大型和中型医院护士生活质量与心理健康状况的比较

Comparison of quality of life and mental health of nurses in large and medium-sized hospitals

目的:探讨不同医院护士群体的生活质量和心理健康状况,为卫生行政管理部门、各级各类医院在护理管理和决策方面提供依据。方法:调查于2001-12/2003-12在武汉大学人民医院精神卫生中心完成。选择在武汉市1所大规模三级甲等医院工作的护士522人及在4所中型二级甲等医院工作的护士581人,均知情同意并参与调查,能独立完成测验内容。由专业测量人员与护士长一起召集该科室护士进行集体指导后填表,主要评估护士的生活质量、睡眠质量、心身状况、抑郁严重程度及焦虑感受,采用世界卫生组织生活质量评定量表中文版(包括100个条目,含6个大项24个小项及1个总的健康状况小项,得分越高,说明生活质量越好)、匹兹堡睡眠质量指数量表(7个成份,每个成份按0～3等级计分,总分范围为0～21,得分越高,表示睡眠质量越差)、90项症状自评量表(包括90个项目,采用5级评分,0～4分为无～严重)、抑郁自评量表(由20个项目构成,总标准分超过41分为阳性,分值越高,抑郁倾向越明显)及焦虑自评量表(由20个项目构成,总标准分超过50分为阳性,分值越高,焦虑倾向越明显)。结果:共发出问卷1280份,177份因资料填写不完整被剔除,最后回收完整资料1103份。①大、中型医院护士的生活质量比较:在心理、独立性和精神支柱个人信仰3个领域中大型医院护士均分显著高于中型医院护士犤15.06±1.77,16.73±1.61,11.81±3.97;14.81±1.84,16.49±1.86,11.17±3.83(t=2.248～2.759,P<0.05～0.01)犦。在自尊、身材与相貌、性生活、经济来源及精神支柱个人信仰等5个层面,大型医院护士均分显著高于中型医院护士(t=2.143～2.799,P<0.05～0.01);在药物及医疗手段依赖性、环境条件2个层面上大型医院护士均分则显著低于中型医院护士(t=2.744,3.275,P<0.05～0.01)。②大、中型医院护士的各量表评分比较:大型医院护士恐怖因子得分、抑郁自评量表总标准分、焦虑自评量表总标准分均显著高于中型医院护士犤1.32±0.37,44.98±8.59,38.24±7.58;1.27±0.34,43.82±9.14,36.76±8.33(t=2.159～3.071,P<0.05～0.01)犦。结论:大型医院护士生活质量的某些方面高于中型医院的护士,但大医院的护士存在着更多的心理情绪问题,可能与大医院护士的工作强度大、压力大、竞争意识强有关。

AIM： To investigate the quality of life and mental health status of nurses in different hospitals, and provide the support for the nursing supervision and management of health administrations and hospitals. METHODS： The survey was carried out at Mental Health Center of Renmin Hospital of Wuhan University from December 2001 to December 2003. After signing the informed consent, 522 nurses from one large hospital, and 581 from 4 medium-sized hospitals participated in the survey and finished the questionnaires independently. Our aim was to evaluate the quality of life, sleep quality, psychic and physical state, the extent of depression and anxiety of nurses, using WHO＇s quality of life rating scale （Chinese revsion）（100 items, including 6 large terms and 24 small terms as well as 1 general health status small item, the high the scores were, the better the quality of life was）. Pittsbury sleep quality index table （.7 items, the score for each item was ranged from 0 to 3,the range of total score was from 0 to 21.The higher the score was, the worse the sleep quality was）, symptoms cbecklist-90 （90 items, using 5-point scale, 0 to 4 was from not present to severe）, Self-rating Depression Scale （20 items, the total score which exceeded 41 was positive, the higher the score was, the more obvious the depression was） and Anxiety Self-rating Scale （20 items, the total score which exceeded 50 was positive ;the higher the score was, the more obvirous the anxity was）. RESULTS： Totally 1280 questionnaires were handed out, 177 were rejected for incomplete information, and 1103 were accepted.①Comparison of the quality of life of the nurse between large and mediumsized hospital ： The scores of following items of nurses in large hospitals were higher than that of nurses in medium-sized hospitals： mental ,independence and ideological pillar individual belief （15.06±1.77,16.73±1.61, 11.81±3.97;14.81±1.84,16.49±1.86,11.17±3.83 （t =2.248 -2.759,P 〈 0.05-0.01））.In self-respect, body figure, appearance, sex life, economy resource and ideological pillar individual belief, the scores of nurses in large hospitals were higher than that of nurses in medium-sized hospitals （t=2.143-2.799,P 〈 0.05-0.01）. The scores of nurses in large hospitals were lower than that of nurses in medium-sized hospitals in the dependence with drug and facilities, as well as work condition（t=2.744,3.275,P 〈 0.0-0.01）.② Comparison of various scales of the nurses in large and medium-sized hospitals： In fear factor, depression self-rating scale and anxiety self-rating scale, the scores of nurses in large hospital were higher than that of nurses in medium-sized hospitals （1.32±0.37,44.98±8.59,38.24±7.58, 1.27±0.34,43.82±9.14,36.76±8.33（t=2.159-3.071, P 〈 0.05-0.01））. CONCLUSION： Some respects of nurse＇s quality of life in large hospitals are higher than that of nurses of medium-sized hospitals, but the nurses in large hospitals have more emotional problems. This may be related to their more work intension, bigger pressure and stronger competition consciousness.