天津市护士职业倦怠现状调查与分析

Investigation and analysis on the current situation of job burnout of nurse in Tianjin

目的了解天津市临床护士职业倦怠的现状并分析其相关影响因素。方法采用便利抽样调查法，以权威的评估职业倦怠的工具问卷（Maslach Burnout Inventory，MBI，Alpha在0．73—0．86）对天津市属的55所二、三级医院的548名护士进行职业倦怠问卷调查。该问卷包含22个条目，共3个维度：情感耗竭（Emotional Exhaustion，EE）、去人格化（Depersonalization，DP）和成就感降低（Personal Accomplishment，PA）。采用Likert7级评分（0～6分），其中情感耗竭和去人格化得分越高、倦怠程度越严重；成就感得分越低、倦怠程度越严重。将天津市护士的职业倦怠得分与Maslach等对美国1104名医务人员的测评常模（M氏常模）进行对比，同时将结果与杭州市的一项1285名大样本调研数据进行比较。采用SPSS17．0软件进行箱式图制作、t检验、Y。检验分析等。结果天津调研对象以三级医院护士为主（67．52％），以内外科护士居多（77．19％），学历以大专为主（50．18％），本科及以上学历者占34．85％；护师及护士职称者分别占40．15％和30．11％；调查对象以工作≤5年的护士为主，占65．33％。在与美国M氏常模的对比中，在EE方面本市护士与美国医护人员调查结果比较，差异无统计学意义（P〉0．05），而DP和PA值均低于美国医护人员（均P〈0.05），表明本市护士去人格化程度低于美国医护人员，但是个人成就感不如美国医护人员强。与杭州市1285名调研数据比较，在EE、DP和PA3方面。本市护士与杭州市护士比较，差异有统计学意义，其中EE和DP程度低于杭州市，PA高于杭州市（均P〈0．05）。护士职业倦怠检出率与杭州市大样本数据比较显示，本市护士的职业倦怠总检出率为63．14％，低于2013年杭州市的调查结果（70．44％）；按轻、中、重度职业倦怠分类进行比较，本市护士的职业倦怠程度低于杭州市，差异有统计学意义（P〈0．05）。结论本市护士的去人格化程度低予美国医护人员，但个人成就感不如美国医护人员强，可能与东西方的文化差异有关；本市护士工作成就感较低，可能与我国护士感知到的社会地位低、福利待遇较低、继续深造及晋升的机会少、护士的个人价值得不到肯定有关；本市护士的职业倦怠程度低于杭州市，可能受南北地域差异以及人文差异的影响。护患关系、护理专业的发展及工作本身因素，包括团队合作、医护关系、内部管理机制、工作自主性、职业拓展等护理专业特性的工作环境是影响护士产生职业倦怠的主要影响因素。

Objective To understand the current situation of job burnout of nurse in Tianjin and analyze the related influencing factors. Methods Convenience sampling survey method was used, and authoritative instrument that can evaluate job burnout was applied to have job burnout questionnaire （Maslach Burnout Inventory, MBI, Alpha between 0. 73 to 0. 86） for 548 nurses of 55 secondary and tertiary hospitals in Tianjin. This questionnaire contained 22 entries, and 3 dimensions which were emotional exhaustion （EE）, depersonalization （DP） and reduced personnel accomplishment （PA） . Likert 7-grade score was used （0 - 6 points）, where the scores of emotional exhaustion and depersonalization were high, and burnout degree was more serious. When the score of personnel accomplishment was lower, burnout degree was more serious. The score of job burnout of nurses in Tianjin was compared with the evaluation norm for 1 104 American medical workers by Maslach （M＇s norm） et al. Meanwhile, the result was compared with the investigation and research data of 1 285 large samples in Hangzhou. SPSS 17.0 software was used to make box-type graphs, t-test and χ^2 check analysis, etc （ P〈0. 05 ）. Results The research objects were prior to the nurses of tertiary hospitals in Tianjin （67.52%）. The nurses of internal medicine and surgical department were in the majority （77.19%）, and the education background was prior to junior college （50. 18% ）. The proportion of bachelor degree or above was 34. 85%. The proportions of nurse practitioners and nurses were 40. 15% and 30. 11%. The object of investigation was prior to nurses who worked equal or shorter than 5 years, which was 65.33%. Compared with American Maslach norm, with regard to the investigation result between the nurses of Tianjin in the aspect of EE and American medical workers, the difference had no statistical significance （P〉0. 05 ）. However, DP and PA values were inferior to American medical workers （P〈0. 05 ）, which indicated that the depersonalization degree of nurses in this city was inferior to American medical workers, but the sense of personal achievement was inferior to it of American medical workers. Compared with the investigation data of i 285 samples in Hangzhou, in the aspects of EE, DP and PA, the difference of comparison between the nurses of this city and Hangzhou had statistical significance, of which EE and DP degrees were inferior to it in Hangzhou, but PA was superior to it in Hangzhou （P〈0. 05）. The detection rate of job burnout of nurses and the large sample data comparison of Hangzhou showed that the overall detection rate of job burnout in this city was 63.14%, which was inferior to the investigation result of Hangzhou in 20i3 （70. 44% ）. Compared based on mild, middle and serious job burnout classification, the job burnout degree of nurses in this city was inferior to it in Hangzhou, and the difference had statistical significance. Conclusions The depersonalization degree of nurses in this city is lower than it of American medical workers, but the sense of personal achievement is inferior to it of Ameri- can medical workers. It may be because of the cultural difference between the east and the west. The sense of achievement for the nurses of this city is lower, which may be because that the social position Chinese nurses perceive is low, social benefits are lower, the opportunity to have further education and promotion is few, the personal value of nurses can＇t be recognized. The job burnout degree of nurses in this city is lower than it of Hangzhou, which may be because of the impact of North-South regional difference and humanity difference. Nurse-patient relationship, development of nursing specialty and job itself, including teamwork, doctor-nurse relationship, internal management system, job autonomy, career development and the working environment of nursing specialty are the major influence factors which may cause job burnout to nurses.