臺灣博碩士論文加值系統

研究目的：了解護理之家護理人員執業環境及其可能接觸之職業危害因子，並提出改善其執業環境之建議。

研究方法：本研究以自擬式之結構性問卷，內容包含生物性、物理化學性、心理社會及人因工程等危害評估護理之家護理人員之執業環境，以中文版工作內容量表(Chinese Job Content Questionnaire)、中文版哥本哈根量表(Chinese Copenhagen Burnout Inventory)及中文版挪威肌肉骨骼傷害問卷(Chinese Nordic Musculoskeletal Questionnaire)評估其健康狀況；研究對象為全台登記聘用註冊護士/護理師10人以上之70所護理之家，每家機構至少請十位實際執行護理業務之護理人員填答執業環境調查之問卷；此外，亦召開專家會議及選取兩種不同型態的護理之家進行實際工作現場訪視，了解護理之家工作環境。

研究結果：本研究共477份問卷進入最後分析，研究對象平均年齡為37.7歲，其中註冊護士/護理師為31.6歲、照顧服務員為45.3歲；在執業危害暴露方面，生物性危害：過去一年共29位(10.9%)護理人員發生針扎事件，86位(18.0%)發生血液體液暴觸、274(57.4%)位需接觸高傳染性的工作，而在控制基本資料與執業環境等變項後發現，註冊護士/護理師最近一年曾發生針扎事件與其發生高工作壓力相關。在物理化學危害方面：大多數護理人員不需接觸具輻射線、血管攝影或斷層掃瞄之個案，也不需要接觸致癌藥品或照顧化學治療個案，半數以上護理人員均需要接觸消毒溶液(n=367；76.9%)，其中有9.4% (n=45)過去一年曾因為接觸消毒溶液發生不適。在心理社會危害部分：本研究56.6% (n=270)的受訪對象需輪班，低工作控制者佔33.3% (n=159)、高工作心理負荷者佔39.4% (n=188)、高工作壓力者佔15.1% (n=72)、低就業安全者佔32.5% (n=155)、低組織管理正義者佔44.4% (n=212)，在控制其他變項後發現，低工作控制與註冊護士/護理師發生高個人疲勞及服務對象疲勞相關；高工作心理負荷與註冊護士/護理師發生高個人疲勞相關、與註冊護士/護理師及照顧服務員發生高工作疲勞及工作相關之肌肉骨骼不適相關；低就業安全與註冊護士/護理師發生高個人疲勞相關，與照顧服務員發生高個人疲勞、工作疲勞及服務對象疲勞相關；低組織管理正義與註冊護士/護理師及照顧服務員發生高工作壓力、高個人疲勞及工作疲勞相關，與照顧服務員發生高服務對象疲勞顯著相關。在人因工程危害方面：最近一年發生肌肉骨骼不適的護理人員高達九成以上(n=452；94.8%)，肌肉骨骼不適部位前三名分別為肩膀、脖子、下背/腰部，而控制其他變項後，註冊護士/護理師上班站立時數超過6小時與其發生高工作壓力相關，上班扭腰轉身次數超過20次與其過去一年發生肌肉骨骼不適相關。

結 論：研究調查結果發現護理之家執業環境中的生物性、心理社會性及人因工程危害將可能影響護理人員的健康狀況，因此，為了減少各項執業危害對其健康狀況所造成的影響，改善職場環境中的各項危害為刻不容緩的工作，除了實際改善工作環境外，亦建議針對各項危害改善進行定期評值，提供各項教育訓練活動，以改善護理之家護理人員的工作環境，減少執業環境所可能帶來之危害。

Objective: To understand working conditions and potential occupational hazards among nursing personnel of nursing homes, and to formulate strategic plans for improvement.
Method: A self-administered questionnaire was used to identify the biological, physical and chemical, psychological, and ergonomic hazards in the work environment of nursing personnel of nursing homes. Chinese Job Content Questionnaire, Chinese Copenhagen Burnout Inventory, Chinese Nordic Musculoskeletal Questionnaire were used to measure the health status of nursing personnel in nursing homes. A total of 70 nursing homes hiring more than 10 registered nurses were recruited into the study. An expert focus group and 2 fields of nursing homes visits were performed to better understand the occupational hazard of nursing homes.
Results: A total of 477 elegible questionnaires were completed and returned by registered nurses and nurse assistants for final analysis. The mean age was 37.7 years among all respondents. As for biological hazards, 38 (8.0%) nursing personnel sustained at least one needlestick injury in the past 12 months, 86 (18.0%) had exposed to blood or body fluids, and 274 (57.4%) had to care for highly infectious patients. After controlling for demographic and work-related variables in regression analysis, needlestick injuries were associated with high job strain of registered nurses. In regard to physical and chemical hazards, having exposed to ionizing radiation through X-ray, angiography, caring for patients undergoing chemotherapy, or handling cancer therapeutic agents were relatively rare in nursing homes. However, 76.9% (n=367) of nursing personnel had contacted with disinfectants, and 45 (9.4%) of them suffered discomfort due to such contacts. As for psychosocial hazards, 56.6% (n=270) of respondents worked in shifts. 33.3% (n=159) of respondents exposed to low job control, 39.4% (n=188) were with high job demand, and 15.1% (n=72) were in high job strain. 44.4% (n=212) of respondents exposed to low workplace justice, and 32.5% (n=155) were with low employment security. After controlling for demographic and work-related variables in regression analysis, for registered nurses, low job control was associated with high personal burnout and client. High job demand was the risk factors of high personal burnout of registered nurses. As for registered nurses and nursing assistants, high job demand was related to high work burnout and musculoskeletal discomfort related to work. For registered nurses, the low level of employment security was the risk factor for high level of personal burnout. Moreover, it was also associated with high level of personal burnout, work burnout, and client burnout for nursing assiatants. The low level of workplace justice was the risk factor for high level of personal burnout, work burnout of registered nurses and nursing assistants. For nursing assistants, it was the risk factor of high client burnout as well. As for ergonomic hazards, the prevalence of musculoskeletal discomforts was 94.8% (n=452). In the terms of discomfort location, shoulder (84.4%) was the most commonly reported affected area, followed by neck (74.4%) and lower back (74.4%). In the multiple regression analysis, for registered nurses, standing for longer than 6 hours was highly associated with high level of job strain. Twisting waist more than 20 times during work was also the risk factor for musculoskeletal discomforts in the past year.

Conclusion: This study has identified that the work environment of nursing homes would affect health status of nursing personnel in different aspects, including biological, psychosocial, and ergonomic hazards. To minimize those health effects on nursing home staff, improving the working environment practically and designing educational programs in preventing occupationally induced harms are warranted. A periodical evaluation system is also suggested, to better understand the psychosocial conditions of nursing home nursing personnel.

口試委員會審定書 i
誌謝 ii
中文摘要 iii
英文摘要 v
目錄 vii
表目錄 ix
第一章 研究動機 1
第二章 研究目的 3
第三章 文獻查證 4
第一節 護理之家服務對象 4
第二節 護理之家註冊護士/護理師護理活動及工作範疇 5
第三節 護理之家照顧服務員護理活動及工作範疇 6
第四節 護理人員可能暴露之職業危害 7
第四章 研究概念架構圖 13
第五章 研究方法 14
第一節 名詞界定 14
第二節 研究假設 15
第三節 研究對象 16
第四節 研究工具 17
第五節 資料收集 21
第六節 統計分析 22
第六章 研究結果 23
第一節 研究對象個人基本資料分佈狀況 23
第二節 研究對象工作狀況及每日護理活動內容分佈狀況 25
第三節 研究對象執業環境各項危害 27
第四節 研究對象個人基本資料、工作狀況對其健康狀況分佈之影響 32
第五節 研究對象個人基本資料、工作狀況及執業環境各項危害對健康狀況之風險評估 36
第七章 討論 44
第一節 註冊護士/護理師與照顧服務員健康狀況的差異 44
第二節 研究對象個人基本資料與健康狀況之相關性 46
第三節 研究對象工作狀況及每日護理活動與健康之相關性 48
第四節 生物性危害 49
第五節 物理化學危害 53
第六節 心理社會危害 55
第七節 人因工程危害 59
第八章 結論及建議 61
第九章 研究限制 63
參考文獻 66
附錄一 問卷統計結果 76
附錄二 專家會議 110
附錄三 工作場所訪視及質性訪談 112
附錄四 研究空白問卷 114

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