重症监护室护士情感衰竭特点及其与抑郁和创伤后应激障碍的关系:正念的调节作用
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摘要
目的研究重症监护室(intensive care unit,ICU)护士情感衰竭的特点及其与抑郁、创伤后应激障碍的关系,探讨正念对情感衰竭和抑郁、创伤后应激障碍的调节作用。方法采用职业倦怠量表(Maslach Burnout Inventory-Human Service Survey, MBI-HSS)的情感衰竭维度(Emotional Exhaustion, EE)、五因素正念量表(Five Facet Mindfulness Questionnaire-Chinese Version, FFMQ-CH)、流调用抑郁量表(Center For Epidemiological Survey, Depression Scale, CES-D)和创伤后应激障碍症状清单平民版(Posttraumatic Stress Disorder Checklist-Civilian Version, PCL-C),于2016年3月至2017年4月对全国11省市500名ICU护士的情感衰竭、正念、抑郁和创伤后应激障碍水平进行便利抽样调查。采用SPSS 20.0进行统计分析。结果①ICU护士情感衰竭得分为(20.82±9.79)分。不同性别和ICU工作年限护士情感衰竭水平差异有统计学意义(F值分别为1.4和3.85,P<0.05)。②ICU护士情感衰竭与其抑郁、创伤后应激障碍水平呈显著正相关(r值分别为0.61和0.42,P<0.01);与正念水平呈显著负相关(r值为-0.80,P<0.01)。③正念在情感衰竭对抑郁和创伤后应激障碍的影响中起调节作用。结论 ICU护士情感衰竭水平与其正念、抑郁和创伤后应激障碍程度相关。正念水平的增加有助于缓减ICU护士抑郁和创伤后应激障碍症状,促进心理健康。
Objective To investigate the level of emotional exhaustion and its relationship with depression and posttraumatic stress disorder symptoms in intensive care unit(ICU) nurses and explore the moderating effects of mindfulness. Methods From March, 2016 to April 2017, we conducted a survey of the levels of emotional exhaustion, mindfulness, depression and posttraumatic stress disorder among 500 Chinese ICU nurses in 11 provinces and cities using the Dimension of Emotional Exhaustion in Maslach Burnout Inventory-Human Service Survey(MBI-HSS), Five Facet Mindfulness Questionnaire-Chinese Version(FFMQ-CH), Center for Epidemiological Studies Depression Scale(CES-D) and Posttraumatic Stress Disorder Checklist-Civilian Version(PCL-C). Results The mean score of emotional exhaustion was 20.82±9.79 among the ICU nurses participated in this survey. The level of emotional exhaustion differed significantly between male and female nurses(F=1.4, P<0.05) and among those with different ICU working experiences(F=3.85, P<0.05). Emotional exhaustion was negatively correlated with mindfulness(r=-0.80, P<0.01) and positively correlated with depression(r=0.61, P<0.01) and posttraumatic stress disorder(r=0.42, P<0.01). Mindfulness moderated the relationship of emotional exhaustion with depression and posttraumatic stress disorder symptoms. Conclusion The level of emotional exhaustion is closely correlated with mindfulness, depression and posttraumatic stress disorder symptoms in ICU nurses. An increased mindfulness level can help the nurses reduce depression and posttraumatic stress disorder symptoms to promote their psychological wellbeing.
Objective To investigate the level of emotional exhaustion and its relationship with depression and posttraumatic stress disorder symptoms in intensive care unit(ICU) nurses and explore the moderating effects of mindfulness. Methods From March, 2016 to April 2017, we conducted a survey of the levels of emotional exhaustion, mindfulness, depression and posttraumatic stress disorder among 500 Chinese ICU nurses in 11 provinces and cities using the Dimension of Emotional Exhaustion in Maslach Burnout Inventory-Human Service Survey(MBI-HSS), Five Facet Mindfulness Questionnaire-Chinese Version(FFMQ-CH), Center for Epidemiological Studies Depression Scale(CES-D) and Posttraumatic Stress Disorder Checklist-Civilian Version(PCL-C). Results The mean score of emotional exhaustion was 20.82±9.79 among the ICU nurses participated in this survey. The level of emotional exhaustion differed significantly between male and female nurses(F=1.4, P<0.05) and among those with different ICU working experiences(F=3.85, P<0.05). Emotional exhaustion was negatively correlated with mindfulness(r=-0.80, P<0.01) and positively correlated with depression(r=0.61, P<0.01) and posttraumatic stress disorder(r=0.42, P<0.01). Mindfulness moderated the relationship of emotional exhaustion with depression and posttraumatic stress disorder symptoms. Conclusion The level of emotional exhaustion is closely correlated with mindfulness, depression and posttraumatic stress disorder symptoms in ICU nurses. An increased mindfulness level can help the nurses reduce depression and posttraumatic stress disorder symptoms to promote their psychological wellbeing.
引文
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[15] 杨晓云,杨宏爱,刘启贵,等.创伤后应激检查量表平民版的效度、信度及影响因素的研究[J].中国健康心理学杂志,2007,15(1):6-9.DOI:10.13342/j.cnki.cjhp.2007.01.003.YANG X Y,YANG H A,LIU Q G,et al.The research on the reliability and validity of PCL-C and influence factors[J].China J Health Psychol,2007,15(1):6-9.DOI:10.13342/j.cnki.cjhp.2007.01.003.
[16] 温忠麟,侯杰泰,张雷,等.调节效应与中介效应的比较和应用[J].心理学报,2005,37(2):268-274.WEN Z L,HAU K T,CHANG L,et al.A comparison of moderator and mediator and their applications[J].Acta Psychologica Sinica,2005,37(2):268-274.
[17] 张红辉,刘怡素,何国平,等.长沙市省级综合三级甲等医院ICU护士职业倦怠现状及其影响因素分析[J].护理管理杂志,2013,13(4):229-231.DOI:10.3969/j.issn.1671-315X.2013.04.001.ZHANG H H,LIU Y S,HE G P,et al.Analysis of the status and influencing factors of job burnout of ICU nurses in provincial 3A-level comprehensive hospitals in Changsha[J].J Nurs Administr,2013,13(4):229-231.DOI:10.3969/j.issn.1671-315X.2013.04.001.
[18] COLVILLE G A,SMITH J G.The overlap between burnout and depression in ICU staff[J].Crit Care Med,2017,45(10):e1102-e1103.DOI:10.1097/CCM.00000000 00002546.
[19] VASCONCELOS E M,MARTINO MM F,FRAN?A S P S.Burnout and depressive symptoms in intensive care nurses:relationship analysis[J].Rev Bras Enferm,2018,71(1):135-141.DOI:10.1590/0034-7167-2016-0019.
[20] 栾志燕.ICU护士创伤后应激障碍发生现状及相关因素分析[D].济南:山东大学,2014.LUAN Z Y.Prevalence and related factors of posttraumatic stress disorder symptoms in intensive care unit nurses[D].Jinan:Shandong University,2014.
[21] COLVILLE G A,SMITH J G,BRIERLEY J,et al.Coping with staff burnout and work-related posttraumatic stress in intensive care[J].Pediatr Crit Care Med,2017,18(7):e267-e273.DOI:10.1097/PCC.0000000000001179.
[22] 曾巍,钱小芳.正念对护士职业倦怠与主观幸福感的中介及调节作用[J].护理学杂志,2017,32(2):73-76.DOI:10.3870/j.issn.1001-4152.2017.02.073.ZENG W,QIAN X F.Mindfulness as a mediator and moderator between job burnout and subjective well-being [J].J Nurs Sci,2017,32(2):73-76.DOI:10.3870/j.issn.1001-4152.2017.02.073.
[23] CHEN Y,YANG X L,WANG L Y,et al.A randomized controlled trial of the effects of brief mindfulness meditation on anxiety symptoms and systolic blood pressure in Chinese nursing students[J].Nurse Educ Today,2013,33(10):1166-1172.DOI:10.1016/j.nedt.2012.11.014.
[24] BERGIN A J,PAKENHAM K I.The stress-buffering role of mindfulness in the relationship between perceived stress and psychologicaladjustment[J].Mindfulness,2016,7(4):928-939.DOI:10.1007/s12671-016-0532-x.
[25] HEARD P L,HARTMAN S,BUSHARDT S C.Rekindling the flame:using mindfulness to end nursing burnout[J].Nurs Manag,2013,44(11):24-29.DOI:10.1097/01.NUMA.0000436366.99397.10.
[26] MüLLER-ENGELMANN M,WüNSCH S,VOLK M,et al.Mindfulness-based stress reduction (MBSR) as a standalone intervention for posttraumatic stress disorder after mixed traumatic events:A mixed-methods feasibility study[J].Front Psychol,2017,8:1407.DOI:10.3389/fpsyg.2017.01407.
[2] 章志伟,王霞,王建宁,等.重症监护室护士道德困境与职业倦怠的相关性研究[J].上海交通大学学报(医学版),2014,34(7):1073-1077.DOI:10.3969/j.issn.1674.8115.2014.07.023.ZHANG Z W,WANG X,WANF J N,et al.Study on correlation of moral dilemmas and professional burnout of nurses in intensive care unit[J].J Shanghai Jiaotong Univ (Med Sci),2014,34(7):1073-1077.DOI:10.3969/j.issn.1674.8115.2014.07.023.
[3] MEALER M,BURNHAM E L,GOODE C J,et al.The prevalence and impact of posttraumatic stress disorder and burnout syndrome in nurses[J].Depress Anxiety,2009,26(12):1118-1126.DOI:10.1002/da.20631.
[4] MOSS M,GOOD V S,GOZAL D,et al.An official critical care societies collaborative statement-burnout syndrome in critical care health-care professionals:A call for action[J].Chest,2016,150(1):17-26.DOI:10.1016/j.chest.2016.02.649.
[5] MOSS M,GOOD V S,GOZAL D,et al.An official critical care societies collaborative statement:burnout syndrome in critical care health care professionals:A call for action[J].Am J Crit Care,2016,25(4):368-376.DOI:10.4037/ajcc2016133.
[6] MOSS M,GOOD V S,GOZAL D,et al.An official critical care societies collaborative statement:burnout syndrome in critical care healthcare professionals:A call for action[J].Crit Care Med,2016,44(7):1414-1421.DOI:10.1097/CCM.0000000000001885.
[7] FREUDENTHALER L,TURBA J D,TRAN U S.Emotion regulation mediates the associations of mindfulness on symptoms of depression and anxiety in the general population[J].Mindfulness (N Y),2017,8(5):1339-1344.DOI:10.1007/s12671-017-0709-y.
[8] KABAT-ZINN J.Mindfulness-based interventions in context:past,present,and future[J].Clin Psychol Sci Prac,2003,10(2):144-156.DOI:10.1093/clipsy/bpg016.
[9] MEALER M,CONRAD D,EVANS J,et al.Feasibility and acceptability of a resilience training program for intensive care unit nurses[J].Am J Crit Care,2014,23(6):e97-105.DOI:10.4037/ajcc2014747.
[10] GAUTHIER T,MEYER R M,GREFE D,et al.An on-the-job mindfulness-based intervention for pediatric ICU nurses:A pilot[J].J Pediatr Nurs,2015,30(2):402-409.DOI:10.1016/j.pedn.2014.10.005.
[11] STEINBERG B A,KLATT M,DUCHEMIN A M.Feasibility of a mindfulness-based intervention for surgical intensive care unitpersonnel[J].Am J Crit Care,2016,26(1):10-18.DOI:10.4037/ajcc2017444.
[12] 邓玉琴.心智觉知训练对大学生心理健康水平的干预效果[D].北京:首都师范大学,2009.DENG Y Q.The effect of mental awareness training on mental health of college students [D].Beijing:Capital Normal University,2009.
[13] 陈素坤.临床心理护理指导[M].北京:科学技术文献出版社,2002:207-219 CHEN S K.Guidance of clinical psychological care[M].Beijing:Science and Technology Literature Press.2002:207-219.
[14] 戴晓阳.常用心理评估量表手册[M].2版.北京:人民军医出版社,2015:154-157,224-226.DAI X Y.Handbook of commonly used psychological assessment scales (revised version) [M].2 ed.Beijing:People’s Military Medical Publisher,2015:154-157,224-226.
[15] 杨晓云,杨宏爱,刘启贵,等.创伤后应激检查量表平民版的效度、信度及影响因素的研究[J].中国健康心理学杂志,2007,15(1):6-9.DOI:10.13342/j.cnki.cjhp.2007.01.003.YANG X Y,YANG H A,LIU Q G,et al.The research on the reliability and validity of PCL-C and influence factors[J].China J Health Psychol,2007,15(1):6-9.DOI:10.13342/j.cnki.cjhp.2007.01.003.
[16] 温忠麟,侯杰泰,张雷,等.调节效应与中介效应的比较和应用[J].心理学报,2005,37(2):268-274.WEN Z L,HAU K T,CHANG L,et al.A comparison of moderator and mediator and their applications[J].Acta Psychologica Sinica,2005,37(2):268-274.
[17] 张红辉,刘怡素,何国平,等.长沙市省级综合三级甲等医院ICU护士职业倦怠现状及其影响因素分析[J].护理管理杂志,2013,13(4):229-231.DOI:10.3969/j.issn.1671-315X.2013.04.001.ZHANG H H,LIU Y S,HE G P,et al.Analysis of the status and influencing factors of job burnout of ICU nurses in provincial 3A-level comprehensive hospitals in Changsha[J].J Nurs Administr,2013,13(4):229-231.DOI:10.3969/j.issn.1671-315X.2013.04.001.
[18] COLVILLE G A,SMITH J G.The overlap between burnout and depression in ICU staff[J].Crit Care Med,2017,45(10):e1102-e1103.DOI:10.1097/CCM.00000000 00002546.
[19] VASCONCELOS E M,MARTINO MM F,FRAN?A S P S.Burnout and depressive symptoms in intensive care nurses:relationship analysis[J].Rev Bras Enferm,2018,71(1):135-141.DOI:10.1590/0034-7167-2016-0019.
[20] 栾志燕.ICU护士创伤后应激障碍发生现状及相关因素分析[D].济南:山东大学,2014.LUAN Z Y.Prevalence and related factors of posttraumatic stress disorder symptoms in intensive care unit nurses[D].Jinan:Shandong University,2014.
[21] COLVILLE G A,SMITH J G,BRIERLEY J,et al.Coping with staff burnout and work-related posttraumatic stress in intensive care[J].Pediatr Crit Care Med,2017,18(7):e267-e273.DOI:10.1097/PCC.0000000000001179.
[22] 曾巍,钱小芳.正念对护士职业倦怠与主观幸福感的中介及调节作用[J].护理学杂志,2017,32(2):73-76.DOI:10.3870/j.issn.1001-4152.2017.02.073.ZENG W,QIAN X F.Mindfulness as a mediator and moderator between job burnout and subjective well-being [J].J Nurs Sci,2017,32(2):73-76.DOI:10.3870/j.issn.1001-4152.2017.02.073.
[23] CHEN Y,YANG X L,WANG L Y,et al.A randomized controlled trial of the effects of brief mindfulness meditation on anxiety symptoms and systolic blood pressure in Chinese nursing students[J].Nurse Educ Today,2013,33(10):1166-1172.DOI:10.1016/j.nedt.2012.11.014.
[24] BERGIN A J,PAKENHAM K I.The stress-buffering role of mindfulness in the relationship between perceived stress and psychologicaladjustment[J].Mindfulness,2016,7(4):928-939.DOI:10.1007/s12671-016-0532-x.
[25] HEARD P L,HARTMAN S,BUSHARDT S C.Rekindling the flame:using mindfulness to end nursing burnout[J].Nurs Manag,2013,44(11):24-29.DOI:10.1097/01.NUMA.0000436366.99397.10.
[26] MüLLER-ENGELMANN M,WüNSCH S,VOLK M,et al.Mindfulness-based stress reduction (MBSR) as a standalone intervention for posttraumatic stress disorder after mixed traumatic events:A mixed-methods feasibility study[J].Front Psychol,2017,8:1407.DOI:10.3389/fpsyg.2017.01407.
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