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」

中文部分
行政院衛生署（2000）‧中華民國飲食手冊‧台北：行政院衛生署員工消費合作社印行。
行政院主計處（無日期）‧由社會發展趨勢探討國人睡眠品質‧2008年12月10日取自http://www.dgbus.gov.tw/public/Date/4122719141571.pdf
勞工安全衛生研究所（2001）‧輪班作業危害預防手冊。
林聖博（2004）‧四二輪輪班制度、員工睡眠品質與工作狀況關係之研究－以系統科技為例‧新竹：真理大學管理科學研究所未發表碩士論文。
林嘉玲（2000）‧自費安養機構老人睡眠品質及其相關因素之探討‧未發表的碩士論文，國立台灣大學醫學院護理學研究所。
洪瑜孺、林佩蓁、潘純媚、陳秋蓉、何啟功、吳明蒼（2006）‧護理人員的輪班工作與睡眠品質、身心健康及家庭功能之間的相關性‧勞工安全衛生研究季刊，15（1），17-30。
姚建安、呂碧鴻（1996）‧睡眠與內科疾病的關係‧基礎醫學，11（12），231-232。
許秀娟（2005）‧醫院護理人員睡眠品質及其相關因素之探討‧臺中健康暨管理學院健康管理研究所未發表碩士論文。
黃志威（2004）．如何克服失眠．台北：憲業企業股份有限公司。
黃峰蕙、巫美鳳（1999）‧夜班對護理人員的影響及改善措施的探討‧護理雜誌，46（3），73-78。
陳光榮、許靜宜（1997）‧不同的輪班系統對工作者生理健康、社交及家庭生活、工作態度影響‧人力資源學報，8，71-96。
許森彥（2005）．薄膜液晶顯示器製造業輪班員工之精神健康與睡眠品質研究．未發表的碩士論文，國立成功大學環境醫學研究所。
馮兆康、李中一（1998）‧護理人員自覺疲勞盛行率及其相關因子‧中華職業醫學雜誌，5（3），73-78。
曾珍麗、尹裕君、馮延芬、歐香縫、鄭秀容（1995）‧輪班制護理人員睡眠型態紊亂之探討‧榮總護理，39（1），35-45。
曾雯琦、楊政議、林彥如（2005）‧女性護理人員的睡眠衛生‧護理雜誌，52（3），71-75。
楊惠美（2003）‧高科技產業員工睡眠品質及其相關因素之探討‧未發表的碩士論文，國立陽明大學環境衛生研究所。
蔡政楒，認識睡眠障礙，宏欣文化，2001。
蔡幸倖（1997）‧換班式女性輪班工作人員之飲食及生理狀況評估‧台北：台北醫學大學保健營養學研究所碩士論文。
黎俊彥、吳家碧、賴正全、林威秀（2002）‧女大學生身體活動與睡眠品質之相關性研究‧體育學報，32，59-68。



英文部分
Akerstedt, T., & Froberg, J. E. (1976). Interindividual differences in circadian patterns of catecholamine excretion, body temperature, performance, and subjective
arousal. Biol Psychol, 4(4), 277-292.
Alward, R., & Monk, T. (1990a). Acomparison of rotating-shift and permanent night
nurses. International Journal of Nursing Studies, 27(3), 297-302.
Alward, R., & Monk, T. (1990b). Supporting shift works. Journal of Nursing
Administration, 24(5), 53-59.
Auwerda, J. J. A., Bac, D. J., & Schouten, W. R. (2001). Circadian
rhythm of motor com plexes. Dis. Colon Rectum, 44, 1328-1332.
Akerstedt, T., Knutsson, A., Westerholm, P., Theorell, T., Alfredsson, L., & Kecklund, G. (2002). Sleep disturbances, work stress and work hours: a cross-sectional study. ournal of Psychosomatic Research, 53(3), 741-748.
Akerstedt, T. (2003). Shift work and disturbed sleep/wakefulness. Occupational
Medicine, 53, 89-94.
Al-Naimi, S., Hampton, S. M., Richard, P., Tzung, C., & Morgan, L. M. (2004).
Postprandial metabolic profiles following meals and snacks eaten during
simulated night and day shift work. Chronobiol Int, 21(6), 937-947.
Beaumont, M., Batejat, D., Pierard, C., Coste, O., Doireau, P., Van Beers, P., et al.
(2001). Slow release caffeine and prolonged (64-h) continuous wakefulness:
effects on vigilance and cognitive performance. J Sleep Res, 10(4), 265-276.
Benjamin, G. (1984). Shify workers:Improve the quality of life for mployees who
are’t on the 9-to-5 rouine. Pers J, 63, 72-76.
Buysse, D. J., Reynolds, C. F., 3rd, Monk, T. H., Berman, S. R., & Kupfer, D. J.
(1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric
practice and research. Psychiatry Res, 28(2), 193-213.
Czeisler, C. A., Moore-Ede, M. C., & Coleman, R. M. (1982). Rotating shift work
schedules that disrupt sleep are improved by applying circadian principles.
Science, 217(4558), 460-463.
Cohen, D., Eisdorfer, C., Prinz, P., Breen, A., Davis, M., & Gadsby, A. (1983). Sleep
disturbances in the institutionalized aged. J Am Geriatr Soc, 31(2), 79-82.
Colligan, M. J., & Rosa, R. R. (1990). Shiftwork effects on social and family life.
Occup Med, 5(2), 315-322.
Chang, C. J., Wang, S. Y., & Liu, H. W. (1993). The effect of shift system on sleep
quality, sleep quantity, psychological disturbance, and family function of workers
in Taiwan. Gaoxiong Yi Xue Ke Xue Za Zhi, 9(7), 410-417.
Cella, L. K., Van Cauter, E., & Schoeller, D. A. (1995). Effect of meal timing on
diurnal rhythm of human cholesterol synthesis. Am J Physiol, 269(5 Pt 1),
E878-883.
Charles, AC., Gary, SR.(1998). Disorders of Sleep and Circadian Rhythms;
InAnthony S.F., Eugene Braunwald, Kurt J. I., et al. : Harrison’s Principles of
Internal Medicine 14th Edi., U.S., McGraw-Hill Companies,Inc., 150-159.
Castro, J. (1999). What are the major correlates of macronutrient selection in Western
populations? . Nutr. Soc, 58, 755-763.
de Assis, M. A., Kupek, E., Nahas, M. V., & Bellisle, F. (2003). Food intake and circadian rhythms in shift workers with a high workload. Appetite, 40(2), 175-183.
Gold, D. R., & Rogacz, S. (1992). Rotating shift work sleep and accident related to
sleepiness in hospital nurse. American Journal of Public Health, 76(10),
1225-1228.
Gatenby, S. J. (1997). Eating frequency: methodological and dietary aspects. Br J
Nutr,77 Suppl 1, S7-20.
Horne, J., & Reyner, L. (1999). Vehicle accidents related to sleep: a review. Occup
Environ Med, 56(5), 289-294.
Hara, M., Mori, M., Shono, N., Higaki, Y., & Nishizumi, M. (2000). Lifestyle-related
risk ＆actors for total and cancer mortality in men and women. Environ Health
Prev Med, 5, 90-96.
Hsu, S., & Su, S. (2003). Health problems of permanent night-shift and rotating shift
workers. Chinese J Occup Med, 10, 71-80.
Hood, B., Bruck, D., & Kennedy, G. (2004). Determinants of sleep quality in the
healthy aged: the role of physical, psychological, circadian and naturalistic light
variables. Age Ageing, 33(2), 159-165.
Herdis, S. (2006). Self assessed quality of sleep, occupational health,working
environment, illness experience and job satisfaction of female nurses working
different combination of shifts. Scand Journal of Caring Science, 20, 229-237.
Knauth, P., & Rutenfranz, J. (1976). Experiment shift work studies of permanent night
and rapidly rotating shift system I: Circadian rhythm if nbody temperature and
reentrainment at shift change. International Archives of Occupational and
Environmental Health, 37, 125-137.
Krauchi, K., Nussbaum, P., & Wirz-Justice, A. (1990). Consumption of sweets and
caffeine in the night shift: relation to fatigue. Bochum:Pontenagel Press, 62-64.
Kim, K., Uchiyama, M., Okawa, M., Liu, X., & Ogihara, R. (2000). An
epidemiological study of insomnia among the Japanese general population.
Sleep,23(1), 41-47.
Lerner, R. (1982). Sleep loss in the aged: implications for nursing practice. J Gerontol
Nurs, 8(6), 323-326.
Lennernas, M., Hambraeus, L., & Akerstedt, T. (1995). Shift related dietary intake in
day and shift workers. Appetite, 25(3), 253-265.
Lund, J., Arendt, J., Hampton, S. M., English, J., & Morgan, L. M. (2001).
Postprandial hormone and metabolic responses amongst shift workers in
Antarctica. J Endocrinol, 171(3), 557-564.
Labyak, S., Lava, S., Turek, F., & Zee, P. (2002). Effects of shiftwork on sleep and
menstrual function in nurses. Health Care Women Int, 23(6-7), 703-714.
Monk, T. H. (2000). What can the chronobiologist do to help the shift workers?
Journal of Biological Rhythm, 15, 86-94.
Naition, P., Kelly, T., & Englund, C. (1990). Healyh effects of sleep deprivation.
Occupational Medicine, 5(2), 209-237.
Niedhammer, I., Lert, F., & Marne, M. (1996). Prevalence of overweight and weight
gain in relation to night work in a nurses cohort. International Journal of
Obesity,20, 625-633.
Pan, W.H., Chang, Y.H., Chen, J.Y., Wu, S.J., Tzeng, M.S., ＆ Kao,M.D.(1999) .
Nutrition and health survey in Taiwan（NAHSIT）1993-1996 Dietary nutrient
intakes assessed by 24-hour recall. Nutritional Sciences Journal, 24(1),11-39.
Pronitis-Ruotolo, D. (2001). Surviving the night shift. Am J Nurs, 101(7), 63-65, 67-68.
Pitsopoulos, N.C., ＆ Greenwood, K. M. (2004). Shift-dependent differences in
self-reporting of health symptom among shiftworkers. International Journal of
Industrial Ergonomics, 34, 187-193.
Pasqua, I. C., & Moreno, C. R. (2004). The nutritional status and eating habits of shift
workers: a chronobiological approach. Chronobiol Int, 21(6), 949-960.
Shepherd, R. (1989). Factors influencing food preferences and choice. Handbook of
the Psychophysiology of Human Eating. Chichester:Wiley,3-24.
Schroer, C., De Witte, L., & Philipsen, H. (1993). Effects of shift work on quality of sleep, health complaints and medical consumption of female nurses. In
Occupational Health for Health Care Workers, 88-92.
Scott,A.J.(1994).Chronobiological considerations in shiftworker sleep and
performance and shiftwork scheduling. Human Performance, 7(3),207-233.
Scott, A.J. (2000). Shift work and health primary Care. Clinics in Office Practice, 27,
1057-1079.
Sudo, N., ＆ Ohtsuka, R. (2001). Nutrient intake amoung female shift workers in a
computer factory in japan. International journal of Food Sciences and Nutrition,
52(4), 367-378.
Strubbe, J. H., & van Dijk, G. (2002). The temporal organization of ingestive
behaviour and its interaction with regulation of energy balance. Neurosci
Biobehav Rev, 26(4), 485-498.
Savard, J., Laroche, L., Simard, S., Ivers, H., & Morin, C. M. (2003). Chronic
insomnia and immune functioning. Psychosom Med, 65(2), 211-221.
Schenck, C. H., Mahowald, M. W., & Sack, R. L. (2003). Assessment and
management of insomnia. JAMA, 289(19), 2475-2479.
Stanley, N. (2005). The physiology of sleep and the impact of ageing. European
Urology Supplements, 3(6), 17-23.
Sleep problems may affect a person，s diet. Available from:
http://www.physorg.com/news100798651.html
Tucker, P., Smith, L., Macdonald, I., & Folkard, S. (2000). Effects of direction of
rotation in continuous and discontinuous 8 hour shift systems. Occup Environ
Med, 57(10), 678-684.
Vener, KJ., Szabo, S., ＆ Moore, JG. (1989). The effecy of shift work on
gastrointestinal(GI)function:a review. Chronobiologia ,16, 421-39.
Van Cauter, E., Blackman, I., Roland, D., Spire, J., Refetoff, S., ＆ Polonsky, K.
(1991). Modulation of glucose regulation and insulin secretion by circadian
rhythmicity and sleep .J. Clin. Invest, 88, 934-942.
Van Deursen, C., Mul, C., Smulder, P., & DeWinter, C. (1993). Health and working situation of day nurses compared with a matched group of nurses on rotating shift work. In Occupational Health for Health Care Workers, 83-87.
Veasey, S., Rosen, R., Barzansky, B., Rosen, I., & Owens, J. (2002). Sleep loss and
fatigue in residency training: a reappraisal. JAMA, 288(9), 1116-1124.
Van Dongen, H. P., Maislin, G., Mullington, J. M., & Dinges, D. F. (2003). The
cumulative cost of additional wakefulness: dose-response effects on
neurobehavioral functions and sleep physiology from chronic sleep restriction
and total sleep deprivation. Sleep, 26(2), 117-126.
Wilkinson, R., Allison, S., Feeney, M., & Kaminska, Z. (1989). Alertness of night
nurses: two shift systems compared. Ergonomics, 32(3), 281-292.
William, CO. (2001). Gastrointestinal functioning during sleep: a new horizon in
sleep Mddicine. Sleep Medicine Review, 5(2), 91-101.
Waterhouse, J., Buckey, P., Edwards, B., Reilly, T. (2003). Measurement of, and
some reasons for, differences in eating habits between night and day workers.
Chronobiology International, 20(6), 1075-1092.
Waterhouse, J., Kao, S., Edwards, B., Weinert, D., Atkinson, G., & Reilly, T. (2005). Transient changes in the pattern of food intake following a simulated time-zone transition to the east across eight time zones. Chronobiol Int, 22(2), 299-319.