论文部分内容阅读
目的 了解长期照护机构护士发生职业倦怠的心理机制,为制订改善护士心理健康的干预策略提供基础.方法 采用主题分析法进行2项质性研究.第1项研究于2019年5-7月在德国8家养老院以工作坊形式对110名护士进行了8次小组访谈.作为补充,第2项研究于2019年12月对德国养老院的14名管理人员进行半结构访谈.结果 第1项研究确定的3个主要主题包括:挑战的原因、员工的变革机会和组织的变革机会.第2项研究确定的3个主要主题包括:工作动机、替班原因和员工的自我关怀.研究还发现,在应对挑战的过程中,自我损耗——当被要求替班或加班时说不的能力减弱——是护士职业倦怠的重要前因.此外,人力资源不足时员工高水平的利他动机和团队或组织认同感与自我损耗有关;自我价值感低也是导致自我损耗的风险因素.结论 关于工作需求与职业倦怠的经典理论模型中常将动机和认同作为资源,但本研究发现与经典理论模型中的一些核心原则不一致.应制订整体性护理干预计划,包括个人辅导、团队干预和组织发展程序.员工自身在长期照护工作中对自我损耗问题要敏感,并应得到支持;政策制定者应该建立合理的资源结构,即不再鼓励这种员工自我损耗行为的结构.“,”Objectives:To develop a more specific understanding of psychological mechanisms in the development of burnout in long-term care as a basis for potential new intervention strategies aiming at improving nurses\' mental health.Methods:Two qualitative studies with thematic analysis were conducted.In Study 1,we conducted eight group interviews with 110 nurses from May-July 2019 in the context of workshops at eight nursing homes in Germany.In Study 2,we supplemented these with semi-structured interviews with 14 exec-utives at German nursing homes in December 2019.Results:The thematic analysis in Study 1 identified three main themes:causes of challenges,employees\' opportunities for change,and organisational opportunities for change.Thematic analysis in Study 2 identified three main themes:job motives,reasons for filling in for others,and employee self-care.Further,our results show that the need to stand in for colleagues,in particular.is one of the greatest challenges for geriatric caregivers.In dealing with these challenges we found that self-endangering behaviour—a diminished ability to say no when asked to fill in or to do work overtime—was an important antecedent of nurses\' burnout.Further,high levels of altruistic motivation and identification with the team or organisation were associated with self-endangering behaviour in the presence of adverse working conditions.Low levels of self-worth are a further risk factor for self-endangering.Conclusions:Our findings are at odds with some core tenets of classic models of job demands and burnout that construe motivation and identification as resources.Our results show the need of a holistic intervention program in nursing including individual coaching,team-based interventions and organ-isational development processes.Employees themselves should be sensitized to this issue and supported in the long term,and politicians should create structures that do not encourage this behaviour any further.