倒班与工作场所暴力对医务人员身心健康的影响:职业倦怠的中介作用

Shift work and workplace violence on healthcare workers' physical and mental health: The mediating role of job burnout

  • 摘要:
    背景 随着医疗行业的不断发展,医务人员面临着越来越多的压力,包括长时间的倒班工作以及来自患者或患者家属的工作场所暴力等。这不仅影响医务人员的心理和生理健康,还可能对患者的护理质量和医疗服务效率产生负面影响。
    目的 通过分析倒班和工作场所暴力对医务人员健康自评和抑郁症状的影响路径,探讨职业倦怠在其中的中介作用,并进行亚组分析以揭示不同人群的差异。
    方法 本研究通过滚雪球抽样法,收集了2019年1月10日至2月5日期间来自23个省市的3706名一线医务工作者的问卷数据。问卷包括基本情况、健康状况自评、抑郁症状使用《两条目患者抑郁问卷(PHQ-2)》评估、工作场所暴力经历(使用《工作场所暴力量表》)、职业倦怠(使用中文版《马氏职业倦怠量表》)等内容。数据分析采用多因素logistic回归模型、结构方程模型(用于中介效应分析)以及亚组分析,探讨倒班和工作场所暴力对健康和抑郁症状的影响。
    结果 经历倒班的为2700人(占73.29%),经历工作场所暴力的为2079人(占56.43%),自评健康的为633人(占17.18%),患抑郁症的为687人(占18.65%)。倒班经历与健康自评(OR=0.572,95%CI: 0.461~0.710)和抑郁症状(OR=1.519,95%CI: 1.190~1.938)相关,工作场所暴力与健康自评(OR=0.566,95%CI: 0.471~0.681)和抑郁症状(OR=2.096,95%CI: 1.740~2.525)相关。职业倦怠在倒班和工作场所暴力对健康自评(间接效应:−0.023,−0.027)和抑郁症状(间接效应:0.032,0.037)的影响中均起中介作用(均 P < 0.001)。亚组分析发现,年龄、婚姻状况、体育锻炼、吸烟、喝酒等因素会影响倒班和工作场所暴力对健康的影响程度。
    结论 倒班和工作场所暴力显著影响医务人员的健康自评与抑郁症状,其中职业倦怠在这一过程中起到了重要的中介作用。这提示医疗机构应加强工作资源配置,提供灵活的排班制度和充足的休息时间,增加心理支持和安全措施,以帮助医务人员更好地应对工作压力和暴力事件。

     

    Abstract:
    Background With the continuous development of the healthcare industry, healthcare workers face increasing pressure, including long-term shift work and workplace violence from patients or their relatives. This not only affects the physical and mental health of healthcare workers but may also negatively impact the quality of patient care and the efficiency of medical services.
    Objectives To analyze the pathways through which shift work and workplace violence affect healthcare workers' self-rated health and depression symptoms, explore potential mediating role of job burnout, and conduct subgroup analyses to reveal differences among various groups.
    Methods Data were collected from 3706 frontline healthcare workers across 23 provinces from January 10 to February 5, 2019, using a snowball sampling method. The survey included basic demographic information, self-rated health, depression symptoms assessed using the Patient Health Questionnaire-2 (PHQ-2), workplace violence experience assessed using the Workplace Violence Scale), and job burnout (assessed using the Chinese Maslach Burnout Inventory). Data were analyzed using logistic regression, structural equation modeling (for mediating effects), and subgroup analysis to examine the impacts of shift work and workplace violence on health and depression symptoms.
    Results Among the subjects, 2700 workers (73.29%) reported shift work experience, 2079 workers (56.43%) experienced workplace violence, 633 workers (17.18%) reported poor self-rated health, and 687 workers (18.65%) reported depression symptoms. Shift work was associated with self-rated health (OR=0.572, 95%CI: 0.461, 0.710) and depression symptoms (OR=1.519, 95%CI: 1.190, 1.938), while workplace violence also associated with self-rated health (OR=0.566, 95%CI: 0.471, 0.681) and depression symptoms (OR=2.096, 95%CI: 1.740, 2.525). Job burnout significantly mediated the effects of shift work and workplace violence on self-rated health (indirect effects: −0.023, −0.027) and depression symptoms (indirect effects: 0.032, 0.037) (all P < 0.001). The subgroup analysis revealed that age, marital status, physical exercise, smoking, and alcohol consumption influenced the impacts of shift work and workplace violence on health.
    Conclusion Shift work and workplace violence significantly affect healthcare workers' self-rated health and depression symptoms, with job burnout playing a key mediating role in this process. This suggests that healthcare institutions should improve resource allocation, provide flexible scheduling systems, ensure adequate rest time, and increase psychological support and safety measures to help healthcare workers better cope with work-related stress and violence.

     

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