艾滋病抗病毒治疗医护人员职业倦怠现状成因及对策的质性研究

Job burnout situation,causes and coping strategy among medical staff providing ART in Yunnan

目的探索云南省艾滋病ART医护人员职业倦怠的现状,分析产生职业倦怠的原因,探索预防和缓解职业倦怠的措施。方法2022年2-5月,针对云南省艾滋病抗病毒门诊的医生及护士,采用方便抽样和最大差异抽样开展半结构化焦点小组访谈,共进行4次小组访谈,42人参加。结果职业倦怠结构维度归为情感耗竭、人格解体、低成就感三个核心类属。共收集105条职业倦怠成因的表述,包括工作压力大(27.6%),主要表现在工作任务重、工作难度大、ART外工作负荷重等方面;工资薪酬低(21.9%),主要表现在ART门诊的绩效总体偏低、职称晋升困难、监督服药费落实不到位;工作不被重视(17.1%),主要表现在工作环境较差,人员配给不足,辅助设备不全,与其他科室协调不畅等;工作挫败感(20.0%),主要表现为自认为工作能力不足,工作没有成就感,因从事ART工作而被歧视;政策落实不到位(13.3%),主要表现为人力资源缺口大,经费政策落实不到位。结论云南省艾滋病医护人员出现职业倦怠现象较为普遍,建议从政策制定、建设规范化门诊、建立心理支持体系等方面预防和减少职业倦怠的发生。

Objective To explore the current situation of the medical staff providing ART in Yunnan and to further analyze the reasons and explore the solution to preventing and remitting their job burnout.Methods 4 semi-structural focus group interviews with 42 participants were conducted from February to May 2022,using convenience sampling and maximum difference sampling to select participants who were doctors and nurses providing ART in Yunnan.Results The structural dimension of burnout was classified into three core categories:emotional exhaustion,depersonalization,and low achievement.105 causes for burnout were sorted out.The first was the heavy work load(27.6%)which was mainly reflected in the heavy work task,rising difficulty,heavy work load except ART clinical work.The second was the low salary(21.9%)which was mainly reflected in the overall low performance of ART clinic,the difficulty in the promotion of professional titles and the inadequate implementation of medication adherence supervising fees.The third was being neglected(17.1%)which was mainly reflected in the poor working environment,insufficient staffing,incomplete auxiliary equipment,ineffective coordination with other departments.The forth was work frustration(20.0%)which was mainly manifested by feeling inability to help the patients,sense of low achievement at work,being discriminated due to working for people living with HIV.The fifth was inadequate implementation of policies(13.3%)which mainly showed that the human resource gap was large and funding policies were not being implemented in place.Conclusions Job burnout phenomena among medical staff providing ART are relatively common.Therefore,it is suggested to prevent and reduce job burnout through policy formulation,the construction of standardized ART service,and the establishment of psychological support system.