比較住宿式長照機構護理師、照顧服務員自覺執業環境、工作特性與其無力感之研究

背景動機：隨著全球人口高齡化，台灣亦逐漸邁入高齡社會，隨之而來是長期照顧產業的蓬勃發展。然而，照顧失能者與高齡長者，服務者經常需付出較多的體力及心力，而友善的職場環境才能留住人才。但是透過文獻搜尋，發現過去研究較多針對長照機構照顧服務員職場環境之探討，較少針對長照機構護理師職場環境之研究，也少有研究進行長照機構照顧服務員與護理師自覺職場環境的比較研究。 研究目的：本研究探討住宿式長照機構護理師與照顧服務員自覺執業環境、工作特性與無力感現況，並比較護理師與照顧服務員自覺執業環境、工作特性與無力感間之差異。研究方法：本研究包含比較性研究及相關性研究，採橫斷式研究設計，並以結構式問卷於112年4月至112年11月進行資料之收集，以中部台灣24家住宿式長照機構 (包含10家一般護理之家、12家老人福利機構、2家住宿式長期照顧機構)的護理師與照顧服務員為選樣對象，研究工具包含：人口學問卷、執業環境調查量表、工作設計量表及無力感量表，統計方法為獨立樣本t檢定、皮爾森積差相關分析、與逐步迴歸分析。研究結果：本研究參與對象共338位 (156位護理師，182位照顧服務員)，護理師平均年齡是40.49歲 (標準差=11.05)，年齡範圍是21歲到70歲，照顧服務員平均年齡49.62歲 (標準差=13.53)，年齡範圍是19歲到77歲。研究結果顯示護理師執業環境調查量表分數平均值是158.97分 (標準差=26.495)；而照顧服務員自覺執業環境得分的平均值是166.37分 (標準差=25.524)，護理師與照顧服務員自覺執業環境得分有顯著差異 (p = .009)。工作特性方面，護理師以任務多樣性得分最高，平均值是16.00分 (標準差=2.907)；照顧服務員則以工作回饋性得分最高，平均值是11.91分 (標準差=2.444)。比較護理師、照服員工作特性僅工作時程自主性具顯著差異 (p = .023)，護理師平均11.08分 (標準差=1.745)較高，在決策自主性、工作方式自主性、任務多樣性、任務重要性、任務完整性、工作回饋性兩者間沒有顯著差異 (p > .05 )。護理師無力感總分平均58.81分 (標準差=22.11)，照顧服務員無力感總分平均51.76分 (標準差=20.93)，護理師與照顧服務員無力感得分有顯著差異 (p = .003)。此外，護理師與照顧服務員執業環境與無力感皆有顯著負相關 (r = -.61; r = -.66)。護理師與照顧服務員在工作時程自主性、決策自主性、工作方式自主性、任務多樣性、任務重要性、任務完整性及工作回饋性皆與無力感有顯著負相關 (護理師r = -.39，r = -.61，r = -.58，r= -.43，r = -.41，r = -.52，r = -.56 ;照顧服務員r = -.30，r = -.49，r = -.55，r = -.38，r = -.41，r = -.49，r = -.44)。回歸分析顯示，影響住宿式長照機構護理師無力感的預測變項為執業環境總分與工作特性中的工作自主性，解釋力是44%，而影響住宿式長照機構照顧服務員無力感的預測變項則僅有執業環境總分，解釋力是43.1%。結論：從研究結果顯示工作自主性越低及自覺執業環境滿意度越低易造成住宿式長照機構護理師的無力感，而自覺執業環境滿意度越低易造成住宿式長照機構照顧服務員的無力感，因此，建議機構主管可提升護理師的工作自主性，並改善護理師及照顧服務員之執業環境，以提升護理師及照顧服務員對執業環境之滿意度，進而降低無力感之產生。

Background: As the global population is aging, Taiwan has also gradually entered an aging society, followed by the booming development of the long-term care industry. Caring for individuals with disability and the elderly often requires caregivers to exert considerable physical and mental effort, although a friendly practice environment can retain professional talents. A literature search revealed that most studies have focused on the practice environment of care attendants in long-term care institutions, and less research has been conducted on the practice environment of nurses in long-term care institutions. Moreover, few comparative studies have addressed the perceived practice environment of nursing assistants and nurses in long-term care institutions.Objective: This study aims to explore the perceived practice environment, task characteristics, and powerlessness of nurses and nursing assistants in residential long-term care institutions, comparing the differences between these two groups.Methods: A cross-sectional research design was adopted, and the questionnaire collection period was from April to November 2023. The participants were nurses and nursing assistants from 24 residential long-term care institutions in central Taiwan (including 10 nursing homes, 12 senior citizens care institutions, and 2 residential long-term care institutions). Research tools included a demographic questionnaire, a self-administered Practice Environment Survey Scale, the Task Characteristic Scale, and the Powerlessness Scale. Statistical methods included independent sample t test, Pearson’s correlation, and stepwise regression analysis.Results: The participants in this study were 338 (156 nurses and 182 nursing assistants). The nurses’ average age was 40.49 years old (SD = 11.05), and the age range was 21–70 years. The nursing assistants’ average age was 49.62 years old (SD = 13.53), and the age range was 19–77 years. The average score of the nurses practice environment survey scale was 158.97 points (SD = 26.495), while that of the nursing assistant practice environment survey scale was 166.37 points (SD = 25.524). Thus, the perceived practice environment showed statistical significance among both nurses and nursing assistants (p = .009). In terms of task characteristics, nurses scored the highest for task variety, with an average of 16.00 points (SD = 2.907); nursing assistant scored highest for feedback from job, with an average of 11.91 points (SD = 2.444). Comparing the task characteristics of nurses and nursing assistants, we only found a statistical significance in task schedule autonomy (p = .023), with nurses having a higher average score of 11.08 (SD = 1.745). We detected no statistical significance (p > .05) between decision-making autonomy, task execute autonomy, task variety, task significance, task identity, and feedback from job. The average total powerlessness score of nurses was 58.81 points (SD= 22.11), and that of nursing assistant was 51.76 points (SD = 20.93); this indicates a statistical significance in the scores of both groups (p = .003). Additionally, the practice environment of nurses and nursing assistants had a significant negative correlation with powerlessness (r = -.61; r = -.66). Task schedule autonomy, decision-making autonomy, task execute autonomy, task variety, task significance, task identity, and feedback from job of nurses and nursing assistant were all significantly negatively correlated with the sense of powerlessness (nurses: r = - .39, r = -.61, r = -.58, r = -.43, r = -.41, r = -.52, r = -.56; nursing assistants: r = -.30, r = - .49, r = -.55, r = -.38, r = -.41, r = -.49, r = -.44). Regression analysis shows that the predictive variables affecting the powerlessness of nurses in residential long-term care institutions are practice environment and task autonomy in task characteristics, with an explanatory power of 44%; conversely, the predictive variable affecting the powerlessness of nursing assistants in residential long-term care institutions is only the total score of practice environment, with an explanatory power of 43.1%.Conclusions: Lower task autonomy and lower satisfaction with the perceived practice environment are likely to cause a sense of powerlessness among nurses in residential long-term care institutions, while lower satisfaction is likely to cause a sense of powerlessness among nursing assistants. Therefore, managers can enhance nurses’ task autonomy and improve the practice environment of nurses and nursing assistants to increase their satisfaction, thereby reducing the occurrence of powerlessness.