全科医生工作困难和压力应对能力及复原力:一项定性研究

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背景“新自由主义”工作策略、工作环境艰苦、英国医疗服务体系(NHS)重组及工作量的增加,造成全科医生职业倦怠及数量短缺,诸如此类的报道越来越多。目的本文旨在探讨全科医生工作上的困难和压力以及其应对策略,尤其是最近NHS要求改变工作环境给全科医生造成的影响。设计与场所本研究为定性研究。研究数据来自两个讨论组的访谈及7个“一对一”电话访谈资料。方法采用方便抽样方法选择研究对象。对研究对象进行半结构化讨论组访谈及“一对一”电话访谈,调查当前英国全科医生的执业情况。对访谈数据进行主题分析。结果共22例全科医生参与研究,其中15例参与讨论组讨论,7例参与电话采访。受访者谈到全科医生正承受着前所未有的强大压力,这种压力与工作环境有关,因为工作环境使得其觉得应该做个“好”医生。许多研究报道了全职全科医生压力太大:工作压力引起情绪改变,导致睡眠不良,焦虑增加,与亲人之间关系紧张。有些人尝试通过减少工作量来改善这种状况。工作环境的变化使得全科医生几乎没有时间采取措施来提高复原力以做到工作与生活之间平衡良好以及更好地与同事相处。尽管有些全科医生能更有效地应对压力,但是其也承认,自己已经尽了最大努力来应对工作压力。结论 NHS诸多因素造成了全科医生在感情生活及工作压力上的明显改变。为促进全科医生提供有效的医疗服务,其复原力的构建应不仅局限于改善全科医生个人情况,还应包括系统地解决其工作上的困难与压力。 Background There has been a growing number of reports of “neoliberal” work strategies, difficult working conditions, restructuring of the UK’s health care system (NHS) and increased workload, resulting in a generalized job burnout and scarcity of general practitioners. PURPOSE This paper aims to explore the difficulties and pressures of general practitioners in their work and their coping strategies, most notably the impact that the NHS has recently required to change the working environment to general practitioners. Design and Location This study is qualitative. The research data came from interviews with two discussion groups and from seven one-on-one telephone interviews. Methods Convenient sampling methods were used to select subjects. Conducted semi-structured panel interviews and “one-on-one” telephone interviews with research subjects to investigate the current practice of general practitioners in the United Kingdom. Thematic analysis of interview data. Results A total of 22 general practitioners participated in the study, of which 15 were involved in the discussion group and 7 were interviews with the telephone. Respondents talked about GPs being under unprecedented pressure to work in a work environment that makes them think they should be “good” doctors. Many studies report that stressing full-time GPs is too stressful: job stress causes mood changes, leads to poor sleep, increased anxiety, and tension with loved ones. Some try to improve the situation by reducing the workload. The changing work environment has given GPs little time to take steps to increase resilience so they can work-life balance and get along well with colleagues. Although some GPs are able to cope with stress more effectively, they acknowledge that they have done their best to cope with work stress. Conclusion Many factors of NHS caused obvious changes of general practitioners in emotional life and work pressure. In order to provide general practitioners with effective medical services, resilience should be built not only to improve the personal condition of general practitioners, but also to systematically address their work-related difficulties and pressures.
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