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  • 學位論文

工作壓力、職場疲勞及病人安全關係 -以台中區醫院護理人員為例

The relationship among job stress, burnout and patient safety- An example of nursing staff of hospitals in Taichung

指導教授 : 蔡雅芳
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摘要


背景與目的:第一線守護病人健康為護理人員,也是維護病人安全最重要且最後防禦的人物。在健保給付政策下,醫院大幅縮減醫療人力,加上因應醫院評鑑增加了不少行政文書作業,醫療員在人力縮編下,造成護理人力嚴重不足。長期處於高壓力及低道德工作環境下,情緒壓力、工作負荷及疲勞感倍增,而讓這些提供良好護理照護為工作目標的醫護人員也會感到疲憊不堪,甚至紛紛遠離醫療照護行業,種種因素影響醫療照護品質,長時間將面臨一連串嚴重醫療疏失,進而危及病人安全。 研究方法:本研究為一橫斷式研究,研究對象主要為中部醫院護理人員進行問卷調查,問卷發放時間為2015年10月07日到同年11月07日,共計一個月。利用SPSS 20統計軟體進行資料分析,以描述性統計描述樣本特性及分佈情形,以平均值、標準差、百分比來呈現特性;推論性統計分別以因素分析、單因子變異數分析(One-way-ANOVA)、迴歸分析、卡方檢定等分析變項間差異。 結果:問卷共發放540份,收回491份,回收率90.9%,中部醫院問卷發放11家,以區域醫院為主要對象,另醫學中心3家,地區醫院5家、地區醫院及診所3家。實得有效問卷458份,有效問卷回收率:93.3%。工作壓力Cronbach's α值0.885,職場疲勞Cronbach's α值0.940,病人安全態度Cronbach's α值0.948。護理人員個人特質及自覺的工作壓力及疲勞程度顯著差異,「性別」對病人安全態度有顯著差異,「年齡」在病人安全態度、工作壓力及職場疲勞間,均有顯著差異;職場疲勞中的「個人與工作疲勞」、「服務對象疲勞」、「工作過度投入」三向度,及病人安全態度中的「管理者對病人安全的支持」、「溝通與回饋」、「團隊合作」三向度,皆有顯著的相關。醫療照護年資、服務單位部門及醫院層級,在病人安全態度中也逹顯著水準。而職場疲勞僅對醫院層級高低逹到顯著水準。工作壓力與職場疲勞皆會影響護理人員對病人安全態度,而工作壓力會影響護理人員的職場疲勞;不同單位護理人員因為工作特質的差異,對於病人安全態度表現上有顯著差異。 結論:個人特質及自覺的工作壓力及疲勞程度有所差異,管理者應制定有效的管理策略,管理者積極建構優質護理工作環境,適度安排病人安全教育訓練,加強人員對病人安全態度之重視。人力運用上,參考單位特性配置較有經驗護理人員,減少新人教育訓練上花費時間。辦理員工減壓活動,以休閒活動方式結合病人安全議題,讓在高壓力職場環境中的護理人員,得到心生理健康與安全滿足,並將滿足轉向病人安全態度的重視提升。

並列摘要


Background and Purpose: Nursing staff is the first line guardian of patient health as well as the most important and the last defense to maintain patient safety. Under the policy of Health Insurance, hospitals have substantially reduced medical workforce and increased a lot of administrative paperwork for Hospital Evaluation. Therefore, there is a serious shortage of nursing staff due to the downsizing of medical staff. In addition, nursing staff is usually working in a high-pressure and poor morality environment, surrounded by emotional stress, overload and burnout, it makes those who providing patients with favorable nursing care feel tired and even stay away from the health care industry. A variety of factors can affect their health care quality and in a long run may lead to series of serious medical errors, and thus endangers patient safety. Methods: This cross-sectional study generally and anonymously surveyed an example of nursing staff of hospitals in Taichung form October 7th to November 7th, 2015. After the data collection, valid samples were processed and analyzed by descriptive statistics, Independent sample t test, One-way ANOVA, Pearson’s correlation coefficient, regression were used to analyze data by SPSS for windows 20.0. The answers wrote by the staff of eleven local hospitals in the middle part of Taiwan were analyzed by statistic program to determine whether the degree of their understanding of the policy is relative to the degree of compliance expectation or not. Results: There were 540 survey participants. The effective survey was only 491. Thus the recovery is 93.3% for this question-survey. “Job Stress” Cronbach's α value of 0.885, “Burnout” Cronbach's α value of 0.940, patient safety attitude Cronbach's α value of 0.948. There is a significant difference between different personal qualities of the nursing staff regarding their job stress and burnout; different “gender” of the nursing staff shows significant difference in the attitude towards patient safety; different “age” of the nursing staff shows significant difference in the attitude towards patient safety, job stress and burnout. In addition, there is an obvious correlation between the three aspects of “individual and work burnout”, “client related burnout” and “over-commitment” in the burnout and the three aspects of “support for patient safety from the management”, “communication and feedback” and “teamwork” in the attitude towards patient safety. Meanwhile, the seniority of healthcare and the level of service units and hospitals also affect the attitude towards patient safety and shows significant difference. Yet significant difference is only observed in the level of hospitals regarding the job stress and burnout will affect the nursing staff’s attitude towards patient safety while job stress also has impact on the burnout. Job stress and burnout will affect the nursing staff’s attitude towards patient safety while job stress also has impact on the burnout; dramatic difference is observed in different characteristics of the work of different medical units regarding the attitude towards patient safety. Conclusion: Since different personal qualities of the nursing staff feel different job stress and burnout, the management shall develop effective management strategies, actively create high-quality nursing work environment and arrange appropriate education and training regarding patient safety to stress the importance of patient safety. In the aspect of human resource, the management shall employ more experienced nursing staff in line with the features of their hospitals to reduce the time spent on the education and training for new staff. Besides, the management shall also organize activities to lower the job stress of the staff and ensure physical and mental health and safety of the nursing staff working in high-pressure work environment by combing leisure activities with patient safety issues, and thus convert the satisfaction of the nursing staff into more attention towards patient safety.

並列關鍵字

Job Stress Burnout Patient Safety

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