探討唾液中可體松濃度與護專生實習壓力相關健康效應之研究

Work-related stress, saliva cortisol response and epression in nursing students

朱慶朝(Ching-Chao Ju)

指導教授 ： 吳佩芝

共同指導教授 ： 郭文隆 ； 莊慧君

長榮大學/健康科學學院/職業安全與衛生學系(所)/碩士(2011年)

https://doi.org/10.6833/CJCU.2011.00082

摘要

中文摘要 護理工作已被公認為高壓產業之一，護生在成為護理人員的臨床實習過程中所帶來的壓力，更是對未來是否可從事護理相關工作扮演著決定性的關鍵。人體中可體松乃為調節壓力生理反應重要的生理指標之一。唾液中可體松的濃度鑑測，因具有簡單及不具侵入性的特色，適合用於大規模的流行病學調查。 本研究利用橫斷性研究，選取台灣南部地區某醫護管理專科學校護理科160位5 年級學生，已完成護理專業課程並於各醫療機構實習達4 個月以上之學生作為研究對象，在99 年10 月29 日返校授課時進行問卷調查與唾液中可體松濃度採樣。問卷調查主要包含個人資料、實習壓力量表及憂鬱量表，並利用酵素免疫分析法 (enzyme-link immunosorbent assay, ELISA) 分析唾液中可體松濃度。 本研共完成157人次問卷及唾液中可體松濃度之分析，研究結果顯示，對護理缺乏興趣、個人對於實習科別安排、個人對實習場所的安排、成績好壞、家中經濟來源類別及性別等與護生對實習壓力的感受性有明顯的關係。護生中有20人在憂鬱量表評量上屬於「已有憂鬱前驅徵兆」，佔總人數12.5%，其所感受到之實習壓力總分亦顯著高於其他人(P=0.000)。透過多元迴歸分析研究顯示護生對各項實習壓力之感受與憂鬱指數呈現顯著關聯性。但，在cortisol平均濃度分別 與壓力及憂鬱感受性則缺乏顯著相關性。因此，做為評估壓力感受的參考指標仍待證實。 綜合以上結論，研究者建議校方應在實習前加強心理輔導，並依據個人志願進行實習科別的安排；另在學習興趣引導上，加強輔導及配套規劃，以改善護生實習的壓力與青少年憂鬱之發生。

關鍵字

護專生 ； 實習壓力可體松

並列摘要

Abstract
Nursing have been recognized as a highly stressful profession. Many stressors from clinical practice and school work during this process might crucial for whether
becoming a nurse in the future. The release of cortisol has been recognized as an important response under physiological stress. Salivary cortisol has the advantages
of noninvasive and high correlated with serum levels that is suit for large scale epidmiological study.
This cross-sectional study recruited about 160 nursing students who are intern for more than 4 months from a college located in southern Taiwan. Self-administrative questionnaire with personal characteristics, stress and depression scale were delivered at the time when they finish the training. Saliva samples were also collected and cortisol levels were analyzed by using enzyme immunosorbent
assay (ELISA).
157 nursing students finished the questionnaires and salivary cortisol analysis in our study. Lack of interests on nurse, satisfaction of the arrangement of training
clinics and hospitals, training performance, economic resources and gender were significantly associated with the score of stresses. Twenty students with "clinical signs of depression" which comprised 12.5% of the total students, have significantly higher scores of stress than those without signs of depression (P= 0.000). The levels of salivary cortisol were not correlated with the scores of stress and depression in our study. Further stydy is need to examine the suitability of using salivary cortisal as a
work stress induced biological indicator in cross-sectional study.
Our findings suggested school should provide consulting service to those students especially before and during internship to improve the conception of stress
and depression among nursing students.

並列關鍵字

Nursing students ； Stress of practice ； Cortisol

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