新冠疫情防控期间社区医务人员职业紧张及影响因素分析

Analysis on occupational stress and influencing factors among community medical staff during prevention and control of Coronavirus Disease 2019

目的了解新型冠状病毒肺炎疫情防控期间社区医务人员职业紧张现况,探索影响因素,为相关政策制定提供科学依据。方法于2020年10月随机在上海市中心城区10个社区卫生服务中心选取835名医务人员开展面对面调查。调查量表采用测量工作要求-自主模式职业紧张(job demands-control model,JDC)的工作内容问卷(job content questionnaire,JCQ)和测量付出-回报失衡模式职业紧张的付出-回报失衡问卷(effort-teward imbalance,ERI)2种量表相结合,问卷均经信度和效度检验,并对数据进行分析。结果社区医务人员JDC职业紧张检出率为42.5%,付出-回报失衡模式职业紧张检出率为34.0%。JDC分值M(P_(25),P_(75))为0.93(0.81,1.13)分,其中工作要求为3.00(2.80,3.40)分,工作自主为3.22(3.00,3.56)分,社会支持为4.00(3.38,4.00)分;ERI分值M(P_(25),P_(75))为0.77(0.53,1.05)分,其中付出为3.00(2.30,3.40)分,回报为3.86(3.00,4.71)分,内在投入为3.17(2.83,3.67)分。不同科室社区医务人员职业紧张检出不同,公共卫生医务人员职业紧张程度最高(JDC为53.0%,P<0.01;ERI为41.9%,P<0.05);参与不同防疫工作,职业紧张程度不同,集中隔离健康观察场所医务人员职业紧张检出率最高(JDC为64.7%,ERI为42.2%)。每周长时间工作为职业紧张的促成因素(JDC OR=2.002,ERI OR=1.379),每周高频次中低强度运动锻炼为保护因素(JDC OR=0.734,ERI OR=0.814)。参加疫情工作种类、文化程度高、科室管理人员、值夜班、每天睡眠时间长、社会支持低及ERI分值高均是JDC的影响因素(均P<0.05);男性、已婚、工龄越长、受聘非正式在编、低收入、罹患慢性病、JDC分值高及内在投入高均是ERI职业紧张的影响因素(均P<0.05)。结论通过JCQ与ERI量表综合评估,新冠疫情防控期间社区医务人员职业紧张程度高,需引起全社会共同关注。可通过减少个体工作时间、开展职工活动或加强心理疏导等方式降低内在投入,提高社会支持从而降低社区医务人员职业紧张,提高职业生命质量,助力疫情常态化防控。

Objective To investigate the occupational stress among community medical staff during the prevention and control of Coronavirus Disease 2019(COVID-2019),explore the influencing factors,and provide scientific basis for relevant policy making.Methods Totally 835 medical workers were randomly selected from 10 community health service centers in the central urban area of Shanghai to conduct face-to-face survey.The questionnaire adopted the combination of the Job content questionnaire(JCQ)and the Effort-reward imbalance(ERI)scale which tested of reliability and validity,JCQ scale measured job requirements demands control model(JDC)of occupational stress,ERI scale measured effort reward imbalance model of occupational stress,and the data were analysed.Results The occupational stress rate of JDC and ERI among community medical staff was 42.5%and 34.0%respectively.The JDC score M(P_(25),P_(75))was 0.93(0.81,1.13)points,in which the work requirement dimension was 3.00(2.80,3.40)points,the work autonomy dimension was 3.22(3.00,3.56)points,and the social support dimension was 4.00(3.38,4.00)points.The ERI score M(P25,P75)was 0.77(0.53,1.05)points,in which the pay dimension was 3.00(2.30,3.40)points,the return dimension was 3.86(3.00,4.71)points,and the internal input dimension was 3.17(2.83,3.67)points.The occupational stress rate was different among community medical workers in different departments,and the occupational stress of public health medical workers was the highest(JDC was 53.0%,P<0.01,ERI was 41.9%,P<0.05).The occupational stress degree was different among medical workers participating in different epidemic prevention,and the detection rate of occupational stress among medical workers in centralized quarantine health observation places was the highest(JDC was 64.7%,ERI was 42.2%).Working long hours per week was the contributing factor of occupational stress(JDC OR=2.002,ERI OR=1.379),while frequently moderate and low intensity exercise per week was the protective factor(JDC OR=0.734,ERI OR=0.814).Moreover,the type of work in epidemic control,high level of education,department management personal,night shift,long sleep time daily,low social support and high ERI score were the influencing factors of JDC(all P<0.05),while the male,married,longer working experience,informal employment,low income,chronic disease,high JDC score and high internal input were the influencing factors of ERI occupational stress.Conclusions Through the comprehensive evaluation with JCQ and ERI scales,the occupation stress of community medical staff during the period of COVID-19 prevention is high,which needs to arouse the common concern of the whole society.It is feasible to reduce internal investment and enhance social support by reducing individual working hours,developing employee activities and strengthening psychological counseling,thereby reducing occupation stress and improving occupation life quality of community medical staff,which is advantageous to normalize epidemic prevention and control.