不同地区助产士共情疲劳现状及其影响因素的研究

doi:10.3761/j.issn.0254-1769.2020.07.019

摘要/Abstract

摘要：

目的调查中国东部、中部、西部地区不同级别医院助产士共情疲劳现状并分析其影响因素。方法采用随机抽样法抽取中国东部、中部、西部地区中的12个省份,便利抽取52所不同级别医院,并采用目的抽样法根据纳入排除标准抽取助产士作为研究对象,采用一般资料问卷、共情疲劳量表及社会支持评定量表进行横断面调查,通过多水平统计模型分析助产士共情疲劳的影响因素。结果共回收489份问卷,有效问卷477份,有效回收率为97.8%。调查对象共情疲劳各维度得分为共情满意（31.64±6.47）分、职业倦怠（27.87±5.01）分、继发性创伤应激（26.21±5.70）分,其中82.6%的助产士为中度及以上共情疲劳,社会支持水平总得分（37.93±6.44）分,多水平Logistic回归分析结果显示,医院级别、子女情况、地区、是否喜欢工作氛围、经历分娩创伤事件次数、睡眠质量、社会支持程度对助产士共情疲劳程度有影响（P<0.05）。结论助产士的共情疲劳程度较重,社会支持水平低、睡眠质量差、工作氛围不和谐、离异或有婴幼儿的助产士共情疲劳程度较严重,西部地区及二级、三级医院助产士共情疲劳程度较重,护理管理者应根据其影响因素,采取有效措施,降低助产士共情疲劳发生率和程度。

关键词: 助产士, 共情疲劳, 影响因素分析, 横断面研究, 护理管理研究, 卫生人力

Abstract:

Objective To investigate compassion fatigue of midwives in different levels of hospitals in eastern,central and western regions of China,and to analyze influencing factors of compassion fatigue. Methods The cross-sectional survey was conducted,and a total of 12 provinces were selected in 3 economic regions of China by random sampling method. 52 hospitals of different levels were conveniently selected,and the midwives who met the inclusion criteria were recruited by the purpose sampling method. A self-developed questionnaire,the compassion fatigue scale and the social support rating scale were adopted to collect data. The influencing factors were analyzed by a multi-level statistical model. Results A total of 489 questionnaires were collected,477 of which were valid with the effective return rate of 97.8%. The scores of conscientious satisfaction,occupational burnout,secondary traumatic stress,and social support were（31.64±6.47）,（27.87±5.01）,（26.21±5.70）,and（37.93±6.44）,while 82.6% of participants reported as moderate or above level of compassion fatigue. The results of multi-level logistic model analysis showed that hospital level,child situation,region,working atmosphere,number of labortrauma events,quality of sleep,and social support were related to the degree of compassion fatigue for midwives（P<0.05）. Conclusion The compassion fatigue of midwives was relatively serious,and midwives with low level of social support,poor sleep quality,disharmonious working atmosphere,divorce or young children are more likely to experience compassion fatigue. The degree of compassion fatigue of midwives from the secondary and tertiary hospitals in the western region was relatively high. Nursing managers should take effective measures to reduce the compassion fatigue among midwives based on influencing factors.

Key words: Midwife, Compassion Fatigue, Root Cause Analysis, Cross-Sectional Studies, Nursing Administration Research, Health Manpower

梁欣, 周红, 孙鑫章, 邓海骏, 高祖梅, 耿敬, 张柳, 海容, 张枭霄, 余勇, 王璐. 不同地区助产士共情疲劳现状及其影响因素的研究[J]. 中华护理杂志, 2020, 55(7): 1060-1066.

LIANG Xin, ZHOU Hong, SUN Xinzhang, DENG Haijun, GAO Zumei, GENG Jing, ZHANG Liu, HAI Rong, ZHANG Xiaoxiao, YU Yong, WANG Lu. Research on status and influencing factors of compassion fatigue among midwives in different areas[J]. Chinese Journal of Nursing, 2020, 55(7): 1060-1066.

图/表 5

表1 被调查医院和助产士分布情况

表2 助产士共情疲劳及社会支持得分情况（n=477,分,±s）

表3 助产士共情疲劳的单因素分析结果[n=477,名（百分比,%）]

表4 自变量赋值表

表5 助产士共情疲劳影响因素的多水平模型分析结果

参考文献 27

[1]	国家卫生部. 医药卫生中长期人才发展规划(2011-2020年)[EB/OL]. (2011-04-28)[2019-10-20]. http://www.gov.cn/zwgk/2011-04/28/content_1854246.htm.
[2]	Leinweber J, Creedy DK, Rowe H , et al. A socioecological model of posttraumatic stress among Australian midwives[J]. Midwifery, 2017,45:7-13.
[3]	Favrod C, Jan du Chêne L, Martin Soelch C , et al. Mental health symptoms and work-related stressors in hospital midwives and NICU nurses:a mixed methods study[J]. Front Psy-chiatry, 2018,9:364.
[4]	Beck CT, Gable RK . A mixed methods study of secondary traumatic stress in labor and delivery nurses[J]. J Obstet Gynecol Neonatal Nurs, 2012,41(6):747-760. URL PMID
[5]	代玲, 曾铁英, 袁梦梅 , 等. 女性分娩创伤的研究进展[J]. 中华护理杂志, 2019,54(2):311-315.
[6]	Hamilton S, Tran V, Jamieson J . Compassion fatigue in emergency medicine:the cost of caring[J]. Emerg Med Australas, 2016,28(1):100-103.
[7]	Elmir R, Pangas J, Dahlen H , et al. A meta-ethnographic synjournal of midwives’ and nurses’ experiences of adverse labour and birth events[J]. J Clin Nurs, 2017,26(23/24):4184-4200.
[8]	陈春宁, 谭淑卓, 陈立芹 , 等. 不良分娩创伤并发精神障碍产妇相关危险因素分析与对策[J]. 中国妇幼保健, 2012,27(31):5022-5023.
[9]	Lindberg I, Mella E, Johansson J . Midwives’ experiences of sphincter tears[J]. Br J Midwifery, 2013,21(1):7-14.
[10]	Adams RE, Figley CR, Boscarino JA . The compassion fatigue scale:its use with social workers following urban disaster[J]. Res Soc Work Pract, 2008,18(3):238-250. DOI URL PMID
[11]	Stamm BH . The Concise ProQOL Manual[EB/OL].[2016-01-01]. .
[12]	Figley C, Charles R . Compassion fatigue:coping with secondary traumatic stress disorder in those who treat thetraumatized[M]. New York,NY: BrunnerRoutledge, 1995: 1-20.
[13]	陈华英, 王卫红 . 中文版同情疲劳量表的信度、效度研究[J]. 中国护理管理, 2013,13(4):39-41.
[14]	肖水源 . 《社会支持评定量表》的理论基础与研究应用[J]. 临床精神医学杂志, 1994,4(2):98-100.
[15]	田凤娥, 陈霞, 米长爱 , 等. 精神病专科医院护士共情疲劳现状及其影响因素研究[J]. 中华护理杂志, 2017,52(6):654-658.
[16]	谢莹莹, 曹姗姗, 王艾红 , 等. 肿瘤内科护士共情疲劳与人格特征的相关性研究[J]. 护理学报, 2018,25(21):1-4.
[17]	田梅梅, 范霖, 施雁 , 等. 临床护士共情疲劳的现状及其影响因素分析[J]. 中华护理杂志, 2018,53(1):76-82.
[18]	Muliira RS, Ssendikadiwa VB . Professional quality of life and associated factors among Ugandan midwives working in mubende and mityana rural districts[J]. Matern Child Health J, 2016,20(3):567-576. URL PMID
[19]	丁婷婷, 罗碧如 . 我国西部地区产科能力建设现状及需求[J]. 中国妇幼保健, 2018,33(24):5682-5684.
[20]	马伟光 . 四川省护理人力资源现状研究[D]. 成都:四川大学, 2006.
[21]	国务院办公厅. 国务院办公厅关于推进分级诊疗制度建设的指导意见[EB/OL]. ( 2015-09-11)[2019-11-10]. .
[22]	Julia L, Rowe HJ . The costs of ‘being with the woman’:secon-dary traumatic stress in midwifery[J]. Midwifery, 2010,18(26):76-87.
[23]	Geraghty S, Speelman C, Bayes S . Fighting a losing battle:Midwives experiences of workplace stress[J]. Women Birth, 2019,32(3):e297-e306. URL PMID
[24]	Geraghty S, Speelman C, Bayes S . Fifhting a losing battle:Mid-wives experiences of workplace stress[J]. Women and birth, 2018,7(12):1-10.
[25]	Stoll K, Gallagher J . A survey of burnout and intentions to leave the profession among Western Canadian midwives[J]. Women Birth, 2019,32(4):e441-e449. URL PMID
[26]	Pierce H, Perry L, Gallagher R , et al. Urinary incontinence,work,and intention to leave current job:a cross sectional survey of the Australian nursing and midwifery workforce[J]. Neurourol Urodyn, 2017,36(7):1876-1883. URL PMID
[27]	Reiter RJ, Tan DX, Korkmaz A , et al. Melatonin and stable circadian rhythms optimize maternal,placental and fetal physiology[J]. Hum Reprod Update, 2014,20(2):293-307. DOI URL PMID