工作在每個人的健康與快樂中扮演了核心的角色，然而工作所帶來之壓力卻是無法避免的。 醫療團隊中，醫師一直被歸類為高工作壓力的職業。本研究的目的是嘗試瞭解醫師之工作壓力源以及醫師對壓力源之感知程度及趨避意向，同時並更進一步的探討醫師個人屬性與行為特質對壓力感知與趨避意向之影響。本研究採普查方式將經過預試及修正後之結構式問卷以郵寄的方式寄給高雄市、高雄縣以及屏東縣三個地區工作於地區醫院以上的醫師。所使用之統計方法包括因素分析、單變數描述性統計、卡方考驗、Pearson相關分析、淨相關、t考驗、單因子及多因子變異數分析以及複迴歸分析。結果：有效回收率為7.9%，回收樣本具有樣本代表性。醫師壓力量表之26個題項中，因素分析後將壓力源萃取出6個構面，分別為「病患處理」、「人際互動」、「工作負荷」、「醫療環境」、「組織結構」與「研究教學」構面。累積解釋變異量百分比為64.7%。整份問卷之內部一致性為0.917。醫師之A型行為特質之平均分數為4.47，A型佔33.8%，B型佔66.2%。醫師對工作壓力感知程度之平均分數為3.13分，比普通略高。最感壓力之前三項分別為『處理病情危急不穩定的病患』、『醫病關係惡化，醫療糾紛日增』與『要做的工作多，時間不夠用』。在壓力源的構面上，以「病患處理」構面壓力最大，「人際互動」構面壓力最小。醫師對各壓力源趨避意向之平均分數為3.50，對大部份之壓力源之趨避意向均傾向於努力謀求改善。在整體之壓力感知方面，醫師擔任的職位與醫師之行為特質類型對壓力感知的程度有顯著的影響。行為特質屬A型的醫師，壓力感知的程度顯著的大於B型的醫師，駐院醫師的壓力感知程度顯著的大於主治醫師。在整體之趨避意向方面，醫師服務醫院之屬性對醫師之趨避意向程度有顯著的影響，在整體之趨避意向上，公立醫院之醫師顯著的大於私立醫院之醫師。各構面壓力源之感知程度與趨避意向以及醫師個人屬性與行為特質對壓力感知程度與趨避意向之干擾效應將在文中有詳盡的探討。

BACKGROUND：Work plays an important role in everyone’s health and happiness. However, facing the rapidly changing medical environment, physicians feel even more stress than ever. PURPOSE：The purpose of this study was to find the current stressors among physicians who worked in hospitals in southern Taiwan, and to evaluate the correlations among demographics, type A behavior pattern(TABP) and the perception and approach-avoidance intention (AAI) of the stressors. METHOD: Structured questionnaires were mailed to physicians who worked in hospitals in Ping tong and Kaohsiung. Data were coded and analyzed with factor analyses, χ2 test, Pearson’s correlation, partial correlation, Student t test, ANOVA and multiple regression when appropriate. RESULTS: The effective response rate was 7.9% and there was no true difference between the samples and population in demographic characteristics. Six factors were extracted from stressors by factor analyses with the cumulative percentage of total variance explained around 64.7%. The overall Cronbach’s α was .917. The extent of stress perception and the AAI of the factors of stressors, namely “patient management (PM)”, ”interpersonal relationship (IR)”, ”work load (WL)”, ”medical environment (ME)”, ”organizational structure (OS) and “research and teaching (RT)”, were used as dependent variables during comparisons between different demographic variables and TABP. The mean TABP score was 4.47, mean perceived stress was 3.13 and the mean AAI of the stressors was 3.5. The most stressful factor of stressors was PM and the least was IR. The AAI of the factor of the stressors revealed that RT was most likely to use approach as the coping strategy whereas the OS was the least. The correlation between the extent of the stress perception and AAI of the stressors varied. Significant correlation was found only in moderate stress zone. TABP significantly correlated to stress perception with Pearson’s r = .227 ( P < .05 ). There was significant difference in overall stress perception on TABP and the position of the physicians. Physicians with TABP perceived more stress than Type B did. Residents were more likely to report their job as stressful than attending physicians did. However, the correlation between TABP and the AAI of the stressors (overall and all 6 factors) were not significant. The attribute of the hospital was the only factor that has the moderator effect on AAI of the stressors. Physicians who worked in public hospitals use approach as the coping strategy to the stressors more likely than physicians who worked in private hospitals did. The correlation between the stress perception and AAI to the factors of the stressors, and the moderator effect of physicians demographics and TABP on stress perception and AAI to the factors of the stressors will be discussed in detail in the text.

第一章 緒論
第一節 研究背景…………………………………………………1
第二節 研究動機 …………………………………………………2
第三節 研究目的…………………………………………………3

第二章 文獻探討
第一節 壓力之定義………………………………………………5
第二節 壓力之處理過程…………………………………………8
第三節 工作壓力之研究模式……………………………………17
第四節 醫師的工作壓力…………………………………………23
第五節 A型行為特質……………………………………………29



第三章 研究方法
第一節 研究架構…………………………………………………32
第二節 研究假設…………………………………………………33
第三節 研究對象…………………………………………………34
第四節 研究工具…………………………………………………40
第五節 名詞解釋與資料編碼 ……………………………………44
第六節 統計方法 …………………………………………………46

第四章 研究結果
第一節 回收問卷樣本代表性檢定………………………………49
第二節 醫師壓力量表之效度與信度……………………………50
第三節 醫師對壓力源之感知程度及趨避意向…………………54
第四節 醫師個人屬性、行為特質與壓力感知之關係…………58
第五節 醫師個人屬性、行為特質與趨避意向之關係…………67
第六節 壓力感知與趨避意向之關聯……………………………77
第七節 醫師個人屬性、行為特質對壓力感知、趨避意向之
干擾效應…………………………………………………79
第八節 醫師個人屬性、行為特質對壓力感知、趨避意向之
分析與預測………………………………………………88

第五章 討論
第一節 研究方法…………………………………………………98
第二節 醫師對壓力源之感知程度與趨避意向…………………100
第三節 醫師個人屬性、行為特質與壓力感知、趨避意向 之關係……………………………………………………104
第四節 壓力感知與趨避意向之關聯……………………………113
第五節 醫師個人屬性、行為特質對壓力感知、趨避意向關係
之干擾效應………………………………………………114
第六節 壓力感知與趨避意向模型之分析及預測………………115

第六章 結論與建議
第一節 研究結論…………………………………………………118
第二節 研究貢獻 …………………………………………………123
第三節 研究限制…………………………………………………124
第四節 未來研究之建議…………………………………………125

參考文獻
中文部分…………………………………………..…………………126
英文部分…………………………………………..…………………127

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