湖南省三级综合性医院医护人员死亡态度与生命意义感及职业倦怠的相关性研究
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摘要
目的了解湖南省三级医院医护人员的死亡态度、生命意义感及职业倦怠的现状,探讨医护人员死亡态度影响因素,以及死亡态度与职业倦怠、生命意义感之间的关系。
方法从2010年4月到2010年10月,采用分层一整群抽样方法,随机抽取湖南省三级医院医护人员为研究对象,参与问卷调查,调查医护人员的死亡态度、职业倦怠和生命意义感的现状。共发放问卷1200份,回收1150份,其中有效问卷1000份,有效回收率86.96%。调查问卷包括：一般资料问卷、死亡态度描绘量表(修订版)、生命意义量表及MaSlach职业倦怠量表。采用SPSS17.0统计软件包对资料进行统计学分析,统计方法包括描述性统计分析、t检验、方差分析、Pearson相关分析和多元线性回归分析等。
结果1.医护人员死亡态度方面：各维度就每题中间值为3分而言,以自然接受得分最高,趋近接受得分最低,死亡恐惧题平均分为2.85±0.70,死亡逃避为2.98±0.75,自然接受为3.91±0.57,趋近接受为2.53±0.65,逃离接受为2.61±0.81；生命意义感方面：生命意义感总得分为63.7±6.83,每题平均分为3.18±0.34；职业倦怠方面：职业倦怠总分平均为64.71±13.46,在情感耗竭维度上,有高达89.5%的医护人员有一定程度的情感耗竭现象。在去个性化维度上,共有87.2%的医护人员有一定程度的去个性化。在个人成就感维度上,有73.4%的医护人员个人成就感比较低。
2.t检验和单因素方差分析表明：不同背景变项如性别、年龄、宗教信仰、婚姻状况、学历、工作年限、职称、职业、是否已育有子女、过去有无罹患重病、自觉身心状况、父母亲职业、父母是否健在、家中谈论死亡情形、有亲自照顾重病或濒死病人经验、面对临终病人有无抚慰、工作中接触死亡的经历、参加葬礼的次数、参加过死亡教育相关的课程或培训、有无阅读过有关讨论死亡的书籍,各组组间在死亡态度上得分有显著性差异(P<0.05)。
3.多元逐步回归分析显示：在死亡恐惧维度上,有以下5个变量进入回归方程：家中谈论死亡的情形、婚姻状况、面对临终病人有无进行抚慰、职业、参加葬礼的次数；在死亡逃避维度上,有以下5个变量进入回归方程：家中谈论死亡的情形、是否已育有子女、有无阅读过有关讨论死亡的书或文章、职业、参加葬礼的次数。在自然接受维度上,有以下3个变量进入回归方程：有学历、过去自己有无罹患过重病、在工作或实习中曾亲自照顾重病或濒死的病人；在趋近接受维度上有以下3个变量进入回归方程：有参加葬礼的次数、有无宗教信仰、学历；在逃离接受维度上,工作年限、自觉目前心理状况、接触死亡病人频率三个变量进入回归方程。
4.在相关性分析方面：医护人员生命意义感与死亡恐惧、趋近接受、逃离接受呈显著负相关。职业倦怠与死亡恐惧呈显著正相关,与自然接受呈正相关,与逃离接受呈显著正相关。
结论1.湖南省三级综合性医院医护人员死亡态度较为积极；生命意义感一般；有较高的职业倦怠水平。
2.影响医护人员死亡态度的影响因素包括人口学变量、家庭及生活经历和工作学习经历。
3.医护人员生命意义感与死亡恐惧、趋近接受、逃离接受呈显著负相关。
4.医护人员职业倦怠与死亡恐惧呈显著正相关,与自然接受呈正相关,与逃离接受呈显著正相关。
Objectives To investigate the attitudes toward death,purpose of life and the level of job burnout of medical staff, then to explore the relationship between purpose of life, the job burnout and the attitudes toward death.The influential factors have been discussed to provide the theoretical basis to improve the level of purpose of life,and decrease the level of job burnout of medical staff.
Methods From April to October in 2010, the medical staffs who work in the tertiary general hospital of Hunan province have been investigated by completely random method in in Hunan Province.There were 1200 volunteers who acceted the investigations and filled in the questionairs,1150 were retrieved,of which 1000 effictive records,the effective retrieve-ratio:86.96%. The questionnaires were composed with four parts:the demographic information questionairs of medical staff,and Death Attitude Profile-Revised(DAP-R), Purpose in Life Test(PIL), Maslach Burnout Inventory MBI—HSS.The statitistical data were analyzed by the Stastistical Package for Social Science(SPSS)17.0,and the strategies included descriptive stastistics,independent-sample t-test,ANOVA,Pearon correlation analysis and multiple linear regression.
Results 1.On average, the medical staffs in the third grade hospital scored 2.85 points on the fear of death,2.98 points on the death avoidance,3.91 points on the natural acceptance,2.53 points on the approach acceptance,2.61 points on the escape acceptance; The average score on the purpose of life and job burnout were 63.70,64.71 respectively.
2.T-test and one-way ANOVA analysis showed that there were significant differences between groups in the sex,age,religious belief, marital status, educational background,years of working,the title of technical post, profession, whether or not have children,serious disease experience, physiology and psychology conditions,parents still are alive or dead,the situation of talking about death at home, caring dying patient experiences, the comfort to dying or terminal patient,the frenquency to contact the dead,the times of taking part in funerals,whether or not receive death education or hospice care course,having readings about death.
3. In a multiple stepwise regression analysis showed that the influencing factors of fear of death were the situation of talking about death at home, marital status, the comfort to dying or terminal patient, profession, father's work, the times of taking part in funerals; the influencing factors of death avoidance were the situation of talking about death at home, whether or not have children,having readings about death,profession, the times of taking part in funerals; the influencing factors of natural acceptance were the educational background, serious disease experience, caring dying patients experiences the influencing factors of approach acceptance were the father's work, the times of taking part in funerals, religious belief,educational background;the influencing factors of escape acceptance were years of working, psychology conditions, the frenquency to contact the dead.
4. Pearson correlation analysis showed that there were negative correlation between fear of death, approach acceptance,escape acceptance and the purpose of life; positive correlation between fear of death and job burnout.
Conclusion 1. In general,the attitudes toward death of medical staff was at a relatively positive; the purpose of life is in the median level, and the job burnout in relatively high level.
2.The influencing factors of death attitudes include variables,family background and living experiences, working and learning experiences.
3.Job burnout and fear of death is significant positively correlated.
4.Fear of death,approach acceptance,escape acceptance and the purpose of life are negatively correlated.
方法从2010年4月到2010年10月,采用分层一整群抽样方法,随机抽取湖南省三级医院医护人员为研究对象,参与问卷调查,调查医护人员的死亡态度、职业倦怠和生命意义感的现状。共发放问卷1200份,回收1150份,其中有效问卷1000份,有效回收率86.96%。调查问卷包括：一般资料问卷、死亡态度描绘量表(修订版)、生命意义量表及MaSlach职业倦怠量表。采用SPSS17.0统计软件包对资料进行统计学分析,统计方法包括描述性统计分析、t检验、方差分析、Pearson相关分析和多元线性回归分析等。
结果1.医护人员死亡态度方面：各维度就每题中间值为3分而言,以自然接受得分最高,趋近接受得分最低,死亡恐惧题平均分为2.85±0.70,死亡逃避为2.98±0.75,自然接受为3.91±0.57,趋近接受为2.53±0.65,逃离接受为2.61±0.81；生命意义感方面：生命意义感总得分为63.7±6.83,每题平均分为3.18±0.34；职业倦怠方面：职业倦怠总分平均为64.71±13.46,在情感耗竭维度上,有高达89.5%的医护人员有一定程度的情感耗竭现象。在去个性化维度上,共有87.2%的医护人员有一定程度的去个性化。在个人成就感维度上,有73.4%的医护人员个人成就感比较低。
2.t检验和单因素方差分析表明：不同背景变项如性别、年龄、宗教信仰、婚姻状况、学历、工作年限、职称、职业、是否已育有子女、过去有无罹患重病、自觉身心状况、父母亲职业、父母是否健在、家中谈论死亡情形、有亲自照顾重病或濒死病人经验、面对临终病人有无抚慰、工作中接触死亡的经历、参加葬礼的次数、参加过死亡教育相关的课程或培训、有无阅读过有关讨论死亡的书籍,各组组间在死亡态度上得分有显著性差异(P<0.05)。
3.多元逐步回归分析显示：在死亡恐惧维度上,有以下5个变量进入回归方程：家中谈论死亡的情形、婚姻状况、面对临终病人有无进行抚慰、职业、参加葬礼的次数；在死亡逃避维度上,有以下5个变量进入回归方程：家中谈论死亡的情形、是否已育有子女、有无阅读过有关讨论死亡的书或文章、职业、参加葬礼的次数。在自然接受维度上,有以下3个变量进入回归方程：有学历、过去自己有无罹患过重病、在工作或实习中曾亲自照顾重病或濒死的病人；在趋近接受维度上有以下3个变量进入回归方程：有参加葬礼的次数、有无宗教信仰、学历；在逃离接受维度上,工作年限、自觉目前心理状况、接触死亡病人频率三个变量进入回归方程。
4.在相关性分析方面：医护人员生命意义感与死亡恐惧、趋近接受、逃离接受呈显著负相关。职业倦怠与死亡恐惧呈显著正相关,与自然接受呈正相关,与逃离接受呈显著正相关。
结论1.湖南省三级综合性医院医护人员死亡态度较为积极；生命意义感一般；有较高的职业倦怠水平。
2.影响医护人员死亡态度的影响因素包括人口学变量、家庭及生活经历和工作学习经历。
3.医护人员生命意义感与死亡恐惧、趋近接受、逃离接受呈显著负相关。
4.医护人员职业倦怠与死亡恐惧呈显著正相关,与自然接受呈正相关,与逃离接受呈显著正相关。
Objectives To investigate the attitudes toward death,purpose of life and the level of job burnout of medical staff, then to explore the relationship between purpose of life, the job burnout and the attitudes toward death.The influential factors have been discussed to provide the theoretical basis to improve the level of purpose of life,and decrease the level of job burnout of medical staff.
Methods From April to October in 2010, the medical staffs who work in the tertiary general hospital of Hunan province have been investigated by completely random method in in Hunan Province.There were 1200 volunteers who acceted the investigations and filled in the questionairs,1150 were retrieved,of which 1000 effictive records,the effective retrieve-ratio:86.96%. The questionnaires were composed with four parts:the demographic information questionairs of medical staff,and Death Attitude Profile-Revised(DAP-R), Purpose in Life Test(PIL), Maslach Burnout Inventory MBI—HSS.The statitistical data were analyzed by the Stastistical Package for Social Science(SPSS)17.0,and the strategies included descriptive stastistics,independent-sample t-test,ANOVA,Pearon correlation analysis and multiple linear regression.
Results 1.On average, the medical staffs in the third grade hospital scored 2.85 points on the fear of death,2.98 points on the death avoidance,3.91 points on the natural acceptance,2.53 points on the approach acceptance,2.61 points on the escape acceptance; The average score on the purpose of life and job burnout were 63.70,64.71 respectively.
2.T-test and one-way ANOVA analysis showed that there were significant differences between groups in the sex,age,religious belief, marital status, educational background,years of working,the title of technical post, profession, whether or not have children,serious disease experience, physiology and psychology conditions,parents still are alive or dead,the situation of talking about death at home, caring dying patient experiences, the comfort to dying or terminal patient,the frenquency to contact the dead,the times of taking part in funerals,whether or not receive death education or hospice care course,having readings about death.
3. In a multiple stepwise regression analysis showed that the influencing factors of fear of death were the situation of talking about death at home, marital status, the comfort to dying or terminal patient, profession, father's work, the times of taking part in funerals; the influencing factors of death avoidance were the situation of talking about death at home, whether or not have children,having readings about death,profession, the times of taking part in funerals; the influencing factors of natural acceptance were the educational background, serious disease experience, caring dying patients experiences the influencing factors of approach acceptance were the father's work, the times of taking part in funerals, religious belief,educational background;the influencing factors of escape acceptance were years of working, psychology conditions, the frenquency to contact the dead.
4. Pearson correlation analysis showed that there were negative correlation between fear of death, approach acceptance,escape acceptance and the purpose of life; positive correlation between fear of death and job burnout.
Conclusion 1. In general,the attitudes toward death of medical staff was at a relatively positive; the purpose of life is in the median level, and the job burnout in relatively high level.
2.The influencing factors of death attitudes include variables,family background and living experiences, working and learning experiences.
3.Job burnout and fear of death is significant positively correlated.
4.Fear of death,approach acceptance,escape acceptance and the purpose of life are negatively correlated.
引文
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