使用行動護理車的肌肉骨骼系統症狀調查

目的：行動護理車在臨床上廣泛應用，已有超過十年以上的歷史，對醫療照顧的效率，品質、與病人安全貢獻卓著。然而關於護理人員使用護理車的經驗，感受，或所遇到的問題，相關文獻甚少，因此本研究的目的在探討與使用護理車相關的肌肉骨骼系統症狀，瞭解情形，提出建議，以增進護理人員工作的福祉。方法：針對北部某醫學中心的病房護理車進行調查，讓42位護理師填答北歐肌肉骨骼系統症狀與護理車使用情形問卷，臨場訪視各病房，觀察護理車作業，量測護理車相關參數，並進行關鍵指標法人因危害風險評估。結果：護理車長76、寬60、高113公分，有四顆五吋的非定向腳輪，直桿把手位於於檯面雙角落，共七層抽屜，電池位置不一。護理車空重約50－60公斤，滿載時可接近100公斤。42位護理師當中28人認為車子太重，10人認為直行不好推，37人認為轉彎不好推。被抱怨最多的部分是車重與輪子，關鍵指標法顯示推拉護理車的人因危害介於低中風險之間。在42位護理師中，28位抱怨肌肉骨骼系統症狀，以下背疼痛9人次居首，左手／手腕痛8人次居次，多元線性迴歸分析顯示疼痛指數與身高、體重、年資並無關聯性。臨場調察顯示護理車的問題在於一體適用的高度，過高的把手，接近100公斤的總重量，四個保養維修不足的非定向腳輪，以及非正統的側推，短邊直推，斜推，與合推方式。結論：操作行動護理車的肌肉骨骼系統症狀可能與車重、車高、把手高度、輪子設計與保養，以及推行方式存在關聯性。在替換成新一代護理車之前，建議針對所發現的問題加以改善，以預防、減輕護理人員的人因性危害。

關鍵字

行動護理車；推拉作業；人因工程；肌肉骨骼系統症狀；職業病

並列摘要

Objective: Mobile nursing carts have been utilized in the hospitals for decades in order to improve the efficiency, quality, and safety of patient care. The experience and potential problems among users, however, have received little attention. The purpose of this study was to investigate in this regard and to advise how to optimize the working condition of nursing staff. Materials and Methods: Nordic musculoskeletal symptoms plus nursing cart questionnaires were filled out by 42 nurses in various wards of a medical center in northern Taiwan. On-site visits were conducted to evaluate the carts, their parameters & condition, and the way they were operated by nurses, coupled with Key Indicator Method for the assessment of physical workloads. Results: Nursing carts were 76 cm long, 60 cm wide, 113 cm high, and equipped with four swivel casters, four vertical handles, seven-layer drawers, and a battery placed in different locations. Fully loaded carts weighed almost 100 kg. Among 42 nurses undergoing interviews, 28 considered that the carts were too heavy to maneuver. Ten of them opined it was hard to push straight forwards, while 37 persons complained about difficulty with making a turn。Cart weight and wheels were the parts bemoaned the most. Key Indicator Method revealed mild to moderate physical loads. As to musculoskeletal symptoms, 28 persons experienced clinical symptoms with low back pain in the first place, followed by left hand/wrist pain. Multiple linear regression analysis failed to find an association between pain indices and body height, body weight or seniority. On-site investigation pointed the problems to uniform cart height, high handle position, heavy cartloads, poor maintenance of swivel casters, and unconventional pushing postures such as lateral pushing, oblique pushing, side pushing and pushing carts together with other equipment. Conclusion: The musculoskeletal complaints among nurses might be associated with the weight & height of nursing carts, handle height, wheel design and maintenance, as well as the way the carts were pushed. It is advised to alert and correct the problems with an aim to minimizing ergonomic hazards.

並列關鍵字

mobile nursing carts ； push & pull tasks ； ergonomics ； musculoskeletal disorders ； occupational diseases

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