University of Worcester, United Kingdom.
Int J Nurs Stud. 2013 Aug;50(8):1090-7. doi: 10.1016/j.ijnurstu.2012.11.022. Epub 2013 Jan 10.
Nursing and medical staff in maternity and gynaecological settings regularly care for patients experiencing miscarriage, neonatal death and stillbirth as part of their work. Qualitative reports have suggested that perinatal death takes a significant emotional toll on staff but to date, reported distress has not been quantified.
The present study, using Lazarus and Folkman's transactional model of stress, explored the extent of staff distress, and its predictive factors, in a sample of United Kingdom nursing and medical staff.
A retrospective, cross-sectional, questionnaire survey was undertaken across five Midlands hospitals, inviting a total of 350 doctors, nurses and midwives to participate. In addition to sociodemographics, the questionnaires assessed staff distress, coping strategies and their perception of working environment via the Impact of Events Scale (IES), Positive And Negative Affect Scale (PANAS), Brief COPE, and Work Environment Scale (WES) respectively.
54% of eligible staff responded. IES scores revealed 55% of participants reporting subjective distress levels indicating a 'high' level of clinical concern. Multiple regression revealed that whilst no socio-demographic variable predicted distress, negative affect experienced at time of care (p=.002; CI 0.164-0.683) negative appraisal of care given to the family (p=.003; CI 0.769-3.358), cumulative number of losses experienced (p=0.004; CI 0.713-3.778), maladaptive ways of coping (p=.000; CI 0.482-1.136), and staff perceptions of support outside work significantly predicted distress (p=0.023; CI -4.818 to -0.355). Working environment, specifically lack of supervisor support, was significantly correlated with negative coping strategies (r=-0.242, p=0.001).
Staff working in these settings appear to experience significant levels of subjective distress, with appraisals of care and coping styles rendering staff more vulnerable. Formal training does not appear to be protective, however opportunity could be given to access support and supervision to mitigate distress and encourage reappraisal of care during which neonatal death has occurred.
在妇产科环境中，护理和医务人员经常照顾经历流产、新生儿死亡和死产的患者，这是他们工作的一部分。定性报告表明，围产期死亡对医务人员造成了巨大的情绪影响，但迄今为止，报告的痛苦尚未量化。
本研究使用 Lazarus 和 Folkman 的应激事务模型，在英国护理和医务人员样本中探讨了员工的痛苦程度及其预测因素。
采用回顾性、横断面问卷调查，在五家米德兰兹医院进行，共邀请 350 名医生、护士和助产士参与。除社会人口统计学因素外，问卷还通过事件影响量表（IES）、正负情感量表（PANAS）、简要应对量表（Brief COPE）和工作环境量表（WES）评估员工的痛苦、应对策略及其对工作环境的感知。
符合条件的员工中有 54%做出了回应。IES 评分显示，55%的参与者报告主观痛苦水平表明存在“高”临床关注。多元回归显示，虽然没有社会人口统计学变量预测痛苦，但在护理时的负面情绪（p=.002；CI 0.164-0.683）、对给予家庭的护理的负面评价（p=.003；CI 0.769-3.358）、经历的累计损失数（p=0.004；CI 0.713-3.778）、适应不良的应对方式（p=.000；CI 0.482-1.136）以及员工对工作外支持的感知显著预测了痛苦（p=0.023；CI-4.818 至-0.355）。工作环境，特别是缺乏主管支持，与负面应对策略显著相关（r=-0.242，p=0.001）。
在这些环境中工作的员工似乎经历了相当程度的主观痛苦，对护理的评估和应对方式使员工更加脆弱。正规培训似乎没有保护作用，但可以提供机会获得支持和监督，以减轻痛苦，并鼓励在发生新生儿死亡时重新评估护理。
