血液透析護理人員之心力枯竭、
因應方式、病人照護品質及滿意度之探討

高工作壓力被認為是二十一世紀危害健康的主要因素之一，近年來高度重視病人安全議題，而血液透析護理人員心力枯竭可能危及病人安全。本研究目的:（1）探討血液透析護理人員心力枯竭、因應方式的情形；（2）血液透析護理人員個人屬性在心力枯竭、因應方式之差異；（3）透析病人個人屬性在滿意度之差異；（4）血液透析護理人員的心力枯竭、因應方式及透析病人滿意度間的相關性；（5）及血液透析護理人員個人屬性對心力枯竭、因應方式之影響。方法：採用橫斷性問卷調查法，以高屏地區十三家醫療院所血液透析護理人員及透析病人為研究對象，血液透析護理人員回收有效問卷共266份（88.6％）；透析病人回收有效問卷共382份（93.4％）。以描述性統計、單因子變異數分析、皮爾森積差相關性分析、並以複迴歸分析找出顯著影響因子。結果：（一）血液透析護理人員心力枯竭指數均高於全國常模（個人枯竭49.2vs.32.9、工作枯竭43.9vs.28.4、工作過度投入46.0vs.35.2、服務對象枯竭37.3vs.30.5）。最常採取尋求協助與他人支持之因應方式。（二）婚姻狀態、職稱、透析工作年資與整體心力枯竭有顯著差異(p＜.05)。年齡、婚姻狀態與整體因應方式有顯著差異(p＜.05)。家庭平均所得與透析病人整體滿意度有顯著差異(p＜.05)。（三）個人枯竭、工作枯竭與面對問題與自我調適呈負相關；工作過度投入與理性思考與解決問題、整體因應方式呈正相關；服務對象枯竭與理性思考與解決問題、面對問題與自我調適、尋求協助與他人支持及整體因應方式呈負相關。（四）透析工作年資、平均月薪、職稱及服務院所層級為心力枯竭之顯著影響因子。婚姻狀態、年齡、照護病患比例、教育程度及服務院所層級為因應方式之影響因子。結論與建議: 本研究結果血液透析護理人員心力枯竭遠較全國受僱者一般行業為高，血液透析護理人員為職場心力枯竭的高危險群。增進血液透析護理人員工作環境，可降低護理人員之高心力枯竭及離職率，以提供安全的醫療照護服務，進而增加病人滿意度。

關鍵字

血液透析護理人員；心力枯竭；因應方式；照護品質；病人滿意度

並列摘要

High occupational stress is considered to be one of the major risks for health in 21 century. People pay more attention to patient’s safty in recent years and the hemodialysis nursing staff with high burnout may harm the patient’s safty. This study is designed to explore (1) condition of burnout and coping of hemodialysis nursing staff (2) difference of burnout and coping among hemodialysis nursing staff (3) difference of patient’s satisfaction caused by personsal characteristics (4) relationship between different hemodialysis nursing staff burnout ,coping and patient’s satisfaction (5) the influence of personal characteristics of hemodialysis nursing staff to burnout and coping. Methods : We conducted cross sectional questionnaires surveyings of hemodialysis nursing staff and patients from 13 units in hospital and dialysis clinics across Pintung and Kaohsiung area. A total of 226 responded questionnaires (88.6% retrieved) are collected from hemodialysis nursing staff and 382 responded questionnaires (93.4% retrieved) from hemodialysis patients. The collected data was analyzed by using descriptive statistics, one-way ANOVA, Pearson’s Product-momnet correlation and stepwise multiple regresses to find the effect of relationship. Results: (1) The index of burnout in hemodilaysis nursing staff is higher than average of the national-wide workers.( personal burnout 49.2 vs 32.9, task burnout 43.9 vs 28.4, work overload 46.0 vs 35.2 client service burnout 37.3 vs 30.5) The most common way of coping are seeking assistance and supports from others. (2) The degree of burnout has significant difference (p<.05) in service seniority ,marital status and official rank.Coping has significant difference (p<.05) in age and marital status. The average family income of hemodialysis patient is significant difference (p<.05) with hemodialysis patient’s satisfaction. (3) Personal burnout and task burnout are negatively correlated with self-adjustment in facing problem. Over commitment to work is positively correlated with solving problem with rational thinking and effective coping . Burnout of client service is negatively correlated with solving problem with rational thinking, self-adjustment in facing problem, seeking asistance,support from others and effective coping.(4) Hemodialysis service seniority, average wage, official rank and working place have significant influence to staff burnout while marital status, age, nurse-patient ratio, degree of education and working place have significant influence to coping. Conclusion and suggestion: This study shows that hemodialysis nursing staff have higher burnout than average of the national-wide workers. Hemodialysis nursing staff is the high risk group of burnout. Improvement of working environment could decrease high burnout of hemodialysis nursing staff and demission rate in the meanwhile it could provide safty health care service and patient’s satisfaction.