(34.228.41.66) 您好!臺灣時間:2018/12/12 19:33
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果

詳目顯示:::

我願授權國圖
本論文永久網址: 
line
研究生:許宸嫚
研究生(外文):Chen-Man Hsu
論文名稱:醫師長工時/輪班與其個人健康及病患安全之文獻回顧
論文名稱(外文):The effect of long working hours/shift work on physicians’ health and patient safety: a literature review
指導教授:陳保中陳保中引用關係
指導教授(外文):Pau-Chung Chen
口試委員:杜宗禮張蓓貞
口試日期:2012-07-24
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:公共衛生碩士學位學程
學門:醫藥衛生學門
學類:公共衛生學類
論文出版年:2012
畢業學年度:100
語文別:中文
論文頁數:54
中文關鍵詞:醫師輪班長工時壓力疲勞過勞病患安全
外文關鍵詞:physicians&apos&aposwork shiftslong working hoursworking stressfatigueburnoutpatients&apos&apossafety
相關次數:
  • 被引用被引用:6
  • 點閱點閱:695
  • 評分評分:系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔系統版面圖檔
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:2
台灣健保給付的制度及醫療糾紛、高風險、工時過長等因素使得醫師不斷流失,尤其是急重症的科別,本文整理國外文獻,以pubmed及medline資料庫為主,探討輪班與長工時對醫師身心理的影響,45篇與輪班及長工時有關之實驗性設計原始文獻,其中13篇文獻指出輪班及長工時造成神經功能降低,增加醫療錯誤率及增加意外事故發生率,4篇關於醫師輪值夜班後,對心血管功能的影響,2篇探討輪夜班之後,免疫功能降低,11篇文獻指出醫師工作壓力與過勞相關,另外15篇探討輪班與睡眠障礙、疲勞、情緒的關係,經回顧文獻發現,醫師輪班及長工時嚴重地影響個人健康、安全以及病患安全,國內雖已有減少醫師過勞之解決方案,但成效如何,未來仍需進一步評估,藉由文獻中許多實驗設計評估工具,其適用性可提供未來臨床評估,以及醫療體制改革之參考,使第一線醫療人員在醫治病患同時能兼顧健康及醫療品質。

Under the multiple pressure such as Taiwan’s health insurance regulations, medical disputes, work risks and long working hours, the physicians have been forced to leave the medical industry, especially those in the Emergency and Critical department. To shed light on the impact of work shifts and long working hours on the mental and physical health of physicians, the present study reviewed 45 experimental studies from the pubmed and medline database. Among the 45 studies, 13 indicated that work shifts and long working hours may affect the physicians’ nerve function, while increasing the rate of medical errors and accidents; 4 studies investigated the impact of work shifts on the physicians’ cardiovascular function; 2 examined the physicians’ immune function after night shifts; 11 discussed the working stress, and other 15 explored the sleep disorders, fatigue and emotions in relation to work shifts. Despite the fact that the solutions to the physicians'' fatigue have been proposed, the effectiveness needs further investigations. Based on the literature reviews, it was found that the implications drawn from the empirical studies were applicabile for future clinical evaluation and health care system reform. In this way, Taiwan healthcare workers could ensure their own health while improving the quality of medical care.

口試委員會審定書…………………………………………………………………I
誌謝…………………………………………………………………………………II
中文摘要……………………………………………………………………………IV
英文摘要……………………………………………………………………………V
圖目錄………………………………………………………………………………VIII
表目錄………………………………………………………………………………IX

第一章 導論.......................................................................................................... .1
第一節 實習單位介紹與特色............................................................1
一、成立宗旨………………………………………………1
二、組織架構………………………………………………2
三、功能特色………………………………………………2
四、未來展望………………………………………………2
五、實習情形………………………………………………3
第二節 研究架構.............................................................................. .4
一、輪班定義與型態………………………………………5
二、輪班與生物性機轉……………………………………5
三、輪班與醫師健康………………………………………6
四、工時與醫師健康………………………………………7
第三節 研究目的………………………………………………….8
第二章 研究材料與方法……………………………………………………….9
第三章 結果與討論……………………………………………………………10
第一節 長工時/輪班與醫師健康..................................................10
一、心血管功能…………………………………………10
二、免疫功能……………………………………………12
三、工作壓力及過勞……………………………………14
四、睡眠障礙、疲勞及情緒……………………………20
第二節 長工時/輪班與醫師安全………………………………..28
第三節 長工時/輪班與病患安全………………………………..30
第四章 結論與建議............................................................................................35
第一節 結論....................................................................................35
第二節 建議....................................................................................36
參考文獻....................................................................................................................44

1. Harrington JM. Healtheffects of shift work and extended hours of work. Occup
Environ Med 2001;58:68-72.
2. Murray A, Pounder R, Mather H, Black DC. Junior doctors'' shifts and sleep
deprivation. BMJ 2005;330(7505):1404.
3. Burch JB, Tom J, Zhai Y, Criswell L, Leo E, Ogoussan K. Shiftwork impacts and
adaptation among health care workers.Occup Med (Lond) 2009;59(3):159-66.
4. Costa G, Sartori S, Akerstedt T. Influence of flexibility and variability of working hours on health and well-being. Chronobiol Int 2006;23(6):1125-37.
5. Boisard P,Cartron D,Gollac M,Valeyre A. Temps et travail:la dur’ee du
travail.Dublin:European Foundation for the Improvement of Living and Working
Conditions, 2002.
6. Czeisler CA, Gooley JJ.Sleep and circadian rhythms in humans.Cold Spring Harb
Symp Quant Biol 2007;72:579-97.
7. Arendt J. Melatonin and the Mammalian Pineal Gland. Bristol: Chapman Hall, 1995.
8. Arendt J, Skene DJ. Melatonin as a chronobiotic. Sleep Med Rev 2005;9(1):25-39.
9. Folkard S, Minors DS, Waterhouse JM. Chronobiology and shift work: current
issues and trends. Chronobiologia 1985;12(1):31-54.
10. Costa G. Shift work and occupational medicine: an overview. Occup Med (Lond) 2003;53(2):83-8.
11. Czeisler CA, Klerman EB. Circadian and sleep-dependent regulation of hormone release in humans. Recent Prog Horm Res 1999;54:97-130.
12. Ross JK. Offshore industry shift work-health and social considerations. Occup
Med (Lond) 2009;59(5):310-5.
13. Lam TP, Wong JG, Ip MS, Lam KF, Pang SL. Psychological well-being of interns in Hong Kong: what causes them stress and what helps them. Med Teach 2010;32(3):e120-6.
14. Rosen IM, Gimotty PA, Shea JA, Bellini LM. Evolution of sleep quantity,sleep deprivation,mood disturbances,empathy,and burnout among interns. Acad Med 2006;81(1):82-5.
15. Akerstedt T. Shift work and sleep disorders. Sleep 2005;28(1):9-11.
16. Akerstedt T, Ingre M, Broman JE, Kecklund G. Disturbed sleep in shift workers, day workers, and insomniacs. Chronobiol Int 2008;25(2):333-48.
17. Rajaratnam SM, Arendt J. Health in a 24-h society. Lancet
2001;358(9286):999-1005.
18. Dawson D, Reid K. Fatigue, alcohol and performance impairment. Nature 1997;388(6639):235.
19. Akerstedt T, Fröberg JE, Friberg Y, Wetterberg L. Melatonin excretion, body temperature a nd subjective arousal during 64 hours of sleep deprivation. Psychoneuroendocrinology. 1979;4(3):219-25.
20. Owens JA, Veasey SC, Rosen RC. Physician, heal thyself: sleep,fatigue and medical education. Sleep 2001;24(5):493-5.
21. Leung L, Becker CE. Sleep deprivation and house staff performance. J Occup Med 1992;34(12):1153-60.
22. Howard SK, Gaba DM, Rosekind MR, Zarcone VP. The risks and implication of excessive daytime sleepiness in resident physicians. Acad Med 2002;77(10):1019-25.
23. Veasey S, Rosen R, Barzansky B, Rosen I, Owens J. Sleep loss and fatigue in residency training: a reappraisal. JAMA 2002;288(9):1116-24.
24. Accreditation Council for Graduate Medical Education. Available at:http://www.acgme.org/acWebsite/dutyHours/dh_dutyHoursCommonPR.pdf.
25. Ming-Chin Yang, Yi-Fan Li, Shi-Lun Wei. An Analysis of the Work Hours and Related Factors Associated with Attending Physicians and Residents in Teaching Hospital. J Med Education 2007;11(3):222-33.
26.鄭雅文、吳宣蓓、翁裕峰:過勞職災的認定爭議與政策因應:日本經驗對台灣的啟示。台灣衛誌 2011;30:301-15。.
27. Sato Y, Miyake H, Thériault G. Overtime work and stress response in a group of Japanese workers. Occup Med (Lond) 2009;59(1):14-9.
28. Philibert I. Sleep loss and performance in residents and nonphysicians: a
meta-analytic examination. Sleep 2005;28(11):1392-402.
29. Amir O, Alroy S, Schliamser JE, et al. Brachial artery endothelial function in residents and fellows working night shifts. Am J Cardiol 2004;93(7):947-9.
30. Fialho G, Cavichio L, Povoa R, Pimenta J. Effects of 24-h shift work in the emergency room on ambulatory blood pressure monitoring values of medical residents. Am J Hypertens 2006;19(10):1005-9.
31. Rauchenzauner M, Ernst F, Hintringer F, et al. Arrhythmias and increased neuro-endocrine stress response during physicians'' night shifts: a randomized cross-over trial. Eur Heart J 2009 (21):2606-13.
32. Tarzia P, Milo M, Di Franco A, et al. Effect of shift work on endothelial function in young cardiology trainees. Eur J Cardiovasc Prev Rehabil 2011.
33. Okamoto H, Tsunoda T, Teruya K, et al. An Occupational Health Study of Emergency Physicians in Japan: Health Assessment by Immune Variables (CD4, CD8, CD56, and NK Cell Activity) at the Beginning of Work. J Occup Health 2008;50(2):136-46.
34. Uchakin PN, Parish DC, Dane FC, et al. Fatigue in Medical Residents Leads to Reactivation of Herpes Virus Latency. Interdiscip Perspect Infect Dis 2011;10:1-7.
35. Castelo-Branco C, Figueras F, Eixarch E, et al. Stress symptoms and burnout in obstetric and gynaecology residents. BJOG 2007;114(1):94-8.
36. Buddeberg-Fischer B, Klaghofer R, Stamm M, Siegrist J, Buddeberg C. Work stress and reduced health in young physicians: prospective evidence from Swiss residents. Int Arch Occup Environ Health 2008;82(1):31-8.
37. Sangi-Haghpeykar H, Ambani DS, Carson SA. Stress, workload, sexual well-being and quality of life among physician residents in training. Int J Clin Pract 2009;63(3):462-7.
38. Tironi MO, Nascimento Sobrinho CL, Barros Dde S, et al. Professional Burnout Syndrome of intensive care physicians from Salvador, Bahia, Brazil. Rev Assoc Med Bras 2009;55(6):656-62.
39. Brown R, Dunn S, Byrnes K, Morris R, Heinrich P, Shaw J. Doctors'' stress responses and poor communication performance in simulated bad-news consultations. Acad Med 2009;84(11):1595-602.
40. Benson S, Sammour T, Neuhaus SJ, Findlay B, Hill AG. Burnout in Australasian Younger Fellows. ANZ J Surg 2009;79(9):590-7.
41. Al-Dubai SA, Rampal KG. Prevalence and associated factors of burnout among doctors in Yemen. J Occup Health 2010;52(1):58-65.
42. Lue BH, Chen HJ, Wang CW, Cheng Y, Chen MC. Stress, personal characteristics and burnout among first postgraduate year residents: a nationwide study in Taiwan. Med Teach 2010;32(5):400-7.
43. Selmanovic S, Ramic E, Pranjic N, Brekalo-Lazarevic S, Pasic Z, Alic A. Stress at work and burnout syndrome in hospital doctors. Med Arh 2011;65(4):221-4.
44. Gregov L, Kovačević A, Slišković A. Stress among Croatian physicians: comparison between physicians working in emergency medical service and health centers: pilot study. Croat Med J 2011;52(1):8-15.
45. Passalacqua SA, Segrin C. The effect of resident physician stress, burnout, and empathy on patient-centered communication during the long-call shift. Health Commun 2012;27(5):449-56.
46. Peisah C, Latif E, Wilhelm K, Williams B. Secrets to psychological success: why older doctors might have lower psychological distress and burnout than younger doctors. Aging Ment Health 2009;13(2):300-7.
47. Smith-Coggins R, Rosekind MR, Buccino KR, Dinges DF, Moser RP. Rotating shiftwork schedules: can we enhance physician adaptation to night shifts.Acad Emerg Med 1997;4(10):951-61.
48. Jockovich M, Cosentino D, Cosentino L, Wears RL, Seaberg DC. Effect of
exogenous melatonin on mood and sleep efficiency in emergency medicine
residents working night shifts. Acad Emerg Med 2000;7(8):955-8.
49. Tzischinsky O, Zohar D, Epstein R, Chillag N, Lavie P. Daily and yearly burnout symptoms in Israeli shift work residents. J Hum Ergol(Tokyo) 2001;30(1-2) :357-62.
50. Defoe DM, Power ML, Holzman GB, Carpentieri A, Schulkin J. Long hours and little sleep: work schedules of residents in obstetrics and gynecology. Obstet Gynecol 2001;97(6):1015-8.
51. Baldwin DC Jr, Daugherty SR, Tsai R, Scotti MJ Jr. A national survey of
residents'' self-reported work hours: thinking beyond specialty. Acad Med
2003;78(11):1154-63.
52. Cavallo A, Ris MD, Succop P, Jaskiewicz J. Melatonin treatment of pediatric residents for adaptation to night shift work. Ambul Pediatr 2005;5(3):172-7.
53. Sarani B, Alarcon LH. Reducing interns’ work hours led to fewer attentional failures and serious medical errors in intensive care units. Crit Care 2005;9(2):E3.
54. Surani S, Subramanian S, Aguillar R, Ahmed M, Varon J. Sleepiness in medical residents: Impact of mandated reduction in work hours. Sleep Med 2007;8(1):90-3.
55. Friesen LD, Vidyarthi AR, Baron RB, Katz PP. Factors Associated with Intern Fatigue. J Gen Intern Med 2008;23(12):1981-6.
56. Taoda K, Nakamura K, Kitahara T, Nishiyama K. Sleeping and working hours of residents at a national university hospital in Japan. Ind Health 2008;46(6):594-600.
57. Cao CG, Weinger MB, Slagle J, et al. Differences in Day and Night Shift Clinical Performance in Anesthesiology. Hum Factors 2008;50(2):276-90.
58. Reimann M, Manz R, Prieur S, Reichmann H, Ziemssen T. Education Research:Cognitive performance is preserved in sleep-deprived neurology residents. Neurology 2009 24;73(21):e99-e103.
59. Gohar A, Adams A, Gertner E, et al. Working Memory Capacity is Decreased in Sleep-Deprived Internal Medicine Residents. J Clin Sleep Med 2009;5(3):191-7
60. Hanlon JG, Hayter MA, Bould MD, Joo HS, Naik VN. Perceived sleepiness in Canadian anesthesia residents: a national survey. Can J Anaesth 2009;56(1):27-34.
61. Shy BD, Portelli I, Nelson LS. Emergency medicine residents'' use of psychostimulants and sedatives to aid in shift work. Am J Emerg Med Am 2011;29(9):1034-6.
62. Tomioka K, Morita N, Saeki K, Okamoto N, Kurumatani N. Working hours,occupational stress and depression among physicians. Occup Med (Lond) 2011;61(3):163-70.
63. Barger LK, Cade BE, Ayas NT, et al. Extended Work Shifts and the Risk of Motor Vehicle Crashes among Interns. N Engl J Med 2005;352(2):125-34.
64. Ayas NT, Barger LK, Cade BE.Extended work duration and the risk of self-reported percutaneous injuriesin interns. JAMA 2006;296(9):1055-62.
65. Williamson AM, Feyer AM. Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication. Occup Environ Med 2000;57(10):649-55.
66. Tornero C, Ventura A, Bourguet M, Poquet I. Evaluation of driving ability among residents after the duty shift. Accid Anal Prev 2012;47:182-3.
67. Dula DJ, Dula NL, Hamrick C, Wood GC. The effect of working serial night shifts on the cognitive functioning of emergency physicians. Ann Emerg Med 2001;38(2):152-5.
68. Landrigan CP, Rothschild JM, Cronin JW. Effect of Reducing Interns’ Work Hours on Serious Medical Errors in Intensive Care Units. N Engl J Med 2004;351(18):1838-48.
69. Lockley SW, Cronin JW, Evans EE. Effect of Reducing Interns’ Weekly Work Hours on Sleep and Attentional Failures. N Engl J Med 2004;351(18):1829-37.
70. Leff DR, Aggarwal R, Rana M,et al. Laparoscopic skills suffer on the first shift of sequential night shifts: program directors beware and residents prepare. Ann Surg 2008;247(3):530-9.
71. Davenport MS, Ellis JH, Khalatbari SH, Myles JD, Klein KA. Effect of work hours, caseload, shift type, and experience on resident call performance. Acad Radiol 2010;17(7):921-7.
72. Qureshi AU, Ali AS, Hafeez A, Ahmad TM. The effect of consecutive extended duty hours on the cognitive and behavioural performance of paediatric medicine residents. J Pak Med Assoc 2010;60(8):644-9.
73. Gordon JA, Alexander EK, Lockley SW. Does simulator-Based Clinical
Performance Correlate With Actual Hospital Behavior? The Effect of Extended
Work Hours on Patient Care Provided by Medical interns. Acad Med
2010;85(10):1583-8.
74. Mache S, Schöffel N, Kusma B, Vitzthum K, Klapp BF, Groneberg DA.Cancer care and residents'' working hours in oncology and hematology departments: an observational real-time study in German hospitals. Jpn J Clin Oncol. 2011 Jan;41(1):81-6.
75. Machi MS, Staum M, Callaway CW, et al. The relationship between shift work, sleep, and cognition in career emergency physicians. Acad Emerg Med 2012;19(1):85-91.
76. Pintor-Mármol A, Baena MI, Fajardo PC, et al. Terms used in patient safety related to medication: a literature review. Pharmacoepidemiol Drug Saf 2012.
77. Folkard S, Tucker P. Shift work, safety and productivity. Occup Med (Lond)
2003;53(2):95-101.




QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
無相關期刊
 
系統版面圖檔 系統版面圖檔