【作者】 徐杰；

【导师】 徐凌忠；

【作者基本信息】 山东大学 ， 公共卫生（专业学位）， 2013， 硕士

【摘要】 研究背景Zelauskas于1992年提出的护士工作环境的定义被广为接受并普遍使用,即使护士获得更多自主、责任和对工作控制的环境。20世纪90年代,护理人员缺勤率和部分地区护理人员离岗率不断提高,同时部分医疗机构改革,使护理人员总数下降，中国的护理人员工作环境问题越来越受到重视。由此引发的一系列问题包括：护士／患者的比例降低、专业护理人员减少和临床支持降低、有限的护理人员承担更多的非临床工作。这些问题导致护理人员工作环境恶化,因为过度的工作压力使得大量的护理人员提前退休或中途转行。护理人员工作环境是一个由多方面构成的复合体,有研究提示护士工作环境与护士工作相关性疲倦呈显著负相关,较差的工作环境可产生高水平的疲倦感。良好的护理工作环境可使护理工作得到有序的开展,管理者要提高风险预判能力,为护士创造良好的工作环境,因地制宜改善自身现有的设施。研究目的通过对护理人员工作环境及满意度进行现状调查,对护理工作环境进行初步探讨,为营造健康的护理工作环境提供相关的科学依据。资料与方法以山东省4所省级三级医院679名护理人员为研究对象,不受年龄、性别、文化程度、种族的限制,采用比例抽样法对其工作环境现状及满意度进行调查分析。1.一般情况调查问卷：由研究者自行设计,包括：护龄、性别、学历、人事状况、职称、年龄、科室、婚姻状况、职务及健康情况。2.护理工作环境量表(Practice Environment Scale, PES):PES是检测护理工作环境的自评式量表。该量表包括5个维度,31个条目,由Lake等发展且现在已被广大护理人员广泛使用。每个条目中均包括“完全同意”、“同意”、“不同意”、“完全不同意”,依次给予4分、3分、2分、1分的分值,统计得分时护理专业工作环境越差,得分越低。3.护理工作环境满意度量表：以毕红梅构建的护士工作环境评价指标体系作为参考,该量表包括7个方面44个条目,填答方式采用理奎德5点量表计分法,分为5种答案,分别是“很不满意”、“不满意”、“不确定”、“满意”、“非常满意”,依上述5种表示计分方式分别是给予5分、4分、3分、2分、1分。被调查者选择其一作答,分数越低,满意度越高。主要结果本次研究共发放问卷700份,遗失问卷16份,收回684份,回收率为97.71%,剔除无效问卷5份,共余有效问卷679份,问卷合格率99.27%。1.护理工作环境量表(PES)问卷调查：各维度的条目平均得分由低到高依次为：充足的人力和物力(2.430分),护士参与医院事务(2.650分)、护理管理者的能力及领导方式(2.915分)、高质量护理服务的基础(2.957分)、医护合作(2.988分)。2.护理工作环境满意度量表：不同年龄、护龄、健康状况、婚姻状况及所在科室护士工作环境满意度得分总体有统计学差异,不同职务、职称、人事状况护士工作环境满意度得分总体无统计学差异,但具体维度中的满意度得分存在差异。总体而言,护龄1～5年、20～29岁年龄段护士的满意度高于护龄>5年、年龄高于30岁的护士；健康状况良好人群的满意度高于一般、差健康状况的人群；未婚、初级职称、正式在编护士的满意度高于已婚、中级职称、合同制护士；满意程度由高到低科室依次为急诊、手术室、内科、妇产科、儿科、ICU、外科。结论缺乏人力和物力资源仍然是护理领域最主要的问题,其次需要引起相关管理者重视的是护士较少有参与医院事务决策的机会。山东省省级三级医院护士的工作环境满意度总体较低,护士满意度程度七个维度由低到高依次为：工作酬劳、团队合作、工作安全、护士参与医院事务、专业及个人发展、管理形态和排班原则。更多还原

【Abstract】 The research backgroundZelauskas in1992nurses working environment definition is widely accepted and used widely, even if the nurse for more autonomy, responsibility and control of work environments. Parts in the1990s, the nursing staff absenteeism and nursing staff absences rate rises ceaselessly, part of the reform of medical institutions at the same time, the total nursing staff, nursing staff working environment problem in China is more and more attention. The resulting a series of problems including:nurse/, professional nursing staff, reduce the proportion of patients and clinical support to reduce, the limited nursing staff to take more of the clinical work. These problem leads to the deterioration of the nursing staff working environment, because of excessive work pressure make a lot of nursing staff to retire ahead of schedule or change careers. Nursing staff working environment is a composite composed of various, research suggests nurses working environment and working correlation is tired, has negative correlation with poor working conditions can produce a high level of fatigue. Good care environment can make the nursing work is orderly, managers should improve risk anticipation ability, create good working environment for nurses, adjust measures to local conditions to improve their existing infrastructure.Research purposesBy nursing staff working environment and satisfaction present situation investigation, carries on the preliminary discussion on nursing work environment, to create a healthy work environment to provide related scientific basis. Materials and methodsWith4provincial level3hospital679nursing staff in Shandong province as the research object, and is not affected by age, gender, culture degree, racial restrictions, by using the method of stratified sampling work environment investigation and analysis on status and satisfaction.1. General situation questionnaire, designed by the researchers themselves, including:age, gender, education, personnel status, marital status, department, title, age, job and health.2. The nursing work Environment Scale (Practice Environment Scale, PES): PES is detection of the nursing work Environment since the rating Scale. This scale includes five dimensions,31items, by the Lake and so on development and now has been widely used general nursing staff. Each entry in the "completely agree","agree","not agree","completely disagree", in order to give4points,3points,2points,1points., score, score statistics when the nursing work environment is poor, the lower the score.3. The nursing work environment satisfaction scale:in Hong-Mei Bi build nurses working environment evaluation index system for reference, this scale includes seven aspects of44entries, complete way by quaid5point scale scoring method, is divided into five kinds of answers, are "very dissatisfied","not satisfied","not sure","satisfaction","very satisfied", according to the above five kinds of said scoring way are respectively given5points,4points,3points,2points,1points. Respondents choose to answer, the lower the score, the higher the satisfaction.The primary outcomeThis study out questionnaire700, lost16questionnaires,684taken back, the recovery was97.71%, excluding invalid5questionnaires,679questionnaires altogether Yu You xiao, questionnaire the percent of pass is99.27%.1. The nursing work environment scale (PES) questionnaire:each dimensions of the items scored an average order from low to high is:plenty of manpower and material resources (2.430) and nurses in the hospital affairs (2.650). nursing ability of managers and leadership (2.915), the basis of high quality nursing service (2.957points)(2.988), medical cooperation.2. Nursing work environment satisfaction scale, different age, health status, marital status, age and where the nurse department, work environment satisfaction scores overall statistically significant different positions, titles, personnel status of nurses working environment satisfaction scores overall no statistical difference, but the specific dimensions of satisfaction scores. Overall, from1to5years old,20to29age nurses satisfaction is higher than n>5years old, age above30years old nurse; Good health crowd’s satisfaction is higher than general, poor health status of people; Unmarried, primary title, formally enrolled nurse satisfaction is higher than married, intermediate title, the contract nurses; Satisfaction from high to low respectively the emergency department, operating room, internal medicine, obstetrics and gynecology, pediatrics, ICU, surgery.ConclusionLack of manpower and material resources is still the main problem in nursing, you need the nurse to the attention of the regulators is less opportunity to participate in hospital affairs decision-making. Shandong provincial level3hospital nurses’work environment satisfaction overall is low, nurse satisfaction degree from low to high in turn seven dimensions:work rewards, team cooperation, work safety, nurses in the hospital affairs, professional and personal development, management and scheduling.更多还原