急重症單位護理人員頭痛之生活經驗與影響

背景：頭痛是現代文明病之一，現今有許多身處高壓工作環境的臨床護理人員深受頭痛所擾，而原發性頭痛之中，其偏頭痛又好發於女性，由於偏頭痛發作時可能會持續4-72小時，不僅會影響工作效率，同時也影響其生活品質。回顧文獻，現階段國內外在患有頭痛護理人員各單位發生率相關文獻略顯不足，亦未有針對急重症單位患有頭痛的護理人員現況調查，現階段也無針其頭痛造成工作及生活中的妨礙與影響做訪談。有鑒於此，本研究調查台灣某一所醫學中心急重症單位護理人員頭痛之現況。目的：（1）調查台灣北部一所醫學中心護理人員偏頭痛的盛行率，並比較有無頭痛的護理人員其生活品質之差異；（2）有頭痛的護理人員中，偏頭痛與其他頭痛族群的失能程度和生活品質之差異；（3）了解患有偏頭痛的護理人員其偏頭痛造成工作及生活中的妨礙與影響。方法：本研究在第一階段採橫斷式研究設計（cross-sectional study），以普查方式邀請台灣北部一所醫學中心所有急重症單位的護理人員參與此研究調查，邀請16個急重症單位護理人員填寫問卷（N = 405），若有頭痛者填寫自擬問卷基本資料表及頭痛相關資料、偏頭痛失能性評估表（MIDAS）、偏頭痛特定族群生活品質問卷量表（MSQ v2.1）、SF-12健康生活品質量表，無頭痛者則只需填寫基本資料及SF-12健康生活品質量表。研究第二階段則依照失能程度（MIDAS）及疼痛程度（NRS）分為九區塊，利用半結構式訪談大綱，篩選具有頭痛的護理人員並符合收案條件者做訪談。研究資料以百分比、平均值、標準差、獨立樣本t檢定（independent sample t-test）、卡方檢定、ANOVA、Colaizzi質性資料分析法作分析。結果：急重症單位護理人員頭痛盛行率43%，偏頭痛的盛行率25%，除了有頭痛者與無頭痛者比，SF-12生活品質量表在生理層面的分數較低之外，在有頭痛者族群中有偏頭痛者在SF-12、MSQ v2.1的分數表現又比其他頭痛者更低。依訪談結果歸納，控制不確定性為最主要的現象，其三大範疇為：與不確定性共存、徘徊不去的干擾及視情況處理疼痛。除了情緒、日常生活及工作受干擾，因頭痛發生時機不明確，而對該疾病產生不確定感。結論：不確定性可以說是頭痛發生時的主要特性。急重症單位護理人員頭痛盛行率高，頭痛對生活造成的影響甚多，建議臨床的護理人員能主動就醫確診，醫療院所設置相關課程之外，也給予同仁在頭痛發作時能夠有彈性休息時間，希望能夠藉由本文令人理解護理人員頭痛的問題，讓頭痛不再是個被忽略的疾病。

關鍵字

頭痛；偏頭痛；護理人員；急重症單位；盛行率；生活品質

並列摘要

Background: Headaches are one of the lifestyle diseases of this generation. Headaches not only affect work efficiency but also life quality. Nurses working in critical care units are more likely suffering from headache because of the high pressure. Literature on the incidence of migraine amongst nurses is inadequate, and there have not been any surveys on the experience and impact of headaches which focus on critical care units. This study aims to investigate the status of headaches at a medical center in northern Taiwan. Purpose: (1) To investigate the prevalence of migraine headaches in the critical care units at one of the medical center hospitals in Taiwan. (2) Knowing the experiences of headache among nurses could guide future research and policy to improve nurses’ well-being, care quality, and patient safety. The study aims to explore the life experiences and impacts of headaches among nurses working in critical care units. Methods: The first stage is a cross-sectional study from 16 critical care units at a medical center in northern Taiwan. Four kinds of questionnaires to headaches: personal information and migraine-related information, migraine disability assessment (MIDAS), migraine specific quality of life questionnaire version 2.1 (MSQ v2.1) and 12-Item Short Form Health Survey (SF-12). Two kinds for do not suffer headaches: personal information and 12-Item Short Form Health Survey (SF-12). The second stage is qualitative study, In-depth interviews were conducted with a purposive sample of 30 female nurses with headaches by the different condition of pain intensity and disability status to maximize the information richness. Participants were screened from 16 critical care units at a medical center in Taiwan between January and July, 2017. The quantitative data were analyzed by percentage, mean value, standard deviation, independent sample t-test, chi-square tests, ANOVA and qualitative data were analyzed by the Colaizzi phenomenological approach. Result: The headache prevalence rate of nurses is high in critical care units and, compared with the control group of nurses who do not suffer headaches, the SF-12 quality of life scales in the physical component summary are low and reveal a decline in quality of life. “Controlling the uncertainty” was revealed an essential phenomenon with three categories emerged: “Living with the uncertainty,” “Staying with the lingering interference,” and “Managing the pain depending on the situation.” Headaches negatively impact the lives of sufferers in areas such as working efficiency, interfering with the concentration, and impairing the memory, Headache also affects the emotions and interaction with people. The disturbance of headache may decrease the quality of nursing care and even damage the patient safety. When headache attack intensively, nurses usually manage their pain actively by taking over-the-counter medicine to minimize the impacts on work and patient safety.which are also disturbed by the uncertainty of when the malady will strike. Conclusion: Uncertainty could be an essential characteristic of headache attack. Nurses with headaches are recommended to seek medical advice; medical institutions can set up courses on headaches, and also give nursing staff flexible break times when headaches attack. The current study discovered the impact of headaches upon nurses working in critical care units and hopes to help make headaches a no longer neglected disease.