臺灣博碩士論文加值系統

目的
先前研究發現從事護理工作的人員需面對種種的工作壓力，也相對有一些心理健康的效應如憂鬱、焦慮、挫折、無望感、疲潰，工作滿意度下降和離職率升高等。本研究的目的是比較台灣地區精神專科醫院護理人員和綜合醫院護理人員工作壓力與心理健康的情形，並追蹤精神專科醫院護理人員工作壓力的變化情形。
方法
本研究採橫斷式研究，研究對象為台灣地區五家精神專科醫院的全職護理人員，共有604名，進行問卷調查，以其中的204名護理人員進行追蹤比較。並以同等級四家綜合醫院的護理人員624名作為對照族群。問卷的第一部分採用中文版的控制負荷支持量表(Chinese Version of the JCQ；C-JCQ)以及中文版的付出回饋失衡量表(Effort Reward imbalance；ERI)及新加入相關於病患暴力攻擊和輪班等護理工作壓力源問題，作為工作壓力評估問卷；第二部分採用台灣人憂鬱量表(Taiwanese Depression Questionnaire；TDQ)作為心理健康的評估問卷。
結果
共有精神專科醫院540名和綜合醫院490名護理人員納入問卷調查的分析中。結果顯示精神專科醫院護理人員付出回饋失衡(E/R ratio>1)的盛行率為14.8 %，有憂鬱症狀的盛行率為16.7%。付出回饋失衡的相關因子是護士職級的人員(AOR=3.32, 95%CI=1.06-14.72)，憂鬱症狀的相關因子是輪班制(AOR=2.10, 95%CI=1.03-4.65)。綜合醫院護理人員付出回饋失衡的盛行率為21.8 %，有憂鬱症狀的盛行率為24.0%。付出回饋失衡的相關因子是護士職級(AOR=4.00, 95%CI=1.15-18.89) 和輪班制(AOR=2.11, 95%CI=1.22-3.80)，憂鬱症狀的相關因子是工作年資五年以下(AOR=1.87, 95%CI=1.00-4.71)。在控制年齡的影響下，兩個族群憂鬱症狀無顯著差異而是呈現年齡愈小憂鬱症狀愈明顯的趨勢。
兩個護理職業族群中，高的心理負荷量伴隨低的工作控制度以及高的工作付出伴隨低的工作回饋的情形下均顯示有較高的憂鬱症狀。204名精神專科醫院護理人員，接受第一年與第二年控制負荷支持量表的施測，結果顯示2003年的上司支持度略高於2002年的上司支持度。
結論
綜合醫院護理人員在工作壓力方面盛行率高於精神專科醫院護理人員，但在憂鬱症狀上則無顯著差異而均呈現與年齡的變化有趨勢關係。無論運用控制負荷理論或是付出回饋理論，護理人員若處於高壓力狀態下均顯示有較差的心理健康。

Objective：Previous literatures suggest that job stress in nurses can be caused by heavy workload, shift work, emergency, needle stick and infectious disease. A significant relationship was found between job stress and depression, frustration, hopelessness, job dissatisfaction and burnout in nurses. The objective of this study is to assess the association between job stress and nurses’ subjective perception of mental health.
Methods： Our participants are nurses working in 5 psychiatric hospitals and 4 general hospitals in Taiwan. A structured questionnaire has been designed. Job stress questionnaire was based on the conceptual framework of job stress model- Karasek’s demand-control model (JCQ), Johannes Siegrist’s effort-reward imbalance model (ERI) and added items of job stressors which included assault and shirt work. The mental health status will be assessed by the Taiwan Depression Questionnaire (TDQ).
Results：A total of 1030 questionnaires were completed . In psychiatric hospitals, the 14.8% of the nurses were in the effort-reward imbalanced group and the 16.7% were depressive syndrome. Working in direct patient care was associated with effort-reward imbalanced than administrative nurse and rotating shirt work was associated with poor mental health.
A total of 21.8% nurses had effort-reward imbalanced and 24.0% had depressive syndrome in general hospitals. Working in direct patient care and rotating shirt work were associated with effort-reward imbalanced and less than 5 working tenure was associated with poor mental health.
Depressive syndrome is not different between nurses in psychiatric and general hospitals after adjusting for age variable. Younger age groups seem to suffer more depressive syndrome.
High demand and low control is a risk factor for depressive syndrome in nurses. High effort and low reward is also a risk factor for depressive syndrome in nurses. In those 204 nurses followed up from 2002, JCQ results showed increased supervisor support scores than first testing.
Conclusion：Nurses in general hospitals have higher effort-reward imbalanced then nurses in psychiatric hospitals. Younger age groups seem to suffer from more depressive syndrome in two kinds of hospitals. As measured by JCQ and ERI model, job strain is a risk factor for depressive syndrome in nurses.

第一章 序 論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第二章 文獻探討 4
第一節 護理人員的工作壓力與心理健康 4
2.1.1 護理人員的角色與工作壓力 4
2.1.2 精神科護理人員的角色與工作壓力 5
2.1.3 病患暴力攻擊的問題 7
2.1.4 護理人員的心理健康問題 8
第二節 工作壓力理論模式 9
2.2.1 工作壓力的定義 9
2.2.2 工作壓力的成因 10
2.2.3 工作壓力模式介紹 11
第三節 憂鬱症 14
2.3.1 憂鬱症的成因 14
2.3.2 憂鬱症的定義與特徵 15
2.3.3 憂鬱症的診斷 15
2.3.4 憂鬱症的合併症 17
第三章 材料與方法 18
第一節 研究對象 18
第二節 個案訪談 18
第三節 建立問卷 18
第四節 問卷施測 21
第五節 資料分析 21
第四章 結 果 23
第一節 護理人員人口學及工作狀況的描述 23
第二節 工作壓力量表與憂鬱量表得分情形分析 24
第三節 感受到病患暴力攻擊程度的分析 26
第四節 付出回饋失衡與憂鬱症狀的相關因子 26
第五節 工作壓力和社會支持對憂鬱症狀的預測 27
第六節 追蹤個案的工作壓力變化情形 28
第七節 量表的建構效度與內部一致性 28
第五章 討 論 30
第一節 平均年齡的分佈 30
第二節 工作壓力量表的得分分析 30
第三節 工作壓力與相關因子 32
第四節 憂鬱症狀與相關因子 33
第五節 工作壓力對憂鬱症狀的預測 34
第六節 社會支持的效應 35
第七節 護理人員面對病患暴力攻擊的威脅 35
第六章 總 結 37
第一節 結 論 37
第二節 研究的限制 39
6.2.1 選樣偏差與外推性 39
6.2.2 回憶偏差 39
6.2.3 因果關係 39
6.2.4 女性角色的工作壓力與心理健康 40
6.2.5 對離職者的追蹤 40
6.2.6 訪談的技巧與人數 40
第三節 建 議 41
第四節 未來的工作 42
參考文獻 43
研究圖表 48
附錄一：職業特質與身心健康調查問卷及護理人員個人報告書 63

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