護理人員工作壓力及因應行為之影響因素 : 以臺北市某醫院婦兒專科區為例

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Title:	護理人員工作壓力及因應行為之影響因素 : 以臺北市某醫院婦兒專科區為例
Other Titles:	The factors affecting work-related stress experienced by nursing staff and their coping strategies : a study of gynecological, obstetric and pediatric regional hospital in Taipei City
Authors:	陳綺霞;Chen, Chii-Shya
Contributors:	淡江大學公共行政學系公共政策碩士在職專班黃琛瑜;Huang, Chen-Yu
Keywords:	護理人員;工作壓力;工作壓力反應;工作壓力因應;Nursing staff;Work-related stress;Response to work-related stress;Coping strategy
Date:	2014
Issue Date:	2015-05-04 09:53:33 (UTC+8)
Abstract:	近年來醫療環境的變遷，以及病人和家屬需求的改變，使得護理人員工作負荷和壓力隨之增加，尤其是少子化之後，婦產和兒科的醫療照護有著相當不同的挑戰。本研究目的係探討婦兒專科護理人員的工作壓力及其相關因素。採橫斷性研究，進行問卷調查，以臺北市某醫院之婦兒專科院區到職日起服務滿一個月以上護理人員為研究對象，但排除請長期病假和留職停薪等人員，自民國103年5月起為期1個月進行資料收集，結構式問卷內容包括個人基本資料、工作壓力感受、工作壓力的反應和工作壓力的因應。研究結果：發出185份問卷，回收率97.84 %(181份)；護理人員最近一個月對工作壓力感受度以「醫院的各項評鑑、檢查之事前準備工作讓我感到壓力。」的平均分數最高(4.31±0.89分)，個人屬性均無統計上顯著差異(p>0.05)；工作壓力的生理反應以「在工作中我常感到腰酸背痛，手軟腳痠。」為最高平均分數(4.12±0.87分)，其次是「我容易失眠、睡眠品質不良等現象。」(3.77±1.02分)，各不同年齡、年資、服務單位、任用性質和班別均具有顯著差異(p<0.05)；工作壓力的心理反應最多人表示「我因為人力不足的壓力而感到不安。」(3.98±1.01分)；壓力因應策略多會尋求紓解壓力的解決之道，最常用方式是「我會向有經驗或相同遭遇者尋求支援或建議。」，「遇到問題時，我會參考以前的經驗來解決問題。」和「我會與朋友聊天、聚會以紓解壓力。」，各不同工作年資、任用性質、子女數、宗教信仰均具有顯著差異(p<0.05)；整體而言，最近一個月內的平均工作壓力為76.45±18.83分；個人相關因素方面，年齡愈高(r= -0.217)和子女數較多(r= -0.143)、年資愈資深(r= -0.207)和正式公務人員任用(r= -0.144)的護理人員具有顯著相對較低的工作壓力感受；年資(r= -0.151, p=0.028)愈資深對於工作壓力的反應愈好；有宗教信仰者(r= -0.161, p=0.021)的工作壓力的因應也較好；工作因素則是班別與壓力感受、反應和因應均是顯著的影響因素(p<0.05)；護理人員的工作壓力程度(0-100分)分別與工作壓力感受(r=0.393, p<0.001)和工作壓力反應(r=0.528, p<0.001)呈現顯著正相關，與工作壓力的因應(r= -0.41, p=0.290)則不具有統計上之顯著意義。建議：衛生行政主管機關和醫院應重視護理人員之工作壓力，提供舒緩管道，而護理人員自身也可自我提升專業與參加活動等正向方式來因應壓力。 The transformation of the healthcare environment in recent years, together with the changes in the expectations and needs of patients and their families, has increased the workload and stress under which nursing staff labor. In particular, the trend towards smaller families has created unique challenges for those nursing staff involved in providing maternity and pediatric care. The present study seeks to explore the work-related stress affecting maternity and pediatric nursing staff, and the factors related to this stress. A cross-sectional study is used, employing a questionnaire survey administered to nursing staff working at a specialist maternity and pediatric hospital in Taipei City, Taiwan who have been working at the hospital for a period of at least one month (and excluding those nursing staff who are on extended sick leave or on an extended period of unpaid leave). Data collection took place over a period of one month starting in May 2014. The content of the structured questionnaire included personal data, experience of work-related stress, reaction to work-related stress, and work-related stress coping strategies. The results obtained in the present study were as follows. A total of 185 questionnaires were sent out, and 181 returned, giving a return rate of 97.84%. With regard to the experiencing of work-related stress, the response which was reported most frequently (with a score of 4.31±0.89 points) was “I feel stress when undertaking work in relation to hospital evaluations and audits.” In regard to this response, there was no statistically significant difference (p>0.05) between respondents with differing personal characteristics. As regards the physiological response to work-related stress, the response with the highest score (4.12±0.87 points) was “When at work, I often experience back pain, and discomfort in my hands and feet”; the response with the next highest score (3.77±1.02 points) was “I often suffer from insomnia or poor sleep quality.” For these responses, there was statistically significant difference (p<0.05) in the scores for respondents in different age groups, with differing years of service, working in different units, with different forms of employment, and working on different shifts. Regarding the psychological reaction to work-related stress, the response with the highest score (3.98±1.01 points) was “I often experience anxiety because of pressure resulting from manpower shortages.” As regards work-related stress coping strategies, most respondents reported seeking to find methods to ease the stress they were experiencing. The most frequent responses here were “I seek support or advice from other people who have relevant experience or who have experienced similar problems,” “When I encounter a problem, I use past experience to help me decide on a solution,” and “I chat and get together with friends to reduce my stress.” Statistically significant difference (p<0.05) was seen in the scores for respondents with differing years of service, with different forms of employment, with differing numbers of children, and with different religious beliefs. Overall, the average level of work-related stress experienced over the past month was 76.45±18.83 points. As regards personal factors, significantly lower levels of work-related stress were reported by nursing staff who were older (r= -0.217), had more children (= -0.143), had more years of service (r= -0.207), or were employed with formal government employee status (r= -0.144). A better response to work-related stress was seen in those respondents with more years of service (r= -0.151, p=0.028); respondents who held religious beliefs displayed better coping strategies (r= -0.161, p=0.021). Which shift nursing staff were assigned to had a significant effect (p<0.05) on their experience of stress, their response to stress, and their stress coping strategies. A positive correlation was seen between nursing staff’s level of work-related stress (on a scale of 0 – 100 points) and their experience of stress (r=0.393, p<0.001) and response to stress (r=0.528, p<0.001); however, the correlation between the level of work-related stress and stress coping strategies was not statistically significant (r= -0.41, p=0.290). Recommendations: It is suggested that both the government agencies responsible for healthcare administration, and individual hospitals, should pay more attention to the level of work-related stress experienced by nursing staff, and should provide channels through which this stress can be eased. Nursing staff themselves can adopt a proactive approach to dealing with stress, for example by working to enhance their own professional expertise, participating in relevant activities, etc.
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