女性護理人員工作型態與身心健康之相關性研究

本研究以高雄(縣市)護理人員為研究對象，進行兩次問卷調查，探討女性護理人員輪班與睡眠品質、身心健康以及工作壓力之相關性。另外，立意選取兩家高雄市醫院，探討護理人員輪班工作與氧化傷害的關係，以8-OHdG為氧化傷害指標。 (第一部分)研究目的: 探討護理員工作時間型態與睡眠品質、身心健康之相關性。研究方法: 利用問卷調查，共有1360位高雄縣市護理人員參與，其中769位參與輪班，其中有407位輪班者完成第二次的問卷調查。研究結果:輪值三班的護理人員有最差的睡眠品質分數(PSQI: 9.04)與自覺身心健康分數(CHQ-12: 5.07)。輪班比白天班工作者發生睡眠品質不良(PSQI>5) 以及身心健康問題(CHQ-12≥4)的危險比分別為2.26 (95%CI: 1.57-3.28)與1.91 (95%CI: 1.39-2.63)。輪班工作者，其排班方式在大夜班後休息至少兩天比一天者，其睡眠品質與身心健康均有改善，PSQI 與CHQ-12分數分別下降1.23與0.86，而兩次的問卷調查，結果發現大夜班工作頻率增加則惡化睡眠品質。 (第二部分)研究目的:探討護理人員工作時間型態與工作壓力的關係。研究方法:利用第一次回覆的1486護理人員進行第二次問卷調查，共有654位護理人員參與，其工作壓力以付出回饋失衡進行評估。研究結果: 輪值三班比白天/不輪值大夜班這組護理人員有較高的付出回饋失衡與過度付出的危險比，調整干擾因素後，輪值三班比白天/不輪值大夜班的護理人員產生的過度付出危險比為2.16 (95%CI: 1.03-4.66)。在輪班護理人員這個族群中，當輪方式安排在大夜班後至少休息2天者，其PSQI與CHQ-12分數均改善，且工作過度投入的危險比也顯著比休息1天者來得低，OR: 0.52(95%CI: 0.32- 0.82)。輪班的安排上，排班的自主性高比自主性低者產生付出回饋失衡的危險比為4.0(95%CI: 2.25- 7.25)。 (第三部分)研究目的:探討輪班者工作前後與氧化傷害濃度改變的關係。研究方法:共有51為兩家醫院輪班護理人員參與，分別在白天班工作前與後以及大夜班工作前與後進行尿液蒐集，進行8-OHdG檢測。研究結果:發現白天班的工作後比工作前，8-OHdG增加2.14ng/mgGr。整個輪班週期最後一天比第一天的8-OHdG增加2.16ng/mgGr。

關鍵字

輪班工作；護理人員；睡眠品質；身心健康；工作壓力；氧化傷害

並列摘要

(PART I) Purpose To investigate the effects of shift work schedules on sleep quality and mental health in female nurses in south Taiwan. Methods This study recruited 1,360 female registered nurses in the Kaohsiung area for the first survey and among them, 769 nurses had a rotation shift schedule. Among the 769 rotation shift work nurses, 407 completed another second survey 6-10 months later. Data collection included demographic variables, work statuses, shift work schedule, sleep quality (Pittsburgh Sleep Quality Index) and mental health (Chinese Health Questionnaire-12). Results Nurses on rotation shift had the poor sleep quality and mental health compared to nurses on day work. The nurses on rotation shift had a relatively higher OR of reporting poor sleep quality and poor mental health (OR 2.26, 95%CI 1.57-3.28; OR 1.91, 95%CI 1.39-2.63 respectively). Additionally, rotation shift nurses who had ≥2 days off after their most recent night shifts showed significantly improved sleep quality and mental health (PSQI decreased of 1.23, CHQ-12 decreased of 0.86 respectively). Comparison of sleep quality between the first and second survey showed aggravated sleep quality only in nurses who had an increased frequency of night shifts. Conclusion Female nurses who have a rotation shift work schedule tend to experience poor sleep quality and mental health, but their sleep quality and mental health improve if they have ≥2 days off after their most recent night shifts. These empirical information are useful for optimizing work schedules for nurses. (PART II) Purpose To investigate whether rotation shift work increases occupational stress in female nurses in southern Taiwan. Methods The study population was 1,486 female nurses, aged, 20-45 years, and registered in Kaohsiung metropolitan area. Of them, 654 returned completed questionnaires, whose contents were analyzed in 2006. Work stress was evaluated by using the Effort-Reward Imbalance model. Results Overcommitment risk was higher in nurses who worked rotation shifts than in those who worked day/non-night shifts (OR, 2.16; 95% CI, 1.03–4.66). However, an effort/reward imbalance was not directly associated with work schedules (OR, 1.88; 95% CI, 0.87–4.35). Among nurses working rotation shifts, those who had 2 days off after their most recent night shifts showed an alleviated risk of overcommitment (OR, 0.52; 95% CI, 0.32–0.82), but those who had worked for at least one series of 7 consecutive work days per month during the preceding 2 months had an increased risk of effort/reward imbalance (OR, 2.75; 95% CI, 1.69–4.48). Additionally, those who had little or no participation in planning working hours and shift scheduling and worked overtime at least three times per week during the preceding 2 months tended to have high stress. Conclusions Female nurses who worked rotation shifts tended to experience work-related stress, but their stress levels improved if they had at least 2 days off after their most recent night shift and if they were not scheduled to work 7 consecutive days. These empirical data can be used to optimize work schedules for nurses to alleviate work stress. (Part III) Purpose Oxidative stress was an imbalance on oxidant and antioxidant in physical under stress. Therefore, we investigate the change of concentration of 8-hydroxy-2’-deoxyguanosine(8-OHdG) at different work time among shift work nurses. Methods A total of 51 nurses with regulated rotation shift in medical center or district hospital. Urinary concentrations of 8-OHdG, a biomarker of oxidative DNA damage, were measured. For urine samples collected from subjects in the 4 or 6 time points, the criteria of shift schedule were in keeping with the forward, continues 5-6 working days and at least 2 day and night shifts in a shift course. The samples collected were on the before work and after to work at the last day shift and last night shift in a course. Results The urinary concentrations of 8-OHdG at after to work was significantly higher than at before work on the last of day shift, but no significant difference on the concentrations of 8-OHdG between at after to and before work on the last night shift. Further, we also found that the concentration of 8-OHdG was significantly increased from the before work at beginning shift work day to after to work at last shift work day. Conclusions We found the amount of change of concentration of 8-OHdG was more increased at a day shift work than a night shift work, even night shift was as a risk to stress from desynchronized between circadian rhythm and environment. The amount of change of concentration of 8-OHdG responded to the workload among shift work nurses.

並列關鍵字

shift work ； nurses ； sleep quality ； mental health ； work stress ； oxidative stress

參考文獻

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