精神科和综合科护士工作疲溃感与应对方式调查研究

目的　了解精神科及综合科护士如何应对工作疲溃感 ,并探讨应对方式与工作疲溃感之间的关系。方法　采用工作疲溃感量表 (包括 3个因子 )和简易应对方式问卷 (包括 2个因子 ) ,分别对北京某三级甲等精神科医院 96名护士和北京某三级甲等综合科医院 110名护士 ,进行了工作疲溃感及应对方式的调查。结果　综合科护士工作疲溃感总分及情绪疲倦因子得分均高于精神科护士 (P <0 .0 1) ;精神科和综合科护士应对方式总分及两个因子得分 ,结果无统计学意义 (P <0 .0 5 ) ;应对方式总分与工作疲溃感总分呈显著正相关。其中积极应对方式与工作成就感、消极应对方式与情绪疲倦感和去人格化呈显著正相关。结论　护士面对各样的工作压力 ,很容易产生工作的疲溃感。应对方式与工作疲溃感有密切的关系 ,因此提高护士对多方面的认知 ,采取有效防治工作疲溃感的措施 ,加强护士积极应对方式的培训工作是很必要的 ,尤其应加强对综合科护士工作疲溃感的防治工作。     

夜班护士工作疲溃感与应对方式的调查分析

[目的]了解夜班护士工作疲溃感与应对方式。[方法]采用工作疲溃感(MBI)量表、简易应对方式量表对医院工作1年以上的106名夜班护士和100名白班护士进行工作疲溃感及应对方式的调查。[结果]夜班护士 MBI 量表评分总分、情绪疲倦、工作成就感与工作疲溃感因子评分均高于白班护士(P <0.05);夜班护士与白班护士简易应对方式量表评分总分及2个因子得分比较,差异无统计学意义(P >0.05)。[结论]护士面对工作压力容易产生工作疲溃感,夜班护士情绪疲溃感高于白班护士。应对方式与工作疲溃感有密切关系,因此提高夜班护士对工作疲溃感的认识,采取有效防治工作疲溃感的措施,加强夜班护士积极应对方式的培训工作,保证夜班护士身心健康。     

护士工作疲溃感及其影响因素调查分析

目的探讨护士工作疲溃感水平及其影响因素。方法采用问卷调查法，调查广州市5所三级甲等综合医院235名护士的工作疲溃感水平及其影响因素。结果护士的情绪疲溃感及工作无成就感均为高度，工作冷漠感为中度；影响护士工作疲溃感的因素包括：个人对工作的喜欢程度、工作意愿、人员性质、因工作对家庭的影响、家庭成员的态度、自我健康感受、工作压力及应对方式等。结论护士的工作疲溃感较为严重，并受多因素影响。建议加强护士对专业的正确认知，培养护士的积极应对及人际沟通技巧，帮助护士协调好工作与家庭的关系，争取家庭成员的支持，对身体条件不良、工作意愿不强的护士多加关注，避免因工作疲溃感过重产生离职意愿或影响临床护理质量。     

广州市3所三级甲等医院ICU护士工作压力及疲倦感分析

目的了解在推进优质护理服务示范病房工程中,ICU护士工作压力源情况及对工作产生的疲倦感,为有效地缓解或消除护士压力提供指导。方法采用中国护士工作压力源量表和护士疲溃量表,对广州市3所三级甲等医院ICU的64名护士,在该病区开展优质护理服务示范工程后进行调查,分析ICU护士工作压力及疲倦感相关性。结果本组护士的工作压力源得分前3项由高到低依次为：护理专业及工作、工作量及时间分配、工作环境及资源;在疲溃量表的3个因子的疲倦程度上均高于常模（P<0.05）;护理专业及工作、患者护理、管理及人际关系3项得分与情绪疲倦感得分、工作冷漠感得分呈正相关（r为0.36～0.57, P＜0.05或P＜0.01）;工作量及时间分配与情绪疲倦感得分呈正相关（P＜0.05）,管理及人际关系得分与个人无成就感得分呈负相关（P＜0.05）。结论在推进优质护理服务示范病房工程中,ICU护士压力主要来自护理工作的量和性质、时间分配和工作环境等,而减少工作量,科学排班、合理安排工作时间和调整管理方法及人际关系,有助于减轻其疲倦感。     

精神科与综合科护士抑郁 人格特质与认知情绪调节策略的相关性

目的 探讨精神科与综合科护士抑郁、人格特征与认知情绪调节策略的相关性.方法 对精神科和综合科护士(各50名)采用大五人格量表、流调用抑郁自评量表、认知情绪调节问卷进行测评分析.结果 精神科与综合科护士流调用抑郁自评量表总分比较差异无显著性(P＞0.05),但显著高于全国常模(P＜0.01);精神科护士大五人格量表的神经质维度分和认知情绪调节问卷的重新关注计划、灾难化认知策略得分与综合科护士比较差异有显著性(P＜0.05或0.01).综合科护士流调用抑郁自评量表评分与认知情绪调节问卷的自我责备、接受、沉思、积极重新关注、理性分析、灾难化、责难他人认知策略得分呈显著正相关(P＜0.05或0.01),精神科护士两量表评分无显著相关性(P＞0.05).精神科护士大五人格量表总分与认知情绪调节问卷的自我责备、接受、沉思及积极重新认知评价策略得分呈显著正相关(P＜0.05或0.01),综合科护士大五人格量表总分与的积极重新关注认知策略呈显著正相关(P＜0.05).结论 护士群体存在不同程度的抑郁情绪,应予以关注;护士的抑郁状况及人格特质与认知情绪调节策略有关.     

护士长工作疲溃感与工作压力源及应对方式的相关研究

目的探讨护士长工作疲溃感、工作压力源及应对方式的水平及其之间的关系.方法采用问卷调查法,调查了广州市5家三级甲等综合医院的200名护士长的工作疲渍感、工作压力源、应对方式及其之间的相互关系.结果护士长的工作压力为中等水平,其首要工作压力为工作量与时间分配方面,最大压力源为非护理性工作太多;护士长情绪疲溃感与工作无成就感均为高度,工作冷漠感为中度;护士长的工作压力与情绪疲溃感和工作冷漠感呈正相关,与工作无成就感不相关;应对方式对护士长工作疲溃感有影响,积极应对有助于降低护士长的工作无成就感,消极应对可以加重情绪疲溃感和工作冷漠感的产生.结论护士长的工作疲溃感严重,并受工作压力及应对方式影响,建议关注护士长工作压力的主要影响因素及减轻护士长的非护理性工作,加强对护士长管理知识、心理知识及专业知识的培训,提高其积极应对技巧.     

广州市城区护士工作疲溃感与心理健康相关性研究

[目的]了解广州市城区护士工作疲溃感状况,探讨工作疲溃感对护士心理健康状况的影响。[方法]通过整群抽样,采用工作疲溃感量表和症状自评量表(SCL-90)对235名护士进行调查。[结果]护士的情绪疲溃感和个人工作无成就感均为高度,工作冷漠感为中度;护士心理健康水平低于常模。[结论]护士工作疲溃感与心理健康密切相关,护理管理者应寻求缓解护士工作疲溃的有效措施,以提高护士的心理健康水平。     

精神科护士的职业应激状况及其相关因素分析

目的探讨精神科护士的职业应激状况,并分析其相关的影响因素。方法采用Mashach工作疲溃感量表（MBS）、护士工作压力源量表（NJSQ）、简化的艾森克个性问卷（EPQ）和简易应对方式问卷（SCSQ）,对58名在职的精神科护士进行调查,并与60名内科护士进行比较。结果精神科护士的职业应激状况中,工作冷漠感为高度,而情绪疲溃感与工作无成就感为轻度,与内科护士比较,差异均有统计学意义（P〈0．01）。护士的工作压力与情绪疲溃感和工作无成就感呈正相关。结论精神科护士的职业应激状况相对较轻,并受工作压力及个性、应对方式的影响。应关注引起精神科护士工作压力的特殊成因,改善他们的工作环境,同时塑造良好的个性,提高其积极应对技巧。     

急诊护士工作疲溃感及应对方式调查分析

目的:调查急诊护士的工作疲溃感情况,探讨工作疲溃感与应对方式及其他因素的关系,为减轻急诊护士的工作疲溃感,提高工作效率及护理质量提供依据。方法:使用Maslach工作疲溃感量表和简易应对方式问卷对北京市4家县级医院107名急诊护士进行问卷调查。结果:急诊护士的工作疲溃感处于中高度耗竭。积极应对方式与情绪枯竭(EE)、去人格化倾向(DP)呈负相关,与个人成就感(PA)呈正相关;消极应对方式与情绪枯竭(EE)呈正相关;健康状况、家庭支持、工作态度与情绪枯竭(EE)和去人格化倾向(DP)呈负相关;工作态度与个人成就感(PA)呈正相关。结论:护理管理者要重视并采取措施降低急诊护士的工作疲溃感,急诊护士应在生活和工作中采取积极应对策略以减轻疲溃感。     

精神科护士心理健康与应付方式的相关性研究

目的：研究精神科护士心理健康、应付方式及相关性,为提高精神科护士的心理健康水平提供依据。方法采用随机抽样方法抽取江苏淮安及南京地区精神科156名护士和综合科160名护士,采用应付方式问卷、SCL－90症状自评量表、对护龄在5年以上的精神科和综合科护士分别进行现场调查,两组量表的各因子分比较均采用t检验。结果精神科护士SCL－90各症状因子分均低于综合科护士（ P＜0．05或P＜0．01）;精神科护士应付方式问卷中的自责、幻想、退避、合理化四个因子分均低于综合科护士（ P＜0．05或P＜0．01）,但解决问题因子分却高于综合科护士（ P＜0．05）;精神科护士应付方式与心理健康状况有相关性。结论精神科护士的心理健康水平好于综合科护士,这与精神科护士在遇到问题时采用良好的应付方式有关。     

Comparison of the National Emergency Department Overcrowding Scale and the Emergency Department Work Index for Quantifying Emergency Department Crowding

Background: Emergency department (ED) crowding is just beginning to be quantified. The only two scales presently available are the National Emergency Department Overcrowding Scale (NEDOCS) and the Emergency Department Work Index (EDWIN). Objectives: To assess the value of the NEDOCS and the EDWIN in predicting overcrowding. The hypothesis of this study was that the NEDOCS and the EDWIN would be equally sensitive and specific for overcrowding. Methods: The NEDOCS, the EDWIN, and an overcrowding measure (OV) were determined every two hours for a ten‐day period in December 2004. The NEDOCS is a statistically derived calculation, and the EDWIN is a formula‐based calculation. The overcrowding measure is a composite of physician and charge nurse expert opinion on the degree of overcrowding as measured on a 100‐mm visual analogue scale (VAS). The primary outcome, overcrowding, was based on the dichotomized OV VAS score at the midpoint of 50 mm (≥50, overcrowded; <50, not overcrowded). The area under the receiver operator characteristic curve (AUC) and an index of adequacy (relative prognostic content) of each measure, on the basis of the likelihood ratio chi‐square statistic, were computed to evaluate the performance of NEDOCS and EDWIN. Results: There were 130 completed sampling times over ten days. The OV indicated that the ED was overcrowded 62% of the time. The AUC for the NEDOCS was 0.83 (95% CI = 0.75 to 0.90), and the AUC for the EDWIN was 0.80 (95% CI = 0.73 to 0.88). The NEDOCS score accounts for 97% of the prognostic information provided by combining all variables used in each model into one combined model. The EDWIN score accounts for only 86% (χ² test for difference, p = 0.02). Conclusions: Both scales had high AUCs, correlated well with each other, and showed good discrimination for predicting ED overcrowding. This establishes construct validity for these scales as measures of overcrowding. Which scale is used in an ED is dependent on which set of data is most readily available, with the favored scale being the NEDOCS.     

Department of law and ethics

Abstract

Claire Conroy and Karen Quinlan will be forever linked by the dubious distinction of having their medical care the subject of a landmark decision from the New Jersey Supreme Court. Quinlan is well known, her high-school yearbook picture a symbol of the perplexing problems occasioned by modem medicine's power to rescue from death some who can never be aware of life. In the New Jersey Supreme Court's decision (1), Karen Quinlan's right to privacy (more accurately, her right t o determine what treatments she would receive), was held to outweigh the public's interest in the preservation of each human life. The authority to determine what Karen Quinlan would have wanted was granted to her father, and he was explicitly authorized to have her respirator discontinued once her prognosis of permanent unconsciousness was confirmed by a “hospital ethics committee”, even though her physician felt that this might well precipitate her death. The court's decision was the first time that a state's highest court acknowledged that some forms of life-sustaining medical treatment are not, from the patient's own perspective, beneficial or necessary.     

Department of law and ethics

Abstract

Elizabeth Bouvia and the California Courts are giving continuity to “Law and Ethics”. Superior Court Judge Jack Newman appointed two physicians, D. H. Catlin and D. A. Gorelick, to evaluate the differences of opinion on Ms. Bouvia's medical management. Their report said in part that she “has not received comprehensive pain control treatment and that she had not received any help in dealing with the 'psychological and social aspects of pain control'” (1). They also said that she had a poor relationship with her doctor and the staff. Given this report, Judge Newman had her removed to University of Southern California Medical Center until she could find a private facility comfortable enough with her situation to treat her as she wishes. Just as important to Bouvia, the judge ordered the physicians to continue her morphine treatment. (The doctors at High Desert had decided that she ought to be weaned from her morphine treatment.)