医护人员职业倦怠影响因素的结构方程模型分析

目的  了解医护人员职业倦怠的影响因素及其作用机制，为采取有针对性的干预措施提供科学依据。方法  采用多阶段随机抽样方法，选取湖北省某地区1 938名医护人员为研究对象进行职业倦怠现况调查，运用结构方程模型探讨其工作压力、焦虑、社会支持、自我效能等对职业倦怠的作用机制。结果  湖北省某地区医护人员的职业倦怠综合得分为[34.00(25.00, 41.00)]分，职业倦怠检出率为64.09%。工作压力、焦虑与职业倦怠均呈正相关(均有P＜0.05)；社会支持、自我效能与职业倦怠均呈负相关(均有P＜0.05)。结构方程模型分析结果显示，工作压力对职业倦怠有直接正向效应(β=0.451, P=0.010)，并通过焦虑产生间接影响(β=0.129, P=0.010)；焦虑对职业倦怠有直接正向效应(β=0.360, P=0.010)；社会支持对职业倦怠有直接负向效应(β=-0.141, P=0.010)，调节变量工作压力与支持利用度对职业倦怠有负向效应(β=-0.051, P=0.018)。结论  工作压力和焦虑为湖北省某地区医护人员职业倦怠的危险因素，提高社会支持特别是支持利用程度可以有效地减少其职业倦怠的发生。

The influencing factors of job burnout among medical staff by structural equation model

  Objective  To understand the influencing factors and mechanism of job burnout among medical staff, and to provide the scientific basis for taking targeted intervention measures.  Methods  A total of 1 938 medical staff in a certain area of Hubei Province were selected as subjects by multi-stage random sampling method. The job burnout status was investigated by questionnaire survey. The mechanism of job burnout caused by work stress, anxiety, social support and self-efficacy was analyzed by structural equation model.  Results  The overall score of job burnout among medical staff in a certain area of Hubei Province was [34.00(25.00, 41.00)], and the detection rate of job burnout was 64.09%. Job burnout was positively correlated with work stress and anxiety (all P < 0.05), whereas it was negatively associated with social support and self-efficacy (all P < 0.05). The results of the structural equation model showed that work stress had a direct positive effect on job burnout (β=0.451, P=0.010), which was also indirectly affected by anxiety (β=0.129, P=0.010). And anxiety also had a direct positive influence on job burnout (β=0.360, P=0.010), while social support (β=-0.141, P=0.010) and moderating variables such as work stress and support utilization (β=-0.051, P=0.018) had direct negative effects on job burnout.  Conclusions  Work stress and anxiety are the risk factors of job burnout among medical staff in a certain area of Hubei Province. Work stress and anxiety can be effectively reduced by social support, especially the degree of support utilization.