精神科護理人員工作特性及壓力與健康相關生活品質(SF-36量表)之關係性研究—醫院脈絡效果分析

A Study on the Relationship Among Job Characteristics, Occupational Stress and Health-Related Quality of Life (SF-36 scale) of Psychiatric Nurses—The Influence on Hospital Moderating Effects

詹雯婷(Wen-Ting Chan)

指導教授 ： 陳端容

國立臺灣大學/公共衛生學院/醫療機構管理研究所/碩士(2009年)

https://doi.org/10.6342/NTU.2009.02042

摘要

背景：工作壓力在健康照護領域中一直是很重要的議題。而精神科護理人員長期處於高危險及高度競爭的工作環境中，很容易直接或間接的工作壓力，導致對健康造成的負面影響或較高罹病風險。然而，過去相關研究大多著重在探討個人層次變項對壓力產生的健康狀況影響，而較少提及群體層次變項對健康的影響。
目的：探討精神科護理人員工作特性、工作壓力感受與自評健康狀況之關係性，並驗證群體層次(醫院)對個人層次(精神科護理人員)的影響。
方法：本研究採用行政院勞工安全委員會之「女性作業員工健康危害調查研究-醫護人員」計畫以及行政院衛生署國民健康局之「臨床醫護人員工作健康危害調查」計畫中部分精神科護理人員之樣本資料進行次級資料分析。對象為臺灣39家區域層級以上之綜合醫院及精神科醫院之精神科護理人員，有效樣本共計852份。研究工具為測量工作壓力之「付出-回饋失衡量表」及健康狀況調查的「台灣版IQOLA簡短36量表」，並以描述性統計、獨立樣本t檢定、單因子變異數和層級線性模型進行分析。
結果：
1.在個人層次變項方面，精神科護理人員的工作付出回饋失衡感受與身體疼痛、活力、心理健康構面達顯著負相關，其工作過度投入傾向則與一般健康、身體疼痛、活力、心理健康及社會功能構面皆達顯著負相關，另工作過度投入與付出回饋失衡之交互作用則僅與心理健康構面達顯著負相關。
2.在群體層次變項方面，精神科醫院護理人員的一般健康構面顯著優於綜合醫院精神科的護理人員，公立醫院精神科護理人員之心理健康構面顯著優於非公立醫院之精神科護理人員。
3.在階層線性模型之交互作用部分，僅醫院類別有正向干擾調節效果，即精神科護理人員在處於工作壓力造成其自評生理及心理健康狀況較差的情況下，其若任職於精神科醫院其壓力對健康的負面影響比任職於綜合醫院精神科的負面影響來得低。
討論：本研究透過跨層次的變項分析可進一步瞭解群體變項對個人層次變項的影響結果，除有助於後續研究者更深入的瞭解影響健康狀況因素間之關係外，更可提供後續研究者及醫院管理者在探討社會現象及內部管理時另一種角度的思維與視野。

關鍵字

工作壓力 ； 付出回饋失衡 ； 簡短36量表 ； 層級線性模型

並列摘要

Background：Job stress is an important issue in the field of healthcare. Psychiatric nurses work in long-term high-danger and highly competitive work environment. This might cause direct or indirect working pressure for the nurses, resulting in adverse health effects or higher-risk disease. However, earlier research often focused on the relationship of individual level variables, but paid less attention to the relationship of group level variables.
Objective: To investigate the relationship among job characteristic, job stress and self-assessment of health status in psychiatric nurses. Furthermore, it also verifies the influence of group-level (hospital) on individual level (psychiatric nurses).
Methods: A secondary data consists of the Council of Labor Affairs, Executive Yuan “Health hazard surveillance of female worker focusing on medical professionals" plan, as well as the Bureau of Health Promotion, Department of Health” Health hazard surveillance of medical Professionals" program. The questionnaires completed by psychiatric nurses from 39 regional hospitals or medical centers and psychiatric hospitals in Taiwan, a total of 852 samples were valid. Research tool for measuring the stress of job “Effort and reward imbalance scale (ERI scale)” and health survey of "Taiwan version IQOLA short scale 36".The data collected from the questionnaire is analyzed by methods of descriptive statistics, independent-samples t-test, one-way ANOVA, and Hierarchical Linear Modeling (HLM).
Results:
1.In the individual level variables, subjects’ efforts and reward imbalance (ERI) in work is significant negative correlation on body pain(BP) ,vitality(VT) and mental health(MH) three scales, and subjects’ over-commitment (OVC) in work showed significant negative correlation on general health (GH),body pain(BP) ,vitality(VT), mental health(MH) and social functioning(SF) five scales. Furthermore, in the interaction of ERI and OVC only showed significant negative correlation on mental health (MH) scale.
2.In the group-level variables, subjects’ general health (GH) scale in psychiatric hospital was significantly superior to subjects’ GH scale in the department of psychiatric in general hospital. And subjects’ mental health (MH) scale in public hospital who also significantly superior to ubjects’ MH scale in non-public hospitals.
3.In the interaction of HLM slope-as-outcome model, only hospital categories have moderating effects. That is, psychiatric nurses in the work pressure would cause their physical and mental health status of poor circumstances, if they employed in psychiatric hospitals, psychiatric nurses’ working pressure of the negative impact on health is lower than they worked in general hospital psychiatric department.
Discussion: In this study, through cross-level analysis of the variables can learn more about the influence of group level variables on individual level variables. Not only can help researchers have further understanding of the relationship between job stress and self-rated health status variables, but also can provide researchers and hospital managers a different point of view to explore the social phenomenon and internal management of organization.

並列關鍵字

Job stress ； Effort and reward imbalance (ERI) ； SF-36 ； Hierarchical Linear Modeling (HLM)

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