Predictors of burnout, work engagement and nurse reported job outcomes and quality of care: a mixed method study.
Predictors of burnout, work engagement and nurse reported job outcomes and quality of care: a mixed method study.
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倦怠、工作投入和护士报告的工作结果和护理质量的预测因素：一项混合方法研究。
DOI：
10.1186/s12912-016-0200-4
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发表时间：
2017
期刊：
影响因子：
3.2
通讯作者：
Franck E
中科院分区：
文献类型：
--
作者：
Van Bogaert P;Peremans L;Van Heusden D;Verspuy M;Kureckova V;Van de Cruys Z;Franck E
高水平的工作相关的压力，倦怠，工作不满，健康状况不佳是常见的护理专业。全面了解护士的心理社会工作环境是应对复杂病人需求的必要条件。本研究的目的有三：（1）重新验证两个结构方程模型，探讨实习环境与工作特性之间的关系，作为倦怠（模型1）和敬业度（模型2）以及护士报告的工作结果和护理质量的预测因素;（2）研究护士和护士管理者对护士工作量的感知和经验;（3）运用质的研究结果对两个模型进行解释和说明。本混合方法研究基于解释性序贯研究设计。我们首先在两个大型的急性护理大学医院进行了横断面调查设计。其次，我们进行了个人半结构化的采访工作人员的护士和护士管理人员分配到医疗或外科单位的研究医院之一。研究数据收集于2014年9月至2015年6月之间。最后，定性研究结果有助于解释和解释这两个模型的结果。以倦怠和投入为中介变量的两个模型与数据拟合充分。护士报告的工作成果和护理质量解释了52%和62%之间的差异。护士管理在单位一级和工作量有直接影响的结果变量之间的解释方差分别为23%和36%之间和12%和17%。个人成就感和人格解体对工作结果的解释方差为23%，对活力的解释方差为20%。倦怠和敬业度对护理质量的直接影响不太相关（≤5%）。定性研究揭示了各种主题，如日常实践和工作条件的组织;跨学科合作，沟通和团队合作;工作人员护士的个人特点和能力;以病人为中心，质量和病人安全。受访者的陈述与模特的联想密切相关。通过重新测试的模型和对研究参与者的访谈，深入了解了各种关联和对研究结果变量（如风险因素和保护因素）的影响。除了软工作特性--如决策自由度、社会资本和团队凝聚力--更深入地了解和了解艰苦工作特性工作量也是必不可少的。
High levels of work-related stress, burnout, job dissatisfaction, and poor health are common within the nursing profession. A comprehensive understanding of nurses’ psychosocial work environment is necessary to respond to complex patients’ needs. The aims of this study were threefold: (1) To retest and confirm two structural equation models exploring associations between practice environment and work characteristics as predictors of burnout (model 1) and engagement (model 2) as well as nurse-reported job outcome and quality of care; (2) To study staff nurses’ and nurse managers’ perceptions and experiences of staff nurses’ workload; (3) To explain and interpret the two models by using the qualitative study findings. This mixed method study is based on an explanatory sequential study design. We first performed a cross-sectional survey design in two large acute care university hospitals. Secondly, we conducted individual semi-structured interviews with staff nurses and nurse managers assigned to medical or surgical units in one of the study hospitals. Study data was collected between September 2014 and June 2015. Finally, qualitative study results assisted in explaining and interpreting the findings of the two models. The two models with burnout and engagement as mediating outcome variables fitted sufficiently to the data. Nurse-reported job outcomes and quality of care explained variances between 52 and 62%. Nurse management at the unit level and workload had a direct impact on outcome variables with explained variances between 23 and 36% and between 12 and 17%, respectively. Personal accomplishment and depersonalization had an explained variance on job outcomes of 23% and vigor of 20%. Burnout and engagement had a less relevant direct impact on quality of care (≤5%). The qualitative study revealed various themes such as organisation of daily practice and work conditions; interdisciplinary collaboration, communication and teamwork; staff nurse personal characteristics and competencies; patient centeredness, quality and patient safety. Respondents’ statements corresponded closely to the models’ associations. A deep understanding of various associations and impacts on studied outcome variables such as risk factors and protective factors was gained through the retested models and the interviews with the study participants. Besides the softer work characteristics — such as decision latitude, social capital and team cohesion — more insight and knowledge of the hard work characteristic workload is essential.