臺灣博碩士論文加值系統

護理工作是肌肉骨骼不適（musculoskeletal disorders, MSDs）盛行率最高的職業之一，造成護理人力流失及影響照護品質。過去研究顯示：協助病患轉移位是造成護理人員肌肉骨骼傷害的主因，使用不同的方式協助病患轉移位對肌肉骨骼系統之風險程度不同，但過去比較不同轉移位方式對MSDs風險之研究多在實驗情境進行，缺乏對護理人員日常協助病患轉移位方式及其對MSDs影響之探究。因此，本研究目的為瞭解國內醫院護理人員MSDs概況（包含：各科別護理人員MSDs之盛行率、不適部位、嚴重程度、影響工作程度等），及協助病患執行各項轉移位活動之情形（包含：頻率、費力程度、使用輔具類型、執行人數），以探討協助病患轉移位方式與身體各部位MSDs之關係；並進一步探討護理人員MSDs（部位數目）之相關因子（包含：人口學資料、工作特性、及協助病患轉移位之變項），作為未來職業災害預防之參考。
本研究採橫斷面研究設計，以自填問卷蒐集資料，收案對象為北部醫學中心、區域醫院、地區醫院及醫院附設護理之家中年滿二十歲之護理人員。問卷包含三部分：人口學與工作環境之基本資料、身體各部位MSDs概況，及協助病患轉移位概況。問卷分送至科別護理站，填完後回收，有效問卷共470份。
問卷調查結果顯示，88.3%護理人員最近六個月有一個部位以上之MSDs，約五成有四個部位以上之MSDs。各部位盛行率以下背部（77.2%）、頸部（64.2%）及肩部（58.7%）最高。各部位MSDs者中，手/手腕（21.6%）不適者因MSDs嚴重影響工作及請假之比例最高，下背部（20%）次之。不同病房單位之肩膀、上背、手/手腕、及足踝/足部不適比例達顯著差異，各部位MSDs盛行率普遍以綜合外科、加護病房、長期照護單位較高，內科及急診較低，下背部之盛行率於神經內外科高達92~95.7%，且在各病房單位均高，值得關注。
協助病患轉移位概況部分，全數轉移位活動需執行之比例皆高於六成，其中四個與床相關之活動（移動床上位置、床上翻身、床上平躺坐起、床到床）需執行比例高達九成，且為執行頻率及負荷程度（頻率乘以費力程度）最高的活動，另外，協助無法坐起者從床到椅、協助從地上起身兩活動則為單次執行自覺費力程度及自覺造成MSDs程度最高之活動，此六項活動需優先注意。十項轉移位活動中，國內護理人員僅有約四項常執行的方式為使用輔具，其他仍以徒手操作為主，以四個與床相關之活動較常使用輔具來執行的比例最高（55.4~93.8%）。使用之輔具以非動力輔具為主，最常使用之輔具為床單/布中單、轉位滑墊/滑板、及電動床。
迴歸分析結果顯示：護理人員MSDs部位數較多的相關危險因子，包含年齡較大、已婚、教育程度在研究所以上、某些病房單位（長期照護、綜合外科及骨科、加護病房）、負荷程度總分較高、轉移位活動方式之平均負重分數較高（較常使用徒手操作）。
本研究之結果顯示協助病患轉移位之負荷程度及執行方式皆為國內護理人員MSDs之相關因子，建議醫療單位需提供適切輔具並教導正確使用方式，以降低協助病患轉移位對護理人員之負荷程度，減少協助病患轉移位對其MSDs之風險。

Nurses have one of the highest prevalence of musculoskeletal disorders （MSDs） among all the occupations and healthcare practitioners, resulting in nursing shortage and decreasing the quality of healthcare. The main cause of musculoskeletal injuries in nurses is showed to be patient handling. Patient handling can be carried out in different methods and may have varied risks for musculoskeletal system. However, previous research to compare the risks of MSDs by different patient handling methods was mostly done in laboratory context. Until now few studies examined nurses'' patient handling methods in working situation and its impact on MSDs. Thus, the purposes of this study include: 1) To survey MSDs (prevalence, affected body parts, pain intensity, and functional impact on work) among nurses in Taiwan. 2) To examined patient handling tasks (frequency, perceived exertion, and patient handling methods such as types of assistive technology and number of executors) executed by hospital nurses in Taiwan. 3) To identify potential risk factors including demographic and workplace characteristics and variables of patient handling tasks for number of prevalent body parts among hospital nurses in Taiwan. The results may provide the strategies for preventing MSDs among nurses in Taiwan.
In this cross-sectional study, a questionnaire survey was carried out among nurses in one medical center, four metropolitan hospitals and belonging nursing homes in northern Taiwan. A self-reported questionnaire was used to investigate 1) demographic and workplace characteristics. 2) MSDs of neck, shoulder, upper back, lower back, elbow, wrist/hand, hip, knee, ankle/foot. 3) Nurses'' performance of 10 patient handling tasks. Questionnaires were distributed by nursing stations, and 470 valid questionnaires were collected.
The 6-month prevalence of MSDs at any body parts was 88.3%, and half of the participants reported at least MSDs of four body parts. Lower back (77.2%）, neck (64.2%）and shoulder (58.7%） were the most prevalent body parts. Nurses with wrist/hand complaints had the highest proportion (21.6%) of severe functional impact on work and absence from work due to MSDs, followed by nurses with lower back complaint s (20%). There''s a significant difference of MSDs prevalence of shoulder, upper back, wrist/hand, and ankle/foot among different wards. In general, surgical, intensive care, and long-term care units had higher prevalence of MSDs, contrary to internal medical and emergency units. The prevalence of lower back MSDs is high among all units, and up to 92~95.7% in neurosurgical and neurology units, implicating the common issue of lower back pain.
All surveyed patient handling tasks were executed by at least 60% of nurses in Taiwan. Four patient handling tasks in bed (moving in the bed, turning or rolling over in bed, from lying to sitting in bed, from bed to bed）were performed by at least 90% of surveyed nurses, and these four tasks were with the highest frequency and patient handling burden (defined as frequency multiply by scores of perceived exertion）. In addition, "from bed to chair/wheelchair with patients unable to sit up " and "up from floor" were two tasks that had the highest perceived exertion and highest perceived extent to cause MSDs. These six tasks mentioned above had high priority to pay attention for. In average, nurses in Taiwan preferred to use transfer equipment in four out of ten patient handling tasks, and the other tasks were mostly carried out manually. Four tasks in bed had the highest proportion to use transfer equipment, ranging from 55.4% to 93.8%. The equipment most often used was bed sheets, slide boards/ slippery sheets, and electric beds.
Ordinal regression analysis showed that older age, married, graduate school, certain wards (long-term care, surgical, intensive care), higher patient handling burden, and higher loads due to manual patient handling were the risk factors for more body parts with MSDs.
In conclusion, the burden and methods of patient handling were both risk factors for MSDs among nurses in Taiwan. Appropriate transfer equipment and education on how to properly handle patients is needed to decrease the burden of patient handling and its unhealthy impact on MSDs among nurses.

誌謝.....................................................i
中文摘要.................................................ii
英文摘要......... .......................................iv
目錄....................................................vi
圖目錄........... .......................................ix
表目錄...................................................x
第一章 前言...............................................1
第二章 文獻回顧............................................2
第一節 護理人員MSDs情形.....................................2
一、 MSDs之定義與資料取得方式............................2
二、 護理人員MSDs之發生率與盛行率.........................3
三、 護理人員MSDs之相關因子..............................5
第二節 護理人員肌肉骨骼傷害之主因─徒手協助病患轉移位..............9
一、 協助病患轉移位之定義與活動項目........................10
二、 徒手協助病患轉移位易造成護理人員肌肉骨骼傷害之原因........11
三、 協助病患轉移位之方式................................12
第三節 不同轉移位方式之比較..................................13
一、 不同轉移位方式對肌肉骨骼系統的影響及臨床使用優劣程度......13
二、 不同轉移位方式的介入對減少護理人員肌肉骨骼傷害的效果......15
三、 不當轉移位方式對照護工作的影響........................15
第四節 護理人員日常執行轉移位活動之情形 ........................16
一、 轉移位活動項目.....................................17
二、 慣用之轉移位方式（包含使用輔具狀況及執行人數）...........17
三、 執行頻率、自覺費力程度、自覺造成MSDs程度...............18
四、 影響護理人員協助病患轉移位方式的因素...................19
第三章 研究目的與研究假設....................................22
第一節 研究目的............................................22
第二節 研究假設............................................22
第四章 研究方法............................................23
第一節 研究架構與設計.......................................23
第二節 研究對象............................................23
第三節 問卷設計............................................24
一、 評估變項..........................................24
二、 問卷信度與效度.....................................26
第四節 研究流程............................................27
第五節 資料分析............................................27
第五章 研究結果............................................28
第一節 人口學資料與工作狀況..................................28
第二節 MSDs概況...........................................29
一、 MSDs盛行率及疼痛程度...............................29
二、 MSDs影響工作程度..................................30
第三節 執行各項轉移位活動概況 ................................30
一、 各活動需執行比例及每人需執行之活動數...................30
二、 執行頻率與自覺費力程度（負荷程度）.....................31
三、 自覺造成MSDs程度...................................32
四、 轉移位方式（負重程度）...............................32
第四節 身體各部位MSDs盛行率之單變項分析........................34
一、 人口學資料........................................34
二、 工作狀況..........................................35
三、 轉移位活動變項.....................................36
第五節 MSDs部位數目之單變項分析..............................39
一、 工作狀況..........................................40
二、 轉移位活動變項.....................................41
第六節 MSDs部位數之危險因子..................................42
第六章 研究討論............................................43
第一節 MSDs概況...........................................44
一、 盛行率與MSDs部位數.................................44
二、 MSDs影響工作程度...................................47
第二節 轉移位活動負荷程度....................................47
第三節 轉移位方式..........................................49
一、 使用輔具之比例.....................................49
二、 轉移位方式與自覺費力程度之關係........................50
第四節 MSDs部位數之相關因子..................................51
第七章 研究結論與建議.......................................55
第一節 研究結論............................................55
第二節 研究限制與未來研究建議 .................................56
參考文獻..................................................58
附錄一、受試者同意書.......................................114
附錄二、問卷..............................................118

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