| 摘要: | 研究目的：本研究旨在調查照顧HIV/AIDS患者對於史瓦濟蘭衛生保健工作者之工作倦怠的影響。
研究背景：照HIV/AIDS患者而來的工作壓力，加重了全球醫療保健工作者的工作負擔。 衛生保健工作者通過對HIV/AIDS患者提供不斷進步的護理、預防、治療和康復服務，在打擊HIV/AIDS方面發揮到了關鍵的作用。對HIV/AIDS患者進行護理的同時，醫療保健工作者也背負生理與心理上的壓力;如感染風險、工作過度負荷、HIV/AIDS的慢性本質、死亡與邁向死亡。此外，有限的工作獎勵，也導致工作者的職業壓力和倦怠。研究方法：這個橫斷面研究使用了Siegrist的付出-回饋失衡模式（effort–reward imbalance, ERI），HIV/AIDS工作壓力問卷和測量過勞之量表（Copenhagen Burnout Inventory, CBI）來獲得368名史瓦濟蘭醫護人員的職業壓力和倦怠情況，對象包含衛生保健經理、醫生、護士、實驗室工作人員和HIV/AIDS諮詢員。應用邏輯回歸來確定醫護人員的倦怠與職業壓力之間的關係，調整潛在的性別、年齡、教育資格、職業、工作經驗和個變項彼此之間的關係。
研究結果：衛生保健工作者在個人倦怠上得分較高（OR = 4.60）、工作相關倦怠（OR = 3.96）、客戶相關倦怠（OR = 2.20）方面具有較高的風險。此外，個人倦怠（OR = 3.13）、工作倦怠（OR = 2.08）和客戶相關倦怠（OR = 1.39）的高風險與低工作獎勵有關，儘管與客戶有關的倦怠沒有發現顯著關聯。相應地，暴露於較高過度承諾分數的工作人員有三倍遭受個人倦怠可能性（OR = 3.51）、兩倍遭受工作倦怠可能性（OR = 2.59），並遭受客戶相關倦怠（OR = 1.66）。 觀察到較高的E / R比對倦怠的顯著影響; 個人倦怠（OR = 4.92），工作倦怠（OR = 4.85）和客戶相關倦怠（OR = 2.35）。
關於HIV/AIDS，工作壓力與ERI工作壓力得到相似認知。高度照顧HIV/AIDS感染患者工作的衛生保健工作者有較高度的個人倦怠（OR = 1.88），工作倦怠（OR = 3.01）和客戶相關倦怠（OR = 3.00）的重大風險，而沒有結果顯示對於照顧HIV/AIDS患者之工作人員之工作獎勵與倦怠有顯著相關。同樣地，我們也觀察了HIV/AIDS工作報酬比例的影響; 個人倦怠（OR = 1.26）、工作相關倦怠（OR = 2.07）和客戶相關倦怠（OR = 2.92）。我們的研究結果表明HIV/AIDS工作壓力與“倦怠”在個人、工作和客戶之間的重要關係。高度HIV/AIDS工作、HIV/AIDS感染率低、HIV/AIDS感染率高，與個人、工作和客戶的倦怠有關。此外，HIV/AIDS工作壓力的四個重要風險因素包括擔心被HIV/AIDS感染的壓力、照顧HIV/AIDS患者的壓力、死亡和面臨死亡問題的壓力以及最後所有的工作需求。
結論：使用HIV/AIDS工作壓力和倦怠的ERI模型的綜合過程是製定有效的衛生系統戰略以減少健康工作者倦怠的重要一步。具體來說，本研究旨在提出降低職業壓力和倦怠風險的具體措施。同時考慮到需要製定針對健康工作者的心理支持計劃。健康工作者倦怠的生理和行為效應值得進一步調查。
Purpose: This study aims to investigate the impact of work stress from caring for People Living with HIV/AIDS (PLWHA) on burnout among Health care workers (HCWS) in Swaziland.
Background: The work stress from caring for PLWHA has increased the burdens for HCWs globally. HCWs play a critical role in the fight against HIV/AIDS by continuously providing promotive, preventive, curative and rehabilitative services through testing, care, and treatment for PLWHA. While executing care to PLWHA, they encounter physically and emotionally demanding tasks; such as infection risk, work overload, the chronic nature of HIV/AIDS, death and dying. In addition, serving their clients with limited work rewards all leading to occupational stress and burnout.
Methods: This cross-sectional study used the Siegrist’s effort–reward imbalance (ERI), HIV/AIDS work stress questionnaire and the Copenhagen Burnout Inventory (CBI) to examine occupational stress and burnout among 368 HCWs; comprising of health care managers, physicians and nurses, laboratory staff and HIV/AIDS counsellors in Swaziland. Logistic regression applied to determine the association between burnout and occupational stress among HCWs, adjusting for potential confounders of sex, age, educational qualifications, profession, work experience, and the significant occupational stress scale of each model for the other.
Results: HCWs with elevated scores of occupational efforts had significant higher risks of suffering from personal burnout (OR= 4.60), work- related burnout (OR = 3.96), client-related burnout (OR = 2.20). Moreover, higher risks of personal burnout (OR = 3.13), work-related burnout (OR = 2.08) and client related burnout (OR = 1.39) were all associated with low work rewards, although no significant association were found on client-related burnout. Correspondingly, workers exposed to higher scores of over commitment were three times likely to suffer personal burnout (OR = 3.51), two times likely to suffer work-related burnout (OR = 2.59) and to suffer client-related burnout (OR = 1.66). Stronger significant effects of higher E/R ratios on burnout were observed; personal burnout (OR = 4.92), work-related burnout (OR = 4.85) and client-related burnout (OR = 2.35).
On HIV/AIDS, work stress similar results as the ERI work stress were recognized. Health workers with higher HIV/AIDS efforts had significant risks of suffering from personal burnout (OR =1.88), work-related burnout (OR =3.01) and client-related burnout (OR =3.00), whereas no significant association were reported for HIV/AIDS rewards with burnout. Similarly, the effects of the HIV/AIDS effort reward ratio were also observed; personal burnout (OR =1.26), work-related burnout (OR = 2.07) and client-related burnout (OR = 2.92). Our findings suggested important associations between HIV/AIDS work stress and ‘burnout’, personal, work and client. High HIV/AIDS efforts, low HIV/AIDS rewards, high HIV/AIDS ER ratio were associated with personal, work and client-related burnout. Additionally, four significant risk factors to HIV/AIDS work stress included stress from fear of HIV/AIDS contagion, stress from caring for children living with HIV/AIDS, stress from death and dying issues and lastly the intensity of work demands.
Conclusions: Using an integrative process of the ERI model on HIV/AIDS work stress and burnout is an essential step to develop effective health systems strategies to reduce burnout among HCWs. Specifically, the present study suggests the development of specific interventions aimed at reducing the risk of occupational stress and burnout. Also considering the need to develop psychological support programs for HCWs. The physiological and behavioural effects of burnout among HCWs warrants further investigations. |
