從家庭、生活習慣、工作相關因素、肌肉骨骼疼痛探討職業倦怠的原因及其與工作相關傷害的關係

To explore the causes of burnout and association with work-related injuries from family, living habits, work-related factors, and musculoskeletal pain

陳詠心(Yong-Hsin Chen)

指導教授 ： 葉志嶸

中山醫學大學/健康管理學院/公共衛生學系/博士(2022年)

https://doi.org/10.6834/csmu202200004

摘要

引言
倦怠(Burnout) 於 1974 年由臨床心理學家 Herbert Freudenberger 首次描述。倦怠(burnout) 是一種身體的、情緒的及心理的耗竭狀態，它是由於長期參與對情緒有要求的工作環境所導致。Maslach Burnout Inventory (MBI)以及Copenhagen Burnout Inventory (CBI)是最常被使用去評估倦怠的工具。倦怠在美國每年至少造成了近46億美元的損失並且影響了將近一半的醫生、護士及其他的醫療人員。此外，倦怠也會影響與病人相關的照護品質。過去的研究已經表明了倦怠與工作相關傷害(work-related injuries, WRIs)有關而且也會增加受傷的風險。本研究將建立職業倦怠的模型，以識別職業倦怠的危險因素，並探討職業倦怠與醫務人員的 WRI/銳器傷 (SI) 之間的關係。

方法與材料
本研究是在2021年以台灣台中一所醫學大學員工為調查基礎所做的一個觀察型及橫斷面研究，總共有1633人完成了包含北歐肌肉骨骼問卷(Nordic MS Questionnaire, NMQ)及哥本哈根倦怠問卷(Copenhagen burnout inventory, CBI)在內的調查，CBI 包含了個人倦怠(PB)、工作相關倦怠(WB)及客戶倦怠(CB)等三個尺度。在排除了資料漏失的問卷後共有1250份為有效問卷。統計分析採用了t 檢定、 卡方(chi-square test)或費雪精確檢定、因子分析(factor analysis)、線性回歸及索博中介分析(Sobel test)。統計分析軟體是使用SAS Enterprise Guide 6.1，統計顯著水準訂為P < 0.05。

結果
研究表明了工作經驗(WE)、教育程度、已婚、為人父母、在假日積極與朋友及家人參與休閒活動(LAFF)、每週定期運動習慣(REW)、慢性病(CD)、一個月內飲酒(AU)、每天睡眠時間短於6小時(SSLD)、加班(OT)、不定期輪班 (IRS)、不同的專業領域、常常頸部與肩膀疼痛(NBSP)、常常腳踝疼痛(BAP)以及常常雙膝疼痛(BKP)都與倦怠顯著相關。職業倦怠的性別差異與性別主導職業有關，女醫師的WB明顯高於男醫師。PB、WB、CB與工作相關傷害(WRIs)及尖銳物扎傷(SIs)密切正相關。SSLD、OT、IRS、護士職業、NBSP等也都與WRIs/SIs相關，其中PB、WB及CB也是這些關係的中介因子。CD、BKP也與WRIs/SIs有顯著關係，PB及WB是這些關係的中介因子。BAP與WRIs緊密相關但與SI沒有顯著相關，PB及WB為BAP與WRIs的中介因子。

結論
本研究通過三種職業倦怠量表和統計方法確定了職業倦怠發展的原因。 此外我們還確定很少與家人和朋友進行休閒活動，睡眠不足、AU、OT和輪班、CD和MS疼痛會增加倦怠程度，這將進一步增加WRIs/SIs的發生率。 因此，WRI的預防計劃應包括職業倦怠的高危識別機制，及早發現工傷高危員工，進一步緩解職業倦怠症狀，有效避免工傷的發生。

關鍵字

個人倦怠 ； 工作相關倦怠 ； 顧客倦怠 ； 中介效應 ； 工作相關傷害 ； 尖銳物扎傷

並列摘要

Introduction
Burnout was first described in 1974 by the clinical psychologist Herbert Freudenberger. Burnout is a state of physical, emotional, and mental exhaustion that results from long-term involvement in work situations that are emotionally demanding. Maslach Burnout Inventory (MBI) and Copenhagen Burnout Inventory (CBI) were most used instruments to assess burnout.
Burnout cause total losses of US$4.6 billion in the United States each year and affects approximately half of all nurses, physicians, and other clinicians. In addition, burnout also affects patient-related quality of care. The previous studies demonstrated burnout is related to work-related injuries (WRIs) and increase in the risk of injury. The present study would establish the relationship models of burnout to identify risk factors of burnout and explore the relationship between burnout and WRIs/sharps injuries (SIs) for medical worker.

Methods and materials
This is an observational and cross-sectional study which was based on members at a hospital affiliated with a medical university in Taichung, Taiwan, in 2021. 1633 individuals completed the questionnaires including Nordic Musculoskeletal Questionnaire (NMQ) and the Copenhagen burnout inventory (CBI). CBI included three burnout scales that are personal burnout (PB), work-related burnout (WB) and client burnout (CB), respectively. Among them, 1250 questionnaires were determined to be valid after exclusion for missing data. Statistical methods included t test, chi-square test or fisher exact test, factor analysis, linear regression, and Sobel test. Analysis was conducted using SAS Enterprise Guide 6.1 software, and significance was set at P < 0.05.

Results
The present study demonstrated participants with master’s degree or above or married or parenthood significantly reported low level for WB and CB than others and those with regular exercise every week (REW) reported low level for PB, WB and CB than others. Participants with chronic diseases (CD) or ever alcohol use (AU) or sleep duration per day less than 6 h (SSLD) or work overtime (OT) or shift work including irregular shift (IRS) and regular shift (RS) work or physicians/nurses reported high level for PB, WB and CB than others. Work experience (WE) and engaging in leisure activities with family or friends (LAFF) in vacation were negatively related to PB, WB and CB. Neck and both shoulders pain (NBSP) was positively related to PB, WB and CB. Both ankles pain (BAP) and both knees pain (BKP) was positively related to PB and WB. Sex difference of burnout was associated with sex--dominated occupations. Under low proportion of women than men in physician field, women physicians significantly reported high WB than man physicians. PB/WB/CB was closely relevant to WRIs/SIs and was mediation factors between WRIs/SIs and SSLD, or work OT, or IRS work, or Nurse, or NBSP. PB/WB mediated the relationship between WRIs/SIs and CD or BKP, too. However, PB/WB only mediated the relationship between WRIs and BAP.

Conclusion
The present study has determined the reasons of burnout development by three burnout scales and statistical methods. In addition, we also determined seldom engaging in leisure activity with family and friends, lack of sleep, AU, OT and shift, CD, and MS pain will increase burnout degree, which will further raise incidence of WRIs/SIs. Therefore, the prevention plans of WRIs should include the high-risk identification mechanism of burnout and early find the high-risk employee of work injuries to further relieve burnout symptoms and effectively avoid occurrence for injuries.

並列關鍵字

Personnel Burnout ； Work-Related Burnout ； Client-related Burnout ； Mediation Effect ； Work-Related Injuries ； Sharps Injuries

參考文獻

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