重症监护，关键差距：中国重症监护病房医护人员职业倦怠与行为特征评估——一项多中心横断面研究

Critical care, critical gaps: assessment of burnout and behavioral profiles of ICU healthcare workers in China-a multicenter cross-sectional study.

作者信息

Zhang Chao Qing, Li Xing, He Lei, Xu BinBin, Wu Yan, He Junjie, Wang Wei, Lu Zhong Qian

机构信息

Department of Intensive Care Unit, Yancheng First People's Hospital, Yancheng, Jiangsu, China.

出版信息

Front Public Health. 2025 Jun 26;13:1617081. doi: 10.3389/fpubh.2025.1617081. eCollection 2025.

DOI:10.3389/fpubh.2025.1617081

PMID:40642244

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12240766/

Abstract

BACKGROUND

Burnout in intensive care unit (ICU) healthcare workers (HCWs) is a persistent threat to patient safety and workforce stability. While most evidence is derived from crisis settings, the behavioral determinants of burnout in routine, post-pandemic ICUs remain under-explored. This study applies a Knowledge-Attitude-Practice (KAP) framework to assess burnout-related KAP and identify its demographic, occupational, and institutional predictors.

METHODS

In this cross-sectional study, 4,500 eligible ICU healthcare workers (HCWs) from 10 facilities in Yancheng, Jiangsu, China, were invited to complete a rigorously validated KAP survey; 3,342 responded (response rate = 74.3%), with KR-20 = 0.87 for Knowledge and Cronbach's  ≥ 0.82 for Attitude and Practice. Descriptive statistics summarized participant characteristics, and multivariable logistic regression identified predictors of adequate (≥75%) KAP profiles.

RESULTS

The cohort was predominantly female (70%) and nurse-dominated (60%). Most respondents identified long shifts (84.0%) and heavy workloads (72.4%) as principal burnout drivers, yet only 35.9% were aware of formal prevention programs. Although 82.8% perceived burnout as a serious threat and 74.7% assumed personal responsibility, formal mitigation remained sparely 53.8% sought managerial support and 39.0% ever accessed counseling. Informal coping was pervasive: breaks (96.0%), peer discussion (78.9%), and exercise (76.8%). Access to workplace mental health resources was reported by 40.0%, with 50.0% reporting no access and 10.0% unsure, strongly predicting higher knowledge (adjusted OR 4.01, 95% CI 3.35-4.80) and good practice (OR 4.01, 95% CI 3.35-4.80). Clinical role, mid-career status, and 1-10 years' ICU experience independently improved KAP scores (ORs 3.98-6.00,  < 0.001), whereas contract and temporary staff were consistently disadvantaged (OR 0.54, 95% CI 0.42-0.70). Gender, marital status, and ICU type were non-significant.

CONCLUSION

Burnout in ICU HCWs persists as a structural-behavioral challenge post-pandemic. Interventions should prioritize institutional support, equitable mental health access, and inclusion of vulnerable groups. This study shows the KAP model's role in crafting scalable, data-driven prevention strategies for critical care.

摘要

背景

重症监护病房（ICU）医护人员的职业倦怠对患者安全和劳动力稳定性构成持续威胁。虽然大多数证据来自危机环境，但在疫情后的常规ICU中，职业倦怠的行为决定因素仍未得到充分探索。本研究应用知识-态度-行为（KAP）框架来评估与职业倦怠相关的知识、态度和行为，并确定其人口统计学、职业和机构预测因素。

方法

在这项横断面研究中，邀请了来自中国江苏盐城10家机构的4500名符合条件的ICU医护人员完成一项经过严格验证的KAP调查；3342人做出回应（回应率=74.3%），知识部分的KR-20为0.87，态度和行为部分的Cronbach's系数≥0.82。描述性统计总结了参与者的特征，多变量逻辑回归确定了KAP状况良好（≥75%）的预测因素。

结果

该队列主要为女性（70%），以护士为主（60%）。大多数受访者认为长时间轮班（84.0%）和工作量大（72.4%）是职业倦怠的主要驱动因素，但只有35.9%的人知道正式的预防计划。尽管82.8%的人认为职业倦怠是一个严重威胁，74.7%的人承担个人责任，但正式的缓解措施仍然很少，53.8%的人寻求管理支持，39.0%的人曾寻求咨询。非正式应对方式很普遍：休息（96.0%）、同行讨论（78.9%）和锻炼（76.8%）。40.0%的人报告可以获得工作场所的心理健康资源，50.0%的人报告无法获得，10.0%的人不确定，这强烈预测了更高的知识水平（调整后的OR为4.01，95%CI为3.35-4.80）和良好的行为（OR为4.01，95%CI为3.35-4.80）。临床角色、职业生涯中期状态和1至10年的ICU工作经验独立提高了KAP得分（OR为3.98-6.00，P<0.001），而合同制和临时工作人员一直处于劣势（OR为0.54，95%CI为0.42-0.70）。性别、婚姻状况和ICU类型无显著差异。