面對全球新冠肺炎爆發台灣護理人員之壓力、心理困擾與緩解方式探討

Exploring the Stress, Psychological Distress, and Stress-relief Strategies of Taiwan Nursing Staffs Facing the Global Outbreak of COVID-19

10.6224/JN.202006_67(3).09

馮明珠(Ming-Chu FENG)；武香君(Hsiang-Chun WU)；林慧姿(Hui-Tzu LIN)；雷蕾(Lei LEI)；趙嘉玲(Chia-Ling CHAO)；陸椿梅(Chun-Mei LU)；楊婉萍(Wan-Ping YANG)

新冠肺炎 ； 防疫 ； 護理人員 ； 壓力 ； 心理困擾 ； COVID-19 ； pandemic prevention ； nursing staff ； stress ； psychological distress

護理雜誌

67卷3期（2020 / 06 / 01）

64 - 74

繁體中文

背景：2019年底新型冠狀病毒疾病（COVID-19）在全球爆發，疫情期間執業護理師需面臨諸多壓力與擔憂，這將對護理人員的心理健康產生立即性與持久性的重大影響。目的：探討護理人員於COVID-19疫情下的壓力、心理困擾與緩解方式。方法：此橫斷式研究採線上問卷填答，問卷含括四部分：基本資料、護理人員於COVID-19期間的壓力、心理困擾、與緩解壓力方式調查。以方便取樣方法，獲全台各級醫院共469位執業護理師參與填答。結果：COVID-19疫情期間，多數護理人員擔心疫情期間的居住問題（72.7%）。護理人員的壓力以照顧病人的負擔構面得分最高，其次是擔心與社會隔離，各細項中，以擔心親友被自己傳染（2.35 ± 0.79）最高、次為擔心感染後與家人分離（2.17 ± 0.92）。護理人員的心理困擾平均5.49 ± 3.83分，其中感覺緊張不安得分最高（1.32 ± 0.84），其次為易苦惱或動怒（1.17 ± 0.92）與感覺憂鬱心情低落（1.12 ±0.94）。61.8%的填答者心理情緒困擾得分在正常範圍，但3.4%的填答者已達重度困擾，「接受教育訓練」是最常用以緩解壓力的方法（2.27 ± 0.51）。結論／實務應用：提出六點意見：（一）關懷—提供心理的評估與關懷照護；（二）支持—營造友善團隊氛圍，提供支持；（三）徵詢—優先招募自願及有相關經驗者；（四）告知—提供及時、公開透明的防疫資訊；（五）裝備—提供完整適切的防疫教育訓練；（六）協助—建立安家策略，減少後顧之憂。

Background: The global outbreak of coronavirus disease (COVID-19) began in December 2019. The high levels of stress experienced by nurses during this pandemic may have immediate and long-term effects on their mental health. Purpose: To explore the stress and psychological problems of nurses during this pandemic and to identify strategies used by these nurses to relieve stress. Methods: A cross-sectional online survey was conducted that included a basic information datasheet, stress of nursing staff during COVID-19 outbreak scale, psychological distress scale, and stress relief methods survey form. Convenience sampling was used and a total of 469 practicing nurses participated in this study. Results: Most of the participants expressed concerns about living problems (72.7%). On the stress questionnaire, the facets of ＂burden of taking care of patients＂ and ＂worries about social isolation＂ earned the first and second highest scores, respectively. In terms of items, ＂worrying about infecting family members and friends＂ and ＂worrying about being separated from family after being infected＂ earned the two highest scores (2.35 ± 0.79 and 2.17 ± 0.92, respectively). Scores for psychological distress averaged 5.49 ± 3.83, with stress anxiety (1.32 ± 0.84) earning the highest mean subscale score followed by distress and irritability (1.17 ± 0.92) and depression (1.12 ± 0.94). Nearly two-thirds (61.8%) of the participants earned psychological and emotional distress scores within the 'normal' range, and 3.4% earned scores indicating severe distress. ＂Receiving education and training＂ was the most common method used by the participants to relieve stress (2.27 ± 0.51). Conclusions: The following six strategies are proposed based on the above findings: (1) Caring: provide psychological assessment and care; (2) Supporting: create a friendly team atmosphere and provide support; (3) Inquiring: recruit volunteers with relevant experience; (4) Informing: provide timely, open, and transparent epidemic-prevention information; (5) Equipping: provide complete and appropriate epidemic-prevention education and training; (6) Assisting: establish a strategy for family support and caring to reduce the stress and worries of nurses.

1. 莊寶玉, P. Y.,羅美芳, M. F.(2005)。醫護人員照顧高危險性傳染疾病病患之壓力量表的發展與測試—以SARS為例。台灣公共衛生雜誌，24(5)，420-430。
   連結：
2. Borwein, S.(2004).In Beijing during the SARS outbreak.Canadian Family Physician,50,861-863.
3. Chan-Yeung, M.(2004).Severe acute respiratory syndrome (SARS) and healthcare workers.International Journal of Occupational and Environmental Health,10(4),421-427.
4. Chen, W.,Huang, Y.(2020).To protect healthcare workers better, to save more lives.Anesthesia & Analgesia
5. Chong, M. Y.,Wang, W. C.,Hsieh, W. C.,Lee, C. Y.,Chiu, N. M.,Yeh, W. C.,Chen, C. L.(2004).Psychological impact of severe acute respiratory syndrome on health workers in a tertiary hospital.The British Journal of Psychiatry,185(2),127-133.
6. Greenberg, N.,Docherty, M.,Gnanapragasam, S.,Wessely, S.(2020).Managing mental health challenges faced by healthcare workers during COVID-19 pandemic.BMJ,368,m1211.
7. Guan, W. J.,Ni, Z. Y.,Hu, Y.,Liang, W. H.,Ou, C. Q.,He, J. X.,Zhong, N. S.(2020).Clinical characteristics of coronavirus disease 2019 in China.The New England Journal of Medicine,382,1708-1720.
8. Iacono, M. V.(2017).Promote a healthy workplace: Build resilience.Journal of PeriAnesthesia Nursing,32(1),81-82.
9. Jones, N.,Seddon, R.,Fear, N. T.,McAllister, P.,Wessely, S.,Greenberg, N.(2012).Leadership, cohesion, morale, and the mental health of UK Armed Forces in Afghanistan.Psychiatry: Interpersonal and Biological Processes,75(1),49-59.
10. Lai, J.,Ma, S.,Wang, Y.,Cai, Z.,Hu, J.,Wei, N.,Hu, S.(2020).Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019.JAMA Network Open,3(3),e203976.
11. Lee, M. B.,Liao, S. C.,Lee, Y. J.,Wu, C. H.,Tseng, M. C.,Gau, S. F.,Rau, C. L.(2003).Development and verification of validity and reliability of a short screening instrument to identify psychiatric morbidity.Journal of the Formosan Medical Association,102(10),687-694.
12. Lee, S. H.,Juang, Y. Y.,Su, Y. J.,Lee, H. L.,Lin, Y. H.,Chao, C. C.(2005).Facing SARS: Psychological impacts on SARS team nurses and psychiatric services in a Taiwan general hospital.General Hospital Psychiatry,27(5),352-358.
13. Li, Q.,Guan, X.,Wu, P.,Wang, X.,Zhou, L.,Tong, Y.,Feng, Z.(2020).Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia.The New England Journal of Medicine,382,1199-1207.
14. Maunder, R.(2004).The experience of the 2003 SARS outbreak as a traumatic stress among frontline healthcare workers in Toronto: Lessons learned.Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences,359(1447),1117-1125.
15. McAlonan, G. M.,Lee, A. M.,Cheung, V.,Cheung, C.,Tsang, K. W.,Sham, P. C.,Wong, J. G.(2007).Immediate and sustained psychological impact of an emerging infectious disease outbreak on health care workers.The Canadian Journal of Psychiatry,52(4),241-247.
16. McPhee, M.(2014).Valuing patient safety: Responsible workforce design.
17. Robertson, E.,Hershenfield, K.,Grace, S. L.,Stewart, D. E.(2004).The psychosocial effects of being quarantined following exposure to SARS: A qualitative study of Toronto health care workers.The Canadian Journal of Psychiatry,49(6),403-407.
18. Rothe, C.,Schunk, M.,Sothmann, P.,Bretzel, G.,Froeschl, G.,Wallrauch, C.,Hoelscher, M.(2020).Transmission of 2019-nCoV infection from an asymptomatic contact in Germany.The New England Journal of Medicine,382(10),970-971.
19. Rubin, G. J.,Wessely, S.(2020).The psychological effects of quarantining a city.BMJ,368,m313.
20. Shanafelt, T.,Ripp, J.,Trockel, M.(2020).Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic.JAMA,323(21)
21. Wang, C.,Horby, P. W.,Hayden, F. G.,Gao, G. F.(2020).A novel coronavirus outbreak of global health concern.The Lancet,395(10223),470-473.
22. Wang, D.,Hu, B.,Hu, C.,Zhu, F.,Liu, X.,Zhang, J.,Peng, Z.(2020).Clinical characteristics of 138 hospitalized patients with 2019 Novel Coronavirus-Infected pneumonia in Wuhan, China.JAMA,323(11),1061-1069.
23. World Health Organization(2020).,未出版
24. World Health Organization. (2020a, January 30). Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). Retrieved from https://www.who.int/news-room/detail/23-01-2020-statementon-the-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-ofnovel-coronavirus-(2019-ncov)
25. Wu, K. K.,Chan, S. K.,Ma, T. M.(2005).Posttraumatic stress after SARS.Emerging Infectious Diseases,11(8),1297-1300.
26. Zander, M.,Hutton, A.,King, L.(2010).Coping and resilience factors in pediatric oncology nurses CE.Journal of Pediatric Oncology Nursing,27(2),94-108.
27. 中華人民共和國國家衛生健康委員會（2020，2月13日）．截至2月13日24時新型冠狀病毒肺炎疫情最新情況．取自http://www.nhc.gov.cn/xcs/yqtb/202002/553ff43ca29d4fe88f3837d49d6b6ef1.shtml [National Health Commission of the People’s Republic of China. (2020, February 13). The new coronavirus pneumonia epidemic situation, February 13, 2020. Retrieved from http://www.nhc.gov.cn/xcs/yqtb/202002/553ff43ca29d4fe88f3837d49d6b6ef1.shtml]

1. 陳秋曲(Chiu-Chu CHEN);李姿月(Tzu-Yueh LEE);趙麗玫(Li-Mei CHAO);吳姿蓉(Tzu-Jung WU)(2024)。後疫情時代護理人員的工作壓力、工作滿意度與韌性之相關性與預測因子。護理雜誌。71(4)。44-56。 
2. 王惠萱(Huei-Shiuan WANG);謝宜娟(Yi-Chuan HSIEH);洪敏瑛(Ming-Ying HONG)(2022)。降低腫瘤病房轉型COVID-19專責病房護理人員工作壓力之專案。護理雜誌。69(6)。75-83。