品管圈在急诊护士经历工作场所暴力致创伤应激障碍中的应用

Application of quality control circle to release emergency nurse’ s workplace violence of posttraumatic stress disorder

目的：评估品管圈对急诊科护士遭受工作场所暴力后应激障碍的影响。方法采用随机数字表法将温州市某几家医院第一次遭受工作场所暴力的急诊科护士45人随机分为观察组（ n＝24）和对照组（ n＝21），观察组成立品管圈小组进行心理危机干预，对照组采用一般心理干预方法。分别在遭受工作场所暴力的早期（1周内）及3个月后进行问卷调查，包括一般人口社会学资料问卷、职业倦怠感问卷、创伤后应激障碍自评量表问卷（ PTSD-SS）及简易应对方式问卷（ WCQ），并对问卷结果进行分析。结果遭受工作场所暴力早期，两组护士PTSD-SS评分、职业倦怠感、应对方式评分差异无统计学意义（P＞0．05）。3个月后观察组护士的PTSD-SS评分为主观评定（2．01±0．19）分、社会功能（5．03±1．09）分、重现体验（20．12±1．80）分、回避症状评分（20．11±3．98）分，均低于对照组[（3．09±0．23），（6．63±1.27），（26．31±1．91），（28．92±4．71）分]，差异有统计学意义（t值分别为2．516，2.121，2．331，2．453；P＜0．05）。职业倦怠感、积极应对方式、消极应对方式评分分别为（3．51±1．01），（34．29±7．17），（14．98±1.94）分，与对照组[（4．17±0．98），（30．83±8．33），（20．25±1．51）分]比较差异均有统计学意义（t 值分别为2.118，2．098，2．382；P＜0．05）。两组警觉性增高评分比较差异无统计学意义（t＝0．762，P＞0.05）。干预后3个月，观察组护士的应激障碍自评量表评分、职业倦怠感、消极应对评分降低，积极应对评分增高，与干预前比较差异均有统计学意义（ P＜0．05）；对照组仅有警觉性增高评分升高，与干预前比较差异有统计学意义（P＜0．05）。结论品管圈可有效改善急诊护士经历工作场所暴力后精神心理健康状况，有利于患者精神心理康复。

Objective To evaluate the effect of quality control circle （ QCC） application on releasing emergency nurse’ s workplace violence of posttraumatic stress disorder.Methods We utilized digital table method to divide forty five emergency nurses in certain hospitals who suffered workplace violence at first time into two groups randomly：experimental group （ twenty four cases） and control group （ twenty one cases） .Emergency nurses in the experimental gruop received psychological crisis interventions by QCC team while nurses in the control group were given general psychological interventions.The questionnaire survey occurred at early period （in the first week） and after three months of violence including demographic information questionnaire, the sense of job accidie questionnaire, PTSD-SS and WCQ, and analyzed the result of survey.Results At the early stage of suffered violence, the score of PTSD-SS, job accidie and the score coping style had no statistical difference （P＆gt;0.05）.After three months, the nurse in experimental group acquired the score of subjective assessment （2.01 ±0.19）, social function （5.03 ±1.09）, re-experienced （20.12 ±1.80）, withdrawal symptoms （20.11 ±3.98） were lower than control group [（3.09 ±0.23）,（6.63 ±1.27）,（26.31 ±1.91）, （28.92 ±4.7）, respectively],the differences were statistically significant （t=2.516,2.121,2.331,2.453, respectively;P＆lt;0.05）.The score of job accidie sense, positive coping style and negative coping style obtained （3.51 ±1.01）,（34.29 ±7.17） and （14.98 ±1.94） in the experimental group, while nurses in the control group achieved （3.51 ±1.01）,（34.29 ±7.17） and （14.98 ±1.94） respectively,the differences were statistically significant （t=2.118,2.098,2.382, respectively;P〈0.05）.The vigilance increasing score had no statistical significance（15.33 ±3.24） in the experimental group and （17.98 ±3.30） in the control group （t=0.762,P〉0.05）.After three months’ intervention, the score of PTSD-SS, job accidie and negative coping style decreased while positive coping style increased in the experimental group （P〈0.05）.Meanwhile, the control group just increased vigilance increasing score （P〈0.05）.Conclusions The QCC is effective to promote psychological wellbeing when emergency nurses suffered workplace environment and benefits to recover.