門診跟診人員工作壓力事件困擾程度、生理數值與生活品質之探討－以南部某醫學中心為例

The exploration on the disturbed degree of working pressure event , physiological values and life of quality among allied personnel in a southern medical center

蔣玉滿(Yu-Man Chiang)

指導教授 ： 李易蓁

高雄醫學大學/健康科學院/醫務管理暨醫療資訊學系碩士班/碩士(2014年)

https://doi.org/10.6832/KMU.2014.00022

摘要

本研究主要目的是探討門診跟診人員工作壓力事件困擾程度、生理數值與生活品質之關聯性，採橫斷式相關性研究，以結構式問卷及生理數值檢測進行資料收集。資料收集流程係於8:00-9:00(門診開始前)測血壓並抽血2cc 荷爾蒙（cortisol )檢測及問卷填寫；另門診結束時再度進行血壓量測。研究對象是收集南部某醫學中心門診跟診人員，有效問卷141份，回收率88.1%，研究工具，內容包括：人口學特質、門診工作環境、楊月雲(2005)發展的門診護理人員工作壓力事件量表及姚開屏教授轉譯之健康相關生活品質量表( WHOQOL-BREF )，統計軟體以Spss 20.0版進行資料分析。
研究結果主要發現：
一、工作壓力事件困擾程度整體構面(mean3.32)，困擾程度介於中度到中高度之間，困擾程度得分最高「病患久候不耐,經常闖入診間詢問」(M=4.01)、其次為「VIP要求插隊看診」(M=3.98)及「本院同仁要求插隊看診」；生理指標方面，收縮壓前測(M=114.07±11.90)、舒張壓前測(M=70.28±8.12)、收縮壓後測(M=122.29±2.86)、舒張壓後測(M=74.83±9.40)、Cortisol值12.36±4.77 ；生活品質四構面，以生理範疇構面的平均得分最高13.96分，其次為社會關係範疇構面13.80分，心理範疇構面構面13.12分、最低環境範疇構面13.08分。
二、本研究發現雖然門診跟診人員跟診後的生理數值會增高且壓力自覺達中等程度以上，但是仍屬於正常範圍內。
三、人口學特性方面，婚姻狀況、職級、教育程度、是否進修學位、自覺健康狀況、生活快樂程度、收入等與工作壓力事件困擾程度有關；門診工作環境方面，本日每診跟診掛號人數、近二週每日每診掛號人數、工作壓力程度在工作壓力事件困擾程度有統計上顯著差異。生活品質則與年齡、教育程度、自覺健康狀況、生活快樂程度、收入、本日每診跟診掛號人數、工作壓力程度等有關係。
四、生理數值與生活品質各層面之相關，「收縮壓差異值」、「舒張壓差異值」與「生理範疇」呈現負向相關；生理數值與工作壓力事件困擾各層面之相關分析中 ，「收縮壓差異值」與「行政作業」呈現正相關；工作壓力事件困擾程度與生活品質各層面之相關分析中均達顯著負向相關，另在逐步複迴歸模式「工作壓力事件」、「生理數值」對於「生活品質」之預測情形，僅工作壓力事件中非常規作業的困擾分數與生活品質所有範疇均呈現負向相關。
本研究結果不僅可提供醫療機構瞭解門診跟人員之工作壓力事件困擾程度、生理數值及生活品質之相關性，皆可作為護理管理部門改善門診跟診人員工作壓力事件措施之參考依據，另生理數值雖屬於正常範圍內，惟經營管理者不可輕忽此現象，仍需要長期持續監測以免造成員工身心健康的損傷，共同維護提升門診跟診人員之生活品質。

關鍵字

工作壓力事件 ； 生理數值 ； 生活品質

並列摘要

The aim of this research was to explore the relations on working pressure event degree, physiological values and quality of life among allied personnel working on outpatient department. This cross-section relational survey was conducted by structured questionnaire and physiiological values. Data were collected between 8am and 9am (before working), including individual´s blood pressure, cortisol level and the structured questionnaire. Blood pressure was also collected when participants finished working. All outpatient department nurses in a southern medical centre were participated.There were 141 valid questionnaires with response rate as 88.1%. Research instruments include: demographic characteristics, working environment, working pressure event scales which was developed by Yan yuch yun(2005) .“Health related quality of life scales (WHOQOL-BREF)” was translated by Yao kai ping. Spss 20.0 version was used for data analysis.
Research results and main findings:
一、The overall score on the disturbed degree of working pressure event was 3.32 which indicates between median to high , “Patient often rush in to inquire because of impatience” had the highest score (mean: 4.01), and both “VIP asking for cutting in to see the doctor” and “Colleague in the same hospital asking for cutting in to see the doctor” had second highest score (mean: 3.98) The pre-test systolic blood pressure was114.07（11.90), diastolic blood pressure was70.28（8.12), the post-test systolic blood pressure was 122.29（2.86), and diastolic blood pressure was74.83（9.40), The cortisol data was 12.36（4.77）. In addition, among the four domains on the quality of life, the physical domain had highest average score as13.96, and the social domain was score as 13.80, the psychological domain was scored as 13.12, and the lowest score was environmental domain as13.08 。
二、Despite both increased physiological values and pressure awareness met the medium level in post-test, the data was still acceptable。
三、Among demographic characteristics, marriage, rank, education, degree, health awareness, life happiness, and income had relation to disturbed degree of working pressure event. Working environment had statistically significant difference on both today´s number of appointments and the number of appointments daily and in two weeks. Quality of life had relation to age, education, health awareness, life happiness, income, today´s number of appointments and working pressure。
四、The relation to physiological values and all domains on quality of life, both the systolic blood pressure variance and the diastolic blood pressure variance had negative relation to physical domain; whereas, the relation to physiological values and the disturbed degree of working pressure event, the systolic blood pressure variance had positive relation to administrative. On the other hand, the disturbed degree of working pressure event had significantly negative relation to all domains on quality of life. Furthermore, stepwise the multiple regression analysis to predict quality of life to disturbed degree of working pressure event, and physiological values, the “non-routine task” was the only one negative relation to all domains on quality of life。.
The results of this explorative study provide medical authorities better understand about the relations on disturbed degree of working pressure event, physiological values and quality of life among allied personnel working on outpatient department. Although the data on physiological values were found acceptable, a long term constant surveillance was needed to avoid personnel from any physically and mentally damage and to promote their quality of life。

並列關鍵字

working pressure event ； physiological values ； quality of life

參考文獻

中文

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