護理人員的職業壓力與生物性壓力指標之相關性

The correlation between occupational stress and biomarkers for nurses

蔣宜珍(Yi-Chen Chiang)

指導教授 ： 蕭淑銖

國立臺灣大學/醫學院/護理學研究所/碩士(2017年)

https://doi.org/10.6342/NTU201701181

摘要

護理工作向來被認為是高壓力(high levels of stress)的職業。持續或長期暴露於醫療環境中，可能會危害健康、倦怠感提升、工作滿意度降低，甚至出現離職行為；若能了解護理人員之壓力狀況，或許能減少上述問題之產生。除了透過填寫問卷了解主觀壓力外，目前國內外亦有研究透過不同的生物性壓力指標以了解個體客觀之壓力狀態。故研究目的是希望能了解護理人員職業壓力(主觀)及生物性壓力指標(客觀)之現況，進一步探討兩者間之相關性。
本文所使用之研究方法為立意取樣，收案對象為台北及新北地區醫學中心及區域醫院之病房護理人員，共計60 位。每位受試者皆需填寫護理職業壓力源量表(NOSS)及自覺壓力情形，並連續留取三天清晨7-8 點之尿液檢體，檢測尿液中Cortisol 及8-OHdG 之濃度。並使用JMP10 統計軟體進行分析，以描述性統計呈現個人資料變項、職業壓力及生物性壓力指標之情形，再以卡方檢定探討職業壓力及生物性壓力指標間之相關性。統計結果顯示，有一半以上之病房護理人員認為自己處於中度或中度以上之壓力狀態，且主要壓力源是以「工作負荷」為主。而基本屬性與Cortisol 及8-OHdG 之結果顯示，班別與 Cortisol 及8-OHdG 有顯著相關，但最終職業壓力與生物性壓力指標是未達統計上顯著差異。
筆者認為這可能與樣本數較少有關。另外，上述兩項生物指標之半衰期皆不長，若未於當下測得受試者之壓力則可能使結果被影響，建議未來資源足夠時，可針對護理人員進行完整上班週期之持續性研究，使個體進行工作前後或休假日與工作日之比較，會更能呈現職業壓力與生物指標之相關性，而本研究之初步結果亦可作為主管或醫院之排班參考，以減緩輪班或職業壓力對護理人員造成的負面影響。

關鍵字

護理人員 ； 職業壓力 ； 生物性壓力指標 ； Cortisol ； 8-OHdG

並列摘要

Nursing has been considered a profession with high level of stress . Nurses with longer tenure may have some impact on their health, increased burnout and intent to leave their job. However, there is not much information available on this topic.
The purpose of this research is to understand if occupational stress has any impact on some of the biomarkers of nurses. This research used purposive sampling and recruited 60 nurses participating in this study. All nurses were from medical centers and
regional hospitals in Taipei city and New Taipei city. All participants filled out the Nurse Occupational Stressor Scale, self-perceived stress level and had their urinary Cortisol, 8-OHdG level being collected at 7 AM to 8AM for three consecutive days. The JMP version 10.0 statistical software was used for data analysis. Descriptive statistics including demographic, the distribution of nurse’s occupational stress and biomarker. Chi-square test was used to identify the correlation between occupational stress and biomarker of nurses. The result indicated that nurses thought they have moderate or severe stress, and the mainly stressor is work load. And shift was significant associated
to Cortisol and 8-OHdG level. But there was no significant associated to occupational stress and biomarker.
It might have been due to the small sample size and the relatively short half-life of Cortisol and 8-OHdG in nature, no signicant correlation was found in this study. A larger scale longitudinal study to compare the biomarker level on off day and work day or before work and after work is strongly suggested if the association between occupational stress and biomarker is to be determined.

並列關鍵字

nurses ； occupational stress ； biomarker ； Cortisol ； 8-OHdG

參考文獻

吳安綺、彭台珠、彭少貞、黃寒裕、李茹萍（2008）・加護病房護理人員對職業危害的擔心程度與因應策略之探討‧志為護理，8(3)，70-80。

周秀娟、趙振瑞（2009）・慢性壓力與代謝症候群的相關性‧中華民國營養師公會全國聯合會，1(2)，1-6。

洪昭安、石芬芬、王郁茗、呂慧蘭、賴德仁（2002）‧中部某醫學中心護理人員的人格特質與壓力感受之探討‧中山醫學雜誌，13(2)，189-196。

張敏琪、薛夙君、周雨青、陳永煌、楊燦（2010）‧吸菸對體內總抗氧化能力(Total antioxidant capacity, TAC)及氧化壓力指標8-hydroxydeoxyguanosine(8-OHdG)之影響‧中華職業醫學雜誌，17(3)，181-192。

陳姿伶（2009）．不同部門護理人員工作壓力之生理指標研究（碩士論文）．取自臺灣博碩士論文系統。