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研究生:陳金凰
研究生(外文):Chin-Huang Chen
論文名稱:探討專科護理師工作壓力和工作特質對焦慮、憂鬱症狀及自我感覺健康狀況之影響
論文名稱(外文):To Explore the Impacts of Job Stress and Job Content on Anxiety, Depressive Symptoms and Self-perceived Health Status among Nurse Practitioners
指導教授:范君瑜范君瑜引用關係
指導教授(外文):Jun-Yu Fan
口試委員:范君瑜王琤楊正三
口試委員(外文):Jun-Yu FanWang JengCheng-San Yang
口試日期:2014-07-04
學位類別:碩士
校院名稱:長庚科技大學
系所名稱:護理研究所在職專班
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2014
畢業學年度:102
語文別:中文
論文頁數:86
中文關鍵詞:專科護理師工作壓力工作特質焦慮症狀憂鬱症狀自我感覺健康狀況唾液皮質醇
外文關鍵詞:Nurse practitionerjob stressjob contentanxiety symptomsdepression symptomsself-perceived health statussalivary cortisol
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背景:台灣首屆的專科護理師於2007年誕生,其職業範疇的準則雖已經「專科護理師培訓計劃暨執業規範委員會」認可,但其角色功能却因各家醫院需求而有所不同,使其職業內容多元且複雜,造成專科護理師的工作壓力過重,進而產生失眠、憂鬱等負面的反應,嚴重者甚至引起體內神經內分泌系統的不正常反應,長期下來影響專科護理師整體的身心健康狀況。
目的:本研究的目的主要是探討雲嘉南區域醫院專科護理師的工作壓力和工作特質對其焦慮、憂鬱症狀及自我感覺健康狀況間的相關性及其影響因素。
方法:本研究為橫斷相關性研究設計,採方便取樣,以雲嘉南區域醫院的專科護理師為對象。研究工具包括「台灣醫院護理人員壓力量表」、「工作特質量表」、「貝氏焦慮量表」、「貝氏憂鬱量表」、台灣版SF-36次量表「一般健康狀況」及唾液中的皮質醇濃度。統計方式包括描述性統計、獨立樣本t檢定、相依樣本t檢定、單因子變異數分析、重複測量變異數分析、皮爾森積差相關與運用階層迴歸分析找出預測影響專科護理師自我感覺健康狀況之預測因子及變異量,所有的分析方法以顯著水準(α) 0.05為基準。
結果:專科護理師工作壓力屬中度,以「個人反應」面向的壓力最大;在工作特質方面,工作控制權與護理師雷同,但需承受較高的心理負荷;社會支持方面:來自同事的支持高過主管的支持。有57.8%及51.2%的專科護理師出現輕度焦慮及中重度憂鬱症狀;專科護理師的憂鬱程度愈高,對自我感覺健康狀況感受較差,皮質醇早晚的變化也會出現較平坦的斜率(即個體對壓力的調適較為緩慢)。工作壓力愈高,個人反應愈大,工作控制愈低,心理負荷愈高,主管支持認同愈低,憂慮及憂鬱程度愈高,自我健康感覺狀況愈差。於校正可能造成影響的共變數後,專科護理師自我感覺健康狀況的預測因子為「個人反應因素」及「勝任因素」。
結論/實務應用:專科護理師本身是健康照顧的提供者及指導者,然專科護理師的職業範疇却因各家醫院的需求而有所差異,至今仍無法清楚規範其工作型態及內容,長期下來不但嚴重影響臨床照護的品質也間接造成專科護理師人才的流失。因此,除完整的專業訓練外,明確的政策及法律規範,及健全的升遷制度、合理的工作時數、薪資與照護床數,都是政府及相關單位需要重視的重要議題。

Background:In 2007, Taiwan recognized the first nurse practitioners. Their practice guidelines are approved by the "nurse practitioner training program and Codex Committee". Their roles are vary between different hospitals due to diverse demands and encompass complex tasks. Thus, nurse practitioners experience heavy workloads that can result in insomnia, depression, negative affect, and abnormal endocrine reactions all of which can profoundly influence their health status.
Purpose:The purposes of the study were (1) to explore the impact of job stress and job content on anxiety, depressive symptoms, and self-perceived health status among nurse practitioners and (2) to explore the relationship between variables and their related factors.
Methods:This study was a descriptive cross-sectional design. A convenience sample of nurse practitioners from southwestern regional hospitals was enrolled in the study. The current study measured health using instruments including the “Taiwan Nurse Stress Checklist”, the “Chinese Version of the Job Content Questionnaire (C-JCQ)”, the “General Health Status checklist”, the “SF-36 Health Survey, Taiwanese Version,” “The Beck Anxiety Inventory-II; BAI”, “The Beck Depression Inventory-II; BDI-II” and a salivary cortisol test. Data were analyzed using SPSS Version 20.0 for Windows, and the threshold for statistical significance was set at P < .05. To analyze the data and identify the predictors and variances of work stress, anxiety symptoms, depressive symptoms, and self-perceived health status in nurse practitioners, descriptive and inferential statistics were used and included independent t-tests, paired t-tests, analysis of variance (ANOVA), repeated measures ANOVA, Pearson’s r correlation, and Hierarchical regression analysis.
Results:The results showed that nurses practitioners reported moderate job stress, with "individual response" rated as the most stressful dimension. In terms of the job content, the job control of nurse practitioners was similar to nurses but they experienced higher psychological stress. Social support was provided by peers rather than by administrators. More than half of nurse practitioners presented with mild anxiety (57.8%) and symptoms of moderate to severe depression (51.2%). The more depressive symptoms nurse practitioners perceived, the poorer they reported their self-perceived health status to be, and the more of a flat slope in cortisol levels between morning and was measured indicating a slower adaptation ability for that individual. The following significant relationships were observed: the more job stress, the greater individual responses, the lower the feelings of job control, the higher the psychological burden, the lower the perceived recognition by administrators, the higher the levels of anxiety and depression symptoms, and the poorer the self-perceived health status. After adjusting covariates, the predictors of self- perceived health status were personal response and the competence subscale of job stress.
Conclusion and clinical implications:Nurse practitioners are very important health providers and educators. Currently job requirements vary between different hospitals that result in a poor quality of patient care and indirectly affect the retention rate of nurse practitioners. The government and hospital managers need to consider providing a professional training program, identifying clear policy and legal norms, arranging appropriate working hours and nurse-patient ratios, providing a reasonable salary and a realistic promotion system in order to enhance the performance of nurse practitioners.

中文摘要.........................................................................................I
Abstract ......................................................................................II
表目錄......................................................................................... VI
圖目錄..........................................................................................VII
附錄........................................................................................... VIII

第一章 緒論...................................................................................... 1
第一節 研究背景及動機......................................................................... 1
第二節 研究目的.............................................................................. 2
第二章 文獻第二章 文獻探討........................................................................ 3
第一節 專科護理師角色與功能.................................................................... 3
第二節 工作壓力和生、心理反應.................................................................. 6
第三節 工作特質.............................................................................. 13
第四節 影響工作壓力的相關因素.................................................................. 15
第五節 自我感覺健康狀況的定義與相關測量......................................................... 16
第三章 研究方法.................................................................................. 17
第一節 研究對象.............................................................................. 17
第二節 研究概念架構........................................................................... 18
第三節 名詞定義.............................................................................. 19
第四節 研究工具.............................................................................. 20
第五節 研究步驟.............................................................................. 24
第六節 研究對象權益保護....................................................................... 24
第七節 資料處理和分析......................................................................... 24
第四章 研究結果.................................................................................. 25
第一節 樣本回收及採樣結果與有效樣本描述性分析.................................................... 25
第二節 專科護理師社會人口學特徵、工作壓力、工作持質、焦慮、憂鬱程度及自
我感覺健康狀況的現況.................................................................... 27
第三節 專科護理師人口學特性於工作壓力、工作特質、焦慮、憂鬱程度及自我感
覺健康狀況之間的差異情形................................................................. 33
第四節 專科護理師人口學特性、工作壓力、工作持質、社會支持、焦慮、憂鬱程
度和自我感覺健康狀況間的相關性............................................................ 42
第五節 專科護理師工作壓力與皮質醇分泌生理指標之相關性.............................................. 45
第六節 影響專科護理師工作壓力、工作持質、焦慮、憂鬱程度和自我感覺健康況
的預測因子............................................................................. 47
第五章 討論與結論................................................................................. 53
第一節 研究對象的特性及量表的信度................................................................ 53
第二節 重要研究結果討論......................................................................... 54
第三節 結論.................................................................................... 61
第六章 研究限制與建議............................................................................... 61
第一節 研究限制................................................................................ 61
第二節 建議.................................................................................... 62
參考文獻........................................................................................... 65
中文部分........................................................................................... 65
西文部分........................................................................................... 69

表目錄
表2-1 建議專科護理師臨床執業範圍....................................................................... 5
表2-2 DSM-IV TR 重症憂鬱症診斷標準................................................................... 10
表4-1 台灣醫院護理人員工作壓力量表整體及各構面的Cronbach’s α............... 26
表4-2 工作特質量表整體及各構面的Cronbach’s α.............................................. 26
表4-3 貝克焦慮量表整體及各構面的Cronbach’s α.............................................. 27
表4-4 整貝克憂鬱量表體及各構面的Cronbach’s α.............................................. 27
表4-5 人口學特徵分布情形.................................................................................. 28
表4-6 台灣醫院護理人員工作壓力及四大構面的平均分數..................................... 29
表4-7 工作壓力前五名及後五名............................................................................... 30
表4-8 台灣工作特質量表描述性統計........................................................................ 31
表4-9 貝克焦慮量表四大因素分數............................................................................ 32
表4-10 貝克焦慮量表分組描述性統計...................................................................... 32
表4-11 貝克憂鬱量表二大因素分數.......................................................................... 32
表4-12 貝克憂鬱量表分組描述性統計...................................................................... 33
表4-13 SF-36 一般健康狀況次量表描述性統計........................................................ 33
表4-14 工作壓力與人口學分布差異情形.................................................................. 34
表4-15 工作特質與人口學分布差異.......................................................................... 36
表4-16 兩家區域醫院與工作控制及年齡分布差異................................................... 38
表4-17 專科護理師焦慮情形與人口學分佈差異性................................................... 38
表4-18 專科護理師憂鬱情形與人口學分佈差異性................................................... 39
表4-19 兩家區域醫院與憂鬱程度及婚姻分布差異................................................... 40
表4-20 一般健康狀況與人口學分布差異.................................................................. 41
表4-21 專科護理師人口學特性與工作壓力之相關性............................................... 43
表4-22 專科護理師人口學特性與工作特質之相關性............................................... 43
表4-23 各量表之間相關性.................................................................................. 44
表4-24 人口學分布與皮質醇斜率之差異.................................................................. 45
表4-25 工作壓力、工作特質、憂鬱、焦慮、自我感覺健康狀況與皮質醇斜率之相關................................. 47
表4-26 憂鬱分組與皮質醇斜率之差異性................................................................. 47
表4-27「工作壓力」之迴歸分析.............................................................................. 49
表4-28「皮質醇濃度」之迴歸分析........................................................................... 49
表4-29「焦慮程度」之迴歸分析.............................................................................. 50
表4-30「憂鬱程度」之迴歸分析.............................................................................. 51
表4-31「自我感覺健康狀況 」之迴歸分析............................................................. 52

圖目錄
圖2-1 工作需求控制模式.................................................................................... 13
圖3-1 研究架構......................................................................................... 18

附錄
附錄一 台灣專科護理師學會「建議專科護理師臨床執業範圍」使用同意書........ 77
附錄四 人體研究計劃核准同意書............................................................................. 80
附錄三 SF-36 台灣版問卷使用同意書...................................................................... 79
附錄二 護理人員壓力量表使用同意書..................................................................... 78
附錄五 問卷調查表.................................................................................... 83
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