Argentero Piergiorgio, Dell'Olivo Bianca, Ferretti Maria Santa
Department of Psychology, University of Pavia, Pavia, Italy.
Am J Kidney Dis. 2008 Jan;51(1):80-92. doi: 10.1053/j.ajkd.2007.09.011.
Although there has been increasing interest in assessing patient satisfaction with health care during the past year, relatively few studies investigated hemodialyzed patient satisfaction.
Cross-sectional study of the relationship between burnout in nephrologists and nurses and patient satisfaction with their care.
SETTING & PARTICIPANTS: Nephrologists (n = 68), nurses (n = 334), and hemodialyzed patients (n = 695) from 10 dialysis centers across northern Italy.
Staff burnout was assessed using the Maslach Burnout Inventory. Three staff burnout subscales were developed by using factor analysis: Emotional Exhaustion, Depersonalization, and Personal Accomplishment.
Patient satisfaction was assessed by means of a multichoice questionnaire that incorporated 4 patient satisfaction dimensions: (1) completeness of medical information, (2) emotional relationship with health care staff, (3) performance of dialysis center staff, and (4) organizational aspects of health care service. Each item was scored on a 4-point scale ranging from 1 (very dissatisfied) to 4 (very satisfied). Spearman rank-order correlation was used to examine relationships between patient satisfaction and each of the 3 staff burnout subscales for each dialysis center.
Overall, burnout scores were lower than the Italian normative sample, with no significant differences between physicians and nurses. However, considering each dialysis center separately, in 2 centers, nurses registered higher emotional exhaustion levels compared with physicians, with statistically significant differences (P = 0.004 and P = 0.003, respectively). Analysis of patient overall satisfaction assessments showed general appreciation for the "courtesy" and "kindness" of staff, but evidence of problems regarding organizational aspects and structural factors. However, the most critical dimension was for "information." There was a significant positive correlation between staff personal accomplishment and client satisfaction (P < 0.01) and a significant negative correlation between staff emotional exhaustion and patient satisfaction (P < 0.01). No significant correlation was found between staff depersonalization and patient satisfaction level.
Factor analysis should be considered exploratory and confirmed in future use of the questionnaire.
Our results suggest that high levels of burnout in physicians and nurses are associated with poor patient satisfaction in dialysis units. Identifying and preventing staff burnout may increase patient satisfaction with health care.
尽管在过去一年中，人们对评估患者对医疗保健的满意度越来越感兴趣，但相对较少的研究调查了血液透析患者的满意度。
对肾病科医生和护士的职业倦怠与患者对其护理的满意度之间的关系进行横断面研究。
来自意大利北部10个透析中心的肾病科医生（n = 68）、护士（n = 334）和血液透析患者（n = 695）。
使用马氏职业倦怠量表评估员工职业倦怠。通过因子分析得出三个员工职业倦怠分量表：情感耗竭、去个性化和个人成就感。
通过一份包含4个患者满意度维度的多项选择题问卷评估患者满意度：（1）医疗信息的完整性，（2）与医护人员的情感关系，（3）透析中心工作人员的表现，以及（4）医疗保健服务的组织方面。每个项目按1（非常不满意）至4（非常满意）的4分制评分。使用斯皮尔曼等级相关分析每个透析中心患者满意度与3个员工职业倦怠分量表之间的关系。
总体而言，职业倦怠得分低于意大利常模样本，医生和护士之间无显著差异。然而，单独考虑每个透析中心时，在2个中心，护士的情感耗竭水平高于医生，差异具有统计学意义（分别为P = 0.004和P = 0.003）。对患者总体满意度评估的分析显示，患者普遍赞赏工作人员的“礼貌”和“友善”，但存在组织方面和结构因素的问题。然而，最关键的维度是“信息”。员工个人成就感与患者满意度之间存在显著正相关（P < 0.01），员工情感耗竭与患者满意度之间存在显著负相关（P < 0.01）。员工去个性化与患者满意度水平之间未发现显著相关性。
因子分析应被视为探索性的，并在问卷的未来使用中得到证实。
我们的结果表明，医生和护士的高职业倦怠水平与透析单位患者的低满意度相关。识别和预防员工职业倦怠可能会提高患者对医疗保健的满意度。
