夜班輪班工作之身心健康影響：護理人員訪談及國際規範比較之研究

Health impacts of shift work and night work: An International comparison of regulations and an interview study of nurses in Taiwan

李佳旃(Chia-Chan Lee)

指導教授 ： 鄭雅文

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2016年)

https://doi.org/10.6342/NTU201600265

摘要

背景與目的：流行病學文獻指出，夜班輪班工作型態對工作者身心健康造成負面影響，包括睡眠障礙、代謝疾病、心血管疾病、憂鬱症狀等。在台灣，勞動部於2014年起將原本屬責任制工時的護理人員全面回歸正常工時，但醫護工作者仍舊工時偏長，致使近年來過勞爭議不斷。如何使醫護工作者在夜班輪班工作型態之下，能維持充分休息並確保身心健康，為政府職業安全健康部門的關注重點。本研究首先比較國際有關夜班輪班工作之相關規範，接著探討醫院護理人員的夜班輪班型態、醫院相關管理制度、夜班輪班可能引發的身心健康問題，以及護理人員對醫院制度與政府政策的看法。

方法：本研究採文獻回顧與半結構式訪談。在訪談研究方面，訪談對象界定為年資一年或以上之女性，於台北市及新北市之醫學中心或區域醫院內科部或外科部擔任臨床護理人員，但排除懷孕及產後一年以內之工作者。研究期間為2015年11月至2015年12月，訪談對象共計23位。

研究結果：參考國際法規經驗，可發現西方國家對於夜班者工時規範較台灣目前法規完善。訪談結果發現，護理人員違反勞基法工時相關規定的問題仍普遍，但不少護理人員囿於勞雇關係而選擇隱忍不舉發，亦有不少護理人員並不清楚自己權益受損。

結論與建議：勞動與健康主管機關應重視夜班輪班對工作者帶來的安全健康危害。具體的策略包括，修訂法規並發行相關指引，提供護理人員適應時差之輪班方法，舉辦教育課程提升護理人員勞動權益意識，加強勞動檢查並提高罰則，以確實落實規範，保障工作者的職業安全健康權益。

關鍵字

夜班輪班 ； 護理人員 ； 身心健康 ； 政策 ； 國際比較

並列摘要

Background and objective: Existing epidemiologic evidences show that shift work and night work are associated with increased health risks, including sleep disorders, metabolic diseases, cardiovascular or cerebrovascular diseases and depression. In Taiwan, long working hours and shift work are common among health care workers. In this occupational group, diseases associated with overwork problems have been a public health issue. The labor authority of Taiwan has taken measures to regulate working hours in attempt to safeguard occupational health of health care workers. Since January 1 of 2014, nurses are no longer exempted from working hour regulations of the Labor Standard Act. This study was conducted to compare with international regulations of shift work and night work, and to explore the patterns of shift work and night work status as well as hospital management concerning shift work and night work among nurses working in hospitals of Taipei City and New Taipei. Nurses’ perceived health impacts associated with night work and shift work and their attitudes toward organizational policies and governmental policies were examined.
Methods: Literature review and in-depth interviews were conducted. In interview study, study subjects were female nurses in hospitals of the Taipei city or New Taipei city, with work tenure of 1 year or longer. Those who were pregnant or had given birth within a year were excluded. A total of 23 nurses were interviewed during the study period from November 2015 to December 2016.
Results: Comparions with international regulations indicated that regulations on shift work and night work of Western countries are more comprehensive as compared to that of Taiwan. Results from interviews with nurses suggested that violations of the Labor Standards Law were commonplace, but many nurses chose to tolerate unlawful practices due to unbalance labor relation. Several nurses did not even know their rights had been infringed.
Conclusion and recommendation: Labor authority should pay attention to the safety and health risks with night work and shift work. We suggest that regulations should be revised and guidelines should be promulgated to help workers to better adapt to night and shift work. In addition, labor right and occupational health education should be provided, and labor inspection should be forcefully implemented with sufficient level of punishment to truly safeguard the labor and health rights of working people in Taiwan.

並列關鍵字

night work and shift work ； nurses ； physical and mental health ； policy ； international comparison

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