自助式正念减压训练对精神科护士心理弹性及职业倦怠的影响

摘要/Abstract

摘要： 目的了解自助式正念减压训练对精神科护士心理弹性及职业倦怠的影响。方法选取2022年1—3月大庆市第三医院符合入组标准的护理人员64人。按照随机列表法将64人分为观察组和对照组,每组各32例。对照组给予每周1次的心理健康教育,观察组在心理健康教育的基础上给予自助式正念减压训练。于干预前及干预第4、8周时用五因素正念度量表（five facet mindfulness questionnaire,FFMQ）评估正念水平,用心理韧性量表（Connor-Davidson resilience scale,CD-RISC）评估心理弹性,用马斯勒职业倦怠量表-服务行业版（Maslach burnout inventory-human services survey,MBI-HSS）评估职业倦怠,并对数据进行分析。结果入组的64名精神科护士MBI-HSS总分为（59.38±17.69）分,其中情绪衰竭得分为（27.33±7.53）分,高于国内常模,去人格化得分为（10.91±5.46）分,高于国内常模,个人成就感得分为（27.06±7.55）分,低于国内常模,差异均有统计学意义（均P<0.05）。干预前2组FFMQ、CD-RISC、MBI-HSS总分和各维度得分比较,差异均无统计学意义（均P>0.05）。观察组干预第4周时CD-RISC总分和自强维度得分及FFMQ总分和观察维度、描述维度、觉知地行动维度、不判断维度得分高于干预前,MBI-HSS总分和情绪衰竭维度、去人格化维度得分低于干预前,差异均有统计学意义（均P<0.05）。观察组干预第8周时FFMQ、CD-RISC总分和各维度得分及MBI-HSS个人成就感维度得分高于干预前,MBI-HSS总分和情绪衰竭维度、去人格化维度得分低于干预前,差异均有统计学意义（均P<0.05）。干预前后,对照组FFMQ、CD-RISC、MBI-HSS总分和各维度得分比较,差异均无统计学意义（均P>0.05）。干预第4周时,观察组FFMQ、CD-RISC、MBI-HSS总分和各维度得分与对照组比较,差异均无统计学意义（均P>0.05）。干预第8周时,观察组CD-RISC总分和自强维度、乐观维度得分、MBI-HSS个人成就感维度得分、FFMQ总分和各维度得分均高于对照组,MBI-HSS总分和情绪衰竭维度、去人格化维度得分均低于对照组,差异均有统计学意义（均P<0.05）。结论自助式正念减压训练能有效提升精神科护士的心理弹性,减轻其职业倦怠。

关键词: 正念, 职业倦怠, 精神科护士, 心理韧性

Abstract: Objective Understand the impact of self-service mindfulness stress relief training on the psychological resilience and occupational burnout of psychiatric nurses. Method Select 64 nursing staff who meet the enrollment criteria from the Third Hospital of Daqing City from January to March 2022. According to the random list method,64 people were divided into an observation group and a control group,with 32 cases in each group. The control group received weekly mental health education,while the observation group received self-service mindfulness stress relief training on the basis of mental health education. Before intervention and at weeks 4 and 8,the five face mindfulness questionnaire（FFMQ） was used to assess mindfulness levels,the Connor Davidson Resilience Scale（CD-RISC） was used to assess resilience,and the Maslach Burnout Inventory Human Services Survey（MBI-HSS） was used to assess job burnout,and the data was analyzed. Result The total MBI-HSS score of the 64 psychiatric nurses enrolled was （59.38±17.69）points,with an emotional exhaustion score of （27.33±7.53）points,which was higher than the domestic norm. The depersonalization score was （10.91±5.46）points,which was higher than the domestic norm. The personal achievement score was （27.06±7.55）points,which was lower than the domestic norm,and the differences were statistically significant（all P<0.05）. Before the intervention,there was no statistically significant difference in the total scores and various dimensions of FFMQ,CD-RISC,and MBI-HSS between the two groups（all P>0.05）. At the 4th week of intervention,the total scores of CD-RISC and self-improvement dimensions,as well as the total scores of FFMQ,observation dimension,description dimension,perceived action dimension,and non judgment dimension in the observation group were higher than before intervention. The total scores of MBI-HSS,emotional exhaustion dimension,and depersonalization dimension were lower than before intervention,and the differences were statistically significant（all P<0.05）. At the 8th week of intervention,the total scores of FFMQ,CD-RISC,and various dimensions,as well as the scores of MBI-HSS personal achievement dimension,were higher in the observation group than before intervention. The total scores of MBI-HSS,emotional exhaustion dimension,and depersonalization dimension were lower than before intervention,and the differences were statistically significant（all P<0.05）. Before and after intervention,there was no statistically significant difference in the total scores and scores of FFMQ,CD-RISC,MBI-HSS in the control group（all P>0.05）. At the 4th week of intervention,there was no statistically significant difference in the total scores and various dimensions of FFMQ,CD-RISC,MBI-HSS between the observation group and the control group（all P>0.05）. At the 8th week of intervention,the total scores of CD-RISC,self-improvement dimension,optimism dimension score,MBI-HSS personal achievement dimension score,FFMQ total score,and various dimension scores in the observation group were higher than those in the control group. The total scores of MBI-HSS,emotional exhaustion dimension,and depersonalization dimension scores were lower than those in the control group,and the differences were statistically significant（all P<0.05）. Conclusion Self-service mindfulness stress relief training can effectively enhance the psychological resilience of psychiatric nurses and alleviate their job burnout.

Key words: Mindfulness, Job burnout, Psychiatric nursing, Resilience

中图分类号:

R181.3⁺1

栾悦, 任凯, 王婷婷, 俎海珍, 毕洪生. 自助式正念减压训练对精神科护士心理弹性及职业倦怠的影响. [J]职业与健康, 2023, 39(17): 2332-2336.

LUAN Yue, REN Kai, WANG Tingting, ZU Haizhen, BI Hongsheng. Effect of self service mindfulness decompression training on psychological resilience and occupational burnout of psychiatric nurses. [J]OCCUPATION AND HEALTH, 2023, 39(17): 2332-2336.

参考文献

[1] 张君. 精神疾病护理中暴力伤害性行为现状分析[J].中国现代药物应用,2010,4(7):230-231.
[2] ZENG L N,LOK K I,AN FR,et al.The prevalence of burnout and its associations with demographic correlates and quality of life among psychiatric nurses in China[J].Psychiatr Q,2021,92(2):645-653.
[3] ÖǦÜTLÜ H,MCNICHOLAS F,TÜRKÇAPAR H.Stress and burnout in psychiatrists in turkey during COVID-19 pandemic[J].Psychiatr Danub, 2021,33(2):225-230.
[4] 张利,阙建宇,王一杰,等.新冠肺炎疫情期间精神卫生工作者职业倦怠与心理健康相关性[J].中国药物依赖性杂志,2021,30(6):428-434.
[5] 孟丽雯,李晓,卜建华.精神科医生工作压力、心理韧性对职业倦怠的影响[J].现代医院,2019,19(5):772-775.
[6] PEREZ-BLASCO J,VIGUER P,RODRIGO M F.Effects of a mindfulness-based intervention on psychological distress,well-being,and mater-nal self-efficacy in breast-feeding mothers:Results of a pilot study[J].Arch Womens MentHealth,2013,16(3):227-236.
[7] RASMUSSEN M K,PIDGEON A M.The direct and indirect benefits of dispositional mindfulness on self-esteem and social anxiety[J].Anxiety Stress Coping,2011,24(2):227-233.
[8] 冯锦妹,陈华玲,卢静文,等.正念冥想干预改善精神科医护人员心理健康的效果[J].中国社区医师,2021,37(2):32-33.
[9] 王杰,杨红梅,王传霞,等.自助式正念训练对胃癌患者焦虑情绪及应对方式的影响[J].齐鲁护理杂志,2020,26(22):11-14.
[10] 徐晓晓,唐婷,龙玲,等.自助式正念训练对接受体外受精-胚胎移植女性创伤后成长和自我效能感的影响[J].第三军医大学学报,2019, 41(22):2253-2260.
[11] MENG Y,MAO K,LI C.Validation of a short-form five facet mindfulness questionnaire instrument in China[J].Front Psychol,2020,10:3031.
[12] 陈燕雅,李泽楷.护士心理韧性的研究进展及启示[J].护理学报,2015,22(9):26-29.
[13] ZHAO X,LIU S,CHEN Y,et al.Influential factors of burnout among village doctors in China:A cross-sectional study[J].Int J Environ Res Public Health,2021,18(4):2013.
[14] 杨永德,张胜,杨雪,等.武汉市10家三级甲等医院儿科护士心理韧性对职业倦怠的影响[J].职业与健康,2021,37(3):301-304,308.
[15] 曹洋洋,沈永红.护士群体职业倦怠及其研究进展[J].职业与健康,2021,37(2):285-288.
[16] 岑芸,马小琴,程思诗.浙江临床护士中医体质与职业倦怠的相关分析[J].浙江中医药大学学报,2019,43(11):1288-1293.
[17] 周莉,张炳奎,康建华,等.精神病专科医院临床一线医护人员职业倦怠状况[J].中国健康心理学杂志,2019,27(10):1529-1531.
[18] 李智慧,于川.精神科护士职业倦怠的现状研究[J].吉林医药学院学报,2022,43(1):42-43.
[19] CARTA M G,PRETI A,PORTOGHESE I,et al.Risk for depression,burnout and low quality of life among personnel of a university hospital in italy is a consequence of the impact one economic crisis in theWelfare System?[J].Clin Pract Epidemiol Ment Health,2017,13:156-167.
[20] PAPATHANASIOU I V,TSARAS K,KLEISIARIS C F,et al.Anxiety and depression in staff of mental units:The role of burnout[J].Adv Exp Med Biol,2017,987:185-197.
[21] KAKEMAM E,CHEGINI Z,ROUHI A,et al.Burnout and its relationship to self-reported quality of patient care and adverse events during COVID-19:A cross-sectional online survey among nurses[J].J Nurs Manag,2021,29(7):1974-1982.
[22] TSOU M T,CHEN J Y.Burnout and metabolic syndrome among healthcare workers:Is subclinical hypothyroidism a mediator?[J].J Occup Health,2021,63(1):e12252.
[23] 王雅星,田军香,关志,等.正念减压疗法对护士压力及职业倦怠干预效果的系统评价[J].职业与健康,2019,35(7):974-980.
[24] 王洁,蒋维连.正念减压疗法对手术室护士职业压力与压力反应的影响[J].护理管理杂志,2016,16(2):88-89,95.
[25] 莫阔,李敏,邵伊凡,等.正念减压训练对护士知觉压力、负性情绪和心理幸福感的影响[J].解放军护理杂志,2020,37(6):47-50.
[26] 何元庆,韦雨.护士正念水平与职业倦怠的关系——心理弹性的中介作用[J].芜湖职业技术学院学报,2021,23(2):68-71.
[27] 文超,蒋春雷,谭莉娜,等.精神科医护人员心理韧性、工作压力与焦虑抑郁情绪关系[J].中国职业医学,2014,41(6):697-700.
[28] 童辉杰,李连连,刘丽,等.坐忘、正念、冥想治疗焦虑的心理与脑电变化研究[J].医学与哲学(B),2017,38(18):84-87.
[29] CRESWELL J D,LINDSAY E K,VILLALBA D K,et al.Mindfulness training and physical health:Mechanisms and outcomes[J].Psychosom Med,2019,81(3):224-232.
[30] VAN DER VELDEN A M,KUYKEN W,WATTAR U,et al.A systematic review of mechanisms of change in mindfulness-based cognitive therapy in the treatment of recurrent major depressive disorder[J].Clin Psychol Rev,2015,37:26-39.