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  • 學位論文

8小時與12小時輪班制度中護理人員疲勞與睡眠之相關性研究

Fatigue and sleep of hospital nurses on 12-hour and 8-hour shifts in Taiwan

指導教授 : 張秀如
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摘要


【研究背景】 護理人員為台灣高疲勞職業之一,政府相關當局欲藉由改善護病比來降低護理人員疲勞程度,但職場留任率仍不佳。自2008年開始有醫院試行12小時輪班制度來改善減少延遲下班及離職率等問題,但延長工時對護理人員疲勞程度影響實為一大隱憂,更有研究指出12小時輪班制上班日睡眠不足,而檢視國內外研究針對12小時輪班制度對於疲勞之影響至今尚無定論,實需更多研究深入探討。 【研究目的】 了解8小時與12小時輪班制度中護理人員的職業疲勞與睡眠情形,比較兩種輪班制度中職業疲勞與睡眠品質的差異,並找出相關因子。同時檢視8小時與12小時輪班制度中超時工時的情形與差異。 【研究方法】 本研究以橫斷式研究設計,採立意取樣法,於2016年10月至2016年11月期間在北部某醫學中心以結構性問卷進行收集資料,本研究工具包含:工作特質量表、職場疲勞量表、職業性疲憊耗竭復原量表、成人版睡眠型態偏好量表、匹茲堡睡眠量表與睡眠日誌。統計分析以IBM SPSS 19.0統計軟體分析,以描述性統計呈現基本屬性、超時工時、職業疲勞、睡眠品質的分布情形,再以輪班制度分組進行護理人員於職業疲勞及睡眠品質的差異檢定。 【研究結果】 本研究案共納入223位受試者,平均年齡為29.8±6.5歲,介於22~51歲,平均工作年資為6.7±6.0年。睡眠品質方面,輪班護理人員的年齡(p=0.03)與年資(p=0.02)越大其睡眠品質較差;有喝咖啡習慣者睡眠品質也較無喝咖啡習慣者差(p=0.02);個人晨昏時型(chronotype)若能與輪班班別相配合能有更好的睡眠品質(p=0.03)。在不同輪班制當中,8小時輪班護理人員上班日睡眠時數平均為6.93±1.62小時,較12小時輪班護理人員的6.14±1.72小時長且達統計上顯著差異(p=0.00),但整體睡眠品質在不同輪班制度上並無統計顯著差異。 在職業疲勞方面,輪班護理人員的年齡(p=0.03)、年資(p=0.04)與工作疲勞呈現負相關;住宿舍者其對服務對象疲勞與工作過度投入的程度較高;在家需照顧子女或老人者在工作疲勞、對服務對象疲勞和工作過度投入程度較低;有喝咖啡習慣者對服務對象疲勞得分較高,其急性疲勞程度也較高。而在不同輪班制度中,8小時與12小時輪班護理人員在各疲勞面向上無統計上顯著差異,但12小時輪班護理人員有較好的班間恢復程度(p=0.00)。 超時工時方面,本研究對象中超過九成護理人員有延遲下班的問題,平均延遲下班時數為53.8±48.1分鐘,8小時輪班護理人員平均超時工時為56.4±48.4分鐘,12小時輪班制護理人員平均超時工時為49.5±45.2分鐘,兩組間無統計上顯著差異。 【結論】 12小時與8小時輪班制度護理人員的職場疲勞與睡眠品質沒有明顯差異,且12小時輪班制度護理人員可藉由較長且連續的休假日來規劃休閒生活以利疲勞恢復,在工作流程上也有減少交班干擾的優點,可作為護理人員另一種輪班選擇。未來研究建議針對延遲下班進一步探討,以減少超時工時對於護理人員疲勞之影響,並同時監測病人照護相關指標,以了解延長工時對病人安全之影響。

並列摘要


【Background】 While Occupational fatigue among nurses has raised concerns in recent years, Taiwan government legislated for nurse-patient ratios but has limited effects. Since 2008, there were few hospitals that introduced a 12-hour shift system to reduce overtime and to increase retention rate, but extended worktime may effect nurses’ performance and patient safety. It is inconclusive that whether long working hours have negative impact on nurses’ fatigue level. 【Aim】 This study investigated the status of occupational fatigue and sleep quality of nurses on 12-hour and 8-hour shifts and identified individual factors. Time off-work was also gathered to exam if the 12-hour shift system can reduce overtime for nurses in Taiwan. 【Methods】 A cross-sectional survey was conducted in a medical center in north Taiwan between September 2016 and November 2016. The Data were collected from structured questionnaires including: job content questionnaire, occupational burnout inventory, occupational fatigue exhaustion/recovery scale (OFER), morning-evening questionnaire (MEQ), Pittsburg sleep quality index (PSQI) and sleep diary. IBM SPSS 19.0 software was used to analyze the data. 【Results】 There were 223 participants, with which the mean age was 29.8±6.5 and the mean seniority was 6.7±6.0 years. Age, seniority and daily coffee consumption were positively correlated with PSQI (all p< .03), and higher PSQI represented poor sleep quality. Nurses could have better sleep quality if their rotation shift matched with their chronotype (p=0.03). Nurses with 8-hour shift had longer total sleep time on work day than the 12-hour shift ones (6.93 vs 6.14 hours, p=0.00), but there was no significant difference on sleep quality between the two shift systems. Higher work-related burnout was associated with age(p=0.03) and seniority(p=0.04), higher client-related burnout was associated with hospital dormitory staying, child or elder careburden was associated with lower work-related burnout and lower client-related burnout, and daily coffee consumption was associated with higher client-related burnout and more acute fatigue. Overall, occupational fatigue was not differed by the two shift systems, but 12-hour shifts nurses had better inter-shift recovery (p=0.00). Over 90% nurses worked overtime, with mean time-overwork was 53.8±48.1 minutes, nurses on 8-hour dayshift had more serious overtime problem, but there was no significant difference between the two shift systems on overtime. 【Conclusion】 12-hour shift system can be an option for nurses in Taiwan considering the benefits on longer day-off and less handover-time, but there should be interventions to reduce overtime. Furture studies should focus on patient care quality and patient safety.

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