精神科勤務の看護者のバーンアウトと医療事故の因果関係についての検討

Causal Relationship of Burnout to Medical Accident among Psychiatric Nurses

要旨

　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．

Abstract

　The present study investigated the causal relationship of burnout to medical accident among psychiatric nurses. The subjects were 1,684 nurses working at 16 psychiatric hospitals. The self-administered survey was carried out with 1,295 effective data obtained. The data was obtained using the Japanese research version of the Maslach Burnout Inventory-General Survey, the Nursing Job Stressor Scale, the General Coping Questionnaire, and a medical accident questionnaire. Lastly, casual model was constructed showing the correlation among job stressors, individual styles of coping, burnout, and medical accidents.

　Results were as follows: Work overload and interpersonal conflict with patients leads to exhaustion, the first step of the burnout development. Exhaustion subsequently leads to cynicism, the second step of the developmental burnout. Those nurses who have difficulty dealing with patients are more likely to be cynical, callous and indifferent toward patients. Those nurses who have an interpersonal conflict with supervisors or co-workers are also prone to have cynical attitudes. Burnout can consequently lead to medical accidents. Finally, it was found that nurses with an emotion-expression coping style are more likely to experience burnout and to cause accidents.