深圳市“1+N”家庭医生团队成员心理契约现状及其与职业倦怠的关联分析

Status quo of psychological contracts among members of the“1+N”family doctor teams in Shenzhen and the impact on job burnout

目的了解深圳市"1+N"家庭医生团队成员对团队的心理契约现状,并探讨心理契约与职业倦怠的关联。方法该研究为横断面研究,于2022年9月30日至10月31日,采用自行设计的一般资料调查问卷、员工心理契约调查问卷(包括组织责任和个人责任2个维度)和职业倦怠量表(包括情感耗竭、去人格化和个人成就感3个维度)对深圳市实行家庭医生团队服务模式的92家社区健康服务中心的92个家庭医生团队共361名家庭医生团队成员进行调查。采用Pearson相关性分析与多重线性回归分析心理契约与职业倦怠的关联。结果361名成员中,女性占82.8%(299/361),男性占17.2%(62/361);全科医生占37.5%(129/361),护士占41.8%(151/361)。361名成员心理契约总分(141.6±19.5)分,其中组织责任和个人责任得分分别为(70.6±11.2)、(71.0±9.3)分。职业倦怠量表中,情感耗竭、去人格化、个人成就感得分分别为(17.89±6.82)、(6.51±2.54)、(30.95±5.70)分。不同岗位家庭医生团队成员的组织责任得分和个人责任得分差异有统计学意义(F=7.341、3.119,均P<0.05),全科医生的组织责任和个人责任得分更低;全科医生情感耗竭和去人格化得分更高(F=7.637、2.415,均P<0.05),工作年限≤5年者个人责任感和个人成就感得分更低(F=3.656、4.205,均P<0.05)。相关性分析结果显示,家庭医生团队成员的组织责任得分、个人责任得分与情感耗竭程度(r=-0.618、-0.526,均P<0.01)、去人格化程度(r=-0.404、-0.393,均P<0.01)均呈负相关,与个人成就感均呈正相关(r=0.500、0.558,均P<0.01)。多重线性回归分析结果显示,组织责任对情感耗竭与去人格化存在负向关联(β=-0.554、-0.274,均P<0.01),与个人成就感存在正向关联(β=0.172,P<0.05);个人责任与个人成就感存在正向关联(β=0.404,P<0.01)。结论家庭医生团队中全科医生的心理契约度低,更容易出现情感耗竭和去人格化,工作年限≤5年的成员个人责任感和成就感较低。家庭医生团队成员组织责任感越高,其情感耗竭、去人格化程度越低,个人成就感越高。

Objective:To investigate the status quo of psychological contracts and influencing factors among members of the"1+N"family doctor teams in Shenzhen and to explore the impact of psychological contracts on job burnout.Methods:This cross-sectional study was conducted from September 30 to October 31,2022 among 361 members of 92 family doctor teams from 92 community health service centers which provided family doctor team service in Shenzhen city.A self-designed general information questionnaire,an employee psychological contract questionnaire(including organizational responsibility and personal responsibility dimensions),and a job burnout scale(including emotional exhaustion,depersonalization,and personal accomplishment dimensions)were used in the study.T-tests,one-way ANOVA,Pearson correlation analysis,and multiple linear regression analysis were used to analyze the influencing factors of psychological contracts and job burnout.Results:Among 361 respondents,there were 299 females(82.8%)and 62 males(17.2%),and a higher proportion of general practitioners(37.5%,129/361)and nurses(41.8%,151/361).The total score of psychological contracts among the 361 respondents was(141.6±19.5),with organizational responsibility scoring(70.6±11.2)and personal responsibility scoring(71.0±9.3).On the job burnout scale,emotional exhaustion scored(17.89±6.82),depersonalization scored(6.51±2.54),and personal accomplishment scored(30.95±5.70).General practitioners scored lower in organizational responsibility and personal responsibility compared to other members(F=7.341,3.119,all P<0.05),and higher in emotional exhaustion and depersonalization(F=7.637,2.415,all P<0.05).Members with≤5 years of work experience scored lower in personal responsibility and personal accomplishment(F=3.656,4.205,all P<0.05).Correlation analysis showed that scores of organizational responsibility and personal responsibility were negatively correlated with levels of emotional exhaustion and depersonalization(r=-0.618,-0.526,all P<0.01),(r=-0.404,-0.393,all P<0.01),and positively correlated with personal accomplishment(r=0.500,0.558,all P<0.01).Multiple linear regression analysis indicated that organizational responsibility negatively affected emotional exhaustion and depersonalization(β=-0.554,-0.274,all P<0.01),and positively affected personal accomplishment(β=0.172,P<0.05).Personal responsibility positively affected personal accomplishment(β=0.404,P<0.01).Conclusions:The study demonstrates that general practitioners in family doctor teams in Shenzhen city have lower psychological contract levels and are more prone to emotional exhaustion and depersonalization;members with≤5 years of work experience have lower personal responsibility and accomplishment.The results indicate that enhancing organizational responsibility can reduce job burnout of members in family doctor teams.