護理人員輪班與飲食型態之相關性研究

研究目的：飲食與營養為人類生存及維持人體健康之必要條件。對於臨床護理人員而言，由於需連續性地提供病人照護與護理專業，使得輪班工作為不可避免之工作型態。據過去研究指出，輪班工作可能妨礙工作者的飲食健康，本研究旨在瞭解護理人員輪班型態與其飲食型態之相關性，包含其上班日與放假日、不同班別護理人員，其攝取熱量和主要營養素、蔬果攝取量、進食餐次及可能影響其飲食型態之相關因子。研究方法：本研究採取立意取樣及方便取樣之方式，透過24小時飲食回憶紀錄（包含兩天上班日及兩天工作日），收集全台北中南東部之醫學中心、區域醫院及地區醫院共33家醫院中129位護理人員，以瞭解不同輪班型態之護理人員飲食型態。資料分析以JMP10.0統計軟體進行，以paired t test及Wilcoxon signed-rank比較整體護理人員上班及放假日、one-way ANOVA及Tukey-Kramer 事後檢定比較不同班別護理人員，其熱量及營養素分布、蔬果攝取量、進食餐次及攝取量多寡原因，並以卡方檢定比較不同班別護理人員其熱量及營養素於標準範圍比率之分布。研究結果：本研究回收有效飲食紀錄共120人份，包含固定白班者25位、固定小夜班者19位、固定大夜班者18位及輪班者58位。研究結果顯示，整體護理人員於放假日攝取之熱量、蛋白質及飽和脂肪占總熱量比率皆顯著高於上班日。而整體研究對象攝取脂質和飽和脂肪過量比率不論上班日（脂質71.7%、飽和脂肪63.3%）或放假日（脂質76.7%、飽和脂肪75.0%）皆超過六成，而蔬果攝取比率則超過八成。另針對不同班別進行探討，結果顯示於上班日時，固定小夜班者相較其他班別，熱量攝取於標準範圍比率（47.4%）和平均正餐進食餐次（一天少於兩餐）皆為最少。若探討研究對象自評上班日攝取量過少原因以「工作忙碌沒時間進食」為眾；而自評攝取量過多原因則以「聚餐」為眾。結論與建議：以120位護理人員，探討其營養攝取發現，整體脂肪及飽和脂肪攝取過量比率超過六成，且蔬果攝取不足比率超過八成，就此建議主管單位可針對護理人員飲食健康進行再教育，加強護理人員對於其營養攝取標準之認知及重視，並於工作場所提供更完善之健康飲食環境。針對固定小夜班者於上班日時，其攝取熱量於標準範圍比率及正餐進食餐次較其他班別為低，且以「工作忙碌沒時間進食」為主因，探討可能由於上夜班時護理人力減少、護病比增加，以致工作忙碌程度增加，建議主管單位在人力及工作分配（如護理人員從事接新病人、環境介紹及相關行政業務工作等）上，可在三個班別中進行更恰當分配，以減少特定班別之工作負荷。本研究探討護理人員不同班別、上班日及放假日其營養攝取及可能影響其飲食型態之相關因子。然我國當前尚未明文訂定醫護人員飲食健康保障之相關條文，而多數醫療機構亦缺乏對醫護人員飲食健康等議題之重視，期透過本研究之探討，將來能引起醫護領導者們對於飲食健康之關心及重視，也作為未來促進護理人員飲食健康政策發展的依據。

關鍵字

護理人員；飲食型態；輪班； 24小時飲食回憶紀錄；上班日與放假日

並列摘要

Objective: Dietary intake is essential for health. To provide around-the-clock patient care services, shift work is unavoidable for hospital nurses. According to previous literatures, shift work is barrier for nurses’ healthy eating behaviors. The purpose of this study is to understand the association between shift work and nurses’ eating behaviors. Methods: By employing convenience sampling, we recruited 129 registered nurses (RNs) from 33 hospitals (including medical centers, regional hospitals and regional hospitals) in different areas of Taiwan. The 24-hour dietary recall (i.e., 2 days for workdays and 2 days for non-working days) was used to collect RNs’ eating behaviors. Data analysis was performed using JMP10.0 statistical software. We employed one-way ANOVA and Tukey-Kramer post-hoc test to compare the differences in calories and nutrients distribution, fruit and vegetable intake, meal frequency, and the factors influencing diet across nurses working on different shift patterns. In addition, we used paired t test and Wilcoxon signed-rank test to understand the differences in nurses’ eating behaviors on workdays and non-working days. Result: A total of 120 RNs (i.e., 25 day-shift workers, 19 evening-shift workers, 18 night-shift workers, and 58 rotating-shift workers) were eligible for final data analysis. On non-working days, the intake of nutrients (i.e., calories, protein, fat, saturated fat, and sodium) of RNs were significantly higher than workdays. Relative to workdays, the proportion of protein and saturated fat consumption was significantly higher on non-working days. On workdays, more RNs’ calorie consumption was lower than dietary recommendations (28.3%). Regard the workdays and nonworking days, more than 60% of RNs consume fat and saturated fat higher than the recommendations, and more than 80% of RNs consume fruit and vegetable less than the recommendations. Compared to workers working on different shifts, evening shifts workers had the lowest percentage (47.3%) of adequate calories consumption on workdays. On average, evening shifts workers consumed less than 2 meals per day. When further examining the possible reasons for insufficient intake on working days, "the work was busy and there was no time to eat" accounted the most. In contrast, the most common reason for the excessive intake was related to “social activity”. Conclusions and recommendations: Through the study results, there were more than 60% of RNs consumed fat and saturated fat higher than the recommendations, and more than 80% of RNs consumed fruit and vegetable less than the recommendations. It’s recommended that the administrators could promote nurses’ healthy eating behaviors by holding training or providing multiple choices of healthy diet, to strengthen their attention to their diet. Compared to other shift workers, evening shifts workers’ had the lowest percentage of adequate calories intake and meal frequency. It’s recommended that the administrators could distribute appropriate job responsibilities between different types of shift workers due to nurses were reduced and the nursing care ratio was increased on evening and night shifts. Through the study, we anticipate recommendations can be provided to policy makers for future strategies to improve nurses’ eating behaviors.

並列關鍵字

nurse ； eating behaviors ； shift work ； 24-hours dietary recall ； workday and non-working day

參考文獻

Pan, A., Schernhammer, E. S., Sun, Q., & Hu, F. B. (2011). Rotating night shift work and risk of type 2 diabetes: Two prospective cohort studies in women. PLoS Medicine, 8(12), e1001141. doi: 10.1371/journal.pmed.1001141

Reinke, L., Ozbay, Y., Dieperink, W., & Tulleken, J. E. (2015). The effect of chronotype on sleepiness, fatigue, and psychomotor vigilance of ICU nurses during the night shift. Intensive Care Medicine, 41(4), 657-666. doi: 10.1007/s00134-015-3667-7

中華民國營養師公會全國聯合會（2018）．簡易營養量計算表（107.09更新）． Retrieved from http://www.dietitians.org.tw/download