| Abstract | Cilj: Ispitati i utvrditi utjecaj iscrpljenosti i radnog okruženja medicinskih sestara na njihovo zadovoljstvo poslom i zadovoljstvo bolesnika pruženom zdravstvenom njegom tijekom hospitalizacije.
Metode: Korišteni postupci i metode ispitivanja su standardizirani i validirani upitnici. Upitnike Copenhagen Burnout Inventory (CBI) i The Practice Environment Scale of the Nursing Work Index (PES-NWI) podijelili smo svim medicinskim sestrama Klinike za Neurologiju Kliničkog bolničkog centra Split. Medicinskim sestrama koje rade izravno s hospitaliziranim bolesnicima smo podijelili upitnik o sestrinskoj procjeni zdravstvene njege za pojedinog pacijenta Nurses’ Assessment of Quality Scale – Acute Care Version (NAQS-ACV) koji su ispunjavale za dva pacijenta tijekom mjesec dana rada. Hospitaliziranim bolesnicima za koje su medicinske sestre ispunjavale upitnik o sestrinskoj procjeni zdravstvene njege podijelili smo upitnik o zadovoljstvu pacijenata- Patient’s Assessment of Quality Scale – Acute Care Version (PAQS-ACV) prilikom otpusta iz bolnice. Pacijentu je omogućeno da upozna sve medicinske sestre tijekom hospitalizacije. Istraživanje je provedeno u mjesecu kada je najmanje promjena u rasporedu sestara (godišnji odmor,slobodni dani i sl.). Upitnik su pacijenti vratili ispitivaču u zatvorenoj omotnici. Statistička Obrada podataka rađena je u statističkom paketu Statistica 7.0. Korišten je χ² test, Mann Whitney test, T test i Pearsonov koeficijent korelacije. Rezultati su interpretirani na razini statističke vjerojatnosti p<0,01.
Rezultati: Rezultati testiranja značajnosti razlika u procjenama zadovoljstva radnim okruženjem i stupnja općeg sagorijevanja i dužine radnog staža medicinskih sestara ukazuju na činjenicu da ne postoji statistički značajna razlika. Rezultati testiranja razlika u učestalosti javljanja simptoma sagorijevanja u medicinskih sestara koji upućuju na osobno sagorijevanje ukazuju na postojanje statistički značajne (X²=64; p ˂ 0,001), na sagorijevanje izazvano radom s bolesnicima ukazuju na nepostojanje statistički značajne razlike (X²=21,5; p = 0,120), a na sagorijevanje izazvano poslom ukazuju na postojanje statistički značajne razlike (X²=88; p ˂ 0,001). Rezultati testiranja povezanosti u procjenama zadovoljstva medicinskih sestara radnim okruženjem i stupnjem općeg sagorijevanja na poslu ukazuju na postojanje statistički značajne povezanosti između sudjelovanja medicinskih sestara u bolničkim poslovima i sagorijevanja izazvanog radom s liječnicima kao i sa sagorijevanjem izazvanim radom s kolegama; sestrinskog doprinosa kvaliteti skrbi i sagorijevanja izazvanim radom s bolesnicima, radom s liječnicima kao i radom s kolegama; rukovođenja medicinskim sestrama i sagorijevanja izazvanim radom s liječnicima; osoblja i adekvatnosti resursa i sagorijevanja izazvanim poslom, sagorijevanja izazvanim radom s bolesnikom, sagorijevanja izazvanim radom s liječnicima kao i sagorijevanja izazvanim radom s kolegama; kolegijalnost i odnos s liječnikom i sagorijevanja izazvanim radom s liječnicima. Ukupni rezultati testiranja utjecaja radnog okruženja na stupanj sagorijevanja medicinskih sestara izazvanim radom s bolesnikom; liječnicima; i kolegama ukazuju na statistički značajnu povezanost. Rezultati testiranja značajnosti razlika u procjenama načina sučeljavanja s radnim zadacima dijela medicinskih sestara (N=26) koje su u neposrednom radu s hospitaliziranim bolesnicima ukazuju na činjenicu da postoji statistički značajna razlika (F=7,87; p˂0,001), a s obzirom na stupanj općeg sagorijevanja ukazuju na postojanje statistički značajne povezanosti između: sagorijevanja izazvanog radom s bolesnikom i osjetljivosti na potrebe bolesnika; sagorijevanja izazvano poslom i interakcijom s bolesnikom. Rezultati testiranja značajnosti razlika u procjenama bolesnika i njihovog zadovoljstva radom medicinskih sestara s obzirom na spol, dob i stručnu spremu bolesnika ukazuju na činjenicu da ne postoji statistički značajna razlika. Rezultati testiranja značajnosti razlika u procjenama bolesnika i njihovog zadovoljstva radom medicinskih sestara ukazuju na činjenicu da postoji statistički značajna razlika (F=12,5; p˂0,001)
Zaključci:
1. Učestalost javljanja simptoma sagorijevanja u medicinskih sestara određena je osobitostima radnog okruženja, prvenstveno radom s liječnicima i radom s kolegama. Kvaliteta skrbi o bolesniku nije samo rezultat opterećenosti medicinske sestre radom s bolesnicima, već zavisi i o kvaliteti rada s liječnicima i radu s kolegama. Medicinske sestre međusobno se razlikuju s obzirom na znakove osobnog sagorijevanja kao što su umor, fizička i emocionalna iscrpljenost, kao i s obzirom na sagorijevanje izazvano poslom što upućuje na različite načine nošenja (sučeljavanja) medicinske sestre s osobnim problemima i sa zahtjevima posla. Rad s bolesnicima podjednako je iscrpljujući za sve medicinske sestre te se one ne razlikuju s obzirom na osjećaj iscrpljenosti vezan uz rad s bolesnicima.
2. Medicinske sestre Klinike za neurologiju koje su u neposrednom radu s hospitaliziranim bolesnikom (N=26) smatraju da kvaliteta njihovog rada zavisi od: 1. kvalitete interakcija s bolesnikom, 2. osobine ličnosti sestre, 3. raspoloženja, 4. zastupanju interesa bolesnika, 5. individualnom pristupu bolesniku, 6. kolegijalnosti, 7. osjetljivosti za potrebe bolesnika i 8. radnim okruženjem. Medicinske sestre koje rade neposredno s hospitaliziranim bolesnikom značajno se razlikuju s obzirom na definirane kriterije kvalitete njihovog rada; kvaliteti interakcija s bolesnikom, osobinama ličnosti sestre, kolegijalnosti, osjetljivosti za potrebe bolesnika i radnom okruženju. Ne razlikuju se u zastupanju interesa bolesnika, individualiziranošću pristupa bolesniku i raspoloženju. Sagorijevanje medicinske sestre na poslu povezano je s povećanom osjetljivošću za potrebe bolesnika i intenzivnijom interakcijom s bolesnikom.
3. Zadovoljstvo bolesnika radom medicinskih sestra razlikuje se s obzirom na postupanja medicinske sestre, a na osjećaj zadovoljstva utječe: individualiziranost pristupa bolesniku, sestrinska njega, karakteristike medicinske sestre, okruženje u kojem medicinska sestra radi i suosjećajnost koju iskazuje u postupanju prema njemu. Zadovoljstvo bolesnika postupanjima medicinskih sestara ne razlikuje se s obzirom na sociodemografska obilježja bolesnika (spol, dob i obrazovanje bolesnika).
4. Obostrano zadovoljstvo bolesnika i medicinskih sestara očituje se u prepoznatljivim obrascima ponašanja medicinske sestre koje bolesnik prepoznaje, a koji su kao takvi osviještene kompetencije i u medicinskih sestara. Kompetencije koje medicinska sestra procjenjuje da posjeduje kao što su osjetljivost za potrebe bolesnika, zastupanje interesa bolesnika, individualni pristup bolesniku, radno okruženje medicinske sestre (prostor, materijal, privatnost, vrijeme potrebno za bolesnika) i osobine medicinske sestre bolesnik prepoznaje kao individualiziran pristup njemu. Kompetencije medicinske sestre kao što su interakcija s bolesnikom i osobine ličnosti medicinske sestre bolesnik prepoznaje kao karakteristiku sestre. Postupci sestrinske njege i suosjećajnost medicinskih sestara ne doprinose značajno bolesnikovu zadovoljstvu radom medicinskih sestara ili su pak inkorporirana ponašanja u druge osobine medicinskih sestara. |
| Abstract (english) | Objective: To investigate and determine the effect of exhaustion and work environment of nurses on their job satisfaction and patient satisfaction with the health care during hospitalization.
Methods: Used methods and procedures are standardized and validated questionnaires. Questionnaires Copenhagen Burnout Inventory (CBI) and The Practice Environment Scale of the Nursing Work Index (PES-NWI) we gave the questionnaire to all nurses at Department of Neurology, University Hospital Split. We gave the questionnaire on nursing assessment of health care for the individual patient Nurses' Assessment of Quality Scale - Acute Care Version (NAQS-ACV) to nurses who work directly with hospitalized patients, which are filled for two patients during the month of work. Hospitalized patients for whom the nurse filling out the questionnaire on nursing assessment of health care, we gave the questionnaire on patient satisfaction-Patient's Assessment of Quality Scale - Acute Care Version (PAQS-ACV) at hospital discharge. The patient was able to meet all the nurses during hospitalization. The study was conducted during the month with minimal changes in work schedule of the nurses (vacation, personal days, etc.). The patients returned the questionnaires to the examiner in a sealed envelope. Statistical data processing was performed in the statistical package Statistica 7.0. We used the χ ² test, Mann Whitney test, t test and Pearson's correlation coefficient. Results were interpreted at the level of the statistical probability of p <0.01.
Results: Results of testing the significance of differences in estimates of satisfaction in working environment and the general level of burnout and length of service of nurses indicate that there is no statistically significant difference. Results of testing the difference in the incidence of symptoms of burnout in nurses pointing to personally burnout indicate statistically significant (X ² = 64, p ˂ 0,001), burnout caused by their work with patients indicate the absence of statistically significant differences (X ² = 21.5; p = 0.120) and the burnout caused by work point to the existence of a statistically significant difference (X ² = 88, p ˂ 0,001), and the results of testing the connection in the assessment of satisfaction of nurses working environment and the level of general burnout indicate a statistically significant correlation between participation of nurses in hospital affairs and burnout caused by working with physicians as well as the burnout-induced work with colleagues; contribution to the quality of nursing care and burnout caused by working with patients, working with physicians and working with colleagues; Leadership nurses and burnout caused by working with physicians; personnel and adequacy of resources and burnout caused by work, burnout caused by working with the patient, burnout caused by working with physicians as well as burnout caused by working with colleagues; collegiality and relationship with the physician and burnout caused by working with physicians. Overall results of testing the impact of the working environment on level of burnout of nurses caused by working with the patient; physicians; and colleagues suggest a statistically significant association. Results of testing the significance of differences between the ways of facing the task assignment part of nurses (N = 26) who are in direct work with hospitalized patients indicate that there is a statistically significant difference (F = 7.87, p ˂ 0,001), and considering the general level of burnout indicate a statistically significant correlation between: burnout caused by working with patients and sensitivity to the needs of patients; burnout caused by work and interaction with patients. Results of testing the significance of differences between the patients and their job satisfaction of nurses with regard to gender, age and qualifications of patients indicate that there is no statistically significant difference. Results of testing the significance of differences between the patients and their satisfaction with work performed by the nurses indicate that there is a statistically significant difference (F = 12.5, p ˂ 0,001)
Conclusions:
1. The incidence of symptoms of burnout in nurses is determined by the characteristics of the working environment, primarily working with physicians and working with colleagues. Quality of patient care is not only a result of the burden nurses work with patients, but also depends on the quality of work with physicians and working with colleagues. Nurses differ from each other with regard to personal burnout signs such as fatigue, physical and emotional exhaustion, as well as with respect to the combustion caused by work suggesting different ways of wearing (debate) nurses with personal problems and the demands of the job.
2. Nurses who are in direct work with hospitalized patients (n = 26) believe that the quality of their work depends on: the quality of interaction with patients, nurses personality traits, moods, representing the interests of patients, individual approach to the patient, collegiality, and sensitivity to the needs of patients and working environment and they differ significantly. The nurses do not differ in representing the interests of patients, in individual approach to the patient, and mood.Burnout of the nurses at work is associated with increased sensitivity to the needs of patients and intensive interaction with the patient.
3. Patient satisfaction with health nurse differs with respect to the treatment of nurses and the feeling of satisfaction influences: individual approach to the patient, nursing care, characteristics of nurses, the environment in which nurses work and compassion that is expressed in their treatment of patients. Satisfaction with treatment by nurses, patients do not differ with respect to demographic characteristics of the patients (gender, age and level of education of patients).
4. Nurses awareness about patients' expectations and its own assessment of the possibilities which can meet the expectations of patients in direct contact leads to its increased burnout. Mutual satisfaction of patients and nurses is reflected in distinctive patterns in behavior of nurses that patient recognizes, as wel as nurses. Competencies nurse estimates that owns such as sensitivity to the needs of patients, representing the interests of patients, individual approach to the patient, a nurse working environment (space, supplies, privacy, the time required for patients) and patient characteristics of the nurses are identified as individualized approach to them. Competence nurses as they interact with the patient and the personality traits of nurses that a patient identified as characteristic of nurses. The methods of nursing care and compassion of nurses do not contribute significantly to the patient's satisfaction with the work of nurses or are incorporated into other behavioral characteristics of nurses. |
