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坂上, 章 ; 相上, 律子 ; グェン, ティ トゥ フォン ; 片山, 美穂 ; 長田, 恭子 ; 北岡, 和代
概要:
This study was performed to examine the effects of emotional labor and work-related stressors along with the relation be
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tween emotional labor and burnout in psychiatric nurses in Japan. A self-administered questionnaire survey was sent to the director of nursing at a mental hospital, who then sent the surveys to all 169 nurses at the hospital. From among existing measures, we chose the Japanese version of the Maslach Burnout Inventory-General Survey （MBI-GS）, to measure burnout; the emotional labor scale to measure emotional labor; and the Japanese version of the Areas of Worklife Survey （AWS） to measure work-related stressors. Multiple regression analysis was applied to the data, with three subscales （exhaustion , cynicism , and professional efficacy ） of the Japanese MBI-GS as dependent variables. The significant predictors of exhaustion were reward and workload （from the Japanese AWS） and display of negative emotions to patients （from the emotional labor scale）. Significant predictors for cynicism were reward , workload , and values （Japanese AWS） and display of negative emotions to patients （the emotional labor scale）. For professional efficacy, only marital status and reward （from the Japanese AWS） were found to have significant effects. The present study revealed some effects of emotional labor, particularly negative emotional labor. However, work-related stressors, notably reward, workload, and values, had greater effects on worker burnout. Some forms of emotional labor, such as empathy for patients and display of positive emotion , emotional dissonance, and emotional sensitivity requirements , were found to have no effect on worker burnout. In clinical practice, it is necessary to ensure that psychiatric nurses do not take on a disproportionate number of patients whose care would require negative emotional labor. It is also important that new nurses are trained by experienced nurses who demonstrate good awareness when engaging in negative emotional labor and know how to persuade patients. Furthermore, instead of simply assuming that emotional labor degrades mental health, we should actively pursue ways to allow professionals to exhibit empathy for patients and to handle emotional dissonance and sensitivity as needed. To prevent burnout among psychiatric nurses, organizations need to evaluate the nursesʼ performance, prevent individual nurses from becoming overworked, and reflect the nursesʼ sense of value in work. In this way, we can prevent burnout among psychiatric nurses and thereby provide better quality care to the patients.<br />日本の精神科看護師を対象として、感情労働と職場ストレッサーの双方がバーンアウトにおよぼす影響を検討し、精神科看護師の感情労働とバーンアウトとの関係を明らかにすることを目的とした。1 単科精神科病院に勤務する看護師 169 名を対象に自己記入式質問紙調査を実施した。バーンアウトは日本版MBI-GS （Maslach Burnout Inventory-General Survey）を、感情労働は感情労働尺度を、職場ストレッサーは日本版 AWS （Areas of Worklife Survey）を採用し、測定した。 日本版 MBI-GS の 3 下位尺度を被説明変数とした重回帰分析を行った結果、‘ 疲弊感 ’ では日本版 AWS の ‘ 報酬 ’ と ‘ 仕事の負担 ’、感情労働尺度の ‘ 患者へのネガティブな感情表出 ’ が有意な説明変数となった。‘シニシズム’では日本版AWS の ‘ 報酬 ’、‘仕事の負担’、‘ 価値観 ’、感情労働尺度の ‘ 患者へのネガティブな感情表出 ’ が有意な説明変数となった。‘ 職務効力感 ’ では ‘ 婚姻状況 ’ と日本版 AWS の ‘ 報酬 ’ のみが有意な説明変数となった。 感情労働の中でも、ネガティブな感情労働のバーンアウトへの影響を認めることができたが、職場ストレッサーがおよぼす影響の方がより大きいと考えられた。精神科看護師のバーンアウトを予防してより質の高い看護を提示していくためには、組織全体で看護師の仕事の成果等を正しく評価すること、看護師個々に仕事の負担がかかりすぎないように配慮すること、看護師の価値観を仕事に反映させることを重要視し、取組んでいく必要がある。
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後藤, 啓一
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Kitaoka-Higashiguchi, Kazuyo ; Nakagawa, Hideaki
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The overall goal of this study was to examine the relationship between burnout and two parameters: job strains and coping styles. The subjects were 568 nurses from a university hospital in Ishikawa Prefecture of Japan. A packet of
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self-administered questionnaires was distributed to the nurses. Four hundred and forty nurses completed the questionnaires. The Japanese version of the Maslach Burnout Inventory (MBI) was used to measure burnout. The Japanese MBI is consisted of three factors: Physical Exhaustion, Emotional Exhaustion/Depersonalization, and Personal Accomplishment. We developed the Nursing Job Stressor Scale (NJSS) to assess perceived job strains. The analysis identified seven major sources of strain. The seven subscales were: conflict with other nursing staffs, nursing role conflict, conflict with physicians/autonomy, dealing with death and dying, qualitative work load, quantitative work load, and conflict with patients. The Japanese version of the Coping Inventory for Stressful Situations (CISS) assessed coping styles. The three coping patterns include: Task-oriented coping, Emotion-oriented coping, and Avoidance-oriented coping. Stepwise multiple regression analysis resulted in significant predictors for Physical Exhaustion being quantitative and qualitative work load strains, the strain variables: quantitative work load, conflict with other nursing staffs, and conflict with patients for Emotional Exhaustion/Depersonalization, qualitative work load strain for diminished Personal Accomplishment, nursing role conflict strain for Personal Accomplishment. Emotion-oriented coping style was a significant predictor for Emotional Exhaustion/Depersonalization and diminished Personal Accomplishment, while both Task-oriented and Avoidance-oriented coping styles were significant predictors for Personal Accomplishment
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北岡-東口, 和代 ; 荻野, 佳代子 ; 増田, 真也
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The purpose of this study was to validate Japanese research version of Maslach Burnout Inventory-General Survey (MBI-GS), a newly developed measure intended for persons of every occupation. The Japanese MBI-GS was administered to a
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sample of hospital workers. Exploratory factor analysis found three factors, as in original MBI-GS. Confirmatory factor analysis largely supported MBI-GS structure of three subscales, but the correlation between two subscales was unexpectedly high. To examine its construct validity, the subscale scores were then examined in relation to selected work characteristics. Conservation of resources theory was successful in its predictions of different patterns of effects among the correlates and three burnout subscales. The successful predictions suggested that meaning of each subscale was quite distinct. In all, our examination showed that Japanese MBI-GS assessed the same three dimensions as the original measure for human service workers.
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北岡-東口, 和代
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北岡-東口, 和代
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本研究は, 精神科勤務の看護者のバーンアウトと医療事故との因果関係を検討したものである. 精神科を主とする16病院に勤務する全看護者1,684名を対象に自己記入式質問紙調査を行い, 1,295名の有効データを得た. データ収集は研究用日本版
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Maslach Burnout Inventory-General Survey, 臨床看護職者の仕事ストレッサー測定尺度, General Coping Questionnaire特性版, 医療事故に関する質問紙を用いて行った. 最終的に仕事ストレッサー, コーピングスタイル, バーンアウトと医療事故との関係を示した因果関係モデルが構築され, 次のことが示唆された. 仕事量の多さや患者との関係に由来する負担感や葛藤が続くと, バーンアウトの最初の現象である疲弊感が生じる. この疲弊感は, シニシズム的態度というバーンアウトの次の現象を生む. 患者に対する冷淡で無関心な態度は患者関係にうまく対応できない看護者で特にみられるが, 職場の上司や同僚関係に悩んでいる看護者もそのような態度に陥りやすくなると考えられた. 看護者のこのようなバーンアウト状態が医療事故発生を導く. 特に感情表出型のコーピングスタイルをとる看護者はバーンアウトに陥りやすく, 医療事故発生に繋がりやすい集団と考えられた.
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鈴木, 英子 ; 叶谷, 由佳 ; 堀井, さやか ; 高田, 絵理子 ; 北岡-東口, 和代 ; 佐藤, 千史
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Yoshino, Satoshi ; Sasahara, Shin-ichiro ; Maeno, Tetsuhiro ; Kitaoka-Higashiguchi, Kazuyo ; Tomotsune, Yusuke ; Taniguchi, Kazuki ; Tomita, Eriko ; Usami, Kazuya ; Haoka, Takeshi ; Nakamura, Hiroyuki ; Matsuzaki, Ichiyo
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Ohnishi, Kayoko ; Kitaoka, Kazuyo ; Bowers, Len ; Stewart, Duncan ; Merwe, Marie Van Der ; Nakano, Masataka ; Ohgushi, Yasuko ; Tanaka, Hiromi ; Fujii, Hirohide
概要:
Aims: To compare moral distress and burnout experienced by mental health nurses in hospitals both in Japan and England. Methods: This is a cross-national study, and a cross-sectional design was adopted. An anonymous questionnaire containing
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43 moral distress items, a 16 item burnout scale, and demographic data was administered to convenient samples; 391 nurses in Japan, and 460 nurses in England. Among the participants, 289 nurses (73.9%) in Japan, and 36 nurses (7.8%) in England responded. Results: The moral distress items which were commonly felt by nurses in both countries dealt with a lack of staff. Several differences, however, existed between the two, which reflected poor conditions such as long term social hospitalization in Japan. The nurses in England felt moral distress in a wider variety of situations, though they confront them less frequently than the nurses in Japan. Only in England was it found that the older nurses became, and the more experience they had accumulated, the less intensely they felt moral distress. The nurses in both countries felt the same levels of exhaustion, and cynicism, but as far as professional efficacy, the scores of the nurses in England were much higher than those of the nurses in Japan. Conclusions: If nurses feel no moral distress, there will be no improvements of care. Nurses should have moral sense, and do their best to improve the situations without being burned out.
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安東, 由佳子 ; 片岡, 健 ; 小林, 敏生 ; 岡村, 仁 ; 北岡, 和代
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目的：神経難病患者をケアする看護師の職場環境改善への示唆を得るために，バーンアウト因果モデルを作成し検証することである． 方法：神経難病専門病棟に勤務する看護師385名を対象として郵送調査を実施し，共分散構造分析でバーンアウト因果モデルの検
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討を行った． 結果および結論：有効回答数は248部であった．分析の結果，バーンアウトに影響を及ぼす仕事ストレッサーは，「仕事の量的負荷」と「上司との軋轢」であった．神経難病看護経験3年未満で「言語的暴力」が「シニシズム」に直接的影響を，また3年未満で「関わりの難しさ」，3年以上で「ケア見通しの不明瞭さ」がバーンアウトに間接的影響を及ぼしていた．バーンアウト後は，離職・配置転換意思が強まるが，3年未満は「同僚との軋轢」，3年以上は「仕事の量的負荷」と「言語的暴力」が離職・配置転換意思に直接的影響を及ぼしていた．3年未満の場合，職場内サポートの弱さは，離職・配置転換意思に直接的に影響していたため，経験の少ない看護師にとってサポートはより重要であると考えられた．以上より，職場環境改善には，職場全体の対策に加えて，難病看護経験年数に応じた対策が必要であることが示唆された．
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