Ruotsalainen Jani, Serra Consol, Marine Albert, Verbeek Jos
Finnish Institute of Occupational Health, Cochrane Occupational Health Field, Neulaniementie 4, PO Box 93, FI-70701 Kuopio, Finland.
Scand J Work Environ Health. 2008 Jun;34(3):169-78. doi: 10.5271/sjweh.1240.
This study evaluated the effectiveness of interventions in reducing stress at work among health care workers.
A systematic search was conducted of the literature on reducing stress or burnout in health care workers. The quality of the studies found was then appraised and the results combined. A meta-analysis was performed when appropriate.
Altogether 14 randomized controlled trials, three cluster-randomized trials, and two crossover trials, comprising 2812 participants, were included. Only two trials were of high quality. The following comparisons were possible: person-directed interventions versus no intervention, person-work interface interventions versus no intervention, and organizational interventions versus no intervention. Person-directed interventions can reduce stress [standardized mean difference (SMD) -0.85, 95% confidence interval (95% CI) -1.21 - -0.49] and burnout, measured as emotional exhaustion [weighted mean difference (WMD) -5.82, 95% CI -11.02 - -0.63) and lack of personal accomplishment (WMD -3.61; 95% CI -4.65 - -2.58). They also reduce anxiety, measured as state anxiety (WMD -9.42, 95% CI -16.92 - -1.93) and trait anxiety (WMD -6.91, 95% CI -12.80 - -1.01). Person-work interface interventions can reduce burnout, measured as depersonalization [mean difference (MD) -1.14, 95% CI -2.18 - -0.10]. Organizational interventions can also reduce stress symptoms (MD -0.34; 95% CI -0.62 - -0.06) and general symptoms (MD -2.90, 95% CI -5.16 - -0.64). No harmful effects were reported.
Limited evidence is available for a small, but probably relevant reduction in stress levels from person-directed, person-work interface, and organizational interventions among health care workers. This finding should lead to a more-active stress management policy in health care institutions. Before large-scale implementation can be advised, larger and better quality trials are needed.
本研究评估了干预措施在降低医护人员工作压力方面的有效性。
对有关降低医护人员压力或职业倦怠的文献进行了系统检索。然后对所发现研究的质量进行评估并合并结果。在适当情况下进行了荟萃分析。
共纳入14项随机对照试验、3项整群随机试验和2项交叉试验，涉及2812名参与者。只有两项试验质量较高。可以进行以下比较：针对个人的干预措施与无干预措施、个人-工作界面干预措施与无干预措施、组织干预措施与无干预措施。针对个人的干预措施可减轻压力[标准化均数差（SMD）-0.85，95%置信区间（95%CI）-1.21至-0.49]和职业倦怠，职业倦怠以情感耗竭[加权均数差（WMD）-5.82，95%CI-11.02至-0.63]和个人成就感低落（WMD-3.61；95%CI-4.65至-2.58）来衡量。它们还可减轻焦虑，焦虑以状态焦虑（WMD-9.42，95%CI-16.92至-1.93）和特质焦虑（WMD-6.91，95%CI-12.80至-1.01）来衡量。个人-工作界面干预措施可减轻职业倦怠，职业倦怠以去个性化来衡量[均数差（MD）-1.14，95%CI-2.18至-0.10]。组织干预措施也可减轻压力症状（MD-0.34；95%CI-0.62至-0.06）和一般症状（MD-2.90，95%CI-5.16至-0.64）。未报告有害影响。
有有限的证据表明，针对医护人员的个人导向、个人-工作界面和组织干预措施能使压力水平有小幅但可能相关的降低。这一发现应促使医疗机构制定更积极的压力管理政策。在建议大规模实施之前，需要进行更大规模和更高质量的试验。
