建構在護理人員之心理疲憊評估量表

Psychometric testing of the Mandarin Chinese version of the Mental Fatigue Scale in registered nurse

楊禮嘉(LI-CHIA YANG)

指導教授 ： 蔡佩珊

臺北醫學大學/護理學院/護理學系碩士暨碩士在職專班/碩士(2015年)

摘要

心理疲憊是一種慢性疲憊，因長時間從事心智活動下造成注意力集中困難、思考遲鈍及記憶力差，且經過充足的睡眠仍無法改善疲憊並感到身心俱疲的症狀，這不僅讓護理人員工作能力和臨床表現降低也危及病人安全和降低護理照顧品質。心理疲憊在概念上應包含感覺、情緒和認知的與神經精神性症狀，目前現存的心理疲憊量表皆無評估認知與神經精神性症狀。過去鮮少討論心理疲憊對護理人員的影響。因此，良好的心理疲憊量表可用來評估護理人員的疲憊狀態，即早找出心理疲憊高危險族群。
本橫斷性研究在台北市兩家醫院進行護理人員的抽樣調查。將醫院的護理人員分成一般病房、急重症及門診，按比例抽取，共268名護理人員，針對台北市某兩家醫院228名護理人員進行中文版心理疲憊量表信效度測試。目的在檢定中文版心理疲憊量表（Mental Fatigue Scale, MFS）之心理計量特性。中文版心理疲憊量表15 個題目，包含心理疲憊應包含感官、情感和認知症狀，及心理疲憊所造成的影響。本研究將MFS 翻譯成中文版本後，檢定量表之內在一致性、再測信度、對照組效度、聚合效度及建構效度之探索性因素分析法。本研究以中文版NASA-TLX（心智負荷量表）和中文版臨床憂鬱症預後評量表（CUDUS）作為聚合效度之檢定工具。
本研究共228份問卷回收，而其中215份問卷填答完整，有效問卷回收率為76.54%。以主成份分析(PCA)萃取共同因素，採用斜交轉軸法萃取共同因素，在中文版心理疲憊量表出「心理疲憊」及「神經精神性症狀」兩個因素，總解釋變異量為58.76%。以轉軸後因素負荷量（factor loading）低於 0.5，為刪除題目之準則，將第14題睡眠增加刪除與以刪除。
中文版心理疲憊量表整體內在一致性（Cronbach’s Alpha ）為0.915。量表之再測信度為0.914。與中文版臨床憂鬱症預後評量表聚合效度相關係數為0.672（p <.001），中文版心理疲憊量表與心智負荷量表之聚合效度相關係數為0.460（p <.001）。對照組效度以Chalder疲憊量表33分將護理人員分為疲憊者和無疲憊者，和以中文版臨床憂鬱症狀評估量表19分將護理人員分為憂鬱者和無憂鬱者比較，結果顯示兩組有顯著差異(p <.001, p <.001)。本研究結果支持此含13題的中文版心理疲憊量表是一個具良好的信度與效度工具使用於護理人員並評估過去六個月之心理疲憊。
護理人員心理疲憊在工作屬性之比較下，護理人員在不同醫院層級之心理疲憊不同，結果顯示醫學中心護理人員心理疲憊高於區域醫院﹔門診護理人員心理疲憊顯著低於一般病房及急重症單位﹔在工作單位擔任組長之護理人員心理疲憊高於未擔任者，且皆達到統計上顯著差異(p <0.05)，但性別、班別、輪班工作及工時皆未達顯著差異。本研究結果期望利用心理疲憊量表及早發現高度心理疲憊護理人員，並作為評估介入措施的依據，亦或訂定護理工作改善策略。

關鍵字

護理人員 ； 心理疲憊 ； 中文版心理疲憊量表 ； 信效度

並列摘要

Fatigue is a subjective and unpleasant experience. Mental fatigue has been associated with concentration difficulties, slowness of thinking and impaired cognitive functioning. Nursing work contains mentally and physically demanding work. Nurses frequently experience fatigue but mental fatigue is rarely discussed in this population. Mental fatigue is associated with negative impacts on nurses’ clinical performance and patient safety. The mechanisms of mental fatigue remain unclear so far. It is difficult to understand mental fatigue by using a multiple-dimensional fatigue scale. Thus, a reliable and valid mental fatigue scale should be established in order to identify nurses at high risk of mental fatigue.
The study was a cross-sectional survey of nurses in two hospitals in northern Taiwan. We purposively sampled the following wards units and divided into 3 categories: (1) medical, surgical, maternal and pediatric wards, (2) emergency and intensive care units, and (3) outpatients departments. The purpose of this study was to test the psychometric properties of the Mandarin Chinese version of the Mental Fatigue Scale (MFS).The MFS contains 15 items including all the major mental fatigue symptoms and its impact on daily life.
The MFS was examined using a two-step process: (1) translation and back-translation of the instrument; and (2) examination of internal consistency reliability, test-retest reliability, convergent validity, constructed validity and known groups’ validity. A principal component analysis was used to examine the constructed validity of the MFS. The Clinical Useful Depression Outcome Scale (CUDOS) and The NASA Task Load Index (NASA-TLX) were used for testing convergent validity.
Two factors emerged from the factor analysis accounting for 58.76% of the variance. Two subscales were named: mental fatigue and neuropsychiatric symptoms subscales. One item was deleted because factor loadings was lower than 0.5. The instrument possessed good internal consistency (Cronbach's α=0.915). The correlation with CUDOS and NASA-TLX were 0.672(p<.001) and 0.460(p <.001). Intraclass correlation coefficients (ICC) indicated high test-retest reliability for all measured parameters (0.914). The MFS scores between the depressive and non-depressive groups were significantly different, and the MFS scores between fatigue and non-fatigue nurses were significantly different (p <.001, p <.001).
Results of this study indicated that the Chinese version of the MFS is a reliable and valid instrument for assessing mental fatigue in Taiwanese nurses. Moreover, mental fatigue significant differed according to hospital levels, work settings and leadership roles. Shift work, working hours and gender failed to show a significant association with mental fatigue. Based on the results of this study, we recommend using the Mental Fatigue Scale to identify individuals at high risk for mental among nurses. Future research is needed to build on strategies that can be implemented to avoid excessive mental fatigue.

並列關鍵字

Nurses ； Mental fatigue ； The Chinese version of The Mental fatigue Scale ； Validity ； Reliability

參考文獻

de Raaf, P. J., de Klerk, C., & van der Rijt, C. C. (2013). Elucidating the behavior of physical fatigue and mental fatigue in cancer patients: a review of the literature. Psychooncology, 22(9), 1919-1929. doi: 10.1002/pon.3225

Noar, S. M. (2003). The Role of Structural Equation Modeling in Scale Development. Structural Equation Modeling: A Multidisciplinary Journal, 10(4), 622-647. doi: 10.1207/S15328007SEM1004_8

Yuan, S. C., Chou, M. C., Chen, C. J., Lin, Y. J., Chen, M. C., Liu, H. H., & Kuo, H. W. (2011). Influences of shift work on fatigue among nurses. Journal of nursing management, 19(3), 339-345. doi: 10.1111/j.1365-2834.2010.01173.x

英文參考文獻

Akerstedt, T., Knutsson, A., Westerholm, P., Theorell, T., Alfredsson, L., & Kecklund, G. (2004). Mental fatigue, work and sleep. Journal of psychosomatic research, 57(5), 427-433.