健康促進對換班式輪班護理人員營養相關因子之影響

The effect of the health promotion on nutrition-related factors of hosptial rotating shift care staff

詹益瑞(Yi-Jui Chan)

指導教授 ： 劉凱莉

中山醫學大學/健康管理學院/營養學系碩士班/碩士(2017年)

摘要

前言：醫療院所為提供24小時照護住院之病人之人力，護理人員有半數以上須投入輪班工作(shift work)。研究發現，輪班護理人員，因不規則的日夜工作時間，常有睡眠障礙、飲食及進餐時間改變等問題，造成生活習慣改變、生理不適應、家庭與社交行為的干擾以及生活上適應不佳等問題。因此，研究發現，換班式輪班之護理人員易罹患消化道、心血管及代謝性疾病。
本研究目的：1、探討換班式輪班之護理人員的飲食攝取狀況。2.探討換班式輪班之護理人員接受營養師提供的健康促進課程指導後，對營養知識、態度與行為之影響。3.探討護理人員輪值大夜班前後之生化值與理學檢查變化。
材料與方法：本研究期間為2014年7月~2014年12月，共有48位受試者。受試者來源為中部某醫學中心，收案條件須符合年齡20~50歲換班式輪班之護理人員。排除固定大、小夜班或只上白班之護理人員、已停經者及確診糖尿病、肝腎疾病、心血管疾病，且接受藥物治療者受試者在進入研究前一個月需為白班或小夜班，研究進行時則改為輪值大夜班。以實體或光碟上課方式，在大夜班輪值期間給予受試者每週1次健康促進課程介入，為期4週，並於輪值大夜班前後進行「基本資料」、「營養認知、態度與行為問卷」、「飲食頻率問卷」及生化與理學檢查之前後測檢驗。
結果與結論：由「營養認知、態度與行為問卷」前後測驗分數可知，無論接受實體課程或觀看預錄課程光碟的受試者，在接受健康促進課程後，皆可顯著提升問卷答對率，尤其是選擇題部分。值得注意的是，雖然前測結果沒有差別，接受實體上課的受試者其後測問卷選擇題答對率顯住高於觀看預錄課程光碟的受試者。此結果表示給予班式輪班之護理人員與營養相關的健康促進課程，對其營養認知、態度與行為改善有幫助，且此改善成效，營養師實體上課的授課方式優於觀看預錄課程光碟的授課方式。由態度與行為分析結果可知，調查中得分最低的三項為，受試者外食機率高，且自覺飲食不健康及需要飲食控制，且前後測結果並無顯著差異，其對換班式輪班之護理人員健康維護之影響，值得進一步探討。在生化與理學檢測結果發現，BMI>24受試者前測之HDL、TG、收縮壓、舒張壓脂異常比率顯著高於BMI≦24受試者；後測之HDL異常比率顯著高於BMI≦24受試者。由此結果可知相較於正常體位，過重或肥胖增加血糖、血脂、血壓異常的風險。本研究希望提供未來健康促進相關政策擬訂規畫及推行，給予營養師給予輪班護理人員營養相關課程教授，有助於修正輪班護理人員營養認知、態度與行為，期有助於能維護輪班護理人員之健康。

關鍵字

換班式輪班護理人員 ； 健康促進 ； 飲食頻率問卷 ； 營養認知態度與行為問卷

並列摘要

Objectives: Most physicians and nursing staff are contractd through shift work in order to provide 24 hours care for hospitalized patients in medical institutions. Studies show that staff working on shift, due to irregular working hours, commonly develop sleep disorders, poor physiological adaptation, and eating and mealtime problems. These result in changes to the individual’s lifestyle, physiological cycle, social behavior and level of resilience. Shift work may induce physical and mental adverse health effects, such as digestive problem, metabolic disease, and cardiovascular disease, etc. This study aims to: 1.Investigate medical staff food intake conditions during night shifts. 2. Explore the influence a health promotion course has on the medical staff’s nutrition knowledge, attitude and behavior. 3. Inspect the staff’s physiological and metabolic changes before and after working a night shift.
Methods: In this study 48 candidates are recruited from one medical center in Taichung. The subjects of this study are physicians and nursing staff, aged 20 to 50, employed through shift work. Inidivuals were excluded from the study if they had any of the following conditions: they were working fixed night or day shifts, they had menopause, they were from the Internal Medicine Ward which does not offer shift work, they were diagnosed with diabetes, liver and kidney problems, cardiovascular disease or they were undergoing medication therapy. This study takes place from July 2014 to December 2014. The self-structured questionnaire consists of “Basic information”, “Nutrition Cognition, Attitude and Behavior Survey” and “Dietary intake frequency”. This study also uses biochemical data (TC, TG, HDL, Creatinine, BS, HbA1c, GOT) and a physical examination (BMI, waist circumference) as research tools. Before entering the study all candidates work fixed day or middle shifts for one month. All candidates then change to night shift work. A health promotion course was given to all candidates once a week for 4 weeks. The survey and biochemical test were performed on candidates before and after working their night shift.
Conclusions: After receiving the health promotion course, candidates show progress on nutrition awareness and an increase in motivation to their enhance self-control diet, but the effect of nutrition knowledge and food intake frequency is not significant, candidates still subject to the original diet preferences. By analyzing the “Nutrition Cognition, Attitude and Behavior” survey, statistics show that staff frequently eat out, they are aware they have unhealthy eating habits and there is a need for diet control. These three areas scored the lowest among all three surveys. Although there is significant difference shown in the pre- and post-treatment, it still requires further assessment. Candidates who received health promotion courses show lower blood pressure in the post-treatment compared to pre-treatment. Candidates are divided into two groups according to their BMI, the biochemical results in the pre-treatment shows that candidates with a BMI > 24 have higher BS and TG levels and lower HDL compared with candidates who have a BMI≦24. While in post-treatment, candidates with BMI>24, have high HbA1C, TG and lower HDL compared with candidates who have a BMI≦24. It should also be noted that candidates with a BMI>24, also have HDL, TG, diastolic and systolic blood pressure, and lipid rates that are significantly higher in abnormalities than candidates with BMI≦24 in the pre-treatment. In post-treatment, candidates with a BMI>24 have higher HDL abnormality rates than candidates with BMI≦24. There is a higher risk of obesity, high blood sugar, hyperlipidemia and hypertension for this higher value BMI group. The results of this study provide evidence for policies to develop health promotion plans and supports swift implementation in the future in order to maintain the health of night shift staff.

並列關鍵字

Shift work ； Health promotion ； Nutrition Cognition ； Attitude and Behavior Survey ； Diet frequency Survey

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