護理人員的工作壓力、習得智謀、心理健康與安全態度相關因素探討

背景:護理人員工作壓力是護理專業重要關注議題，醫療環境快速成長，新冠肺炎(COVID-19)全球大流行，且有越來越嚴重趨勢，進而影響心理健康。工作壓力與病人安全態度有相互關係，安全態度更具重要性。護理人員於醫療工作最前線，目前並未有習得智謀(自我控制力)的相關研究，故進而了解習得智謀與心理健康、安全態度之相關性。研究目的:探討護理人員(1)基本屬性(性別、年齡、教育程度、婚姻狀態)、工作特性(工作職級、本院工作年資、服務單位)、工作壓力、習得智謀、心理健康與安全態度之關係；(2)並檢視習得智謀是否為(i)工作壓力與心理健康；(ii)工作壓力與安全態度的中介變項。研究方法:此為相關性、橫斷面之研究，對象為南台灣地區醫院208位護理人員；以立意取樣、結構自填式問卷收集。統計分析包括描述性統計、皮爾森積差相關、獨立樣本t檢定及單因子變異數及複迴歸。研究結果:以女性、未婚佔多數；平均年齡為33歲；學士比例較高為80%。工作職級以N及N2最多；在本院工作年資平均為2.8年；服務單位以門診佔最多。教育程度、婚姻狀況及服務單位與心理健康及安全態度有顯著差異，為學士、未婚者、手術室及一般病房心理健康較差；一般病房壓力認知構面比門健診及急重症單位較為負向態度，門健診工作的滿意度及對管理部門的感受構面比一般病房較為正向態度；門健診、手術室及其他單位工作生活平衡構面皆比一般病房較為正向態度。工作壓力(r = - .404，p < .01)、習得智謀(r = .413，p < .01)與安全態度成顯著相關。工作壓力與習得智謀是護理人員心理健康及安全態度的重要預測因子。年齡越輕、工作壓力感受越大、習得智謀程度越小(自我控制力越差)的護理師的心理較不健康，工作壓力越大的護理師，他們的安全態度就越差；而習得智謀越高的護理師，他們的安全態度越好。結論:本研究結果能提供醫院管理者做為依據，能瞭解護理師的工作壓力與心理健康及安全態度的關係，若能藉由習得智謀介入教育訓練，將可能提升心理健康、重視安全態度，甚而提升照護品質。

關鍵字

工作壓力；習得智謀；心理健康；安全態度

並列摘要

Background: The work stress in nurse is an important concern issue of the nursing profession. The medical environment is growing rapidly, and the global pandemic of the coronavirus disease (covid-19) is making more serious, which affects mental health. There is a correlation between work stress and patient safety attitude, and safety attitude is more important. Nurses are the forefront of medical work, and there is currently no relevant research on learned resourcefulness (self-control), they can understand the correlation between learned resourcefulness and mental health and safety attitudes. Purpose: To understand nurses (1) characteristics (gender, ager, education and marriage), the character of service (position, working experience, service unit), work stress, learned resourcefulness, mental health and self-attitude. (2) To examine whether the acquisition of learning resourcefulness is (i) work stress and mental health; (ii) work stress and safety attitudes as an intermediary variable. Methods: This study was a cross-sectional study, and focused on 208 nurses who were working in a district hospital in the south of Taiwan. The statistical analysis of Descriptive Statistics, Pearson correlation coefficient, independent sample t-test, Analysis of Variance (ANOVA) and multiple regression analysis were included. Results: The results of the study were female and unmarried in the majority. Mean age was 33 years-old, 80% participate graduated from university, the position of N and N2 were most, the mean of seniority were 2.8 years and working in the out-patient departments had the most. Education, marital status and service unit have significant differences from mental health and safety attitudes. Bachelor, unmarried, working in operation theater and general ward has poor mental health. The cognitive dimension of general ward pressure is more negative than that of outpatient health clinics and emergency and critical illness units, and the satisfaction of outpatient health clinic work and the perception of management departments are more positive than the general ward. Outpatient health clinics, operation thearter and other units have a more positive attitude towards work-life balance than general wards. Work stress (r =-.404, p <.01), learned resourcefulness (r = .413, p <.01) were significantly related to safety attitudes. Work stress and learned resourcefulness were important predictors of nurses’ mental health and safety attitudes. Nurses who were younger, more stressful at work, and have less learned resourcefulness (poor self-control) were mentally unhealthy and had worse safety attitude. Conclusion: The results of this study can provide hospital administrators as a basis to understand the nurses’ work stress from mental health and safety attitudes. Through the learned resourcefulness intervention into education program may improve mental health wellbeing, concerned safety attitudes and quality improvement in healthcare.

並列關鍵字

work stress ； learned resourcefulness ； mental health ； safety attitude

參考文獻

Huang, C.-H., Wu, H.-H., & Lee, Y.-C. (2018). The perceptions of patient safety culture: A difference between physicians and nurses in Taiwan. Applied Nursing Research, 40, 39–44. https://doi.org/10.1016/j.apnr.2017.12.010

Sonoda, Y., Onozuka, D., & Hagihara, A. (2018). Factors related to teamwork performance and stress of operating room nurses. Journal of Nursing Management, 26(1), 66–73. https://doi.org/10.1111/jonm.12522

中文部分