【作者】 黄丽；

【导师】 戴俊明；

【作者基本信息】 复旦大学 ， 社区卫生与健康促进， 2013， 硕士

【摘要】 目的评估上海市三甲医院医务人员的职业紧张、职业倦怠及隐性缺勤现况,分析职业倦怠作为中介变量在职业紧张与隐性缺勤之间的作用。方法本研究为横断面研究。以医院为基本抽样群,在上海市医务工会下辖的三级甲等医院中分层随机抽取8家样本医院,在知情同意、自愿参与的基础上,将在职医务人员纳入研究。采用统一设计的调查表,由医务人员自填的方式收集资料。调查内容包括个体特征因素、职业倦怠、职业紧张和隐性缺勤情况,其中职业倦怠采用职业倦怠通用版量表(中文版)进行评估,职业紧张采用简明工作内容问卷中文版和付出-回报失衡模型量表中文版进行评估,隐性缺勤情况由斯坦福隐性缺勤量表进行评估。采用的统计分析方法有卡方检验、t检验、方差分析、缺失值分析、Logistic回归分析和结构方程模型等。结果1.基本情况：本研究共发放问卷2500份,回收有效问卷2456份,回收率为98.2%。研究对象中男性有677人(27.6%),女性有1772(72.1%)；年龄多集中在40岁以下(68.6%)；学历以大专及以上为主(86.7%)；户口以本市户籍为主(90.5%)；岗位中护士所占比例最多(43.8%),其次是医生(29.9%)；工龄多集中在5年及以下和11～20年两个组别中；职称以初级最多(52.9%)；75.6%的调查对象为在编员工；47.9%的调查对象表示工作中需要倒班。不同性别间年龄、学历、岗位、工龄、职称和编制情况分布不同(P<0.001),但不同性别间户籍、倒班情况的分布没有差异。2.研究对象职业紧张状况：研究人群中工作要求得分为3.66±0.84,工作自主性得分为2.90±0.63,社会支持得分为3.78±0.71,工作要求与自主性比值为1.34±0.52,调查人群职业紧张阳性率为72.5%；31～40岁年龄组、医生／护士、有职称者职业紧张较高。社会支持是职业紧张的保护因素,本市户籍、副高及以上职称和不倒班者获得社会支持更高。调查人群中付出得分为3.07±0.99、回报得分为3.87±0.92、内在投入得分为2.74±0.89、付出回报比值得分为0.92±0.83,付出回报失衡人数占调查人群总数的30.5%；男性、医生／护士、6-20年工龄组、无编制及需倒班者表现出更高的付出回报失衡率,所承受的职业紧张更大。3.研究对象职业倦怠状况：研究人群中情感耗竭得分为2.88±1.55,人格解体得分为2.06±1.63,个人成就感得分为4.12±1.14,职业倦怠总分为2.34±1.11。有59.3%的调查对象有轻中度职业倦怠,15.0%的调查对象有重度职业倦怠。个体特征中31～40岁年龄组、医生和护士、倒班者的职业倦怠率较高。4.研究对象隐性缺勤状况：研究对象的隐性缺勤平均得分为15.24±3.89。个体特征中医生和护士、工龄为6-10年者和倒班者的隐性缺勤得分更高。5.职业紧张与职业倦怠的关联分析：在控制了个体特征因素后,相较于工作要求-自主模型,付出-回报失衡模型对情感耗竭、人格解体和职业倦怠总分的解释能力更大；但工作要求-自主模型对个人成就感的解释能力更大,尤其是社会支持变量对个人成就感变异的解释能力最高。6.隐性缺勤与职业紧张的关联分析：在简单相关关系分析中,隐性缺勤和工作要求、付出及内在投入呈现正向相关关系,与工作自主性、社会支持和回报呈现负向相关关系。多因素Logistic回归分析中,在控制了个体特征因素后,付出-回报失衡模型变量对隐性缺勤的解释能力更大。7.隐性缺勤与职业倦怠的关联分析：在简单相关关系分析中,隐性缺勤和职业倦怠总分、情感耗竭和人格解体呈现正向相关关系,与个人成就感呈现负向相关关系。多因素Logistic回归分析中,在控制了个体特征因素的情况下,职业倦怠对隐性缺勤的变异有基本稳定的解释能力。8.职业紧张、职业倦怠与隐性缺勤的关联分析：在控制了个体特征因素后,相较于工作要求-自主模型变量,付出-回报失衡模型变量结合职业倦怠三维度变量对隐性缺勤的解释能力更大。结构方程模型分析结果显示,职业紧张对职业倦怠和隐性缺勤的直接效应结构因子分别为0.79(P<0.001)和0.38(P<0.001),职业倦怠对隐性缺勤的直接效应结构因子为0.68(P<0.001),职业紧张通过职业倦怠对隐性缺勤的间接效应结构因子为0.54(P<0.001)。结论在上海市三甲医院的医务人员中存在较高水平的职业紧张、职业倦怠和隐性缺勤。职业倦怠在职业紧张与隐性缺勤的关系中可能发挥着中介作用,即职业紧张既可以对隐性缺勤产生直接影响作用,亦可通过职业倦怠对隐性缺勤产生间接影响作用,尤其是付出-回报失衡导致的职业紧张可通过职业倦怠对隐性缺勤产生较大的负面影响。更多还原

【Abstract】 Objective:To describe the prevalence of job stress, job burnout and presentieesm among health care workers in the top three hospitals of Shanghai, and to estimate the mediating effect of job burnout as a mediator on job stress and presenteeism.Methods:This study was conducted through a cross-sectional survey. Eight hospitals were selected from Shanghai medical trade unions with stratified random sampling. All eligible participants were included with informed consent. A questionnaire was completed by themselves independently. The questionnaire covered information on demograghics, job characteristics, job burnout, job stress and presenteetism. Job burnout was measured by Maslach Burnout Inventory-General Survey (Chinese version), job stress by job content questionnaire (Chinese version) and effort-reward imbalance questionnaire (Chinese version), and presenteeism by Stanford Presenteeism Scale. It was used to analysing the whole data by the statistical analysis technique including chi-square test, t-test, one-way ANOVA, missing value analysis, logistic regression analysis, structural equation model and so on.Results:1. Basic information:There were a total of2456participants attending this survey with participation ratio being98.2%. There were677males (27.6%) and1772females (72.1%), who were mainly under40years old and had associate college degree or above. Most respondents (90.5%) had registered permanent residence of Shanghai.43.8%of total respondents were nurses and29.9%were doctors. A large proportion of participants had5working years or below or11to20working years, and primary level of professional qualifications.47.9%of total respondents were permanent staff. There were significant differences among age, education, occupation, working years, professional qualification and authorized strength varying from gender, but no significant differences in registered permanent residence and shift work.2. Status of job stress in respondents:The mean scores of job demands, job control, social support and demands-control ratio in all participants were3.66±0.84,2.90±0.63,3.78±0.71and1.34±0.52, respectively. The rate of job stress in respondents was72.5%. The persons, who were characterized by the age of31to40years old, doctors or nurses and holding professional qualifications, tended to be more stressful. And it was also showed that the respondents, who were characterized by having registered permanent residence of Shanghai, Subtropical high title or above and no working in shifts, could obtain more social support which was a positive factor for stress. The mean scores of effort, reward, over-commitment and effort-reward ratio in all participants were respectively3.07±0.99,3.87±0.92,2.74±0.89and0.92±0.83. The rate of effort-reward imbalance was30.5%. The persons, who were characterized by male, doctors or nurses,6to20working years, no authorized strength and shift working, tended to be effort-reward imbalance. That is, they were more stressful.3. Status of job burnout in respondents:The mean scores of emotional exhaustion, depersonalization, personal accomplishment and burnout were2.88±1.55,2.06±1.63,4.12±1.14and2.34±1.11, respectively. It was showed that the percentage of59.3in all participants had mild or moderate burnout, and15.0%had severe burnout. The participants who were characterized by the age of31to40years old, doctors or nurses and working in shifts tended to be more burnout.4. Status of presenteeism in respondents:The mean score of presenteeism was15.24±3.89. The ones who were characteristic by doctors or nurses,6to10working years and working in shifts tended to have a higher score of presenteeism.5. Correlation analysis between job stress and burnout:Compared with job demand-control model (JDC), effort-reward imbalance model (ERI) had more explanatory power for emotional exhaustion, depersonalization and burnout by controlling the effect of social and demographic factors. On contrary, JDC model, especially the variable of social support, had more explanatory power for personal accomplishment.6. Correlation analysis between job stress and presenteeism:There were positive correlations between presenteeism and job demands, effort and over-commitment, and negative correlations between presenteeism and job control, social support and reward. ERI model had more explanatory power for presenteeism by controlling social and demographic factors with logistic regression analysis.7. Correlation analysis between job burnout and presenteeism:There were positive correlations between presenteeism and burnout, emotional exhaustion and depersonalization, negative correlations between presenteeism and personal accomplishment. Burnout had stable explanatory power for presenteeism by controlling social and demographic factors with logistic regression analysis.8. Correlation analysis among job stress, burnout and presenteeism:Compared with JDC model, ERI model combinding with emotional exhaustion, depersonalization and personal accomplishment had more explanatory power for presenteeism by controlling the effect of social and demographic factors with logistic regression analysis. The analysis results of structural equation model showed that the structure factor of direct effect from stress to burnout was0.79(P<0.001), from stress to presenteeism was0.38(P<0.001) and from burnout to presenteeism was0.68(P<0.001). The structure factor of indirect effect of burnout from stress to presenteeism was0.54(P<0.001).Conclusions:There were high prevalence of job stress, burnout and presenteeism among health care workers in top three hospitals of Shanghai. It was showed that job burnout may play a mediating role between job stress and presenteeism, that is, job stress could directly affect on presenteeism, and meanwhile indirectly impact on presenteeism by burnout. Especially, job stress resulting from effort-reward imbalance which may lead to higher job burnout prevalence could have a negative effect on presenteeism.更多还原