不同輪班方式對護理人員疲勞及認知功能之影響

The effect of different shift schedule on fatigue and cognitive performance in hospital nurses

林峰正(Feng-Cheng Lin)

指導教授 ： 何啟功

高雄醫學大學/健康科學院/職業安全衛生研究所/碩士(2008年)

摘要

目的
輪班工作在護理人員是常見的工作型態，過去研究也發現夜班工作會影響護理人員之生理時鐘並導致睡眠不足，進一步影響其工作表現，若能找出影響生理及心理較少之輪班方式，相信對須輪值夜班工作行業之人員是非常重要的。
額葉是人類大腦演化過程中最新發展的區域，它佔了大腦皮質約三分之一的範圍，人類很多的智能與行為都和額葉密切相關，尤其是高級執行功能。再者，事件性關聯電位是目前廣為大家所應用之偵測高級腦皮質功能的檢查方式之一，將能了解人類進行思考之過程及受激發之大腦皮質的部位，找出其相關性，並可藉此評估大腦功能。希望藉此研究了解生理時鐘干擾所引起額葉功能以及神經生理功能的變化，分析不同輪班方式的影響，進而選擇對護理人員最佳的排班方式，以提升工作表現及滿意度。

方法
本研究以不同輪班方式的護理人員，來探討輪班方式所導致生理時鐘干擾對護理人員認知功能及神經生理現象之影響，實驗設計為實驗性交叉研究設計，輪班方式為快速輪班、緩慢輪班以及固定大夜班，受測者在一週白班與三次輪班後接受評估（共接受4次評估），研究對象為高雄市某醫學中心臨床護理人員，收取24名符合收案條件之護理人員。採用的研究工具包含主觀與客觀評估，主觀部分採用倦怠嚴重度量表，客觀部分為額葉功能神經心理測驗檢查及事件性關聯誘發電位。本研究將使用這兩部分研究工具評估護理人員在各種不同輪班方式後的倦怠感與認知功能。

結果
共有21名年紀小於40歲的護理人員完成4次額葉神經心理測驗的評估，16名護理人員完成4次倦怠量表與誘發電位的檢查。結果顯示在倦怠量表平均分數方面，護理人員在一週白班與3種不同輪班方式後的倦怠感並沒有顯著差異。在事件誘發電位評估方面，護理人員在4次的檢查結果（包括震幅與潛時）並沒有顯著差異。在額葉神經心裡學檢查方面，包括注意力、視覺建構、記憶力、動作計畫、高階執行功能等，4次的檢查結果並沒有顯著的差異。

結論
護理人員在以月為單位的輪班工作中，經過一個月的快速輪班、緩慢輪班或是固定大夜班，其倦怠程度與認知功能並沒有顯著的差異。

關鍵字

生理時鐘 ； 輪班工作 ； 倦怠 ； 額葉功能 ； 誘發電位

並列摘要

Objective
Night duty rotation is the common practice in nursing. Disturbed circadian rhythm, insufficient restorative daytime sleep and inadequate recovery time from night work may lead to sleep deprivation that affects the ability of nurses to provide the high standard of care to their patient. Although nursing and occupational health are acknowledged in the literature, there is little focus on the relationship between different rotating schedule and cognitive performance.
The frontal lobes play a critical role in human cognition and behavior. Functionally, it serves executive function. Executive function includes attention, judgment, estimation, and planning motor program. It is accepted that the event-related potentials (ERP, P300) are related with cognitive function. P300 is also related to the utilization of information in planning future action.

Methods
The study design is experimental cross-over design. Twenty four nurses in a medical center hospital in Kaohsiung City were enrolled in this study. The participants would complete 3 different shift work schedules, consisting of rapid-rotating, slow-rotating and fixed night course. The fatigue severity scale (FSS), the frontal lobe test battery and evoked potentials were assessed at the beginning and end of each shift woke schedule. One baseline test was done after one week’s day shift.

Results
A total of 21 nurses completed 4 times of frontal lobe battery test and 16 of them completed 4 times of fatigue severity scale and event-related potential. In subjective evaluation, there was no significant difference between 4 times of FSS. In objective evaluation, the latency and amplitude of event-related potential (P300) were not significantly different. There were also no significant difference in the frontal lobe battery test, including attention, visuo-constructional ability, motor programming, and higher executive function.

Conclusion
After one month of rapid-rotating, slow-rotating or fixed night duty schedule, the fatigue and cognitive performance were no significant different among hospital nurses.

並列關鍵字

circadian rhythm ； fatigue ； frontal lobe ； shift work ； evoked-potential

參考文獻

參考文獻

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