摘要
目的探讨医护人员的职业倦怠和情绪劳动的现状,了解医护人员组织支持和组织认同的情况,明确医护人员情绪劳动对职业倦怠的作用机制,为缓解医护人员的职业倦怠、提升职业效能、维护身心健康提供相关性的可视化数据参考依据。方法使用方便抽样调查方法,选取四川省内各级医院(四川省中医医院,四川省人民医院,开江县中医院,成都肛肠医院,成都金堂仁爱医院)2019-12-20-2020-02-20在岗医护人员作为研究对象,在取得调查对象的知情同意后进行电子问卷调查。该调查问卷由4部分内容构成,包括一般情况、情绪劳动问卷(ELS)、职业倦怠问卷(MBI-GS),组织支持和组织认同问卷。问卷结果采用Excel进行描述性统计,采用SPSS 20.0进行统计推断,二分类资料采用t检验,多分类变量采用方差分析,因素间采用Pearson进行相关性分析,结构方程模型采用AMOS 20.0进行构建,使用Process插件Bootstrap法对修正后的结构方程中介效应进行验证。结果共发放450份问卷,有效问卷421份,有效率为93.56%。其中医生218人(51.78%),护士203人(48.22%);男性117人(27.79%),女性304人(73.40%);平均年龄(34.72±8.95)岁;平均工作时间(12.23±9.31)年。问卷调查结果显示,情绪耗竭为(17.51±5.12)分,消极怠慢为(15.31±3.67)分,高于常模,低效能感为(10.79±3.53)分,医护人员目前处于中度职业倦怠;情绪劳动得分:浅层表演为(3.31±1.05)分,深层扮演为(2.30±0.91)分,自然表现为(1.99±0.81)分,医护人员较多采用浅层表演的方式面对患者;组织支持得分为(2.04±0.81)分,组织认同为(1.73±0.60)分。组织支持、组织认同是职业倦怠各维度的影响因素,对职业倦怠中的情感耗竭(r=-0.61)和消极怠慢(r=-0.69)产生负向影响(P<0.01),对低效能感(r=0.55)产生正向影响(P<0.01);情绪劳动中的浅层表演对职业倦怠中情感耗竭(r=0.55)和消极怠慢(r=0.53)产生正向影响(P<0.01),对低效能感(r=-0.37)产生负向影响;深层扮演和自然表现对职业倦怠中的情感耗竭(r=-0.18,r=-0.43)和消极怠慢(r=-0.25,r=-0.57)产生负向影响(P<0.01),对低效能感(r=0.39,r=0.57)产生正向影响(P<0.01)。结构方程模型结果显示,χ^(2)自由度比(χ^(2)/df)=5.73,近似误差均方根(RMSEA)=0.15,均方根残差(RMR)=0.02,比较拟合指数(CFI)=0.98,规范配适指标(NFI)=0.99。模型拟合较好(P<0.05),能有效说明情绪劳动在组织支持与职业倦怠中产生中介作用。浅层表演是组织支持与职业倦怠中的情绪耗竭和消极怠慢的部分中介因素,能够正向预测职业倦怠,间接效应为0.25和0.21;自然表现是组织支持影响低效能感的部分中介因素,可以负向预测低效能感,间接效应为0.15。结论医护人员处于中度职业倦怠,组织支持、情绪劳动是职业倦怠的影响因素;医院的组织支持和组织认同可有效降低医护人员的职业倦怠;医护人员的情绪劳动会影响职业倦怠水平,浅层表演加剧职业倦怠感的产生,深层扮演和自然表现能有效缓解职业倦怠;情绪劳动是组织支持影响职业倦怠的中介因素。科学地认识情绪劳动和职业倦怠的关联和作用机制,给予医护人员组织支持组织认同,指导医护人员采取正确的情绪策略,能有效缓解职业倦怠。
Objective To explore the current situation of burnout and emotional labor of medical staff,to understand the organizational support and organizational identity of medical staff,to clarify the mechanism of emotional work on burnout of medical staff,and to provide a visual reference basis for alleviating burnout,improving occupational efficiency and maintaining physical and mental health.Methods Using the survey method of convenient sampling,the on-the-job medical staff of hospitals at all levels in Sichuan Province(Sichuan Provincial Hospital of Traditional Chinese Medicine,Sichuan Provincial People’s Hospital,Kaijiang County Hospital of Traditional Chinese Medicine,Chengdu Proctology Hospital,Chengdu Jintang Renai Hospital)from December 20,2019to February 20,2020were selected as the research subjects,and an electronic questionnaire survey was conducted after obtaining the informed consent of the survey subjects.The questionnaire consists of four parts:General condition,emotional labor questionnaire(ELS),Maslach burnout inventory-general survey(MBI-GS),organizational support and organizational identity questionnaire.The questionnaire results were constructed using Excel for descriptive statistics,SPSS 20.0for statistical inference,t-test for dichotomous data,analysis of variance for multi-categorical variables,Pearson for correlation analysis between factors,AMOS 20.0software for row structural equation model,and Process plug-in Bootstrap method to verify the mediating effect of the modified structural equation.Results A total of 450questionnaires were distributed,421of which were valid,with an effective rate of 93.56%.Among them,218doctors(51.78%),203nurses(48.22%),117 men(27.79%),304 women(73.40%),with an average age of(34.72±8.95)years and an average working life of(12.23±9.31)years.The results of questionnaire survey showed that,emotional exhaustion was 17.51±5.12points,negative neglect was 15.31±3.67points,higher than the norm,inefficient energy sense was 10.79±3.53points,and medical staff were currently in moderate job burnout.The scores of emotional labor were 3.31±1.05for shallow performance,2.30±0.91for deep performance,and 1.99±0.81for natural performance.Most of the medical staff used shallow performance to face patients.The score of organizational support was 2.04±0.81points,and the score of organizational identity was 1.73±0.60points.Organizational support and organizational identity were the influencing factors of various dimensions of job burnout,which had a negative impact on emotional exhaustion(r=-0.61)and negative burnout(r=-0.69)in job burnout(P<0.01),and a positive impact on low efficiency(r=0.55),P<0.01.Shallow performance in emotional work had a positive impact on emotional exhaustion(r=0.55)and negative burnout(r=0.53)in job burnout(P<0.01),and a negative impact on inefficient energy sense(r=-0.37).Deep acting and natural performance had a negative impact on emotional exhaustion(r=-0.18,r=-0.43)and negative burnout(r=-0.25,r=-0.57)in job burnout(P<0.01),and a positive impact on inefficient energy(r=0.39,r=0.57),P<0.01.Structural equation model showed that,chi square degree of freedom ratio(χ^(2)/df)=5.73,root mean square error of approximation(RMSEA)=0.15,root mean square residual(RMR)=0.02,comparative fit index(CFI)=0.98,normed fit index(NFI)=0.99,the model fit well(P<0.05),which could effectively explain that emotional labor played a mediating role in organizational support and job burnout.Shallow performance was part of the mediating factor of emotional exhaustion and negative burnout in organizational support and job burnout.It could positively predict job burnout,with indirect effects of 0.25and 0.21.Natural performance was part of the mediating factor that organizational support affects inefficient perceived energy.It could negatively predict inefficient perceived energy,with an indirect effect of 0.15.Conclusions At present,medical staff are in moderate job burnout.Organizational support and emotional labor are the influencing factors of job burnout.Hospital organizational support and organizational identity can effectively reduce the job burnout of medical staff.The emotional work of medical staff will affect the level of job burnout.Shallow acting will aggravate the sense of job burnout,while deep acting and natural performance can effectively alleviate job burnout.Emotional labor is the intermediary factor of organizational support influencing job burnout.Scientific understanding of the relationship and mechanism between emotional labor and job burnout,giving medical staff organizational support and organizational identity,and guiding medical staff to adopt correct emotional strategies can effectively alleviate job burnout.
作者
陈小雪
李爱玲
罗建
CHEN Xiao-xue;LI Ai-ling;LUO Jian(School of Public Health,Southwest Medical University,Luzhou646000,China;School of Management,Chengdu University of Traditional Chinese Medicine,Chengdu610037,China)
出处
《社区医学杂志》
CAS
2023年第1期36-42,共7页
Journal Of Community Medicine
基金
2021西南医科大学校级课题(21YYJC0578)
2021西南医科大学第二批“双带头人”教师党支部社会医学党支部工作室基金
关键词
医护人员
职业倦怠
情绪劳动
组织支持
结构方程模型
medical staff
job burnout
emotional labor
organizational support
structural equation model
作者简介
第一作者:陈小雪,女,四川成都人,硕士,主要从事健康教育与健康促进以及医药卫生方针政策的研究工作。E-mail:cxx@swmu.edu.com;通信作者:罗建,男,四川成都人,副教授,主要从事中医药卫生政策的研究工作。E-mail:2583389626@qq.com
