【作者】 王伟；

【导师】 周新明； 王培席；

【作者基本信息】 河南大学 ， 护理学， 2010， 硕士

【摘要】 背景疲劳(fatigue)是一种常见的非特异性症状,它既可以是正常生理状况下的不适反应,也可以是某些疾病的临床表现,还可以是介于病与非病之间的亚健康状态。由于疲劳对人们身体的不良影响不像其他疾病那么显著,日常生活中往往被人们忽视,然而持续的疲劳会给人们造成身心疾病,严重的会出现慢性疲劳综合征,甚至猝死。近年来各学界对疲劳进行了大量的研究,并取得了一些有价值的成果。但对临床护士疲劳的研究较少,尤其对其定量研究更少。临床护士是一个特殊群体,工作中要面对各种各样的病人,除了要为这些病人做日常治疗外,还要给予他们心理支持,因此临床护士是极易产生疲劳的一个群体。有研究显示疲劳与长期过重的工作压力有关。持续的压力给护士所造成的几乎是灾难性的影响。因此,把护士工作压力源纳入本研究,以了解临床护士压力程度及其对疲劳的影响;把应对方式、生活满意度纳入本研究,以了解应对方式、生活满意度与疲劳的关联性;最后把临床护士目前工作中所需解决的主要问题进行排序,探寻临床护士目前最关心的问题是什么,为临床护士制定相应的干预措施提供理论依据。目的通过本研究了解临床护士的疲劳现状、职业压力源、生活满意度、疲劳的应对方式以及临床护士目前工作中所需解决的主要问题,探讨临床护士疲劳与职业压力、生活满意度、应对方式之间的关系,为探索减轻临床护士疲劳的方法和路径提供理论依据。对象与方法采用随机整群抽样的方法,以某市2家市级医院的临床护士为研究对象,通过问卷调查临床护士疲劳程度、工作压力源、应对方式、生活满意度及目前工作中所需解决的主要问题等。共发放问卷350份,收回有效问卷306份,有效回收率87.4%。本研究采用的问卷有《FS-14量表》、《护士压力源量表》、《WHO-5生活质量问卷》、《特质应对方式问卷》及临床护士目前工作中所需解决的主要问题的排序。用SPSS11.5软件进行数据处理,统计方法包括:描述性统计分析、单因素方差分析、Pearson相关分析、t检验、秩和检验、多因素Logistic回归模型等。结果1.临床护士疲劳现状306名护士的疲劳总分为7.17±3.406;躯体疲劳为4.84±2.190;脑力疲劳为2.33±1.673。其中130人在7分以下,占42.5%;176人在7分以上(包括7分),占57.5%。2.临床护士压力源分析在被调查的306名护士中,压力源分值最小为47,最大为140,均值为84.7,属中度压力水平。其中35-70分轻度压力的护士有50(16.3%);71-105分属中度压力的护士有235人(76.8%);106-140分属重度压力的护士有21(6.5%)人。在压力的5个维度上,按压力大小排序依次为工作量及时间分配、护理专业及工作方面、工作环境及仪器设备问题、病人护理方面、管理及人际关系方面。其中,工资及其它的福利待遇低、经常倒班、工作量太大、护理工作的社会地位太低、无用的书面工作太多、工作中的独立性少、上班的护士数量少、非护理性的工作太多、担心工作中差错事故、工作环境差分别排在35个条目的前十位。3.临床护士应对方式从总体应对情况看,消极应对分值(31.97±7.45)高于积极应对分值(23.22±6.790),说明临床护士总体应对情况不容乐观。不同科室护士的积极应对差异有统计学意义(P<0.05),外科、手术室、儿科护士的积极应对能力强于内科护士。4.临床护士生活满意度调查对象的生活满意度大于12分者占59.2%;小于等于12分者占40.8%。经过统计学分析,结果显示,年龄、科室、护龄、职称、职务对护士生活满意度有影响;不同文化程度的护士生活满意度得分差异无统计学意义。多因素回归分析结果显示,疲劳总值、压力总值、消极应对的OR值分别是1.279,1.024,1.048,是护士生活满意度的危险因素。5.临床护士目前工作中所需解决的主要问题调查对象认为目前工作中所需解决的主要问题排序结果如下:①提高待遇;②关心护士生活和工作;③完善医院管理体制;④减少工作量;⑤有机会进修学习或培训。从结果中可以看到,护士最突出的问题是待遇低。6.不同个体特征的临床护士疲劳状况分析按护士年龄、职称、职务、文化程度、婚姻状况、值班情况不同进行分组,比较护士疲劳上的差异,结果表明各组间差异均无统计学意义。不同护龄临床护士疲劳比较发现,躯体疲劳得分差异有统计学意义(P<0.05),护龄5-20年的护士躯体疲劳程度最高,护龄大于20年的护士躯体疲劳程度最低,不同护龄护士疲劳总分及脑力疲劳得分比较无统计学差异;通过对不同科室护士疲劳总分、躯体疲劳得分和脑力疲劳得分进行分析,不同科室护士疲劳总分、躯体疲劳得分和脑力疲劳得分差异均有统计学意义(P<0.05),ICU护士不论是疲劳总分,还是躯体疲劳和脑力疲劳的分值均最高,而儿科护士的疲劳总分和躯体疲劳分值最低;妇科护士脑力疲劳分值最低。7.疲劳影响因素的相关分析疲劳影响因素的相关性分析结果显示,疲劳总分与压力总分及其各维度得分、应对方式、生活满意度均相关(P<0.05)。其中,积极应对(r=-0.032),生活满意度(r=﹣0.049)与疲劳呈负相关,消极应对(r=0.229)与疲劳呈正相关。8.疲劳影响因素的多因素回归分析疲劳影响因素的多因素回归分析结果表明,压力总分,消极应对的OR值分别是1.068,1.059;积极应对的OR值为0.939。与ICU相比,内科,妇科,儿科的OR值分别是0.09,0.021,0.005。结论1.临床护士工作压力大,压力源复杂。工资及其它的福利待遇低、经常倒班、工作量太大、护理工作的社会地位太低、无用的书面工作太多、工作中的独立性少、上班的护士数量少、非护理性的工作太多、担心工作中差错事故、工作环境差排在临床护士工作压力源的前十位。临床护士面对压力以消极应对为主,消极应对分值大于积极应对分值。2.临床护士疲劳主要影响因素为工作压力、应对方式。临床护士压力大且消极应对会加重疲劳程度,但他们如能在工作中积极应对压力则会减轻其疲劳程度。3.临床护士生活满意度不容乐观,有40.8%的护士生活满意度低。生活满意度受疲劳、工作压力、应对方式的影响:生活满意度与积极应对呈正相关;与工作压力、消极应对、疲劳均呈负相关。更多还原

【Abstract】 BackgroundFatigue is a common non-specific symptom. It not only can be a normal physiological reaction to the discomfort, but also can be a clinical manifestation of certain diseases, or a sub-health status which lies between the disease and the non-disease. Fatigue is often ignored in daily life since the adverse effects of fatigue on human body are not as significant as other diseases; however, long-lasting fatigue will cause physical and mental illnesses, chronic fatigue syndrome and even sudden death. In recent years, there are extensive researches on fatigue by various scholars and some valuable results have been made, but there are few studies on the fatigue of clinical nurses, in particular, the quantitative studies. Clinical nurses are a special group of people, who have to face a wide variety of patients. In addition to doing routine treatments for the patients, the clinical nurses need to offer psychological support and thus become a group that are apt to fatigue.A few studies have shown that the fatigue is related to the long-term stressful working. The impact of continued stress on the nurses is disastrous. Therefore, we include the stress in this study in order to understand the stress level of clinical nurses and its impact on the fatigue; include response methods and life satisfaction level in order to understand their relevance with fatigue; and finally sort the main problems that the clinical nurses have to encounter in their daily work, explore what clinical nurses are most concerned about and provide a theoretical evidence for the clinical nurses to develop appropriate intervention methods.ObjectiveThis research is to understand the fatigue status of clinical nurses, stress, life satisfaction, response method, and the main problems clinical nurses encounter in the daily work; to explore the relationships between the fatigue of nurses and stress, life satisfaction, response method; to provide theoretical evidence of exploring ways for clinical nurses to reduce fatigue.Objects and MethodsUsing the random cluster sampling method, fatigue, stress, response method, life satisfaction, and the main issues in the daily work, etc. of the clinical nurses in two municipal hospitals in one city were investigated through questionnaires. A total of 350 questionnaires were issued, 306 valid questionnaires were received, with a response rate of 87.4%. The questionnaires include“FS-14 Scale Table”,“Table for Nurse Stress Scale”,“WHO-5 Questionnaire on Quality of Life”,“Questionnaire on Styles of Coping with Trait“and“Sorting for The Critical Problems to Be Solved”. SPSS11.5 software was used for data processing. The statistical methods include: descriptive statistics analysis, single-factor variance analysis, Pearson correlation analysis, t test, rank sum test, multi-factor logistic regression model, etc.Results1. The fatigue status of clinical nurses306 nurses have a total fatigue score of 7.17±3.406; a physical fatigue score of 4.84±2.190; and a mental fatigue score of 2.33±1.673. 130 of them score below 7, with a percentage of 42.5%; 176 people score above 7(including 7), with a percentage of 57.5%.2.Stress origin analysis of clinical nursesIn the surveyed 306 nurses, the stress origins have a minimum score of 47, a maximum score of 140, and the average score of 84.7, which is at a moderate stress level. Among the 360 nurses, 50 nurses (16.3%) score 35-70 with a light stress; 235 (76.8%) nurses score 71-105 with a moderate stress; 21 (6.5%) nurses score 106-140 with a severe stress. Among the five dimensions of the stress, we sorted by stress level as follows: workload and time allocation, health care professional and work, working environment and equipment issues, patient care, management and interpersonal skills. Among them, the low salary and other benefits, frequent shifts, heavy workload, low social status of nursing work, redundant paperwork, no independence in the work, limited number of nurses, redundant non-nursing type of work, worrying about errors and accidents in the work, and poor working environment are ranked top 10 of 35 items.3.Response methods of clinical nursesFrom the overall response point of view, the negative response score (31.97±7.45) is higher than the positive response score (23.22±6.790), shows that the overall response of clinical nurses is not optimistic. The difference among the active responses from nurses in different departments is significant in statistics (P <0.05), the nurses from department of surgery, operating room and pediatrics have better response capability than the nurses from department of internal medicine.4.Life satisfaction of clinical nurses59.2% of the surveyed nurses have a life satisfaction level greater than 12 while the rest of the nurses have a life satisfaction level equal to or less than 12. After statistical analysis, it is shown that the life satisfaction of nurses is affected by age, departments, working age, job position and job title; Educational level has no statistical significance in life satisfaction of nurses. Multi-variant regression analysis showed that the OR values of gross fatigue value, gross stress value, negative response value are 1.279, 1.024, 1.048, respectively, which are the risk factors for nurses’life satisfaction.5.The main problems encountered in the daily work of clinical nursesThe surveyed nurses claim that the main problems encountered in their work of are sorted as follows:①improve salary;②take care of nurses’life and work;③improve the hospital’s management system;④reduce workload;⑤have the opportunity to further their studies or training. It can be observed from the results, the most concerned problem in clinical nurses’work is the low salary.6. Fatigue analysis of clinical nurses with individual charactersThe clinical nurses were grouped by age, job position, job title, education level, marital status, shift situation then the fatigue is compared, the results showed that the difference between the groups is not statistically significant. The fatigue of clinical nurses was compared according to the working age and the difference in physical fatigue scores is significant in statistics (P <0.05). Nurses with 5-20 years of working age have highest physical fatigue level, nurses with more than 20 years of experiences have lowest physical fatigue level, nurses with different working age show no statistical difference in total fatigue score and mental fatigue score; By analyzing total fatigue score, physical fatigue score, mental fatigue score of the nurses from different departments, nurses in different departments all have statistically significant (P <0.05) differences in total fatigue score, physical fatigue score and mental fatigue score, the scores of the nurses in ICU are highest in either total fatigue, physical fatigue or mental fatigue, while the nurses in department of pediatrics have lowest total fatigue score and physical fatigue; nurses in department of Gynecology have the lowest mental fatigue score.7. Correlation analysis of fatigue factorsThe correlation analysis of fatigue factors showed that total fatigue score, total stress score and its various dimensions, response method, life satisfaction level are correlated (P <0.05). Among them, positive response (r = -0.032), life satisfaction level (r = - 0.049) and fatigue are negatively related. Negative response (r = 0.229) and fatigue are positively correlated.8. Multi-variant regression analysis of fatigue factorsMulti-variant regression analysis of fatigue factors showed that the OR values corresponding to the total stress score and the negative response are 1.068, 1.059, respectively; OR value of positive response is 0.939. Compared to the department of ICU, the OR values of departments of internal medicine, gynecology, and pediatrics are 0.09, 0.021, and 0.005, respectively.Conclusions1. Clinical nurses undergo great stress in work, and the stressors are complicated. Low salary and benefits, frequent shifts, heavy workload, low social status of nursing work, redundant paperwork, no independence in the work, limited number of nurses, too much non-nursing type of work, worrying about errors and accidents in the work, and poor working environment are ranked top 10 of clinical nurses stress origins. Clinical nurses react negatively when encountering the stress; the negative response score is greater than the active response score.2. The main factors leading to the fatigue of clinical nurses are stress, response method. Clinical nurses’negative response to the stress will increase the fatigue level; on the contrary, positive response to the stress will reduce their fatigue.3. The satisfaction of clinical nurses with their life is not optimistic, 40.8% of nurses have low life satisfaction. Life satisfaction level is affected by fatigue, stress, response method: life satisfaction level is positively related to the positive response; however negatively related to the stress, the negative response, and the fatigue.更多还原