【作者】 项炯；

【导师】 王德斌；

【作者基本信息】 安徽医科大学 ， 社会医学与卫生事业管理， 2011， 硕士

【摘要】 背景:医务人员的情境状况主要包括其身心健康状况、身心感受、工作特征与要求、工作热情与满意度、工作的个人与社会影响等,不仅仅关系到医务人员自身的生活和工作质量,也关系到他们向全社会所提供的卫生服务质量水平。因此,对广大医务人员进行情境方面的调查与研究,不仅有助于全面深入地了解广大医务人员的情境状况、发现其主要影响因素,也能有针对性地改善和提高情境状况的总体水平,最终有利于保障卫生服务水平不断上升发展。2008年,江苏省在全省第四次卫生服务调查中,共抽出了1483名医务人员作为样本人群,对他们的身心健康状况、卫生行为等等进行了深入细致的调查。调查结果显示,该样本人群具有流动性小、依从性好的特点。本研究主要立足此次调查中该样本人群的身心健康状况、身心感受等方面的相关数据,对江苏省医务人员的情境状况开展研究。目的:通过对江苏省第四次卫生服务调查中抽取的医务人员样本人群情境状况方面的相关数据进行整理分析,了解该省医务人员的执业状况、工作满意度等情况;探讨医务人员情境状况的主要影响因素;为国家的医疗卫生政策的制定和对医务人员的管理进一步提供科学依据;为进一步深入开展对医务人员情境情况的调查与研究打下基础。资料与方法:调查主要使用结构化问卷,以苏南苏中苏北为参考,以城市与农村为参照,对全省的医务人员进行科学合理的整群抽样,共抽出1483名医务人员作为样本人群。每名被抽中的医务人员需要认真细致地填写调查表,并由江苏省县(区、市)卫生局负责调查对象的组织以及调查表的收集和质量核查。调查问卷用epidata3.10录入计算机;使用SPSS11.0软件对数据进行统计分析,对医务人员情境状况的现状进行描述性分析,对医务人员性别、年龄、从业年数、技术职务、职业资格等等相关因素做了Χ2检验比较其差异,并对相关因素对医务人员情景状况的影响进行了多因素分析等。结果:(1)共调查了1483名医务人员,共搜集到1483份有效问卷,应答率为100%。(2)医务人员的身心健康状况总体评分为95.7分,自感健康状况总体评分为81.79分,说明医务人员健康状况良好。(3)医务人员感觉工作疲劳者所占比例最高(41.59%)。(4)绝大多数医务人员认为医务工作的意义很大(评分为83.43分)、医务工作具备技能多样性(评分为82.49分)、医务工作负荷很重(评分为82.64分);大多数医务人员认为工作自主性较强(评分为78.34分)、在从事医务工作中需要隐藏自己的不满情绪并且需要做出友善表情和身体动作与难相处的患者打交道(评分为75.24分);较多人认为在工作中需要反馈(评分为69.59分)。(5)医务人员自报对工作情绪沮丧较多(平均评分70.03分),而兴奋较少(平均评分40.52分);大多数医务人员之间自觉同事关系亲密融洽(男性平均评分67.57分,女性69.65分),并报工作并未对家庭产生消极影响并能够较好地处理二者关系(平均评分50分左右);医务人员自报总体压力较大(男性平均评分57.23分,女性60.75分);离职意向评分也相对较高(男性平均评分74.53分,女性75.27分)。(6)医务人员平均每周工作时间为52小时,自报月收入大都集中在1000-3000元左右; 58.88%的医务人员最希望改善的是个人收入,19.78%医务人员最希望改善的是执业环境秩序。讨论与结论:(1)江苏省医务人员自报身心健康总体良好,这是由医疗卫生工作的特殊性决定的,同时也与江苏省经济发达程度很高有关。(2)医务人员的普遍疲劳,已不仅仅影响到个人身心感受,也医疗卫生服务质量产生不利影响。应当从管理体制机制改革、加强宣传教育(特别是医疗风险教育)两方面着手加以改善。(3)医务人员对医务工作的意义评价很高,同时承受着很大的压力,心情容易沮丧压抑,缺乏必要的兴奋。应当从合理配置医务人员的人力资源、提高医务人员的社会待遇、制定合理的奖惩制度、人性化的管理等方面着手加以改善。(4)医务人员的工作满意度普遍不高的原因在于执业环境较差、收入水平相对较低、福利待遇较差、个人职业发展受限等因素有关。应从宣传教育、改进社会保障模式、加大投入、改善从业者的收入和待遇等方面着手加以改善。(5)医务人员之间的关系大多亲密融洽,工作环境、上下级关系、同事间关系、晋升机会、经济报酬等均对其有所影响。(6)医务人员工作压力大、离职意向高的原因主要是医疗服务需求越来越大、医务人员始终缺乏、人力配置数量和结构不尽适宜。应从合理配置人力资源、重视人本管理、建立健全安全管理制度等方面着手加以改善。(7)医患关系紧张的现象普遍。原因主要有医疗体制的不合理、社会医疗保障制度的不完善、医务人员和患者自身的原因等等。应从加强医务人员自身队伍建设、加强和患者的沟通、致力减少医疗纠纷的发生等方面着手加以改善。更多还原

【Abstract】 Research background:The comprehensive state of medical workers mainly consists of physical and mental health conditions, bodily and emotional feelings, occupational features and requirements, enthusiasm for work, degree of career satisfaction, personal and social influences an so on. It not only affects the personal life of medical workers but also related to the quality of health service they provide to the whole society. So the related research is helpful to understand on the comprehensive state of medical workers and to define the major factors so that we can improve the current situation and guarantee a better health service quality in our country. The 2008 health service survey across Jiangsu Province, which based on a sample of 1483 medical workers, made a thorough investigation on the physical, mental health conditions and medical practices and other elements of medical workers. The result shows that the sample manifests the characteristics of small mobility and good compliance. My research, based on the related statistics in the survey mentioned above, probes into the comprehensive state of medical workers in Jiangsu province.Objectives: This research studies the licensed ratio and degree of career satisfaction of medical workers in Jiangsu province and discusses the major factors influencing the comprehensive state of medical workers. It aims at providing further scientific evidences to make national health care policy and management of the medical workers. It is hoped that the research will lay a good foundation to the further studies and researches of the comprehensive state of medical workers in China.Material and methods: This research is based on the 2008 health service survey across Jiangsu Province. By using the structured questionnaire, the 2008 health service survey across Jiangsu Province takes into account of the regional factors in Southern, central and northern parts of Jiangsu province and fully considers different situations in urban and rural areas of Jiangsu province. The sample of 1483 medical workers is chosen by cluster sampling. The Health Departments at all levels in Jiangsu province is responsible for the organization of survey, questionnaire collecting, and quality auditing. Each chosen medical workers is required to fill out the questionnaire, which is then input into the computer using software edidata3.10 and analyzed by software SPSS11.O. SPSS11.0 provides a detailed description and multivariate analysis of the comprehensive state of medical workers by doingΧ2 check and comparing the gender, age, length of service and working position etc.Results:(1)1483 medical workers participant in the survey and 1483 valid questionnaire are collected. (2) The physical and mental health status is scored with 95.7 points and the self-perceived health status is scored with 81.97 points, which is a clear indication of good health status. (3) The number of medical workers who feels fatigue caused by overwork ranks the highest, which is 41.59 percent. (4) The overwhelming majority of medical workers hold that medical work has great significance, skill variety, and heavy working load, which are scored with 83.43 points, 82.49 points and 82.64 points respectively; the majority of medical workers think themselves as self-motivated, which is scored with 78.34 points; Many need to hide their dissatisfaction to show friendliness to difficult patients, which is scored with 75.24 points; many need feedbacks from patients, which is scored with 69.59 points. (5) A good many medical workers feel depressed during work, which gained an average 70.03 points, while relatively small number feel they are excited, which is scored with 40.52 points. A majority of medical workers get along well with their colleagues, which is scored with 67.57 points among male workers and 69.65 points among female workers; many think that their work has no negative influence on their family life and can balance their work and family life, which gained an average 50 points; medical workers on the whole feels working pressure, which is scored with 57.23 points among male workers and 60.75 points among female workers; intention to leave their job is also relatively higher, which is scored with 74.53 points among male workers and 75.27 points among female workers.(6)The average working time per week for medical workers is 52 hours; the monthly income is mainly between 1000-3000 yuan; 58.88 percent medical workers want to increase their salary and 19.78 percent of them want a better working environment and order.Discussions and conclusions:(1) The medical workers involved in the survey in Jiangsu Province claim that they are in good health conditions. The result is determined by their professional characteristics as well as the highly developed economy in Jiangsu province. (2) The common feeling of fatigue among medical workers has already affected not only their Physical and mental feelings but also caused the negative effect in the quality of healthcare service. The situation should be improved from strengthening both the management mechanism and the public education, especially the education in the consciousness of medical risk. (3) Medical workers think highly of the significance of their work, however, since they work under high stress, there are more likely to feel depressed and their enthusiasm cannot be aroused very easily. In consideration of the above problems, it is necessary to improve the situation by redistributing the human resources in medical department, improving the treatment of medical workers, developing reasonable reward and punishment system and establishing people-oriented management system. (4) The relatively lower career satisfaction is mainly due to the lower income and welfare treatment as well as the certain confinement of individual career development. This should be improved by strengthening public education, optimize the models of social security; improve the investment to increase the income and welfare treatment of the medical workers. (5) The relationship between the medical workers is intimate and friendly in most cases. This is influenced by factors like working environment, relationship between superiors and subordinates and among colleagues, chances of promotion and reward. (6) The high working pressure and inclination to leave their work is mainly caused by the increasing demand of medical service but lack of medical stuff and the unreasonable quantity and structure in human resource distribution. This should be improved by rationally arranging human resource, placing great importance on human-centered management, establishing the safety management policy. (7) There exists common tension of relationship between doctor and patient. This is caused by unreasonable elements healthcare system, inadequacy of social security system and reasons exist in doctors and patients themselves. This should be improved by building up better teams of medical workers, strengthen the communication between doctors and patients and working hard to reduce medical disputes.更多还原