醫療工作的壓力源感受量表之設計及信效度檢定

Development and Evaluation of Validity and Reliability of a Questionnaire on Medical Workers' Stress

史麗珠(Lai-Chu See) ； 張薰榕(Hsun-Jong Chang) ； 劉孟茹(Meng-Ju Liu) ； 鄭秀貴(Hsiu-Kuei Cheng)

《台灣公共衛生雜誌》 26卷6期 (2007/12) Pp. 452-461

https://doi.org/10.6288/TJPH2007-26-06-02

摘要

目標：健保支付制度不斷改變，醫療院所均節省人事開銷，醫療人員的工作壓力遽增。過去研究多採用職業壓力指標第二版問卷(OSI-2)的壓力源感受量表，但此量表未依醫療工作的特性設計。因此我們參考OSI-2的壓力源感受量表，擬定「醫療工作的壓力源感受量表(QMWS)」，並進行信效度的評估。方法：QMWS的8個題目：維持醫療院所的營運、應付醫院評鑑工作、病患病情穩定度、與病人關係的維持、面對醫療糾紛、薪水的給付制度、個人考核的制度、升等或學術研究。結果：13位專家的評分皆在4分以上。兩週再測信度的相關係數r=0.85。以OSI-2的壓力源感受量表為金字標準效標，r在0.48至0.67間。以職業倦怠－醫療行業調查(MBI-HSS)的情緒耗竭及去人性化向度來評估QMWS的輻合效度，r分別為0.37、0.16。又OSI-2的工作滿意度、身、心健康量表評估QMWS的分歧效度，r在－0.31至－0.38間。QMWS的Cronbach's α為0.84。結論：QWMS具良好的內容效度、同時效標效度、建構效度、兩週的再測信度，內在一致性。期望這份問卷能廣泛被採用，成果也能互相比較。

關鍵字

醫療工作 ； 壓力源 ； 信效度

並列摘要

Objectives: Due to the constant changes in the payment systems of the National Health Insurance, hospitals have had to cut the cost of personnel, which has resulted in an increase in stress among the medical workers. Although the second Chinese version of the Occupational Stress Indicator (OSI-2) is commonly used in research, questions about workload for medical workers are not included. Hence, we followed the format of the OSI-2 and designed a questionnaire to assess medical workers’ stress (QMWS). The reliability and validity of the QMWS were examined. Methods: There are eight questions in the QMWS, as follows: 1) running the hospital, 2) preparing the hospital for accreditation, 3) maintaining patients’ disease conditions, 4) maintaining a good relationship with patients, 5) managing medical disputes or lawsuits, 6) paying employees' salaries, 7) having a good job performance, and 8) seeking a job promotion or doing academic research. Results: The average rating by 13 experts of the QMWS was ＞4. The two-week test-retest reliability was 0.85. The correlation coefficient, r, between the QMWS and the source of stress in the OSI-2 was between 0.48 and 0.67. Emotional exhaustion and depersonalization according to the Maslach Burnout Inventory-Health Service Survey (MBI-HSS) served as a convergent validity and a significant r (0.37 and 0.16, respectively) was observed. Job satisfaction, physical health, and mental health in the OSI-2, and personal accomplishment in the MBI-HSS, served as a divergent validity and a significant r (-0.31 to -0.38) existed. The Cronbach's alpha for the QMWS was 0.84. Conclusions: The QMWS has a good content, concurrent criteria, construct validity, test-retest reliability, and internal consistence. We welcome other researchers to use the QMWS so that findings can be compared on the same basis.

並列關鍵字

medical workload ； source of stress ； validity and reliability

參考文獻

Lee I,Wang H.(2002).Perceived occupational stress and related factors in public health nurses.J Nurs Res.10,253-260.

陸洛、李惠美、謝天渝(2005)。牙醫師執業壓力與身心健康及職業倦怠之關係:以高雄市牙醫師為例。應用心理研究。27，59-80。

李逸(2004)。公共衛生護理人員工作壓力感受、因應策略與壓力結果之探討－以互動型工作壓力模式為架構。台灣衛誌。23，398-405。

Callaghan P,Tak-Ying SA,Wyatt PA.(2000).Factors related to stress and coping among Chinese nurses in Hong Kong.J Adv Nurs.31,1518-1527.

Goodfellow A,Varnham R,Rees D,Shelley MP.(1997).Staff stress on the intensive care unit: a comparison of doctors and nurses.Anesthesia.52,1037-1041.