【作者】 黄海燕；

【导师】 许军；

【作者基本信息】 南方医科大学 ， 社会医学与卫生事业管理， 2008， 硕士

【摘要】 研究目的调查军队三甲医院护士的自测健康状况,探索和发现影响军队三甲医院护士自测健康的因素,并提出相应的管理对策,为促进军队三甲医院护士的健康水平提供参考和依据。对象和方法本研究采用随机整群抽样法,于2007年7～9月间进行现场调查。共调查北京、上海、广州、重庆四座城市八所三甲医院的护士共1508名为研究对象。获有效问卷1413份,有效率为93.70%。调查对象均为女性。其中,研究组年队三甲医院护士727人,对照组地方三甲医院护士686人。调查采用的问卷包括:自测健康评定量表(SRHMS)、护士工作压力源量表(NJSI)、摩斯腊克工作疲溃感量表(MBI)、简易应对方式量表(SCSQ)等。用Foxpr06.0建立数据库,SPSS13.0软件进行数据处理,统计方法包括:描述性分析、独立样本t检验、方差齐性检验、方差分析、相关分析、多元逐步回归分析及路径分析。结果一、军队三甲医院护士自测健康状况分析1、军队三甲医院护上在自测健康评定的各维度、子量表的均分以及总均分在6.14～9.54之间,处于中间偏上水平。与地方三甲医院护士的得分相比,军队三甲医院护士在各维度、子量表分以及SRHMS量表总分均高于地方三甲医院护士的得分,而且在心理健康子量表及其正向情绪维度、社会健康子量表及其社会支持维度、自测健康评定量表总分的比较上有统计学上意义(P<0.05)。2、进一步比较军队和地方护士自测健康评定量表的48个条目,发现与地方三甲医院护士的得分相比,军队三甲医院护士在生理健康的体能,心理健康的自信心、安全感、幸福感方面,社会健康的与家庭和朋友的关系方面均好于地方三甲医院护士,焦虑、强迫等症状的程度低于地方三甲医院护士,比较在统计学上有显著性差异(P<0.05)。3、统计护士自测健康评定量表条目的均分低于6分的项目,结果生理健康子量表中有两个条目,分别反映护士的胃肠道症状、疲劳方面的情况;心理健康子量表中也有两个条目,反映护士的抑郁、强迫症状;社会健康子量表中有三个条目,反映护士参加社团活动、遇到困难的时候寻求帮助和依靠朋友的情况。二、影响军队三甲医院护士自测健康的单因素分析军队三甲医院护士的自测健康在不同文化程度、职称等方面,各子量表和自测健康评定量表总分均无显著差异;在是否经常参加体育锻炼、是否吃早餐方面,各子量表和SRHMS总分在统计学上均有显著性差异(P<0.01);在不同婚姻状况的比较方面,已婚的军队三甲医院护士心理健康和SRHMS得分高于未婚护士得分,在统计学上有显著性差异(P<0.05)。三、军队三甲医院护士工作压力源与自测健康的关系除了继续深造的机会太少等5个条目的得分军队三甲医院护士大于地方三甲医院护士的得分外(差异在统计学上无显著意义),其余条目的评分都是军队三甲医院护士小于地方三甲医院护士的得分,表明军队三甲医院护士的工作压力源小于地方三甲医院护士,尤其是工作量及时间分配问题、工作环境及资源方面的问题、病人护理方面的问题三个因子的所有条目,两者之间的差异均有统计学意义。军队与地方三甲医院护士工作压力源得分前10位的条目基本相同,依次为工资及其他的福利待遇低、经常倒班、晋升的机会太少、继续深造的机会太少、护理工作的社会地位太低、担心工作中出现差错事故、工作量太大、上班的护士数量少、非护理性的工作太多、护士工作未被病人及家属承认。军队三甲医院护士工作压力源五个因子得分从高到低依次为护理专业及工作方面的问题、工作量及时间分配问题、病人护理方面的问题、工作环境及资源方面的问题、管理及人际关系方面的问题。军队三甲医院护士工作压力源的五个因子分与自测健康评定量表的各子量表得分以及总分呈显著负相关,其中与心理健康的相关程度最高(相关系数达到0.355)。四、军队三甲医院护士工作疲溃感与自测健康的关系军队三甲医院护士工作疲溃感的条目得分绝大多数低于地方三甲医院护士的得分,而且两者之间的差异均有统计学意义。军队三甲医院护士工作冷漠感得分与自测健康评定量表的各子量表得分以及总分呈显著正相关;情绪疲溃感得分、工作无成就感得分与自测健康评定量表的各子量表得分以及总分呈显著负相关。五、军队三甲医院护士应对方式与自测健康的关系从军队三甲医院护士选择各种应对方式的人数和百分数统计结果可以看出,他们最多采用的五种应对方式依次为:“与人交谈,倾诉内心烦恼(42.5%)”,“尽量看到事物好的一面(40.7%)”,“向亲戚朋友或同学寻求建议(38.6%)”,“自己安慰自己(35.5%)”,以及“找出几种不同的解决问题的方法(32.2%)”,其中有4种为积极应对方式。最少采用的五种应对方式为:“依靠别人解决问题(3.3%)”,“通过吸烟、喝酒、服药和吃东西来解除烦恼(4.1%)”,“认为时间会改变现状,唯一要做的便是等待(6.6%)”,“幻想可能会发生某种奇迹改变现状(7.7%)”,以及“试图忘记整个事情(8.8%)”,均为消极应对方式。军队三甲医院护士的积极应对方式得分与自测健康评定量表的三个子量表得分及总分均呈正相关(P<0.01),而消极应对方式得分与自测健康评定量表的三个子量表得分及总分均呈负相关(P<0.01)。六、军队三甲医院护士自测健康影响因素的多因素分析分别以军队三甲医院护士自测健康评定量表各子量表得分和总分为因变量,以工作疲溃感量表三个因子分、工作压力源五个因子分、积极应对和消极应对因子分为自变量进行多元逐步线性回归分析。在α=0.05的水平上,进入全部四个回归方程的有积极应对和消极应对因子,工作疲溃感量表的三个因子、工作压力源的五个因子分分别进入不同的回归方程。七、自测健康影响因素间相互关系的路径分析本研究假设军队三甲医院护士工作压力、工作疲溃感、应对方式会影响他们的自测健康状况,并且各因素之间也可能存在相互影响。经过路经分析得出两条路径有统计学意义:一为总压力源→工作冷漠感因子→积极应对→自测健康;二为总压力源→工作无成就感因子→自测健康。结论1、军队三甲医院护士自测健康总体处于中等偏上水平,相对高于地方三甲医院护士,尤其在心理健康和自测健康评定量表总分上差异显著。军队三甲医院护士自测生理健康以胃肠道症状、疲劳较突出;自测心理健康以抑郁、强迫症状较明显;自测社会健康以遇到困难的时候寻求帮助和依靠朋友为特点。2、经常参加体育锻炼、吃早餐的军队三甲医院护士的自测健康状况好;已婚的军队三甲医院护士的自测心理健康和自测健康总体水平较好。3、军队三甲医院护士工作压力源、工作疲溃感均低于地方三甲医院护士,主要的压力源反映在工资及其他的福利待遇低、经常倒班、晋升的机会太少、工作量及时间分配等方面。4、军队三甲医院护士应对挫折时,采取的积极应对方式较多,消极应对方式较少,“与人交谈,倾诉内心烦恼”和“尽量看到事物好的一面”是军队三甲医院护士最常采用的应对方式。5、军队三甲医院护士工作压力源、工作疲溃感、应对方式对其自测生理、心理和社会健康状况均有显著影响,其中对自测心理健康的影响最为显著。6、应激性压力源对军队三甲医院护士的自测健康有一定的直接作用,但通过认知评价和应对方式的中介作用,对个体自测健康状况的间接作用和影响更大。7、针对上述结果,从管理的层面上,提高军队三甲医院护士的工资及其他福利待遇、增加工作人员、调整倒班制度、增加晋升的机会、调整工作量及时间分配等,是提高其健康水平的途径。特色或创新之处1、对军队三甲医院护士的自测健康状况进行系统而全面的调查,并探讨工作压力源、工作疲溃感、应对方式等因素对军队三甲医院护士自测健康的影响作用。样本量大,得出结果有较高的代表性。2、量化反映了军队三甲医院护士自测健康的总体水平和生理、心理、社会各维度的健康水平,探讨并总结出影响军队三甲医院护士自测健康的因素以及各影响因素对自测健康的作用方式和相互作用。3、有针对性地提出了提高军队三甲医院护士自测健康水平的管理对策。局限性以及进一步研究的设想1、本研究属于横断面调查设计,得出结论有限,有些发现有待进一步验证。2、研究样本限于三甲医院的护士,研究结论不能直接推广到在其他级别医院工作的护士,有待进一步研究中扩充。更多还原

【Abstract】 ObjectivesTo investigate the self-rated health status of nurses in 3A military hospitals;to explore and investigate the psychosocial factors that affect the self-rated health of nurses in 3A military hospitals;and to bring forward the corresponding management strategies to provide reference for the improvement of the heath status of nurses in 3A military hospitals.Research Subjects and Research MethodsThis research uses random cluster sampling method to conduct a field survey from July to September in 2007.The survey is carried out with 1508 nurses in eight 3A hospitals in Beijing,Shanghai,Guangzhou,and Chongqing as its research subjects.There are 1413 valid questionnaires received,accounting for 93.70%.All the research subjects are female.The experimental group constitutes 727 nurses in 3A military hospitals,while the control group is composed of 686 nurses in 3A local hospitals.The following scales are adopted in the questionnaires of this research: Self-rated Health Measurement Scale(SRHMS),Nursing Job Stressor Inventory (NJSI),The Maslach Burnout Inventory(MBI),Simplified Coping Style Questionnaire(SCSQ),etc.In this research,the database is established by using Foxpro 6.0,and the data is processed by applying SPSS13.0 software.The statistical methods used include Descriptive Analysis,t Test,Homogeneity Test of Variances,Variance Analysis, Factor Analysis,Analysis of Correlation,Multiple Stepwise Regression Analysis etc.Results1.The Analysis of the self-rated health status of nurses in 3A military hospitals1) The standard mean of each dimension and subscale of nurses in 3A military hospitals and their total mean are above average,ranging from 6.14 to 9.54.The standard mean of each dimension and subscale of nurses in 3A military hospitals and their total mean are higher than those of nurses in 3A local hospitals.Moreover,there is an evident difference in the comparison of the subscale of psychological health and its positive effect,the subscale of social health and its SSRS,and the total score of self-rated health.2).With further comparison among the 48 entries of the SRHMS of nurses in military hospitals and local hospitals,we find that nurses in 3A military hospitals are better than those in 3A local hospitals in their physical fitness in the aspect of physical health,their sense of confidence,security and happiness in the aspect of psychological health,and their relation with families and friends in the aspect of social health,while their degree of some symptoms like anxiety and compulsion is lower than that of nurses in 3A local hospitals.The evident statistical difference is found through comparison.3) After gathering statistics of the entries of the SRHMS with the mean score lower than 6 points,we find two entries of the subscale of physical health reflecting the status of gastrointestinal symptoms and burnout of the nurses,two entries of the subscale of psychological health reflecting the depression and compulsion of the nurses,and one entry of the subscale of social health reflecting their seeking for help and support from their friends in social activities and in difficulty.2.Analysis on one-factor that affects the self-rated health of nurses in 3A military hospitals The scores of the subscales and the overall scores of the self-rated health of nurses in 3A military hospitals show no difference in aspects of different educational attainments and professional titles,but they show significant statistical difference (P＜0.01) in the aspects of frequently taking physical exercises and having breakfast. There is significant statistical difference in the aspect of different marital statuses (P＜0.05),where the scores of the psychological health and self-rated health of married nurses are higher than those of unmarried nurses in 3A military hospitals.3.The relationship between the job stressors and the self-rated health of nurses in 3A military hospitalsThe difference of scores of the five entries,like little opportunity for further study and training,where the scores of nurses in 3A military hospitals are higher than those of nurses in 3A local hospitals,is of no statistical significance.The scores of the rest of the entries,where the scores of nurses in 3A military hospitals are lower than those of nurses in 3A local hospitals,indicate that job stressors of nurses in 3A military hospitals are fewer than those in 3A local hospitals.Notable statistical significance is found especially in the difference of all the entries in the factors of workload and time distribution,working environment and resources,and patient care.The ten entries with the highest scores of job stressors of nurses in 3A military hospitals and those of nurses in 3A local hospitals are basically the same,the sequence of which is low pay and welfare benefits,regular shifts,little chance of promotion,little opportunity for further study and training,low social status of nursing profession,worries about miswork,too much workload,too few nurses on duty,too much non-nursing work,and no appreciation from patients and their families.The five factor scores of job stressors of nurses in 3A military hospitals in sequence from the highest to the lowest are as follows:nursing and the job,workload and time distribution,patient care,working environment and resources,and management and interpersonal relation.The live factor scores of the job stressors of nurses in 3A military hospitals are significantly negatively correlated with the scores of the subscales and the overall scores of the self-rated health,with the highest degree of correlation with psychological health where the correlation coefficient reaches as high as 0.355.4.The relationship between the burnout and the self-rated health of nurses in 3A military hospitalsThe scores of the entries of the burnout of nurses in 3A military hospitals are mostly lower than those of nurses in 3A local hospitals,and the difference between the two is of evident statistical significance.In the scores of the burnout of nurses in 3A military hospitals,depersonalization and decreased personal accomplishment have high level of exhaustion,accounting for 90.1%and 94.9%respectively.The scores of the subscales and the overall scores of the self-rated health are significantly positively correlated with the scores of depersonalization of nurses in 3A military hospitals,and significantly negatively correlated with the scores of emotional exhaustion and the decreased personal accomplishment.5.The relationship between the coping styles and the self-rated health of nurses in 3A military hospitalsFrom the statistical results of the number and percentage of nurses in 3A military hospitals that choose each coping style,we may conclude that the five most commonly used coping styles in sequence are as followings:"to communicate to pour out worries and troubles(42.5%)","to try to look on the bright side of things (40.7%)","to seek for suggestions from relatives,friends,or colleagues(38.6%)","to comfort oneself(35.5%)",and "to find out several solutions to the problem(32.2%)", among which there are four positive coping styles.The least commonly adopted coping styles are "to depend on others to solve the problem(3.3%)","to get rid of worries by smoking,drinking,dosing and eating (4.1%)","to believe that the current situation will change with time,and that the only thing to do is to wait(6.6%)","to cherish the illusion that some wonders would change the current situation(7.7%)",and "to try to put the trouble out of their heads (8.8%)",among which there are five negative coping styles.The scores of the three subscales and the overall scores of the self-rated health are positively correlated with the scores of positive coping styles of nurses under different management patterns(P＜0.01),and negatively correlated with the scores of negative coping styles(P＜0.01).6.Multiple factor analysis of the factors influencing the self-rated health of nurses in 3A military hospitalsMultiple stepwise regression analysis is conducted in the research.The dependent variables are the scores of the subscales and the overall scores of the self-rated health of nurses in 3A military hospitals,while the independent variables are scores of life event,factor scores of positive coping and negative coping,three factor scores of the Maslach Burnout Inventory(MBI),and the five factor scores of job stressors.When a=0.05,positive coping factors and negative coping factors are found in all four regression equations,but the three factors of the Maslach Burnout Inventory(MBI) and the five factors of job stressors are found in different regression equations.7.Pathway analysis of the correlation among the factors influencing the self-rated healthThe study is based on the hypothesis that job stress,burnout,and coping styles of nurses in 3A military hospitals will have impact on their self-rated health,and these factors may have influence on each other as well.Two remarkable pathways are found through the analysis.The most remarkable one is as follows:total stressors factors of depersonalization→positive coping→self-rated health,and the other is: total stressors→factors of decreased personal accomplishment→self-rated health.Conclusion1.The overall level of the self-rated health status of nurses in 3A military hospitals is above average,higher than that of nurses in 3A local hospitals,and a significant difference is found especially in the total scores of the psychological health and the self-rated health.In the self-rated health status of nurses in 3A military hospitals,gastrointestinal symptoms and burnout are found to be more prominent;in their self-rated psychological health status,depression and compulsion are found to be more striking;and their self-rated social health is characterized by seeking help and support from friends when in difficulty.2.The self-rated health status of those nurses in 3A military hospitals who frequently take physical exercises and have breakfast is in good condition;and the overall level of the self-rated psychological health status and the self-rated health status of married nurses in 3A military hospitals is better.3.There are fewer job stressors and less burnout of nurses in 3A military hospitals than those in 3A local hospitals.The principal job stressors are reflected in aspects associated with nursing and the job,such as low pay and welthre benefits, regular shifts,little chance of promotion,and workload and time distribution.4.There are more positive styles and fewer negative ones in the frustration coping styles of nurses in 3A military hospitals,with "to communicate to pour out worries and troubles" and "to try to look on the bright side of things" being the most commonly adopted coping styles.5.There is outstanding impact of job stressors,burnout and coping styles of nurses in 3A military hospitals on their self-rated physical,psychological,and social health,with their most notable influence on the self-rated psychological health.6.Irritable stressors play a somewhat direct role in the self-rated health of nurses in 3A military hospitals,but they may play an indirect role with greater impact through the mediating effects of cognitive evaluation and coping styles.7.For administrators,the means to improve health status of nurses in 3A military hospitals include raising the pay and welfare benefits of nurses,hiring more staff, adjusting shift system,providing more chance of promotion,and adjusting workload and time distribution.Characteristics and Innovation1.This is a systematic and thorough investigation on the self-rated health status of nurses in 3A military hospitals to explore the impact of job stressors,burnout,and coping styles on their health.With a large sample size,the results of the research are highly representative. 2.The research quantificationally reflects the overall level of the self-rated health status of nurses in 3A military hospitals,and their physical,psychological,and social health.It explores and sums up the factors that influence their self-rated health, and the influencing style of each factor on the self-rated health and their interaction.3.The research pertinently comes up management strategies for improving the self-rated health status of nurses in 3A military hospitals.Limitations and Implications1.As a cross-section survey,the limited results of the research need further experimental verification.2.As the sample is just limited to nurses in 3A hospitals,the results of the research cannot be popularized and applied to nurses in hospitals at other levels,which need further expansion.更多还原