工作壓力、職場疲勞及病人安全關係 -以台中區醫院護理人員為例

Background and Purpose: Nursing staff is the first line guardian of patient health as well as the most important and the last defense to maintain patient safety. Under the policy of Health Insurance, hospitals have substantially reduced medical workforce and increased a lot of administrative paperwork for Hospital Evaluation. Therefore, there is a serious shortage of nursing staff due to the downsizing of medical staff. In addition, nursing staff is usually working in a high-pressure and poor morality environment, surrounded by emotional stress, overload and burnout, it makes those who providing patients with favorable nursing care feel tired and even stay away from the health care industry. A variety of factors can affect their health care quality and in a long run may lead to series of serious medical errors, and thus endangers patient safety. Methods: This cross-sectional study generally and anonymously surveyed an example of nursing staff of hospitals in Taichung form October 7th to November 7th, 2015. After the data collection, valid samples were processed and analyzed by descriptive statistics, Independent sample t test, One-way ANOVA, Pearson’s correlation coefficient, regression were used to analyze data by SPSS for windows 20.0. The answers wrote by the staff of eleven local hospitals in the middle part of Taiwan were analyzed by statistic program to determine whether the degree of their understanding of the policy is relative to the degree of compliance expectation or not. Results: There were 540 survey participants. The effective survey was only 491. Thus the recovery is 93.3% for this question-survey. “Job Stress” Cronbach's α value of 0.885, “Burnout” Cronbach's α value of 0.940, patient safety attitude Cronbach's α value of 0.948. There is a significant difference between different personal qualities of the nursing staff regarding their job stress and burnout; different “gender” of the nursing staff shows significant difference in the attitude towards patient safety; different “age” of the nursing staff shows significant difference in the attitude towards patient safety, job stress and burnout. In addition, there is an obvious correlation between the three aspects of “individual and work burnout”, “client related burnout” and “over-commitment” in the burnout and the three aspects of “support for patient safety from the management”, “communication and feedback” and “teamwork” in the attitude towards patient safety. Meanwhile, the seniority of healthcare and the level of service units and hospitals also affect the attitude towards patient safety and shows significant difference. Yet significant difference is only observed in the level of hospitals regarding the job stress and burnout will affect the nursing staff’s attitude towards patient safety while job stress also has impact on the burnout. Job stress and burnout will affect the nursing staff’s attitude towards patient safety while job stress also has impact on the burnout; dramatic difference is observed in different characteristics of the work of different medical units regarding the attitude towards patient safety. Conclusion: Since different personal qualities of the nursing staff feel different job stress and burnout, the management shall develop effective management strategies, actively create high-quality nursing work environment and arrange appropriate education and training regarding patient safety to stress the importance of patient safety. In the aspect of human resource, the management shall employ more experienced nursing staff in line with the features of their hospitals to reduce the time spent on the education and training for new staff. Besides, the management shall also organize activities to lower the job stress of the staff and ensure physical and mental health and safety of the nursing staff working in high-pressure work environment by combing leisure activities with patient safety issues, and thus convert the satisfaction of the nursing staff into more attention towards patient safety.