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急診醫師疲勞因素及對離職之影響
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急診醫師疲勞相關因素探討及其對離職意願之影響 台灣大學 醫療機構管理研究所 蔡依倫 98 年 7月
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2014 AHA/ACC/HRS Atrial Fibrillation Guideline
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🅷🅾🆃 & 🆂🅴🆇🆈🔥 🅲🅰🅻🅻💞 🅸🅽🅳🅴🅿🅴🅽🅳🅴🅽 /𝐁𝐄𝐒𝐓 𝐂𝐀𝐋𝐋 𝐆𝐈𝐑𝐋 𝐄𝐒𝐂𝐎𝐑𝐓𝐒 𝐒𝐄𝐑𝐕𝐈𝐂𝐄 𝐈𝐍/𝐎𝐔𝐓 𝐂𝐀𝐋𝐋 𝐋𝐎𝐖 𝐑𝐀𝐓𝐄 𝐂𝐀𝐋𝐋 𝐭𝐨 𝐰𝐞 𝐡𝐚𝐯𝐞 𝐚 𝐥𝐨𝐭 𝐨𝐟 𝐡𝐨𝐫𝐧𝐲 𝐜𝐚𝐥𝐥 𝐠𝐢𝐫𝐥 𝐢𝐧 𝐢𝐧 𝐨𝐮𝐫 𝐭𝐞𝐚𝐦. 𝐖𝐡𝐨 𝐜𝐚𝐧 𝐠𝐢𝐯𝐞 𝐦𝐚𝐬𝐬𝐢𝐯𝐞 𝐬𝐞𝐱𝐮𝐚𝐥 𝐩𝐥𝐞𝐚𝐬𝐮𝐫𝐞 𝐭𝐨 𝐭𝐡𝐞𝐢𝐫 𝐜𝐥𝐢𝐞𝐧𝐭'𝐬. 𝐎𝐮𝐫 𝐡𝐢𝐠𝐡 𝐩𝐫𝐨𝐟𝐢𝐥𝐞 𝐞𝐬𝐜𝐨𝐫𝐭 𝐚𝐫𝐞 𝐧𝐨𝐭 𝐨𝐧𝐥𝐲 𝐟𝐨𝐫 𝐬𝐞𝐱𝐮𝐚𝐥 𝐩𝐥𝐞𝐚𝐬𝐮𝐫𝐞 𝐭𝐡𝐞𝐲 𝐚𝐥𝐬𝐨 𝐠𝐢𝐯𝐞 𝐚 𝐠𝐢𝐫𝐥 𝐟𝐫𝐢𝐞𝐧𝐝 𝐥𝐢𝐤𝐞 𝐞𝐱𝐩𝐞𝐫𝐢𝐞𝐧𝐜𝐞. 𝐓𝐡𝐞𝐬𝐞 𝐞𝐱𝐩𝐞𝐫𝐢𝐞𝐧𝐜𝐞𝐝 𝐞𝐬𝐜𝐨𝐫𝐭 𝐠𝐢𝐫𝐥𝐬 𝐚𝐫𝐞 𝐟𝐫𝐨𝐦 𝐯𝐚𝐫𝐢𝐨𝐮𝐬 𝐜𝐢𝐭𝐢𝐞𝐬 𝐨𝐟 𝐈𝐧𝐝𝐢𝐚 𝐚𝐧𝐝 𝐟𝐨𝐫𝐞𝐢𝐠𝐧𝐞𝐫 𝐠𝐢𝐫𝐥𝐬 𝐚𝐥𝐬𝐨 𝐚𝐯𝐚𝐢𝐥𝐚𝐛𝐥𝐞 𝐟𝐨𝐫 𝐲𝐨𝐮𝐫 𝐡𝐮𝐧𝐠𝐫𝐲 𝐧𝐞𝐞𝐝𝐬. 𝐈𝐭’𝐬 𝐚𝐥𝐥 𝐲𝐨𝐮𝐫 𝐜𝐡𝐨𝐢𝐜𝐞 𝐭𝐨 𝐬𝐞𝐥𝐞𝐜𝐭 𝐭𝐡𝐞 𝐠𝐢𝐫𝐥 𝐚𝐬 𝐩𝐞𝐫 𝐲𝐨𝐮𝐫 𝐝𝐞𝐬𝐢𝐫𝐞 𝐚𝐧𝐝 𝐰𝐞 𝐦𝐚𝐤𝐞 𝐬𝐮𝐫𝐞 𝐲𝐨𝐮 𝐰𝐢𝐥𝐥 𝐞𝐧𝐣𝐨𝐲 𝐞𝐯𝐞𝐫𝐲 𝐦𝐨𝐦𝐞𝐧𝐭 𝐰𝐢𝐭𝐡 𝐥𝐨𝐭𝐬 𝐨𝐟 𝐟𝐮𝐧 𝐚𝐧𝐝 𝐞𝐱𝐜𝐢𝐭𝐞𝐦𝐞𝐧𝐭. 𝐖𝐞 𝐨𝐟𝐟𝐞𝐫 𝐛𝐨𝐭𝐡 𝐈𝐧𝐜𝐚𝐥𝐥 𝐚𝐧𝐝 𝐎𝐮𝐭𝐜𝐚𝐥𝐥 𝐬𝐞𝐫𝐯𝐢𝐜𝐞 𝐚𝐯𝐚𝐢𝐥𝐚𝐛𝐥𝐞 𝟐𝟒𝐱𝟕. 𝐖𝐞 𝐠𝐮𝐚𝐫𝐚𝐧𝐭𝐲 𝐟𝐮𝐥𝐥 𝐬𝐚𝐭𝐢𝐬𝐟𝐚𝐜𝐭𝐢𝐨𝐧 𝐋𝐎𝐖 𝐑𝐀𝐓𝐄 𝐅𝐄𝐋𝐋 𝐓𝐇𝐄 𝐇𝐄𝐀𝐕𝐄𝐍𝐋𝐘 𝐓𝐎𝐔𝐂𝐇 𝐖𝐈𝐓𝐇 𝐀𝐋𝐋 𝐏𝐎𝐒𝐈𝐓𝐈𝐎𝐍 ....𝐖𝐀𝐈𝐓 𝐓𝐎 𝐒𝐔𝐂𝐊 𝐘𝐎𝐔𝐑 𝐁𝐎𝐃𝐘 𝐎𝐮𝐫 𝐞𝐬𝐜𝐨𝐫𝐭 𝐩𝐫𝐨𝐟𝐢𝐥𝐞𝐬 •𝐂𝐨𝐥𝐥𝐞𝐠𝐞 𝐆𝐢𝐫𝐥𝐬 •𝐇𝐨𝐮𝐬𝐞𝐰𝐢𝐯𝐞𝐬 •𝐇𝐢𝐠𝐡 𝐏𝐫𝐨𝐟𝐢𝐥𝐞 𝐆𝐢𝐫𝐥𝐬 •𝐑𝐚𝐦𝐩 𝐌𝐨𝐝𝐞𝐥𝐬 •𝐅𝐨𝐫𝐞𝐢𝐠𝐧𝐞𝐫 𝐆𝐢𝐫𝐥𝐬 𝐎𝐮𝐫 𝐞𝐬𝐜𝐨𝐫𝐭 𝐬𝐞𝐫𝐯𝐢𝐜𝐞𝐬 •𝐇𝐉 (𝐇𝐚𝐧𝐝 𝐉𝐨𝐛) •𝐁𝐉 (𝐁𝐥𝐨𝐰𝐣𝐨𝐛) •𝐂𝐁𝐉 (𝐂𝐨𝐯𝐞𝐫𝐞𝐝 𝐁𝐥𝐨𝐰 𝐉𝐨𝐛) •𝐎𝐫𝐚𝐥 •𝐒𝐞𝐱 𝐰𝐢𝐭𝐡 𝐚 𝐜𝐨𝐧𝐝𝐨𝐦 •𝐅𝐊 (𝐅𝐫𝐞𝐧𝐜𝐡 𝐤𝐢𝐬𝐬𝐢𝐧𝐠) •𝐊𝐢𝐬𝐬𝐢𝐧𝐠 𝐰𝐢𝐭𝐡 𝐭𝐨𝐧𝐠𝐮𝐞 •𝐎-𝐋𝐞𝐯𝐞𝐥 (𝐎𝐫𝐚𝐥 𝐬𝐞𝐱) •𝐋𝐨𝐧𝐠 𝐒𝐢𝐥𝐤𝐲 𝐁𝐫𝐨𝐰𝐧 𝐇𝐚𝐢𝐫 •𝐌𝐚𝐬𝐬𝐚𝐠𝐞 •𝟔𝟗 (𝟔𝟗 𝐬𝐞𝐱
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社團法人高雄市醫師公會--高雄醫師會誌116期-心情分享|蔡瑞聲:我退休了!為了改變一成不變的生活型態
社團法人高雄市醫師公會--高雄醫師會誌116期-心情分享|蔡瑞聲:我退休了!為了改變一成不變的生活型態
社團法人高雄市醫師公會--高雄醫師會誌116期-專題論壇 | 蕭孟芳:紐西蘭精神健康照護的危機與變革
社團法人高雄市醫師公會--高雄醫師會誌116期-專題論壇 | 蕭孟芳:紐西蘭精神健康照護的危機與變革
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社團法人高雄市醫師公會--高雄醫師會誌116期-醫學專欄|王建勝、黃琮懿:「親愛的,我把腎臟石頭變不見了」- 淺談“RIRS”,軟式輸尿管鏡手術
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急診醫師疲勞因素及對離職之影響
1.
急診醫師疲勞相關因素探討及其對離職意願之影響 台灣大學
醫療機構管理研究所 蔡依倫98年7月
2.
本研究的對象為在急診部門工作的急診專科醫師,包括已通過急診專科醫師考試但尚未升任主治醫師的研究醫師(fellow) 研究方法為橫斷性問卷調查法,共發出問卷840份,回收有效問卷528份
3.
性別
4.
年齡
5.
工作年資
6.
上班時數
7.
每月班數
8.
夜班比例
9.
計薪方式
10.
醫院等級
11.
醫院屬性
12.
醫院位置
13.
本研究五大構面 相互關係示意圖 +
+ + – + + + – – –
14.
影響醫師工作疲勞因素之重要性
15.
影響醫師服務疲勞因素之重要性
16.
影響醫師離職意願因素之重要性
17.
研究結果討論
18.
急診醫師的「工作疲勞」指數平均為57.9,約為2004 年全國受僱者調查結果的兩倍 「服務疲勞」指數平均為48.5,也比2007
年台北市調查結果更高
19.
五十歲以上急診醫師的「要求總分」、「工作疲勞」、「服務疲勞」最低 急診醫師的工作年 資與「工作疲勞」、
「服務疲勞」、 「每月班數」皆呈 負相關,「每月班 數」與「工作要求」 呈正相關
20.
單身無子女的醫師在「工作疲勞」和「服務疲勞」分數均高於已婚有子女者 單身有子女者的「離職意願」最高
21.
夜班比例為60-80%的急診醫師「工作要求」和「服務疲勞」分數較高,夜班比例小於20%者的「工作資源」最高
22.
計薪方式為「無底薪純績效」的急診醫師「工作疲勞」和「離職意願」較高
23.
醫學中心急診醫師的「要求總分」最高,地區醫院的「工作疲勞」最低 公立醫院醫師的「工作疲勞」和「離職意願」比私立醫院醫師高 東部急診醫師的「要求總分」和「離職意願」最低,南部醫師的「服務疲勞」的分數比中部和東部高
24.
預測「工作疲勞」的多元迴歸模式中,「醫療糾紛」具有最佳的解釋力,其次為「工作─家庭衝突」、「臨床教學」、「工作參與」、「輪班工作」、 「工作保障」、「學習成長」、 「年齡」
25.
預測「服務疲勞」的多元迴歸模式中,「臨床教學」具有最佳的解釋力,其次為「醫療糾紛」、「回饋」、「年齡」、「學習成長」、「家庭支持」、「工作保障」 預測「離職意願」的多元迴歸模式中,「工作疲勞」具有最佳的解釋力,其次為「服務疲勞」、「工作環境」、「工作氣氛」
26.
對醫療機構管理者的建議
27.
提供急診醫師更彈性的計薪方式、上班時間和排班方式,或醫師自行討論後,再與管理者商議實行,以增加急診醫師的工作參與,更人性化的排班方式 也有助於減少醫師的 工作─家庭衝突
28.
對中年的急診醫師,考慮減少臨床工作的比例,依醫師的興趣和專長,調整到教學或研究工作,並比照臨床工作給予適當的薪資報酬 這樣可以增加中年醫師的工作保障,而年輕醫師在資深醫師的指導下,有更多學習成長機會,同時能減輕年輕醫師在臨床教學方面的壓力
29.
急診部門可設置諮詢或支持團體,促進醫師工作或生活上的相互交流(例如醫療糾紛的困擾或生涯規劃),也可以增進年長醫師與年輕醫師在各方面的經驗傳承 藉由營造良好的工作環境和氣氛,凝聚急診部門的向心力,同時降低急診醫師的離職意願
30.
增加急診與其他科交流互動(如學術研討會或工作人員輪替) 積極發展急診特有次專科(如毒物學、野外醫學、創傷醫學) 以提昇各科對急診醫師的尊重互信,讓急診醫師對自己的工作更有回饋感和成就感
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