輪班護理人員的睡眠品質、壓力、疲勞與相關生理指標之探討

Investigation of Sleep Quality, Stress, Fatigue and Relevant Biological Markers among Shiftwork Nurses

蕭桂榮(Guei Rung Shiau)

指導教授 ： 李素幸

共同指導教授 ： 何聖佑(Sheng Yow Ho)

長榮大學/健康科學學院/職業安全與衛生研究所/碩士(2009年)

https://doi.org/10.6833/CJCU.2009.00082

摘要

下視丘主管人體24小時日夜節律，而輪班工作會干擾此節律之運作，因此輪班工作對工作人員會造成不良的健康影響。本研究利用縱貫性設計來探討輪班護理人員的壓力、疲勞、睡眠與唾液中相關生理指標。
本研究以南部某教學醫院之輪班護理人員為研究對象，採立意取樣的方式，徵求需輪班、年齡在20-45歲、目前在醫院病房工作、且工作年資大於一年以上的女性臨床護理人員參與。資料收集分三天完成，這三天分別為在休假滿2日以上第一天返回日班工作時，及上完2日日班與上完2日大夜班後的第三天，在收集當天，參與者利用上班中間休息時間填寫有關睡眠、工作壓力及疲勞之問卷，並在當日上午八點及下午四點採集唾液檢體，唾液檢體採用酵素連結免疫分析法（Enzyme-linked immunosorbent assay，簡稱ELISA）進行測定，而資料分析則以SPSS統計軟體進行。
研究結果顯示，三班護理人員中，大夜班護理人員的「工作負荷」顯著高於日班及休假後；大夜班的疲勞指數較高且前晚的睡眠問題比例較高，但三班間並無顯著差別；在比較各班睡眠問題、壓力及疲勞之相關，發現三班之疲勞與長期睡眠問題均呈正相關，而疲勞與工作負荷之正相關則僅在日班呈現。
在日班及休假後，護理人員唾液中cortisol早上及下午的平均濃度呈現早高午低的情形，而在夜班護理人員則呈現早低午高的相反狀況。睡眠品質不佳及休假時的疲勞與cortisol濃度降低有關，且大夜班工作負荷的增加則與下午的cortisol濃度增加有關。
休假後唾液TNF-α濃度呈現早低午高的情形，而大夜班則在TNF-α濃度呈現早高午低之情形，此外疲勞指數也與大夜班下午IL-6的濃度成正相關。TNF-α及IL-6濃度分別在休假早上、夜班早上及下午呈現正相關，cortisol濃度與休假後早上IL-6濃度呈負相關和大夜班早上TNF-α濃度則呈正相關。
輪值夜班之護理人員，一方面受到生理節律改變的影響，一方面又因工作負荷較大，具潛在睡眠及疲勞的問題，較容易影響身體健康，因此針對長期夜班輪值人員應給予密切健康追蹤及職場健康促進活動。

關鍵字

護理人員 ； 輪班 ； 睡眠品質 ； 工作壓力 ； 疲勞 ； 生理指標

並列摘要

In the human body, hypothalamus controls our 24 hours circadian rhythm, but shiftwork tends to interfere with this regular rhythm and causes adverse health effects among shiftworkers. This study, designed longitudinally, was conducted to investigate the relationship between sleep quality, work stress, fatigue and relevant saliva biological markers among shift workers.
Study subjects were purposively recruited from shiftwork nurses in a teaching hospital from southern Taiwan. Shiftwork nurses, aged 20-45, currenly working in a hospital ward and with at least one-year shiftwork experience, were invited to participate. Data collection was completed on three different days, as the following: the first day of a day shift after returning from at least two days of off day; the third day of a day shift; and the third day of a night shift. On each day of data collection, a questionnaire was completed during mid-day break and saliva specimens were collected at 8am and 4pm, respectively. Saliva specimen was analyzed using Enzyme-linked immunosorbent assay and numerical data was analyzed by SPSS statistical software.
The results showed that night shift workers were significantly higher on the average score of “work demand” scale than off and day shift workers; while compared to off and day shift workers, night shift workers had higher fatigue scores and greater proportion of sleep problems on the previous night, the discrepancies were not statistically significant. Nevertheless, fatigue was closely related to long-term sleep problems on all shifts but was merely related to work demand on day shift.
On off and day shift, average saliva cortisol concentrations were both higher in the morning and lower in the afternoon; as a contrary, concentration on night shift was lower in the morning and higher in the afternoon. Poor sleep quality and fatigue during off day were related to decreased concentration of cortisol; while elevated work demand increased afternoon cortisol concentration on night shift.
Concentration of Saliva TNF-α was lower in the morning and higher in the afternoon on off shift; while on night shift TNF-α concentration was higher in the morning and lower in the afternoon. Concentration of TNF-α and IL-6 were correlated to each other on off day morning, night shift morning and evening. Concentration of cortisol was negatively correlated with IL-6 on off day morning and positively correlated with TNF-α on night shift morning.
Nurses who work on night shift are affected by the circadian rhythm and work demand, therefore they might have greater potentials for sleep problems, fatigue and even adverse health effects. Hence, for long-term night shift nurses, management should follow their health conditions closely and provide workplace health promotion.

並列關鍵字

nurses ； shiftwork ； sleep quality ； work stress ； fatigue ； biological markers

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