臨床護理人員職場疲勞、工作特質與健康指標之關聯探討

Associations Between Workplace Fatigue, Work Characteristics and Health Indicators in Clinical Nurses

林思婷(Sih-Ting Lin)

指導教授 ： 蘇千田

臺北醫學大學/公共衛生暨營養學院/公共衛生學系暨研究所/碩士(2013年)

https://doi.org/10.6831/TMU.2013.00040

摘要

近年來，臺灣醫護人員的勞動環境惡劣問題逐漸浮上檯面，由於服務性質與病患的健康相關，醫護人員不但責任重大，也由於臺灣醫療體制的問題，造成醫護人員工作量龐大、時常必須負責超額的病患。醫療工作需要極度的細心及耐心，也需要時常面對他人，同時也需要體力，由於職業倦怠容易發生在時常接觸他人的工作者，因此醫護人員通常被認為是職業倦怠的高危險族群。
工作壓力和職業倦怠是發展身心疾患的顯著因子，過去也有文獻指出職業倦怠可能會造成心血管疾病、潰瘍、身體病痛及心理病症，本研究的目的為檢視在大型醫院執業之臨床護理人員的職場疲勞、工作特質，以及健康指標情形，並探索職場疲勞、工作特質與健康指標之間的關係，分析職場疲勞、工作特質情況是否可以預估健康指標之正常與否。
研究收集執業於臺灣臺北市某大型醫院的臨床護理人員，問卷包含個人基本資料、工作變項、生活型態，以及職場疲勞量表、工作特質量表；健康指標包含身體質量指數、腰圍、空腹血糖、總膽固醇、三酸甘油脂、低密度脂蛋白。
問卷收集的期間為2013年3月4日至同年3月29日，發放於一間大型醫院之16個護理部門，共發放263份，共收回216份，回收率為81.13%。為提高樣本同質性，將其中4份男性刪去(1.85%)，有效樣本回收總計共212份，有效樣本之回收率為80.61%。
在本次的研究中，發現工作缺乏保障程度高的人增加2.524倍腰圍超標的風險，但在調整變項後只達到邊緣性顯著(p=0.059)；在調整變項後，主管支持低的人空腹血糖過高的風險多出3.921倍，但只達到邊緣性顯著(p=0.054)，而其他職場疲勞、工作特質沒有看到與健康指標之間的關聯性。本研究之護理人員樣本的職場疲勞及工作負荷程度較過去研究高，而職場正義較差。
建議管理者可以從減輕工作量的方向來制定政策，減少超時情況，保障薪資福利，增聘充足的護理人員，改善工作環境，建立與醫院上層的溝通管道，減少暴露於暴力及騷擾的情況，設立健身設備、提供營養餐，設立固定的支持團體或交流平台，減輕護理人員整體的疲勞，提升護理人員整體的健康狀況。

關鍵字

職場疲勞 ； 工作特質 ； 過勞 ； 護理人員 ； 體位指標 ； 生化指標

並列摘要

The poor working conditions for nurses in Taiwan have received a lot of attention in recent years. Taiwan nurses have high work load, looking after excessive number of patients, and their work needs attentive and patience in high level, and often encounter different kinds of personality, physical labor also. Those characteristics put nurses in high risk of burnout.
Work stress and burnout are considered the risk factors of physical and mental disorders. Many literatures indicate that burnout could cause cardiovascular diseases, peptic ulcers, physical pain and mental illness. The purpose of the study is to examine the workplace fatigue, work characteristics and health indicators of the clinical nurses practicing in a large-scaled hospital, and to explore the relation ship between workplace fatigue, work characteristics and health indicators, and analyse whether workplace fatigue, work characteristics could predict the adverse outcomes of health indicators.
Study data was collected from the clinical nurses practicing in a large-scaled hospital in Taipei, Taiwan. The questionnaires include demographic characteristics, work characteristics, life styles, Chinese version of Copenhagen Burnout Inventory (workplace fatigue), Chinese Version of the Job Content Questionnaire (work characteristics). Health indicators include body mass index, waist circumference, fasting glucose, total cholesterol, triglycerides, and low-density lipoprotein.
The questionnaire was collected from March 4 through 29, 2013. Altogether 263 copies of questionnaires were sent out to 16 nursing stations in the hospital, and 216 completed questionnaires were received. The early response rate was 81.13%. To pursue the homogeneity of sample, 4 men were deleted (1.85%), and the final sample number was 212 questionnaires, the final response rate was 80.61%.
In this study, we found a high degree of job insecurity has increased 2.524 times the risk of excess waist circumference, but only approaching significance (p = 0.059) after adjusting same variables. Low supervisor support people has increased 3.921 times the risk of Impaired fasting glucose, but only approaching significance (p = 0.054) after adjusting the variables. No other correlations were observed between workplace fatigue after adjusting variables, work characteristics and health indicators. The nurses of the study had higher degrees of workplace fatigue and job demand compared with previous studies, and had poor degree of workplace justice.
According to the finding of the study, nurse managers can put “reduce the workload” the priority developing organization policies, for example: to reduce work overtime, to protect wages and benefits, to recruit enough nurses, to improve the work environment, to establish channels of communication with the managements, to reduce exposure in the violence and harassment, to establish fitness equipment, to provide nutritious meals, to establish support groups or a network. As the result, reduction overall situation of fatigue, and enhancement overall situation health can be achived.

並列關鍵字

burnout ； workplace fatigue ； work characteristics ； Chinese version of Copenhagen Burnout Inventory ； Chinese Version of the Job Content Questionnaire ； nurse ； body mass index ； waist circumference ； fasting glucose ； total cholesterol ； triglycerides ； low-density lipoprotein

參考文獻

行政院衛生署. (2004). 二代健保改革綜論. 行政院衛生署.

行政院衛生署. (2004a). 二代健保改革綜論. 行政院衛生署.

行政院衛生署. (2007). 醫師法.

行政院衛生署全民健康保險醫療品質資訊公開網. (2010a). 糖尿病醫療品質資訊 指標說明 三酸甘油脂.

吳秀美, 劉佩芬, 何雪華, 陳品玲, 趙慧玲, & 陳小蓮. (2012). 最後一哩學程改善新進護理人員職場疲勞與工作表現之成效探討. [Reducing Occupational Burnout and Enhancing Job Performance in New Nurses: The Efficacy of "Last Mile" Programs]. 護理雜誌, 59(4), 30-42. doi: 10.6224/jn.59.4.30