醫療異常事件發生在護理人員之人格韌性、工作壓力、離職意願及護理工作環境知覺上的差異

本研究主要目的在探討有無發生醫療異常事件之護理人員，在其人格韌性、工作壓力、離職意願及護理工作環境知覺的差異，並瞭解主要變項間的相關性。研究設計採用橫斷式調查法，以南部某醫學中心及區域、地區醫院護理人員為立意取樣之研究對象。於96年12月1日至97年2月15日利用結構式問卷進行研究調查，共發出問卷535份，回收有效問卷519份，回收率為97.0%。調查所得資料以SPSS 12.0 for Windows套裝統計軟體進行描述統計、卡方檢定、雙樣本t檢定及Pearson相關係數分析，檢測有無發生醫療異常事件者在人格韌性、工作壓力、離職意願及護理工作環境知覺的差異情形，並探討人格韌性、工作壓力、離職意願及護理工作環境知覺間之相關性。本研究結果發現：1.有無發生醫療異常事件者在個人基本特性中有顯著差異的包括婚姻狀況、年齡、子女數、護理總工作年資、單位服務年資及服務單位等變項。2.有發生醫療異常事件者在人格韌性及其三項特徵（控制、承諾及挑戰特徵）的平均值皆低於無發生醫療異常事件者，t檢定結果顯示兩組在人格韌性及其三項特徵上具有顯著差異(p <.05)。3.有發生醫療異常事件者之工作壓力、內在及外在付出構面、付出/回饋比值之平均值均高於無發生醫療異常事件者，而在回饋構面的平均值低於無發生醫療異常事件者。統計檢定發現，兩組在內在付出及外在付出構面上有顯著差異(p <.05)。4.有發生及無發生醫療異常事件者自覺離職意願皆屬中上程度，t檢定結果顯示，兩組在離職意願有顯著差異(p <.05)。5.有發生醫療異常事件者對護理工作環境及其次構面的知覺平均值皆低於無發生醫療異常事件者，t檢定結果顯示，兩組除在協調與團隊合作構面達顯著差異外，其餘次構面皆無顯著差異。6.護理人員除了離職意願與工作壓力間無顯著相關外，其人格韌性與工作壓力有邊緣性顯著正相關，與護理工作環境知覺亦呈顯著正相關，且人格韌性與離職意願呈顯著負相關。此外，護理人員之離職意願與護理工作環境知覺呈顯著負相關，而其工作壓力與護理工作環境知覺呈顯著正相關。本研究結果顯示有發生醫療異常事件者，在人口學及工作屬性上有年輕、多有大學學歷、單身、無子女、護理總年資及單位年資淺、多在重症加護單位工作的顯著特徵，本研究支持人格韌性、工作壓力、離職意願及護理工作環境的重要性，文獻指出醫療異常事件是可被避免的，故護理管理者應將醫療異常事件防範納入新進人員輔導計畫中，強化護理人員的人格韌性，營造溫暖開放的工作氣氛，並適時提供支持與關懷，藉此將有助於預防護理人員醫療異常事件的發生。

關鍵字

醫療異常事件；人格韌性；工作壓力；離職意願；護理工作環境知覺

並列摘要

The purpose of this study is to compare the hardiness, perception of work environment, intention to quit and work stress of nurse who have experience of medical error with who don’t have experience of medical error. Otherwise, this study is to explore the correlation between these factors. We use structured questionnaire to collect cross-section data from December 1, 2007 to February 15, 2008. We sent 535 questionnaires and there were 519 questionnaires to be collected. The response rate to the questionnaires was about 97%. Stratification sampling was used to select nurses who worked in medical center, regional hospital and district hospital in the south of Taiwan. The data is analyzed by descriptive statistics, chi-square statistics, t statistics and Pearson’s correlation. We use SPSS12.0 for windows to calculate above statistics. It is found some results as follows, 1. Individual background such as marital status, age, children numbers, total nursing service year, working department and nursing service year in the department are significantly different between nurses who have experience of medical error and who don’t have such experience. 2. If nurses have experience of medical error, her hardiness level (including control, commitment and challenge characteristic) are lower than who don’t have such experience. The outcome of t-test shows that the two group’s hardiness level are significantly different (p<0.05). 3. If nurses have experience of medical error work, her work stress (including intrinsic effort, extrinsic effort subscale) and effort/reward ratio are higher than that don’t have such experience. And the reward subscale level is lower than that don’t have experience of medical error. The outcome of t-test showed that the two group’s intrinsic effort and extrinsic effort are significantly different (p<0.05). 4. If nurses have experience of medical error, her intention to quit are significant different from who don’t have such experience by t-test (p<0.05). 5. If nurses have experience of medical error, her perception of work environment is lower than that don’t have such experience. The outcome of t-test shows that the two group’s collaboration and team work are significant different. Besides, other subscales are not significantly different. 6. There is a positive relationship between hardiness and work stress. And there is also a positive relationship between hardiness and work environment. But there is a negative relationship between hardiness and intention to quit. Otherwise, there is a negative relationship between intension to quit and perception of work environment. And there is a positive relationship between work stress and perception of work environment. We find that nurses who have experience of medical error have some significant characteristic, such as young, single, don’t have children, junior service year, and work in intensive care unit. Our study supports the importance of hardiness, work stress, intention to resign, and perception of work environment. The literature pointed out that the medical error could be avoided. Therefore, nursing managers should design training program for new staffs against the medical error, promote nurses’ hardiness, develop warm and opening work atmosphere, and provide support and concern at the right moment. These will prevent nurses from medical error.