(含精神科) 」為抽樣母群體，以內政部之全國北中南東分區，以系統抽樣方式於各區抽取有執業登記之全職臨床護理人員，以郵寄方式進行問卷發放。收案對象包含：一般病房、產兒科病房、急性精神病房、慢性精神病房、加護病房、門診、手術室、急診、血液透析室、呼吸照護中心與其他工作科別之護理人員。問卷內容包括：護理工作壓力源量表、職場疲勞量表、簡式健康量表與個人基本資料等四大部份，並以JMP10.0統計軟體進行分析。由描述性統計呈現個人資料變項、護理工作壓力源、心理健康狀態、自覺工作壓力表現與離職傾向的分布情形，再以羅吉斯迴歸(logistic regression)分析臨床護理人員的離職傾向相關因素。

研究結果：本研究共回收1,867份有效問卷(回收率79.3%)。參與研究的護理人員平均年齡為33.5歲(標準差7.4)，平均目前工作年資為7.6年(標準差6.4)，平均臨床護理工作總年資為10.9(標準差7.3)。近三個月主要工作班別為白班，工作單位屬8小時班制者，平均每日工作時數8.7小時，平均一週工作45.2小時；工作單位屬12小時班制者，平均每日工作12.4小時，平均一週工作57.3小時。護理工作壓力源量表總分平均值為61.7(標準差14.1)，以工作科別分析量表各題時，得不同科別之主要工作壓力源相異，又以「須承受病人或家屬的負向情緒」、「醫師的情緒性言語」、「因工作責任，須改變家庭活動安排」、「須支援其他專科病房」、「同事間沒有良好的互動關係」以及「病人可能有感染性疾病(如SARS，AIDS等)」為多數科別平均值達3分以上的工作壓力源，且多屬於「職業危害」分量表之題項。參與研究的護理人員中，僅4.2%身心狀況適應良好，34.3%有輕度心理困擾，24.4%有中度心理困擾，7.1%為重度心理困擾。

結論與建議：護理工作壓力源量表總分屬於前20%(≧72分)者，於自覺壓力表現的預測模式中，發生高個人疲勞、高對服務對象疲勞、有心理困擾、常自覺壓力大、工作滿意度差的機率，以及離職意圖遠高於非前20%者。護理工作壓力源因工作科別不同而有差異。一般病房顯著的護理工作壓力源多與職業危害及負荷過重有關；急診獨特的護理工作壓力源則為「工作時遭遇心理暴力」。護理人員的心理困擾程度因工作科別不同而有所差異，建議醫療院所可定期使用護理工作壓力源量表評估工作壓力程度與分析護理工作壓力源，作為改善職業環境的參考。

關鍵字

護理人員 ； 護理工作壓力源量表 ； 工作壓力源 ； 心理健康 ； 工作科別

並列摘要

Objective: The purpose of this study was to investigate general occupational stress in nurses, and variation of occupational stressors and mental health status among nurses working in different hospital units.

Methods: The study population was all qualified hospitals of New Hospital Accreditation between 2010 and 2013. A cross-sectional questionnaire survey using systematic sampling method was performed in North, Central, South and East Taiwan. Questionnaires were delivered to the study hospitals units including general wards, gynecology and pediatric wards, acute psychiatric wards, chronic psychiatric wards, intensive care units, outpatient department, operating room, emergency department, dialysis center, respiratory care unit and others. The questionnaires include the Nurse Occupational Stressor Scale (NOSS), occupational burnout inventory, Brief Symptom Rating Scale (BSRS-5) and demographics. The JMP version 10.0 statistical software was used for data analysis. Descriptive statistics include demographics, distribution of nursing occupational stressors, mental health status, expressions of occupational stress and intention to leave. Logistic regression was used to identify the predictive factors for nurses’ intention to leave their jobs.

Results: A total of 1,867 questionnaires were eligible for final analysis, resulted a high response rate of 79.3%. The mean age was 33.5 years (SD 7.4), and the average work tenure was 10.9 years (SD 7.3). The average working hour per day was 8.7 hours and 45.2 hours per week in 8-hour shifts. In 12- hour shifts, the average working hour per day and per week were 12.4 hours and 57.3 hours. The mean NOSS score was 61.7 (SD 4.1). The major occupational stressors were different across units. “having to bear negative sentiments of patients and/or of their relatives,” “emotional wording of physicians,” “compulsory alteration of family activities due to work responsibilities,” “having to be a substitute for other specialized units,” “poor workplace relationships with colleagues,” and “the patient might have contagious disease, such as SARS and AIDS” were the most common occupational stressors, and of which were classified as “Occupational Hazards” subscale of NOSS. Of all participants, 4.2% self-reported to be in good health, while 34.3% reported to have minor mental disorders associated with depression and anxiety, and 7.1% in severe condition.

Conclusions and Recommendations: Nurses with mean NOSS score of 20% tile (≧72) were more likely to have personal burnout, client burnout, psychiatric morbidity, stress, job dissatisfaction, and intention to leave. The nursing occupational stressors were different across hospital units. The significant stressors of general wards were associated with occupational hazards and workload. The unique stressor of emergency department was “psychosocial harassment at work”. In summary, mental health status of nurses were different across hospital units, periodically identify nursing stressors using NOSS and to to improve working environment for nurses are warranted.

並列關鍵字

nursing staff ； the Nurse Occupational Stressor Scale (NOSS) ； occupational stress ； mental health ； hospital units

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