正念介入措施對護理師情緒、專業生活品質、自我慈悲、和睡眠品質成效之研究

Effects of mindfulness interventions on the emotions, professional quality of life, self-compassion, and sleep quality of nurses

王淑貞(Shu-Chen Wang)

指導教授 ： 胡文郁

國立臺灣大學/醫學院/護理學研究所/博士(2019年)

https://doi.org/10.6342/NTU201901041

摘要

研究背景
第一線護理人員兼具在照顧病人的病苦，自己也須面對工作的壓力情境，如果沒有調適好自己的身心，有可能會陷入負向的情緒中。
主要研究目的
1.測試以正念介入措施不同方案對護理人員正念程度、情緒、專業生活品質、自我慈悲和睡眠品質成效。
2.探索護理人員在正念介入措施歷程中的感受。
3.探索接受正念介入措施後對護理人員的主觀改變與對課程的建議。
研究方法
本研究分為二階段，第一階段為前驅測試，調查某醫學中心護理人員情緒分佈。第二階段為混合性研究，採量性和質性研究同步程序。以臺灣某醫學中心62位護理人員為研究對象，量性研究方法採類實驗研究，共分二組實驗介入組及一組無介入對照組。二組正念介入措施分別為五週正念介入組及五週引導式正念呼吸組，三組在介入前測、介入後每週測量1次、及介入三個月後測，共7次測試。研究工具包括人口學基本資料、止觀覺察注意量表、專業生活品質量表、自我慈悲、及匹茲堡睡眠品質量表。統計方法採用無母數分析Kruskal-Wallis test和Wilcoxon Signed-rank test檢定及廣義估計方程式。質性研究採深入訪談，質性資料採主題分析方法，共六個步驟，以歸納法分析主題。
研究結果
結果顯示，女性護理人員慈悲滿足和次發創傷壓力高於男性（p< .05），睡眠也較男性差（p< .05）;已婚者正念程度高，自我關愛、共同人性、自我批判、隔離程度、和過度認同都較單身者高（p< .05）;有輪班者的自我關愛、共同人性都較無輪班者高（p< .05）;碩士畢業者的正念程度較專科畢業者低，大學畢業者的睡眠品質較專科畢業者差（p< .05）;年紀越輕者和年資越長者越不會過度認同和隔離（p< .05），睡眠也較好（p< .05）。介入前後改變的差異，在正念程度以引導式正念呼吸組進步最多，正念介入組次之。專業枯竭和焦慮以正念介入組改善最多。
三組在介入措施後，從T0至T5的改變及T0至T6的改變，在正念介入組除了自我慈悲的共同人性和正念沒有變化之外，其他MAAS, ProQOL, DASS, PSQI皆有成效，但自我關愛在T5有下降的現象。在引導式正念呼吸組在正念、專業枯竭、壓力、自我慈悲及睡眠品質有顯著效果。
質性和量性混合分析，二組正念介入後在正念、自我慈悲和睡眠都有改變，從質性資料也顯示護理人員在覺察力、自我慈悲、及慈悲同理實務和睡眠改變的經驗。
結論
護理人員對於壓力情境有自我調適的方式，但短時間正念訓練除了對護理人員有調整情緒的作用，而且對於壓力事件的轉念，讓護理人員更能提供慈悲照護及對護理的覺知與認同產生正向觀點。研究也發現護理人員面對當下的壓力，最常運用深呼吸，讓自己暫停在當下，沈澱自己的情緒，然後做出回應。不過因為三班排班及身體疲累，影響到護理人員的參與意願及練習的動力，未來研究建議，可以運用短時間，且方便護理人員參與的線數位上課程或是智慧手機的運用，以方便護理人員參與及練習。

關鍵字

正念介入措施 ； 引導式正念呼吸 ； 慈悲 ； 專業生活品質 ； 睡眠品質

並列摘要

In addition to being subjected to the toil of caring for patients suffering from diseases, primary nurses are often faced with stressful situations at work. If primary nurses are unable adapt to the stressful situations physically and psychologically, they are likely to become trapped in negative emotions, which may in turn lead to compassion fatigue and burnout.
Main purpose
1. To examine the effects of different mindfulness interventions on the mindfulness level, emotions, professional quality of life, self-compassion, and sleep quality of nurses.
2. To explore the feelings experienced by nurses during the mindfulness interventions
3. To explore the subjective changes perceived by the nurses after receiving the mindfulness interventions, and their suggestions for the intervention program.
Study method
This study was divided into two stages. The first stage was a pilot study that focused on examining the level of the depression, anxiety, stress (DASS) in nurses. The second stage was a mixed-mode study in which both quantitative and qualitative research data were collected simultaneously. The sample for this mixed-mode study consisted of 62 nurses from a Taiwanese medical center. A quasi-experimental study design was adopted for the quantitative research. This study had two experimental intervention groups and one nonintervention control group. The mindfulness-based interventions administered to each of the experimental intervention groups were 5-week mindfulness-based intervention (MBI) and 5-week guided respiration mindfulness therapy (GRMT). The measurement tools used in this study were a demographic questionnaire, the Mindful Attention Awareness Scale (MAAS), the Professional Quality of Life Scale (ProQOL), the Self-compassion Scale, and the Pittsburgh Sleep Quality Index (PSQI). For the quantitative data analysis, nonparametric analysis methods such as the Kruskal-Wallis test, the Wilcoxon Signed-rank test, and the Generalized Estimating Equation test were used. For the qualitative study, data were collected through in-depth interviews. In terms of the qualitative data analysis, a six-step thematic analysis approach was adopted, in which the induction method was used to identify the themes of the interview data.
Study results
The results indicated that compared to male nurses, female have higher levels of compassion satisfaction and secondary traumatic stress (p < .05), and poorer sleep quality (p < .05). Nurses who are married have higher levels of mindfulness, self-kindness, common humanity, self-criticism, isolation, and over-identification than those who are not married (p < .05). Nurses who work in shifts have higher levels of self-kindness and common humanity than nurses who do not work in shifts (p < .05). Nurses who hold a master degree have a lower level of mindfulness than do those with a junior college diploma, whereas those who hold a bachelor degree have a lower level of sleep quality than do those with a junior college diploma (p < .05). The younger the nurse is, or the longer he/she has worked in nursing, the lower the levels of over-identification and isolation (p < .05) are and the lower the level of PSQI is (p < .05). As for the changes from pre- to post-intervention, the GRMT group demonstrated the highest level of improvement in MAAS, followed by the MBI group. The MBI group demonstrated the highest level of improvement in terms of burnout and anxiety.
After receiving the interventions, all three groups have shown some changes from T0 to T5 and from T0 to T6. The MBI group demonstrated improvement with the majority of the measuring instruments, including MAAS, ProQOL, DASS, self-compassion, and PSQI. Nevertheless, in addition to an evident decrease in self-kindness at T5, the group did not show any improvement in self-compassion, common humanity, and mindfulness through the study period. The GRMT group demonstrated some improvement in terms of MAAS, burnout, stress, self-compassion isolation, over-identification, and PSQI.
In terms of the mixed quantitative and qualitative analysis of the data, the quantitative data analysis results indicated that the two intervention groups have shown changes in MAAS, overall self-compassion, and sleep quality; the qualitative data analysis results also revealed that the nurses have experienced changes in awareness, self-compassion, compassionate empathy, and sleep quality after receiving the interventions.
Conclusions
When faced with stressful situations, nursing personnel have their own methods of self-regulation. However, short-term mindfulness-based training does more than just providing emotion regulation for the nursing personnel: mindfulness programs also teach nursing personnel to reconsider stressful events and see them from other perspectives and in turn to provide better compassionate care to the patients. The study results revealed that when faced with stressful situations, the strategy most commonly adopted by nurses is the deep breathing strategy: by taking a deep breath, the participants can be in the moment and let their emotions settle before making a response. However, the physical and mental fatigue associated with working in a three-shift system may affect the nursing personnel’s willingness and motivation to participate in short-term mindfulness-based training, as well as affect their willingness to practice the skills they acquired from the training. To ease nurses’ participation and practice processes, future training program designers can look into delivering mindfulness-based training in short modules on online learning platforms or through smart phone apps.

並列關鍵字

Mindfulness intervention (MBI) ； Guided respiration mindfulness therapy (GRMT) ； Compassion ； Professional quality of life (ProQOL) ； sleep quality

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