医务人员职业紧张源专用量表的研制及应用

Development and application of a specialized scale of occupational stressors for medical staff

【目的】编制医务人员职业紧张源专用量表(CSSM)并检验信度和效度,为医务人员职业紧张的调查评估和管理提供技术工具。【方法】通过文献检索、深度访谈、专家评议形成初始指标条目池。2021年4月,采用分层抽样随机抽取上海市三级医疗卫生机构1家、二级医疗卫生机构2家、社区卫生服务中心1家。按照各级医院医务人员人数和医师、护士、医药技师比例抽样,发放预调查问卷,回收有效问卷848份,采用项目区分度法、相关性分析、探索性因子分析等对预调查条目池进行筛选并形成正式量表。2021年6—7月,采用分层抽样方法,使用正式量表进行调查,开展量表信效度验证,共回收正式调查有效问卷5510份。采用验证性因子分析检验量表的结构效度,分别以职业倦怠、睡眠障碍和工作要求-自主模式职业紧张为校标,采用Pearson相关分析检验量表的校标效度与聚合效度,同时采用Cronbach′sα系数评价量表信度。【结果】通过项目区分度法、相关性分析、探索性因子分析等对预调查条目池进行筛选,形成维度7个、条目32个的最终量表,分别是“职业发展”“人际关系”“工作超时及工作-生活失衡”“工作物理环境”“医患关系”“社会环境”“工作负荷”。探索性因子分析公因子累计方差贡献率为65.937%,各条目的因子载荷值范围为0.513~0.880。运用量表进行正式调查,验证量表信度,验证性因素分析上述7个因子模型拟合度较好,拟合优度指数(GFI)、比较拟合指数(CFI)、近似误差均方根(RMSEA)分别为0.913、0.909和0.064。量表及各维度得分与职业倦怠、睡眠障碍症状及工作要求-自主-组织支持模式职业紧张得分呈正相关(r=0.235~0.754,P<0.05)。总量表及各维Cronbach′sα系数为0.743~0.937,具有较好的信度与效度。【结论】CSSM具有较好的信度与效度,为精准开展医务人员职业紧张预防控制提供测量评估工具。

[Objective]To develop a professional occupational stress scale for medical staff(CSSM)and test its reliability and validity,so as to provide a technical tool for the evaluation and management of medical staff occupational stress.[Methods]The initial index item pool was formed by literature retrieval,in-depth interview and expert evaluation.Pre-survey questionnaires were distributed in April 2021,stratified sampling was used to randomly select 1 tertiary hospital,2 secondary hospitals and 1 community health service center in Shanghai.Sampling was performed according to the number of medical staff in all level hospitals and the proportion of doctors,nurses and medical technicians.848 valid questionnaires were collected.Item differentiation method,correlation analysis and exploratory factor analysis were used to filter the pre-survey item pool and form a formal scale.From June to July 2021,stratified sampling method was used to carry out formal survey with formal scale,and the reliability and validity of the scale were verified.A total of 5510 valid questionnaires were collected.Confirmatory factor analysis was used to test the construct validity of the scale.Job burnout,sleep disorder and job demand-autonomy(-support)model occupational stress scales were used as calibration scales,respectively.Pearson correlation analysis was used to test the scale′s calibration validity and aggregate validity,and Cronbach′sαcoefficient was used to evaluate the scale′s reliability.[Results]Through project differentiation method,correlation analysis,exploratory factor analysis on the preliminary survey item pool,we produced the formal scale of 7 dimensions and 32 items,respectively,including"career development","interpersonal relationship","working overtime and work-life imbalance","physical environment","the doctor-patient relationship","social environment","work load".The cumulative variance contribution rate of common factors in exploratory factor analysis was 65.937%,and the factor loading value of each item ranged from 0.513 to 0.880.The scale was used for formal investigation to verify the reliability and validity of the scale.The goodness of fit index(GFI),comparative fit index(CFI)and root mean square error of approximation(RMSEA)were 0.913,0.909 and 0.064,respectively.The scores of the scale and all dimensions were positively correlated with the scores of occupational stress in the mode of job burnout,sleep disorder symptoms and job demand-autonomy(r=0.235‒0.754,P<0.05).The Cronbach′sαcoefficients of the total amount table and each dimension ranged from 0.743 to 0.937,showing good reliability and validity.[Conclusion]CSSM has good reliability and validity,which provides a measurement and assessment tool for the targeted prevention of occupational stress in medical staff.The popularization and use of this scale in other regions need further verification.