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研究生:吳姿瑩
研究生(外文):Yzu-Ying Wu
論文名稱:病人安全文化量表新增職業倦怠構面之信效度分析
論文名稱(外文):Reliability and validity of patient safety culture measurement with a new domain of burnout
指導教授:楊銘欽楊銘欽引用關係
口試委員:鄭雅文王拔群
口試日期:2015-01-27
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:健康政策與管理研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2015
畢業學年度:103
語文別:中文
論文頁數:65
中文關鍵詞:病人安全文化職業倦怠團隊合作安全風氣工作滿意壓力認知對管理的感受工作狀況
外文關鍵詞:safety attitude questionnaireburnoutpatient safety
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研究背景:2001年美國Institute of Medicine (IOM)於跨越品質的鴻溝(Crossing the Quality Chasm)一書中提出醫療照護者應致力改善病人安全,病人安全自此成為醫療照護的重要核心價值。透過調查員工對於安全的態度與感受,可以及早偵測群體的感受形成的風氣文化,成為前驅性的安全指標,以期減少不良事件的發生
安全態度問卷(Safety Attitude Questionnaire, SAQ) 被廣泛的運用於調查機構安全風氣,但不論是中英文版的信效度研究皆指出部分構面「壓力認知」與其他構面的相關性不佳,對安全文化的解釋力偏低。可能原因為「壓力認知」構面的目的在於了解醫療人員對於個體處在壓力疲勞的情況下會影響照護安全與成效的認知程度,而非照護人員職場壓力累積的感受而影響工作的程度。
研究目的:使用「工作壓力的感受:職業倦怠」取代原病人安全態度量表的「壓力認知」構面,並測試其模型信效度,以作為發展安全文化風氣調查工具的參考。
方法:採橫斷性研究,以北部某三家醫院(醫學中心、區域醫院以及地區醫院各一)全院員工共3484人為調查對象。員工至匿名線上問卷收集系統填答,以保障隱私性。研究使用驗證性因素分析的最大概似估計法對量測模型進行估計,以了解假設模型與實際資料的契合,驗證工具的信效度。
結果:回收有效問卷965分,有效問卷回收率佔全體員工之27.7%。以護理人員回答率最高。首先將職業倦怠納入SAQ問卷成為其中一項構面成為模型一,信度指標(composite reliability, CR)在0.84到0.94間,內部一致性理想。但個別項目的信度係數有8個小於0.5,潛在變項的信度組合均大於0.8,潛在變項的平均變異抽取值有1個小於0.5,未盡理想。整體適配度指標在絕對適配度、增值適配度以及簡約適配度指標皆表現不佳。依據研究目的提出第二個模型,以職業倦怠構面取代壓力認知構面,並參考模型一的結果,刪除因素負荷小於0.5以及多元相關平方信度(Squared Multiple Correlation, SMC)小於0.5的題目,信度以及模型適配度達到理想。職業倦怠構面與病人安全態度問卷的5構面間有顯著的負相關,分別是團隊合作(r=-0.11, p≦0.01)、安全風氣(r=-0.11, p≦0.01)、工作滿意度(r=-0.26, p≦0.01)、對管理的感受(r=-0.1, p≦0.01)以及工作情況(r=-0.1, p≦0.01)。本研究所提出簡版的職業倦怠(5題)在醫療各職類有良好的信效度(0.79 ≦ Cronbach α≦0.91)。
不同的健保特約層級、年齡層、教育程度、職務類別以及異常事件通報行為有顯著不同的職業倦怠比率。醫學中心有較高的職業人員職業倦怠比率,年紀較輕、教育程度較高、護理人員以及有進行異常事件通報的人員職業倦怠率較高。建議未來的研究可以朝向進一步了解各職類職業倦怠的調節因素,以及職業倦怠如何影響照護成效以及病人安全。


Objective: Institute of Medicine (IOM) mentioned in “Crossing the quality chasm” that healthcare provider organizations should contribute to improve patient safety in 2001. Healthcare provider attitudes about organization safety are patient safety condition predictor. The Safety Attitude Questionnaire (SAQ) has been widely used in several contries to measure healthcare worker’s attitudes toward safety. Both the original SAQ and the Chinese version of the SAQ are indicated that one of the domains of safety culture, Stress Recognition, is weak correlated with other five domains. The possible reason is “Stress Recognition” domain aims to measure worker’s acknowledgement of how performance is influenced by stressors, not what level does worker perceived stressors influenced the ability to work safety. The objective of this study was to examine reliability and validity of patient safety culture measurement with a new domain of burnout.
Methods: The cross-sectional surveys of three hospitals workers (including one medical center, one district hospital, and one regional hospital, n=3,484) in north Taiwan were conducted. The online anonymous survey is committed to assuring the complete confidentiality of all responses. The reliability reliability and validity of patient safety culture measurement with a new domain of burnout were examined by multilevel confirmatory factor analysis.
Result: The overall response rate was 27.7%. The internal consistency of each domain was high (composite reliability: 0.84-0.94). The explanatory abilities of thirty one over thirty nine (31/39) of the core items are considered important for the corresponding domains (squared multiple correlation, SMC

口試委員審定書 I
致謝 II
中文摘要 III
英文摘要 V
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 2
第三節 名詞解釋 2
第二章 文獻探討 3
第一節 病人安全文化 3
第二節 職業倦怠 5
第三節 研究工具的信效度 10
第四節 職業倦怠與臨床照護結果之實證研究 14
第五節 小結/綜合討論 15
第三章 16
研究設計與研究方法 16
第一節 研究架構與假說 16
第二節 研究對象 18
第三節 研究過程/資料收集 18
第四節 研究工具 18
一、 安全態度問卷Safety Attitude Questionnaires, SAQ 18
二、 職業倦怠Burnout: 19
第五節 分析方法 23
一、 信、效度分析 23
二、 描述性統計 24
三、 推論性統計 25
第四章 研究結果 26
第一節 信度與效度分析 26
第二節 簡版職業倦怠問卷信度分析 42
第三節 樣本基本資料分布 43
一、 問卷回收情況 43
二、 樣本基本特質 43
三、 樣本工作相關特質 44
第四節 醫院層級、個人特質、工作相關特質與職業倦怠之相關性 45
第五章 討論 50
第一節、研究結果討論 50
第二節、研究限制 59
第六章 結論 60
第一節、研究結論 60
第二節 研究建議 60


中文部分
王嵩竑, 林筱芸, 林晉鋒, 杜貞儀, & 鄭鈺樺. (2011). 醫院員工個人特質與病人安全文化關係之研究. [The Relationship between Hospital Employee Personality Characteristics and Patient Safety Culture]. 北市醫學雜誌, 8(2), 116-125. doi: 10.6200/tcmj.2011.8.2.03
吳永隆, 張嘉晃, 吳宛庭, 鄭嘉惠, 王拔群, & 侯紹敏. (2009). 急診護理人員病人安全文化-以某醫學中心為例. [Patient Safety Culture of Nursing Staff in an Emergency Room: Survey of a Medical Center]. 輔仁醫學期刊, 7(1), 17-27.
李偉強, 簡淑芬, 陳玉枝, 黃東波, 李建賢, & 李壽東. (2008). 中文版病人安全態度問卷信效度分析. [Validation Study of the Chinese Safety Attitude Questionnaire in Taiwan]. 臺灣公共衛生雜誌, 27(3), 214-222.
林木泉, 吳鏘亮, 陳俊賢, 李仁傑, & 陳福士. (2009). 醫院從業人員工作特質與疲勞關係之探討. [Association between Work Characteristics and Burnout among Hospital Staff in Taiwan]. 醫務管理期刊, 10(2), 93-110.
邱孟君, 史麗珠, 黃怡樺, 張薰榕, & 林雪蓉. (2013). 桃園地區臨床護理人員在健保總額預算期間的工作倦怠及離職意向. [Burnout and Quit Intention among Clinical Nurses in Taoyuan during Global Budget Payment System]. 若瑟醫護雜誌, 7(1), 33-44.
施貞伶. (2005). 醫院病人安全文化初探—醫事人員對病人安全氣候知覺與其促進病人安全行為表現之關聯性探討. 臺灣大學. Available from Airiti AiritiLibrary database. (2005年)
洪瑞斌. (2013). 職業倦怠研究在台灣之回顧與前瞻. [Studies on Burnout in Taiwan: A Critical Review]. 人力資源管理學報, 13(3), 107-140. doi: 10.6147/jhrm.2013.1303.04
陸洛, 李惠美, & 謝天渝. (2005). 牙醫師職業壓力與身心健康及職業倦怠之關係:以高雄市牙醫師為例. [Occupational Stress, Health and Occupational Burnout among Dentists: A Study of Clinical Dentists in Kaohsiung]. 應用心理研究(27), 59-80.
葉婉榆, 鄭雅文, 陳美如, & 邱文祥. (2008). 職場疲勞量表的編製與信效度分析. [Development and Validation of an Occupational Burnout Inventory]. 臺灣公共衛生雜誌, 27(5), 349-364.
鄭嘉惠, 張嘉晃, & 王拔群. (2008). 病人安全文化調查初報-以某醫學中心為例. [The Preliminary Investigation of Patient Safety Culture-Survey from a Medical Center]. 輔仁醫學期刊, 6(1), 19-30.

英文部分
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Aiken, L. H., Sermeus, W., Van den Heede, K., Sloane, D. M., Busse, R., McKee, M., . . . Kutney-Lee, A. (2012). Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ, 344, e1717. doi: 10.1136/bmj.e1717
Campbell, D. A., Jr., Sonnad, S. S., Eckhauser, F. E., Campbell, K. K., & Greenfield, L. J. (2001). Burnout among American surgeons. Surgery, 130(4), 696-702; discussion 702-695. doi: 10.1067/msy.2001.116676
Chen, K. Y., Yang, C. M., Lien, C. H., Chiou, H. Y., Lin, M. R., Chang, H. R., & Chiu, W. T. (2013). Burnout, job satisfaction, and medical malpractice among physicians. Int J Med Sci, 10(11), 1471-1478. doi: 10.7150/ijms.6743
Chou, H. Y., Hecker, R., & Martin, A. (2012). Predicting nurses'' well-being from job demands and resources: a cross-sectional study of emotional labour. J Nurs Manag, 20(4), 502-511. doi: 10.1111/j.1365-2834.2011.01305.x
Chou, L. P., Li, C. Y., & Hu, S. C. (2014). Job stress and burnout in hospital employees: comparisons of different medical professions in a regional hospital in Taiwan. BMJ Open, 4(2), e004185. doi: 10.1136/bmjopen-2013-004185
Cimiotti, Jeannie P., Aiken, Linda H., Sloane, Douglas M., & Wu, Evan S. (2012). Nurse staffing, burnout, and health care-associated infection. American Journal Of Infection Control, 40(6), 486-490. doi: 10.1016/j.ajic.2012.02.029
Colla, J. B., Bracken, A. C., Kinney, L. M., & Weeks, W. B. (2005). Measuring patient safety climate: a review of surveys. Qual Saf Health Care, 14(5), 364-366. doi: 10.1136/qshc.2005.014217
Dyrbye, L. N., & Shanafelt, T. D. (2011). Physician burnout: a potential threat to successful health care reform. JAMA, 305(19), 2009-2010. doi: 10.1001/jama.2011.652
Halbesleben, J. R., Rathert, C., & Williams, E. S. (2013). Emotional exhaustion and medication administration work-arounds: the moderating role of nurse satisfaction with medication administration. Health Care Manage Rev, 38(2), 95-104. doi: 10.1097/HMR.0b013e3182452c7f
Halbesleben, J. R., Wakefield, B. J., Wakefield, D. S., & Cooper, L. B. (2008). Nurse burnout and patient safety outcomes: nurse safety perception versus reporting behavior. West J Nurs Res, 30(5), 560-577. doi: 10.1177/0193945907311322
Hsu, H. Y., Chen, S. H., Yu, H. Y., & Lou, J. H. (2010). Job stress, achievement motivation and occupational burnout among male nurses. J Adv Nurs, 66(7), 1592-1601. doi: 10.1111/j.1365-2648.2010.05323.x
Kanste, O., Miettunen, J., & Kyngas, H. (2006). Factor structure of the Maslach Burnout Inventory among Finnish nursing staff. Nurs Health Sci, 8(4), 201-207. doi: 10.1111/j.1442-2018.2006.00283.x
Keeton, K., Fenner, D. E., Johnson, T. R., & Hayward, R. A. (2007). Predictors of physician career satisfaction, work-life balance, and burnout. Obstet Gynecol, 109(4), 949-955. doi: 10.1097/01.aog.0000258299.45979.37
Kiekkas, P., Spyratos, F., Lampa, E., Aretha, D., & Sakellaropoulos, G. C. (2010). Level and correlates of burnout among orthopaedic nurses in Greece. Orthop Nurs, 29(3), 203-209. doi: 10.1097/NOR.0b013e3181db53ff
Lee, H. F., Chien, T. W., & Yen, M. (2013). Examining factor structure of Maslach Burnout Inventory among nurses in Taiwan. J Nurs Manag, 21(4), 648-656. doi: 10.1111/j.1365-2834.2012.01427.x
Lin, Y. W. (2013). The causes, consequences, and mediating effects of job burnout among hospital employees in Taiwan. Journal of Hospital Administration, 2(1), 15-27.
Lindblom, K. M., Linton, S. J., Fedeli, C., & Bryngelsson, I. L. (2006). Burnout in the working population: relations to psychosocial work factors. Int J Behav Med, 13(1), 51-59. doi: 10.1207/s15327558ijbm1301_7
Lue, B. H., Chen, H. J., Wang, C. W., Cheng, Y., & Chen, M. C. (2010). Stress, personal characteristics and burnout among first postgraduate year residents: a nationwide study in Taiwan. Med Teach, 32(5), 400-407. doi: 10.3109/01421590903437188
Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001). Job burnout. Annu Rev Psychol, 52, 397-422. doi: 10.1146/annurev.psych.52.1.397
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Ozyurt, A., Hayran, O., & Sur, H. (2006). Predictors of burnout and job satisfaction among Turkish physicians. QJM, 99(3), 161-169. doi: 10.1093/qjmed/hcl019
Pines, A. M., & Kanner, A. D. (1982). Nurses'' burnout: lack of positive conditions and presence of negative conditions as two independent sources of stress. J Psychosoc Nurs Ment Health Serv, 20(8), 30-35.
Poghosyan, L., Aiken, L. H., & Sloane, D. M. (2009). Factor structure of the Maslach burnout inventory: an analysis of data from large scale cross-sectional surveys of nurses from eight countries. Int J Nurs Stud, 46(7), 894-902. doi: 10.1016/j.ijnurstu.2009.03.004
Profit, J., Sharek, P. J., Amspoker, A. B., Kowalkowski, M. A., Nisbet, C. C., Thomas, E. J., . . . Sexton, J. B. (2014). Burnout in the NICU setting and its relation to safety culture. BMJ Qual Saf, 23(10), 806-813. doi: 10.1136/bmjqs-2014-002831
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4. 王嵩竑, 林筱芸, 林晉鋒, 杜貞儀, & 鄭鈺樺. (2011). 醫院員工個人特質與病人安全文化關係之研究. [The Relationship between Hospital Employee Personality Characteristics and Patient Safety Culture]. 北市醫學雜誌, 8(2), 116-125. doi: 10.6200/tcmj.2011.8.2.03
5. 吳永隆, 張嘉晃, 吳宛庭, 鄭嘉惠, 王拔群, & 侯紹敏. (2009). 急診護理人員病人安全文化-以某醫學中心為例. [Patient Safety Culture of Nursing Staff in an Emergency Room: Survey of a Medical Center]. 輔仁醫學期刊, 7(1), 17-27.
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