臺灣博碩士論文加值系統

輪班制度造成人員工作時間的不固定，進而影響人體生理時鐘的規律性，同時造成輪班者的飲食和睡眠型態改變，所產生的改變甚至可能對其睡眠品質和身體健康形成極大的影響。
本研究屬於描述性研究，研究的目的為探討在輪班制度下護理人員的睡眠與飲食行為。自中部某醫學中心病房中工作年資六個月以上輪班的護理人員，分別選擇固定白班（n＝18）、固定小夜班（n＝17）、固定大夜班（n＝15）、和輪值三班（n＝17）共67名，以「基本資料」、「匹茲堡睡眠品質量表」、「三天睡眠日記」、「三天全天飲食紀錄」為研究工具，由參與研究的護理人員自行填寫並做紀錄。調查時間預計自2008年8月15日至2008年9月15日，並將所收集的資料以平均值、標準差、卡方檢定及ANOVA方式分析其睡眠和食物的營養攝取及腸胃症狀的表現。
結果顯示在睡眠品質部分，各班睡眠品質不佳（PSQI≧5分）的人數約77.8％-82.4％，之間並無顯著差異。在睡眠潛伏期和睡眠效率部分，各班的睡眠潛伏期約28.5-18.8分鐘，白班及小夜班的睡眠效率都可達到85 ％以上，大夜班及輪班約81.7 ％，但各班之間並無差異性。在睡眠總時數部分，各班平均睡眠時數為6.1-7.8小時，睡眠日記中平均睡眠時數為7.3-8.9小時，其中皆以小夜班顯著大於其它班別（p＜.001）。在營養部分的比較，白班及輪班人員三日的平均熱量攝取為1643-1684大卡，顯著大於小夜班及大夜班約300-400大卡的熱量攝取(F=10.8, P<.001)。另外白班及輪班者之蛋白質（64.4 g及64.9 g）和脂肪（63.8 g及67.3 g）的攝取量，也比夜班者多且達顯著性差異（p＜.001），但醣類部份，白班、大夜和輪班相當（平均191.2 g-205.9 g），小夜班顯著小於其它班別（約151.6 g）（p＜.001）。計算各營養素的熱量百分比，蛋白質為13-16％、脂肪為33-36 ％、醣類為49-54 ％，各班之間無顯著性差異。而在腸胃症狀表現部分，各班有腸胃不適症狀的表現約26.8 ％-47.1 ％，之間並無顯著不同。
透過本研究結果發現護理人員的睡眠時數多數在正常範圍內，但睡眠品質大多呈現不佳狀態，其中又以大夜班和輪班者的表現最明顯，這也許和他們在休息日仍以白班的作息型態表現導致日晝節律的混亂有關。因此不論任何班別都應盡可能去除會使睡眠受影響的原因，以改善睡眠品質。另外在飲食部分，小夜班熱量的攝取明顯少於其他班別且未達每日所建議的標準。然而各班在營養素百分比的比例，並不受輪值班別的影響。此外護理人員也明顯有腸胃機能障礙的現象。研究結果提供護理人員一訊息期望對輪班工作能達到較好的適應。

Introduction：Shift work has great impact on biological clock to alter nurses’ sleep and dietary patterns. This study investigated nurses’ sleep and dietary patterns under shifts and their consequences on sleep quality and health.
Methods：Sixty-seven nurses were recruited from a medical center in Taiwan. They were grouped into fixed day (DS, n=18), fixed evening (ES, n=17), fixed night (NS, n=15) and rotating shifts (RS, n=17). Shift was lasting for one month. Participants filled out questionnaires of the “Pittsburg Sleep Quality Index (PSQI),” the“3-day sleeping diary,” the “3-day dietary record,” and the “GI dysfunction checklist” in the middle 3 days of their shift.
Results: There were 52.9 %-82.4 % of nurses reported their sleep as poor (PSQI≧5). Sleep quality in the RS group was the worst. Most of the NS (80.0 %) and the RS (100 %) groups lived in DS or ES patterns in their off shift. The ES group has the longest sleep hours (8.9 hrs vs. 7.3-7.9 hrs). Sleep fragmentation significantly happened in most of the NS (46.7 %) and the RS (23.5 %) groups. The 3-day average of total caloric intake in the ES and NS groups (1193-1409 Kcal) were significantly less than the DS and RS groups (1643-1684 kcal) (F=10.8, p<.001). Nurses in the ES group also took less protein, fat, and carbohydrate significantly than the others. Moreover, there were 26.8 ％-47.1 ％ of nurses reported various G-I dysfunctions, but no significant differences among groups.
Conclusion：More than half of nurses perceived their sleep as poor, and nurses’sleep in the rotating shift and night shift are the worst. Live pattern in off shift may play a role to disturb their circadian rhythm. Moreover, the total caloric intake in nurses under evening shift is less than the recommended. Findings in this study provide information for nurses to better adapt their shift work.

中文摘要……………………………………………………i
英文摘要…………………………………………………iii
目錄…………………………………………………………v
圖表目錄…………………………………………………viii
第一章 緒論………………………………………………1
第一節 研究動機及重要性……………………………………1
第二節 研究目的………………………………………………4
第三節 研究問題………………………………………………5
第四節 名詞界定………………………………………………6
第二章 文獻查証…………………………………………7
第一節 睡眠概論…………………………………………… 7
第二節 正常飲食現象……………………………………… 11
第三節 第三節制度對睡眠和飲食的影響………………… 14
第三章 研究架構…………………………………………20
第四章 研究方法…………………………………………21
第一節 研究設計………………………………………………21
第二節 研究對象………………………………………………23
第三節 收案流程………………………………………………23
第四節 資料分析………………………………………………24
第五章 研究結果…………………………………………25
第一節 研究對象基本屬性……………………………………25
第二節 輪班下的睡眠品質與睡眠型態………………………27
第三節 輪班下的營養攝取……………………………………29
第四節 研究對象腸胃症狀的表現……………………………31
第六章 討論………………………………………………33
第一節 輪班制度下護理人員的睡眠品質與睡眠型態………33
第二節 輪班制度下護理人員的營養攝取現況………………36
第三節 輪班制度下護理人員腸胃症狀表現現況……………38
第七章 結論與建議………………………………………39
第一節 結論……………………………………………………39
第二節 研究結果應用…………………………………………40
第三節 研究限制與建議………………………………………41
參考文獻……………………………………………………43
中文部分……………………………………………………………43
英文部分……………………………………………………………45
【附錄一】「輪班制度下護理人員的睡眠品質和飲食之探討」
之調查問卷……………………………………………53
【附錄二】「匹茲堡睡眠品質量表」計分方式……………………57
【附錄三】「二時四小時睡眠日記範例」、「二時四小時睡眠
日記空白表」…………………………………………59
【附錄四】「飲食記錄表範例」、「飲食記錄空白表」…………62
【附錄五】「人體試驗研究計畫許可證明書」

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