護理人員失眠狀況之研究

護理人員之失眠現象普遍高於一般民眾，失眠除影響睡眠品質外，也會導致工作表現變差，嚴重者甚至造成醫療疏失的發生。本研究目的主要是分析護理人員失眠之盛行率、失眠情形與失眠相關因素之關係、失眠相關因素對門診利用與醫療費用之差異以及影響護理人員失眠之相關因素。使用橫斷式研究法，從全民健康保險研究資料庫中擷取2011年執業於醫療機構之護理人員，共取得112,274人作為本研究之對象。採用卡方檢定分析人口學特性、執業場所特性、疾病特性與失眠情形之關係，使用t檢定與單因子變異數分析分析失眠相關因素對門診利用與醫療費用之差異，利用邏輯斯迴歸探討影響護理人員失眠之相關因素。護理人員失眠的盛行率為2.1%。年齡層、投保薪資、護理人員類別、執業醫療機構層級別、執業醫療機構權屬別、執業醫療機構業務組別、疾病特性與失眠情形具顯著性關係；年齡層、護理人員類別、頭痛（有/無）、背痛（有/無）、憂鬱症（有/無）、焦慮症（有/無）之門診次數達顯著差異；投保薪資、執業醫療機構層級別、執業醫療機構權屬別、執業醫療機構業務組別、頭痛（有/無）、背痛（有/無）、憂鬱症（有/無）、焦慮症（有/無）之醫療費用達顯著差異。控制相關因素後，年齡30-39歲與40-49歲其失眠勝算比均高於18-29歲（OR=1.500, p<0.001；OR=1.169, p=0.031）；執業類型為護士其失眠勝算比高於護理師（OR=1.200, p=0.001）；執業於基層院所與地區醫院其失眠勝算比均高於醫學中心（OR=1.923, p<0.001；OR=1.834, p<0.001）；執業於中區業務組、北區業務組其失眠勝算比均高於台北業務組（OR=1.244, p<0.001；OR=1.194, p=0.007）；罹患頭痛（OR=2.024, p<0.001）、罹患背痛（OR=1.416, p<0.001）、罹患憂鬱症（OR=2.224, p<0.001）、罹患焦慮症（OR=9.490, p<0.001）等因素其失眠勝算比皆高於未罹患疾病者。此外，執業於非營利醫療機構其失眠勝算比低於公立醫療機構（OR=0.720, p<0.001），執業於南區業務組、高屏區業務組之失眠勝算比均低於台北業務組（OR=0.841, p=0.018；OR=0.701, p<0.001）。護理人員經醫師診斷罹患失眠的盛行率為2.1%。人口學特性、執業特性與疾病特性是影響護理人員失眠的顯著性因素。未來，可進一步探討職場健康促進之推動與個人疾病之防治對失眠的效應。關鍵字：失眠症、醫療機構、護理人員、危險因素、共病症

關鍵字

失眠症；醫療機構；護理人員；危險因素；共病症

並列摘要

The incidence of insomnia is uniformly higher among nurses than it is in the general population. In addition to exerting a negative influence on the quality of sleep, insomnia may lead to poor work performance, and, in severe cases, may even result in medical negligence. The aims of this study were to analyze the prevalence of insomnia, the relationship between insomnia and various relevant factors, the differences between factors linked to insomnia and outpatient utilization/medical costs, and relevant factors influencing insomnia in nurses. This study employed a cross-sectional research design, and took 112,274 nursing personnel working at healthcare institutions in 2011 from the National Health Insurance Research Database as the research sample. The chi-square test was used to analyze the relationship between demographic characteristics, workplace characteristics, disorder characteristics, and state of insomnia; the t-test and one-way ANOVA were employed to analyze differences between factors linked to insomnia and outpatient utilization/medical costs; logistic regression was used to explore factors affecting insomnia in nurses. The prevalence of insomnia among nurses was found to be 2.1%. Age group, insured salary, nurse type, grade of the healthcare institution at which the nurse practiced, ownership of the healthcare institution, location of healthcare institution, and disorder characteristics were significantly correlated with insomnia. Age group, nurse type, headache (Yes/No), back pain (Yes/No), depression (Yes/No), and anxiety (Yes/No) varied significantly in the number of outpatient visits. Insured salary, grade of the healthcare institution, ownership of the healthcare institution, the healthcare institution’s division, headache (Yes/No), back pain (Yes/No), depression (Yes/No), and anxiety (Yes/No) showed significant difference in medical expenses. After relevant factors were controlled, nurses in the 30-39 and 40-49 age groups both had higher odds ratios for insomnia than did nurses in the 18-29 age group (OR=1.500, p<0.001; OR=1.169, p=0.031). Nurses had higher odds ratios for insomnia than registered nurses (OR=1.200, p=0.001). Nurses practicing at primary-level hospitals and clinics and regional hospitals had higher odds ratios for insomnia than nurses practicing at medical centers (OR=1.923, p<0.001; OR=1.834, p<0.001). Nurses practicing in Central and Northern Divisions had higher odds ratios for insomnia than nurses practicing in Taipei Divisions (OR=1.244, p<0.001; OR=1.194, p=0.007). Nurses with headaches (OR=2.024, p<0.001), back pain (OR=1.416, p<0.001), depression (OR=2.224, p<0.001), and anxiety (OR=9.490, p<0.001) had higher odds ratios for insomnia than nurses without these disorders. In addition, nurses practicing at nonprofit healthcare institutions had lower odds ratios for insomnia than nurses practicing at public healthcare institutions (OR=0.720, p<0.001), and nurses practicing in Southern and Kaoping Divisions both had lower odds ratios for insomnia than nurses practicing in Taipei Divisions (OR=0.841, p=0.018; OR=0.701, p<0.001). Nurses diagnosed by physicians suffering from insomnia prevalence rate of 2.1%. With regard to demographic characteristics, work characteristics and disorder characteristics, all were significant factors influencing insomnia in nurses. Future research can investigate the effectiveness of health promotion and disorder prevention and treatment in the workplace for individuals in alleviating insomnia. Keywords: Insomnia, Healthcare institutions, Nurses, Risk factors, Comorbidity