探討手術室護理人員肌肉骨骼傷害、工作危險因素及自我保護行為之關係

中文摘要本研究目的在瞭解手術室護理人員肌肉骨骼傷害的嚴重程度、工作危險因素及自我保護行為的情形，並進一步探討肌肉骨骼傷害的預測因子。研究採橫斷式描述性相關性研究設計，採立意取樣，利用結構式問卷調查台南市及高雄市各一家醫學中心在手術室及麻醉科工作的護理人員，共發出問卷272份，回收有效問卷253份，回收率為93.0%。排除問卷填寫不完整及從事護理工作前，即有肌肉骨骼問題至今未痊癒者共35人，總收案人數218人。調查所得資料以SPSS 17.0 版套裝統計軟體進行描述統計、卡方檢定、雙樣本t檢定及Pearson相關係數分析，檢定手術室護理人員基本屬性、工作危險因素、站立時間及自我保護行為與肌肉骨骼傷害嚴重程度之相關性，並探討肌肉骨骼傷害嚴重程度的預測因子。本研究發現手術室護理人員有肌肉骨骼傷害者佔83.9%，最常發生部位依次為下背或腰部（58.3%）、肩部（45.9%）及頸部（43.1%）。研究結果顯示不同年齡、性別、工作年資、現職年資、脊椎疾病病史、進階層級者在肌肉骨骼傷害嚴重程度上有顯著差異。工作危險因素與肌肉骨骼傷害嚴重程度呈顯著正相關，站立時間與肌肉骨骼傷害嚴重程度未達統計顯著相關，自我保護行為與肌肉骨骼傷害無顯著相關，但是自我保護行為與工作危險因素呈顯著的負相關。本研究發現工作危險因素、年齡及過去病史，可以解釋肌肉骨骼傷害嚴重程度21.3%的變異量。本研究發現手術室護理人員肌肉骨骼傷害比例較高，且每週工作時間及站立時間皆長，顯示手術室護理人員的肌肉骨骼傷害及工作負荷值得關注。建議工作機構應監督護理人員每日的工作負荷，避免因為人力不足導致站立時間或每週工作時數增長；建立輪替的工作習慣，如輪流擔任流動或刷手職務、制定站立時間限制等，以減輕手術室護理人員的工作負荷。肌肉骨骼傷害嚴重程度隨年齡、工作年資及手術室年資增加而嚴重。因此對年齡較長及工作年資較深者，除注意避免工作危險因素和加強自我保護行為外，可安排肌肉骨骼害嚴重者輪調至不需長期站立的科別，並於工作中獲得適當的休息時間，以減輕肌肉骨骼的累積性傷害。根據本研究結果提出下列建議：在護理科系課程宜安排認識工作危險因素及自我保護的授課單元，使其在未進入職場前即具備防護或因應措施的知能；另外建議醫院於護理人員的在職訓練上，安排預防肌肉骨骼傷害的主題，使護理人員具備預防肌肉骨骼傷害的知識技能，並購置足夠的人因工程設備給手室術人員使用，如滑板、高腳椅等，以避免長期工作導致的累積性傷害。

關鍵字

肌肉骨骼傷害；作危險因素；自我保護行為

並列摘要

Abstract The purpose of this study is to investigate the relationship between musculoskeletal disorders (MSDs), job risk factors, and self-protective behaviors in operating room nurses. This study used a cross-sectional descriptive correlation design with the purposive sampling method. Structure self-report questionnaires were used in this study to survey operation room nurses and anesthetists from two southern medical centers in Tainan and Kaohsiung County. A total of 272 questionnaires were distributed to operating room nurses, and 252 questionnaires were returned. The response rate was 93.0%. Statistical analyses were performed using SPSS version17. Data was analyzed by descriptive statistics, chi-square tests, t tests and Pearson’s correlation. Approximately 84% of the operation room nurses and anesthetists had reported MSDs in last year. The most frequently reporting MSDs at body regions were low back (58.3%), shoulder (45.9%), and neck (43.1%). Significant correlations were found between age, gender, spinal disease history, clinical years of experience, duration of operation room employment, level of clinical ladder and the severity of MSDs (p <.05). Job risk factors and the severity of MSDs was significantly correlated. However, there was no significant correlation between standing times per day, self-protective behaviors and the severity of MSDs. There was a significant negative correlation between self-protective behaviors and job risk factors. Furthermore, job risk factor, age and spinal disease history were the predictors of the severity of MSDs. They had accounted 21.3% of total variance. This study has identified a higher prevalence rate of MSDs in operation room nurses, and a higher weekly work hours and longer standing hours per day compared to previous nurses’ studies. It should be concerned about the MSDs and workload in operation room nurses. We recommend monitoring nurses’ daily workload in organization; ensuring adequate staffing to maintain reasonable weekly work hours and standing time per day, or to rotate job duties such as a circulating or scrub nurse, or to limit standing times per shift. This study suggests that the severity of MSDs increase with age, clinical years of experience, and duration of operation room employment respectively. The senior nurses who suffered severe MSDs may be arranged to less prolonged standing positions, or noticed for taking a break during the work to reduce their musculoskeletal disorders. We recommended nursing students receiving classes about job risk factors and self-protective behaviors, to develop better coping strategies for musculoskeletal problems. In order to enhance the levels of knowledge and skill of nurses, conducting continuing education programs about the preventing MSDs is suggested. Preparing an adequate number of ergonomic instruments such as roller board, a standing support stool or standing aid in operating rooms to reduce personnel’s cumulative musculoskeletal disorders are recommended.