Yang Y, Koh D, Ng V, Lee F C, Chan G, Dong F, Chia S E
Department of Community, Occupational and Family Medicine, Faculty of Medicine, National University of Singapore, 16, Medical Drive, Singapore 117597.
J Occup Environ Med. 2001 Dec;43(12):1011-8. doi: 10.1097/00043764-200112000-00003.
The objective of this study was to assess and compare the self-perceived work-related stress of emergency department (ED) and general ward (GW) nurses and to assess the relationship between self-perceived stress and salivary cortisol levels in these groups of nurses. Seventy-three female ED (n = 23) and GW (n = 50) nurses from a general hospital completed a self-administered questionnaire. A modified mental health professional stress scale (PSS) was used to measure self-perceived work-related stress. Salivary samples were collected at the start and end of morning shiftwork. An enzyme-linked immunosorbent assay method was used to determine the salivary cortisol concentration (nmol/L). ED nurses perceived that nursing was more stressful (mean, 1.58; 95% confidence interval [CI], 1.35 to 1.81) than did GW nurses (mean, 1.30; 95% CI, 1.18 to 1.40). On the PSS subscales, scores of organizational structure and process, lack of resources, and conflict with other professionals were higher in ED nurses (all P < 0.01). The morning cortisol was significantly lower in ED (geometric mean, 9.10; 95% CI, 6.62 to 12.42 nmol/L) than in GW (geometric mean, 15.45; 95% CI, 11.86 to 20.14 nmol/L) nurses. Log morning salivary cortisol was negatively correlated with PSS (r = -0.255), scores of organizational structure and process, and conflict with other professionals (all P < 0.05). The difference between morning and afternoon cortisol concentration in ED nurses (geometric mean, 6.35; 95% CI 4.14 to 9.93 nmol/L) was lower than in GW nurses (geometric mean, 12.42; 95% CI, 9.38 to 16.28 nmol/L). The log value of the difference correlated marginally with PSS (r = -0.21, P = 0.07) and significantly with scores of organizational structure and process, lack of resources, and conflict with other professionals (all P < 0.05). There was no difference between the two groups in afternoon salivary cortisol level. ED nurses perceived more stress compared with GW nurses. Morning salivary cortisol concentration is better correlated with PSS compared with the morning-afternoon salivary cortisol difference. The result raises the possibility of using a single morning salivary cortisol sample to reflect self-perceived stress.
本研究的目的是评估和比较急诊科（ED）护士和普通病房（GW）护士自我感知的工作相关压力，并评估这些护士群体中自我感知压力与唾液皮质醇水平之间的关系。一家综合医院的73名女性ED（n = 23）和GW（n = 50）护士完成了一份自填式问卷。使用改良的心理健康专业人员压力量表（PSS）来测量自我感知的工作相关压力。在早班工作开始和结束时收集唾液样本。采用酶联免疫吸附测定法测定唾液皮质醇浓度（nmol/L）。ED护士认为护理工作比GW护士更有压力（平均值为1.58；95%置信区间[CI]，1.35至1.81）（平均值为1.30；95%CI，1.18至1.40）。在PSS子量表上，ED护士在组织结构与流程、资源缺乏以及与其他专业人员的冲突方面的得分更高（所有P < 0.01）。ED护士的晨间皮质醇水平（几何平均值为9.10；95%CI，6.62至12.42 nmol/L）显著低于GW护士（几何平均值为15.45；95%CI，11.86至20.14 nmol/L）。晨间唾液皮质醇对数与PSS（r = -0.255）、组织结构与流程得分以及与其他专业人员的冲突得分呈负相关（所有P < 0.05）。ED护士晨间和下午皮质醇浓度的差异（几何平均值为6.35；95%CI 4.14至9.93 nmol/L）低于GW护士（几何平均值为12.42；95%CI，9.38至16.28 nmol/L）。差异的对数值与PSS呈微弱相关（r = -0.21，P = 0.07），与组织结构与流程、资源缺乏以及与其他专业人员的冲突得分显著相关（所有P < 0.05）。两组护士下午唾液皮质醇水平无差异。与GW护士相比，ED护士感知到更多压力。与晨间 - 下午唾液皮质醇差异相比，晨间唾液皮质醇浓度与PSS的相关性更好。该结果增加了使用单次晨间唾液皮质醇样本反映自我感知压力的可能性。
