应对挑战性行为：一项关于针对痴呆症特殊护理单元中具有挑战性行为的新护理计划对护理人员职业倦怠、工作满意度和工作需求影响的整群随机对照试验。
Coming to grips with challenging behaviour: a cluster randomised controlled trial on the effects of a new care programme for challenging behaviour on burnout, job satisfaction and job demands of care staff on dementia special care units.
作者信息
Zwijsen S A, Gerritsen D L, Eefsting J A, Smalbrugge M, Hertogh C M P M, Pot A M
机构信息
Department of General Practice and Elderly Care Medicine/EMGO+Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands.
Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Radboud Alzheimer Center, Nijmegen, The Netherlands.
出版信息
Int J Nurs Stud. 2015 Jan;52(1):68-74. doi: 10.1016/j.ijnurstu.2014.10.003. Epub 2014 Oct 13.
BACKGROUND
Caring for people with dementia in dementia special care units is a demanding job. Challenging behaviour is one of the factors influencing the job satisfaction and burnout of care staff. A care programme for the challenging behaviour of nursing home residents with dementia might, next to diminishing the challenging behaviour of residents, improve job satisfaction and reduce the care staff's feelings of burnout.
OBJECTIVES
To determine the effects of a care programme for the challenging behaviour of nursing home residents with dementia on the burnout, job satisfaction and job demands of care staff.
DESIGN
The care programme was implemented according to a stepped wedge design in which care units were randomly divided over five groups with different time points of starting with implementation.
SETTING
17 Dutch dementia special care units.
PARTICIPANTS
Care staff members of the 17 units.
INTERVENTION
The care programme consists of an education package and of various structured assessment tools that guide professionals through the multidisciplinary detection, analysis, treatment and evaluation of treatment of challenging behaviour.
METHODS
Burnout, job satisfaction and job demands were measured before implementation, halfway through the implementation process and after all the care units had implemented the care programme. Burnout was measured with the Dutch version of the Maslach burnout inventory (UBOS-C, three subscales); job satisfaction and job demands were measured with subscales of the Leiden Quality of Work Questionnaire. Mixed model analyses were used to determine effects. Care staff could not be blinded for the intervention.
RESULTS
Of the 1441 questionnaires, 645 were returned (response 45%, 318 control measurements, 327 intervention measurements) by 380 unique care staff members. Significant effects were found on job satisfaction (0.93, 95% CI 0.48-1.38). On the other outcomes, no significant changes in the scores were found.
CONCLUSION
Positive effects of using the Grip on Challenging behaviour care programme were found on job satisfaction, without an increase in job demands.
背景
在痴呆症特殊护理单元照顾痴呆症患者是一项要求很高的工作。具有挑战性的行为是影响护理人员工作满意度和职业倦怠的因素之一。针对养老院痴呆症患者具有挑战性的行为制定的护理计划，除了可以减少患者具有挑战性的行为外，还可能提高工作满意度并减轻护理人员的职业倦怠感。
目的
确定针对养老院痴呆症患者具有挑战性的行为的护理计划对护理人员的职业倦怠、工作满意度和工作需求的影响。
设计
护理计划按照阶梯楔形设计实施，护理单元被随机分为五组，每组开始实施的时间点不同。
设置
17个荷兰痴呆症特殊护理单元。
参与者
17个单元的护理人员。
干预措施
护理计划包括一套教育资料和各种结构化评估工具，这些工具指导专业人员对具有挑战性的行为进行多学科检测、分析、治疗和治疗评估。
方法
在实施前、实施过程中以及所有护理单元都实施了护理计划后，测量职业倦怠、工作满意度和工作需求。使用荷兰版的马氏职业倦怠量表（UBOS-C，三个子量表）测量职业倦怠；使用莱顿工作质量问卷的子量表测量工作满意度和工作需求。采用混合模型分析来确定效果。护理人员无法对干预措施进行盲法评估。
结果
在1441份问卷中，380名不同的护理人员共返回了645份（回复率45%，318份对照测量，327份干预测量）。在工作满意度方面发现了显著效果（0.93，95%可信区间0.48-1.38）。在其他结果方面，得分没有发现显著变化。
结论
使用“应对具有挑战性的行为护理计划”发现了对工作满意度的积极影响，且工作需求没有增加。
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