面对患者的痛苦和死亡对专业人员的幸福感和倦怠感的影响：一项横断面研究。
Impact of confrontation to patient suffering and death on wellbeing and burnout in professionals: a cross-sectional study.
机构信息
Faculty of Psychology, Swiss Distance Learning University, Technopôle 5, Sierre, 3960, Switzerland.
Chair of palliative psychology, Lausanne University Hospital and University of Lausanne, Hôpital Nestlé, Av. Pierre-Decker 5, Lausanne, 1011, Switzerland.
出版信息
BMC Palliat Care. 2024 Mar 15;23(1):74. doi: 10.1186/s12904-024-01393-8.
BACKGROUND
Palliative care and oncology generate a risk of burnout and psychological distress in professionals. The purpose of this study is to identify both psychopathological and positive factors related to mental health at work. It aims (i) to explore the extent to which these professionals are confronted with suffering, illness, and death; and to explore the prevalence of psychological distress and/or burnout, (ii) to identify potential determinants of burnout and psychological wellbeing at work, (iii) to develop an integrative model of mental health; and to identify frequency and impact of confrontations with death, and (iv) to identify profiles of professionals are at risk of developing a mental health disorder or, conversely, characterized by wellbeing.
METHODS
A cross-sectional questionnaire study was conducted in palliative care and oncology evaluating confrontations with death, coping, burnout, psychological distress, personality, self-esteem, well-being and meaning at work. Regressions, clustering, and structural equation modeling analyses were performed.
RESULTS
109 professionals participated (58% from oncology and 42% from palliative care), of which 79% were female, and 65% were between 30 and 49 years old. Aim i: 30% witnessed an intolerable suffering at least 9 times a month, 45% reported moderate to high levels of burnout, 39% suffered from anxiety and 11% from depression. Aim ii: the determinants of burnout were the personality traits conscientiousness and neuroticism, low meaning of work, and low wellbeing (R = 0.44). The determinants of wellbeing were work meaning, depersonalization, self-esteem, fulfillment and low emotional exhaustion (R = 0.71). Aim iii: the integrative model included both well-being (self-esteem, conscientiousness) and psychopathology (neuroticism, anxiety) parameters, and strongly satisfied the standard SEM goodness of fit indices (e.g., CFI, IFI, and TLI ≥ 0.95). Aim iv: three profiles were identified: (a) a "distressed profile" with a majority of professionals at the patient's bedside, (b) a "disengaged profile" with professionals working as second-line consultants, (c) a "wellbeing profile" contains profiles of caregivers insensitive to psychological distress and with a high level of positive Impact of confrontation on different areas of their lives.
CONCLUSIONS
An integrative approach is essential to understand the full range of mental health issues for professionals. Meaning of work is a key factor in professional interventions that should primarily affect front-line professionals with limited experience.
背景
姑息治疗和肿瘤学专业的人员会面临职业倦怠和心理困扰的风险。本研究的目的是确定与工作相关的心理健康的心理病理学和积极因素。它旨在：（i）探索这些专业人员面对痛苦、疾病和死亡的程度；并探讨心理困扰和/或职业倦怠的流行程度；（ii）确定职业倦怠和工作心理健康的潜在决定因素；（iii）制定心理健康综合模型；并确定与死亡接触的频率和影响；（iv）确定有心理健康障碍风险的专业人员的特征，或者相反，以幸福感为特征。
方法
在姑息治疗和肿瘤学中进行了一项横断面问卷调查研究，评估了与死亡的接触、应对、职业倦怠、心理困扰、个性、自尊、幸福感和工作意义。进行了回归、聚类和结构方程模型分析。
结果
109 名专业人员参与了研究（58%来自肿瘤学，42%来自姑息治疗），其中 79%为女性，65%年龄在 30 至 49 岁之间。目的 i：30%的人每月至少 9 次目睹无法忍受的痛苦，45%的人报告有中度至高度职业倦怠，39%的人患有焦虑症，11%的人患有抑郁症。目的 ii：职业倦怠的决定因素是人格特质尽责性和神经质、工作意义低、幸福感低（R=0.44）。幸福感的决定因素是工作意义、去人性化、自尊、实现和低情绪疲惫（R=0.71）。目的 iii：综合模型包括幸福感（自尊、尽责性）和心理病理学（神经质、焦虑）参数，强烈满足标准 SEM 拟合度指标（例如，CFI、IFI 和 TLI≥0.95）。目的 iv：确定了三个特征：（a）以大多数在患者床边工作的专业人员为特征的“痛苦特征”；（b）以二线顾问工作的专业人员为特征的“脱离特征”；（c）以对心理困扰不敏感且对生活各个方面的积极影响水平高为特征的“幸福感特征”。
结论
综合方法对于理解专业人员心理健康的各个方面至关重要。工作意义是专业干预的关键因素，主要应影响经验有限的一线专业人员。
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