基于社会支持理论的医护人员职业耗竭风险模型研究
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摘要
根据Maslach的定义,职业耗竭是情绪耗竭、缺乏人情味和个人成就感低落的一系列症状。随着生活节奏的加快和社会竞争的日趋激烈,职业耗竭已成为一种不可忽视的社会现象,它会给个体、家庭、组织,甚至总个社会等带来严重的负面影响。作为职业耗竭的易发人群,医护人员的职业耗竭问题值得关注。
研究目的
描述我国医疗机构医护人员职业耗竭现状以及人口学特点;探讨一般性的社会支持、工作场所社会支持对于职业耗竭的影响,以及内外向性、神经质性、精神质性和完美主义等人格特质与职业耗竭的关系;识别医护人员职业耗竭的宏观、中观、微观层面压力源的风险因素,评估各风险因素的影响大小;在此基础上,提出预防与干预医护人员职业耗竭的对策。
研究方法
资料来源:资料均来源于现场问卷调查和定性访谈。对不同医疗机构672名医护人员、护理管理者进行了问卷调查。
调查工具:职业耗竭量表(MBI-HSS)、艾森克人格问卷(EPQ)、领悟社会支持量表(PSSS)、组织承诺问卷、完美主义问卷、工作相关的社会支持问卷(上级、同事、患者/下级、家人支持)、工作压力源问卷。
定量数据分析:描述性分析、t检验、方差分析、相关分析、多元回归分析、多分类有序变量Logistic回归、路径分析。用SPSS12.0软件进行数据分析与处理。
研究结果
本研究综合社会学和心理学等学科对社会支持的界定,认为医护人员的社会支持涵盖三个子系统――制度/环境支持子系统、组织支持子系统和工作场所支持子系统,并构建了医护人员职业耗竭的制度-组织-个人作用机制模型。由于缺乏宏观制度/环境支持而造成的压力直接导致整个卫生从业人员产生职业耗竭,通过组织、个体特征间接影响到个体,中观层面组织支持的缺乏造成的压力直接会使该组织员工出现职业耗竭,并通过个体特征间接影响个体;工作场所缺乏支持与个体人格特质一起共同影响到个体的职业耗竭。职业耗竭会对个体、组织、家庭及社会层面产生负面影响。
研究者认为,影响医护人员职业耗竭的宏观制度与环境因素有:现代生产方式和社会文化价值观、医疗卫生体制不完善、医疗纠纷频发和医患关系紧张、医疗事故等相关法律法规带来的压力、医疗风险责任分担机制尚未建立、媒体对卫生行业的不恰当报道、社会要求和人们期望过高等。
考察医护人员的人格特质和获得的一般社会支持对职业耗竭的影响,实证研究一结果显示,分别有72.4%、49.8%和54.6%的医护人员具有中高度情绪衰竭、缺乏人情味和个人成就感低落现象。采用多分类有序变量Logistic回归的方法分析婚姻状况、受教育程度、年龄、值夜班、人格特质(内外向性、神经质性、精神质性)、领悟社会支持、医院类型等因素对职业耗竭的影响,结果发现:情绪衰竭的预测变量有医院类型(OR=0.175)、神经质性(OR=1.147)、内外向性(OR=0.911)、受教育程度(OR=2.794);缺乏人情味的预测变量有精神质性(OR=1.418)、神经质性(OR=1.081);个人成就感的预测变量是精神质性(OR=0.855)、内外向性(OR=1.129)和年龄(OR=1.004);同时,职业耗竭三个维度的Logistic回归中,领悟社会支持变量均未进入模型。路径分析显示,个人成就感、人格的精神质性与情感和规范承诺有关,情绪衰竭、缺乏人情味、个人成就感和人格的内外向性与经济和机会承诺有关,缺乏人情味、个人成就感与理想承诺有关。
考察工作相关的社会支持、宏观中观微观压力源、完美主义对医护人员职业耗竭的影响,实证研究二发现,分别有73.2%、47.4%和41.1%的医护人员具有中高度情绪衰竭、缺乏人情味和个人成就感低落现象。用分层回归分析的方法探讨各因素对职业耗竭的影响(第一层变量有:性别、婚姻状况、职业、受教育程度、职称、值夜适应、睡眠质量、收入满意度、医院类型等,第二层变量为完美主义、工作相关的社会支持和压力源变量),情绪衰竭的影响因素有:医院类型、宏观压力、完美主义两个维度(行为迟疑和个人标准),解释率为42.1%;缺乏人情味的预测变量有:医院类型、性别、收入满意感、工作特征压力因子、患者支持、行为迟疑、个人标准,所有变量的解释率为42.6%;就个人成就感而言,职称、领导支持、家人支持、担心错误、个人标准五个变量进入回归方程,可以解释个人成就感总体变异的38.7%。
对护理管理者的实证研究三发现,与普通护理人员相比,护理管理者的情绪衰竭、缺乏人情味的症状较少,个人成就感较高。年龄、受教育程度、职称、职务等人口学变量对管理者职业耗竭的影响不明显。工作时间、工作量、加班次数、睡眠质量和医院类型等因素有影响。22项工作压力源中,只有8个条目与情绪衰竭有关,3个项目与缺乏人情味有关,没有项目与成就感有显著相关。从完美主义、工作支持与职业耗竭的关系来看,行为迟疑与情绪衰竭、个人标准与成就感有显著相关,领导支持与成就感、同事支持与缺乏人情味和成就感有关。
总体而言,缺乏宏观制度和环境的支持所带来的压力是医护人员职业耗竭的重要原因。从中观层面上讲,医疗机构类型是医护人员职业耗竭的预测变量。宽泛的、一般性的社会支持对医护人员职业耗竭的缓解作用相对有限,而工作相关的社会支持对职业耗竭有更强的解释力。从个体层面上看,内外向性、神经质性、精神质性以及完美主义倾向等人格特质是预测职业耗竭的风险因素。职业耗竭存在某些人口学变量的差异。
对策建议
职业耗竭的宏观干预对策:倡导关心他人福祉、重视人与人之间关系的质化生活的文化价值观取向;健全医疗保障体系,构建有利和谐医患关系的卫生体制;建立健全医疗责任保险等制度,为医护人员创造良好的执业环境;加强健康宣传教育,改变群众不合理就医观念和习惯;加强社会公关,塑造医疗机构良好的媒体形象。
在组织和管理层面上,完善管理制度和运行机制等。应重视医护人员职业倦怠等心理健康问题,尽量改善组织结构和管理制度;在工作任务方面,减少医护人员的角色模糊和角色冲突,提高医护人员工作的自主性;通过制定合理和灵活的工作作息减少工作负荷、改善睡眠质量,尤其是职业耗竭易发的科室和人群;制定科学的考核、评价制度,采取公平的激励机制;开展职业生涯规划,为医护人员职业发展提供机会和平台;减少工作环境和工作特征中的应激源,建立健全突发事件、医疗纠纷方面的处理机制,改善医护人员工作环境;加强上级、同事和患者的支持,减少工作-家庭冲突,重视家庭支持的重要性;开展提高应对能力、改善沟通技能的相关培训等。
个人层面上,对新近员工,可实施实际工作预览和期望降低计划,调整新员工的期望值;开展员工帮助计划,包括压力管理、职业生涯规划、人际关系和社会技能培训、归因方式训练、培养乐观态度、组织承诺感、正情绪和主动应对策略等,提高个体的应对能力;个体还可通过改变个人价值观取向、提高个体自我效能感和自尊、多与家人和朋友相处、关注自身健康、自我价值认同、不断学习以促进个人成长等方式预防、缓解和消除工作倦怠。
创新性
本研究从社会支持理论出发构建了针对医护人员职业耗竭的制度-组织-个人作用机制模型,实证研究显示宏观体制上缺乏支持造成的压力是医护人员职业耗竭的重要原因,研究在一定程度上弥补了现有研究主要关注组织特征、工作及角色特征和个人特征等中观和微观因素、而不重视宏观因素的不足。
本研究澄清了一般社会支持和工作相关的社会支持的不同作用,认为由于职业耗竭是与工作有关的一系列症状,因此工作相关的社会支持对职业耗竭的预测力应该更强,实证研究也证实了这一点。研究结果为组织实施干预措施提供了科学依据。
在国内同类研究中,本研究较早通过实证研究证实完美主义人格与职业耗竭的关系,并发现完美主义不同维度对职业耗竭有不同的影响。研究填补了国内研究的不足。
Job burnout has been a common problem in modern society that was defined as a syndrome of emotional exhaustion, depersonalization of others, and a feeling of reduced personal accomplishment by Maslach. Job burnout could have a negative influence on the individual, family, organization, even the whole society. Medical professionals were vulnerable to job burnout, which should be paid more attention.
Objectives
To investigate the job burnout of medical professionals in different medical institutions, and analyze its demographic characteristics; to explore the effects of social support (perceived or work-related social support) and personality (such as Extraversion, Neuroticism, Psychoticism, and Perfectionism) on job burnout; to examine the correlation between the macro (institutional), organizational, job stress and burnout; to put forward the preventions and interventions to reduce job burnout based on the findings.
Methods
Data resources: Data were collected through questionnaire survey. The empirical study consisted of three sections. As for Section One, 252 medical professionals working in three hospitals completed a questionnaire that included MBI-HSS (Maslach Burnout Inventory-Human Services Survey), EPQ (Eysenck Personality Questionnaire), PSSS (perceived social support scale), and organizational commitment. As for Section Two, 329 medical professionals from four kinds of medical institutions participated the investigation, and the questionnaire included MBI-HSS, perfectionism scale, work-related social support scale (four subscales: superior, colleague, patient and family support), and perceived sources of stress survey. Section Three investigated 91 nurse managers, and the questionnaire was the same as that used in Study Two except that the patient support scale was replaced by the subordinate one, and the depersonalization dimension of job burnout was modified to orient to the subordinate.
Using SPSS, the data were analyzed by descriptive analysis, t test, ANOVA, correlation, multiple regression, Logistic regression, and path analysis.
Results
The paper presumed that social support should be seen as a network which included institutional, organizational and workplace support systems. An institution-organization- individual mechanism model was put up to explain job burnout. Stress caused by lacking institutional support would affect the individual directly and indirectly through the organizational and personal characteristics. Stress caused by lacking organizational support would impact the individual directly and indirectly through the personal characteristics. Work related support and personal characteristics would influence the individual. And the burnout would have negative effects on the individual, family, organization, and society.
The risk factors at macro level to medical professionals’burnout included the cultural values, health system, laws and regulations, tense relationship between medical staffs and patients, mass media, over-high expectation of people, and so on.
The results of the study which examined the relationship between perceived social support, personality, and burnout showed that 72.4% medical professionals got moderate and high scores on EE (Emotional Exhaustion) and as for DP (Depersonalization) and PA (Personal Accomplishment), the respective proportions were 49.8% and 54.6%. Ordinal Logistic regression analyses indicated that among marital status, educational background, age, on duty at night, personality (Extraversion, Neuroticism, and Psychoticism), perceived social support, and the hospital type, the predictors for EE were hospital type(OR=0.175), Neuroticism (OR=1.147), Extraversion (OR=0.911), and educational background (OR=2.794); those for DP were Psychoticism (OR=1.418) and Neuroticism (OR=1.081); those for PA were Psychoticism (OR=0.855), Extraversion (OR=1.129) and age(OR=1.004); perceived social support did not enter any of the three Logistic regression equations. From the path analysis, PA and Psychoticism had a relationship with affective and normative commitment; three dimensions of burnout and Extraversion affected economic and opportunity commitment; and DP and PA predicted ideal commitment.
When exploring the influence of the work-related social support, perceived sources of stress and perfectionism on the burnout, it was found that 73.2%, 47.4%, and 41.1% respectively medical professionals were experiencing moderate and high levels of EE, DP, and PA. Three separate hierarchical multiple regression analyses (the variables at the first block were gender, marital status, career, educational background, title, on duty at night, sleep quality, satisfaction with income, and hospital type; the variables at the second block included perfectionism (four dimension: Doubts about Actions, Concern over Mistakes, Personal Standards, and Plan and Control), work-related social support (superior, colleague, patient and family support), and perceived sources of stress (at macro, organizational, professional and job level)) revealed that: (a) EE was predicted by hospital type, macro stress, two dimension of perfectionism (Doubts about Actions and Personal Standards); (b) DP was predicted by hospital type, gender, satisfaction with income, job stress, patient support, Doubts about Actions, and Personal Standards; and (c) PA was predicted by title, superior support, family support, Concern over Mistakes, and Personal Standards.
As far as nurse managers were concerned, the empirical investigation indicated that compared with medical professionals, the nurse managers had lower EE and higher PA. The demographic variables such as age, educational background, title, and position had no significant effects on any dimension of job burnout. There were significantly differences among different amount of work, work hour, sleep quality, overtime, and hospital type. Among the 22 perceived sources of stress, eight ones were related significantly to EE, and three ones for DP, and none for PA. There were significantly relationship between Doubts about Actions and EE, Personal Standards and PA, superior support and PA, colleague support and DP and PA.
In conclusion, macro stress caused by lacking institution and environmental support had a significant effect on job burnout. Medical institution type was an important predictor to burnout. The general social support had a limit influence on reducing job burnout, and the work-related social support was closely associated with burnout. At the individual level, Extraversion, Neuroticism, and Psychoticism and some dimension of Perfectionism were the risk factors to burnout. There were some demographic differences on job burnout.
Suggestions
The interventions at macro level were to advocate cultural value of qualitative life, to develop harmonious relationship between medical professionals and patients, to establish good medical environment, to promote the health education, to improve the social public relations, and so on.
The interventions at organizational level were to pay more attention to the mental health of staffs and improve management such as reducing the role ambiguity and role conflict, giving more autonomy to staffs, reducing the work overload, improving the sleep quality, promoting fair motivation, implementing career life plan, eliminating the stressor, enhancing the superior, colleague, patient and family support, carrying out the training, and so on.
As for the interventions at personal level, some programs such as realistic job preview and expectation lowering procedure could be applied for the newcomer. And employee assistance program could be applied for the staffs.
Innovations
The paper constructed an institution-organization-personality mechanism model, and confirmed the effect of macro stress (institutional and environmental) on job burnout. The paper called on paying more attention to the macro institutional and environmental factors besides the organizational, job and role, and personal characteristics;
The paper examined the general social support and work-related social support respectively, and the investigation found the latter was the more important predictor to burnout;
Since few empirical studies at domestic were carried out to explore the relationship between Perfectionism and burnout, the current study would be a domestic-leading one in this field. And the study showed job burnout was attributed to some dimensions of Perfectionism.
研究目的
描述我国医疗机构医护人员职业耗竭现状以及人口学特点;探讨一般性的社会支持、工作场所社会支持对于职业耗竭的影响,以及内外向性、神经质性、精神质性和完美主义等人格特质与职业耗竭的关系;识别医护人员职业耗竭的宏观、中观、微观层面压力源的风险因素,评估各风险因素的影响大小;在此基础上,提出预防与干预医护人员职业耗竭的对策。
研究方法
资料来源:资料均来源于现场问卷调查和定性访谈。对不同医疗机构672名医护人员、护理管理者进行了问卷调查。
调查工具:职业耗竭量表(MBI-HSS)、艾森克人格问卷(EPQ)、领悟社会支持量表(PSSS)、组织承诺问卷、完美主义问卷、工作相关的社会支持问卷(上级、同事、患者/下级、家人支持)、工作压力源问卷。
定量数据分析:描述性分析、t检验、方差分析、相关分析、多元回归分析、多分类有序变量Logistic回归、路径分析。用SPSS12.0软件进行数据分析与处理。
研究结果
本研究综合社会学和心理学等学科对社会支持的界定,认为医护人员的社会支持涵盖三个子系统――制度/环境支持子系统、组织支持子系统和工作场所支持子系统,并构建了医护人员职业耗竭的制度-组织-个人作用机制模型。由于缺乏宏观制度/环境支持而造成的压力直接导致整个卫生从业人员产生职业耗竭,通过组织、个体特征间接影响到个体,中观层面组织支持的缺乏造成的压力直接会使该组织员工出现职业耗竭,并通过个体特征间接影响个体;工作场所缺乏支持与个体人格特质一起共同影响到个体的职业耗竭。职业耗竭会对个体、组织、家庭及社会层面产生负面影响。
研究者认为,影响医护人员职业耗竭的宏观制度与环境因素有:现代生产方式和社会文化价值观、医疗卫生体制不完善、医疗纠纷频发和医患关系紧张、医疗事故等相关法律法规带来的压力、医疗风险责任分担机制尚未建立、媒体对卫生行业的不恰当报道、社会要求和人们期望过高等。
考察医护人员的人格特质和获得的一般社会支持对职业耗竭的影响,实证研究一结果显示,分别有72.4%、49.8%和54.6%的医护人员具有中高度情绪衰竭、缺乏人情味和个人成就感低落现象。采用多分类有序变量Logistic回归的方法分析婚姻状况、受教育程度、年龄、值夜班、人格特质(内外向性、神经质性、精神质性)、领悟社会支持、医院类型等因素对职业耗竭的影响,结果发现:情绪衰竭的预测变量有医院类型(OR=0.175)、神经质性(OR=1.147)、内外向性(OR=0.911)、受教育程度(OR=2.794);缺乏人情味的预测变量有精神质性(OR=1.418)、神经质性(OR=1.081);个人成就感的预测变量是精神质性(OR=0.855)、内外向性(OR=1.129)和年龄(OR=1.004);同时,职业耗竭三个维度的Logistic回归中,领悟社会支持变量均未进入模型。路径分析显示,个人成就感、人格的精神质性与情感和规范承诺有关,情绪衰竭、缺乏人情味、个人成就感和人格的内外向性与经济和机会承诺有关,缺乏人情味、个人成就感与理想承诺有关。
考察工作相关的社会支持、宏观中观微观压力源、完美主义对医护人员职业耗竭的影响,实证研究二发现,分别有73.2%、47.4%和41.1%的医护人员具有中高度情绪衰竭、缺乏人情味和个人成就感低落现象。用分层回归分析的方法探讨各因素对职业耗竭的影响(第一层变量有:性别、婚姻状况、职业、受教育程度、职称、值夜适应、睡眠质量、收入满意度、医院类型等,第二层变量为完美主义、工作相关的社会支持和压力源变量),情绪衰竭的影响因素有:医院类型、宏观压力、完美主义两个维度(行为迟疑和个人标准),解释率为42.1%;缺乏人情味的预测变量有:医院类型、性别、收入满意感、工作特征压力因子、患者支持、行为迟疑、个人标准,所有变量的解释率为42.6%;就个人成就感而言,职称、领导支持、家人支持、担心错误、个人标准五个变量进入回归方程,可以解释个人成就感总体变异的38.7%。
对护理管理者的实证研究三发现,与普通护理人员相比,护理管理者的情绪衰竭、缺乏人情味的症状较少,个人成就感较高。年龄、受教育程度、职称、职务等人口学变量对管理者职业耗竭的影响不明显。工作时间、工作量、加班次数、睡眠质量和医院类型等因素有影响。22项工作压力源中,只有8个条目与情绪衰竭有关,3个项目与缺乏人情味有关,没有项目与成就感有显著相关。从完美主义、工作支持与职业耗竭的关系来看,行为迟疑与情绪衰竭、个人标准与成就感有显著相关,领导支持与成就感、同事支持与缺乏人情味和成就感有关。
总体而言,缺乏宏观制度和环境的支持所带来的压力是医护人员职业耗竭的重要原因。从中观层面上讲,医疗机构类型是医护人员职业耗竭的预测变量。宽泛的、一般性的社会支持对医护人员职业耗竭的缓解作用相对有限,而工作相关的社会支持对职业耗竭有更强的解释力。从个体层面上看,内外向性、神经质性、精神质性以及完美主义倾向等人格特质是预测职业耗竭的风险因素。职业耗竭存在某些人口学变量的差异。
对策建议
职业耗竭的宏观干预对策:倡导关心他人福祉、重视人与人之间关系的质化生活的文化价值观取向;健全医疗保障体系,构建有利和谐医患关系的卫生体制;建立健全医疗责任保险等制度,为医护人员创造良好的执业环境;加强健康宣传教育,改变群众不合理就医观念和习惯;加强社会公关,塑造医疗机构良好的媒体形象。
在组织和管理层面上,完善管理制度和运行机制等。应重视医护人员职业倦怠等心理健康问题,尽量改善组织结构和管理制度;在工作任务方面,减少医护人员的角色模糊和角色冲突,提高医护人员工作的自主性;通过制定合理和灵活的工作作息减少工作负荷、改善睡眠质量,尤其是职业耗竭易发的科室和人群;制定科学的考核、评价制度,采取公平的激励机制;开展职业生涯规划,为医护人员职业发展提供机会和平台;减少工作环境和工作特征中的应激源,建立健全突发事件、医疗纠纷方面的处理机制,改善医护人员工作环境;加强上级、同事和患者的支持,减少工作-家庭冲突,重视家庭支持的重要性;开展提高应对能力、改善沟通技能的相关培训等。
个人层面上,对新近员工,可实施实际工作预览和期望降低计划,调整新员工的期望值;开展员工帮助计划,包括压力管理、职业生涯规划、人际关系和社会技能培训、归因方式训练、培养乐观态度、组织承诺感、正情绪和主动应对策略等,提高个体的应对能力;个体还可通过改变个人价值观取向、提高个体自我效能感和自尊、多与家人和朋友相处、关注自身健康、自我价值认同、不断学习以促进个人成长等方式预防、缓解和消除工作倦怠。
创新性
本研究从社会支持理论出发构建了针对医护人员职业耗竭的制度-组织-个人作用机制模型,实证研究显示宏观体制上缺乏支持造成的压力是医护人员职业耗竭的重要原因,研究在一定程度上弥补了现有研究主要关注组织特征、工作及角色特征和个人特征等中观和微观因素、而不重视宏观因素的不足。
本研究澄清了一般社会支持和工作相关的社会支持的不同作用,认为由于职业耗竭是与工作有关的一系列症状,因此工作相关的社会支持对职业耗竭的预测力应该更强,实证研究也证实了这一点。研究结果为组织实施干预措施提供了科学依据。
在国内同类研究中,本研究较早通过实证研究证实完美主义人格与职业耗竭的关系,并发现完美主义不同维度对职业耗竭有不同的影响。研究填补了国内研究的不足。
Job burnout has been a common problem in modern society that was defined as a syndrome of emotional exhaustion, depersonalization of others, and a feeling of reduced personal accomplishment by Maslach. Job burnout could have a negative influence on the individual, family, organization, even the whole society. Medical professionals were vulnerable to job burnout, which should be paid more attention.
Objectives
To investigate the job burnout of medical professionals in different medical institutions, and analyze its demographic characteristics; to explore the effects of social support (perceived or work-related social support) and personality (such as Extraversion, Neuroticism, Psychoticism, and Perfectionism) on job burnout; to examine the correlation between the macro (institutional), organizational, job stress and burnout; to put forward the preventions and interventions to reduce job burnout based on the findings.
Methods
Data resources: Data were collected through questionnaire survey. The empirical study consisted of three sections. As for Section One, 252 medical professionals working in three hospitals completed a questionnaire that included MBI-HSS (Maslach Burnout Inventory-Human Services Survey), EPQ (Eysenck Personality Questionnaire), PSSS (perceived social support scale), and organizational commitment. As for Section Two, 329 medical professionals from four kinds of medical institutions participated the investigation, and the questionnaire included MBI-HSS, perfectionism scale, work-related social support scale (four subscales: superior, colleague, patient and family support), and perceived sources of stress survey. Section Three investigated 91 nurse managers, and the questionnaire was the same as that used in Study Two except that the patient support scale was replaced by the subordinate one, and the depersonalization dimension of job burnout was modified to orient to the subordinate.
Using SPSS, the data were analyzed by descriptive analysis, t test, ANOVA, correlation, multiple regression, Logistic regression, and path analysis.
Results
The paper presumed that social support should be seen as a network which included institutional, organizational and workplace support systems. An institution-organization- individual mechanism model was put up to explain job burnout. Stress caused by lacking institutional support would affect the individual directly and indirectly through the organizational and personal characteristics. Stress caused by lacking organizational support would impact the individual directly and indirectly through the personal characteristics. Work related support and personal characteristics would influence the individual. And the burnout would have negative effects on the individual, family, organization, and society.
The risk factors at macro level to medical professionals’burnout included the cultural values, health system, laws and regulations, tense relationship between medical staffs and patients, mass media, over-high expectation of people, and so on.
The results of the study which examined the relationship between perceived social support, personality, and burnout showed that 72.4% medical professionals got moderate and high scores on EE (Emotional Exhaustion) and as for DP (Depersonalization) and PA (Personal Accomplishment), the respective proportions were 49.8% and 54.6%. Ordinal Logistic regression analyses indicated that among marital status, educational background, age, on duty at night, personality (Extraversion, Neuroticism, and Psychoticism), perceived social support, and the hospital type, the predictors for EE were hospital type(OR=0.175), Neuroticism (OR=1.147), Extraversion (OR=0.911), and educational background (OR=2.794); those for DP were Psychoticism (OR=1.418) and Neuroticism (OR=1.081); those for PA were Psychoticism (OR=0.855), Extraversion (OR=1.129) and age(OR=1.004); perceived social support did not enter any of the three Logistic regression equations. From the path analysis, PA and Psychoticism had a relationship with affective and normative commitment; three dimensions of burnout and Extraversion affected economic and opportunity commitment; and DP and PA predicted ideal commitment.
When exploring the influence of the work-related social support, perceived sources of stress and perfectionism on the burnout, it was found that 73.2%, 47.4%, and 41.1% respectively medical professionals were experiencing moderate and high levels of EE, DP, and PA. Three separate hierarchical multiple regression analyses (the variables at the first block were gender, marital status, career, educational background, title, on duty at night, sleep quality, satisfaction with income, and hospital type; the variables at the second block included perfectionism (four dimension: Doubts about Actions, Concern over Mistakes, Personal Standards, and Plan and Control), work-related social support (superior, colleague, patient and family support), and perceived sources of stress (at macro, organizational, professional and job level)) revealed that: (a) EE was predicted by hospital type, macro stress, two dimension of perfectionism (Doubts about Actions and Personal Standards); (b) DP was predicted by hospital type, gender, satisfaction with income, job stress, patient support, Doubts about Actions, and Personal Standards; and (c) PA was predicted by title, superior support, family support, Concern over Mistakes, and Personal Standards.
As far as nurse managers were concerned, the empirical investigation indicated that compared with medical professionals, the nurse managers had lower EE and higher PA. The demographic variables such as age, educational background, title, and position had no significant effects on any dimension of job burnout. There were significantly differences among different amount of work, work hour, sleep quality, overtime, and hospital type. Among the 22 perceived sources of stress, eight ones were related significantly to EE, and three ones for DP, and none for PA. There were significantly relationship between Doubts about Actions and EE, Personal Standards and PA, superior support and PA, colleague support and DP and PA.
In conclusion, macro stress caused by lacking institution and environmental support had a significant effect on job burnout. Medical institution type was an important predictor to burnout. The general social support had a limit influence on reducing job burnout, and the work-related social support was closely associated with burnout. At the individual level, Extraversion, Neuroticism, and Psychoticism and some dimension of Perfectionism were the risk factors to burnout. There were some demographic differences on job burnout.
Suggestions
The interventions at macro level were to advocate cultural value of qualitative life, to develop harmonious relationship between medical professionals and patients, to establish good medical environment, to promote the health education, to improve the social public relations, and so on.
The interventions at organizational level were to pay more attention to the mental health of staffs and improve management such as reducing the role ambiguity and role conflict, giving more autonomy to staffs, reducing the work overload, improving the sleep quality, promoting fair motivation, implementing career life plan, eliminating the stressor, enhancing the superior, colleague, patient and family support, carrying out the training, and so on.
As for the interventions at personal level, some programs such as realistic job preview and expectation lowering procedure could be applied for the newcomer. And employee assistance program could be applied for the staffs.
Innovations
The paper constructed an institution-organization-personality mechanism model, and confirmed the effect of macro stress (institutional and environmental) on job burnout. The paper called on paying more attention to the macro institutional and environmental factors besides the organizational, job and role, and personal characteristics;
The paper examined the general social support and work-related social support respectively, and the investigation found the latter was the more important predictor to burnout;
Since few empirical studies at domestic were carried out to explore the relationship between Perfectionism and burnout, the current study would be a domestic-leading one in this field. And the study showed job burnout was attributed to some dimensions of Perfectionism.
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