護理畢業生職業壓力、輪班和月經來潮狀況之探討

Abstract

護理人員因醫療照護工作的特性必須輪班，而輪班所帶來的睡眠問題及身、心理疲勞，及醫療工作本身所帶來的極大身心壓力等，國內外許多研究個別探討各變項對於女性護理人員月經異常、受孕所需時間、及對懷孕結果（是否早產、流產、出生體重不足）影響的相關性。至今，國內對於此領域之研究多為橫斷式研究，無法推斷各變項間的因果關係。本研究建立國內理人員生殖健康之研究世代，收集國內護理學校應屆畢業生進入職場初期的月經來潮狀況，再與其進入護理專業工作較長時間後月經來潮狀況之變化做比較，並全面性評估研究對象在職場中面臨輪班、工作相關壓力等職業暴露，綜合分析以了解醫療照護工作特性對女性護理人員之生殖影響。 研究對象為國內四家學校的護理科系2015年畢業生，有404位下載APP參與研究；扣除資格不符、資料過少者，共108人進入分析，護理職場組受試者佔63.0%（n=68），未進入護理職場組佔37.0%（n=40）。有變換班別的受試者占72.1%(n=44)，固定班別者有27.9%(n=17)。分析之月經狀況包括：月經週期天數、月經週期規律性、月經來潮天數、經血量變化及痛經情形。本研究結果發現進入職場組較未進入職場組痛經狀況較為嚴重。且進入職場組進入護理工作後出現痛經的比率顯著增加。進入職場組職業暴露後月經週期天數較職業暴露前顯著較長。在護理人員職業暴露與月經狀態部分，有變換班別之護理人員的痛經狀況亦較固定班別之護理人員嚴重。夜班工作之進入職場組與未進入職場組相比，痛經狀況較為嚴重。護理工作壓力大亦與痛經狀況有相關。 本研究以前驅研究的概念提供護理人員執業壓力、輪班與月經來潮現況之初步成果。研究結果可提供了解護理人員其護理工作職業暴露與月經週期改變影響的參考。護理人員生殖健康世代研究需要繼續發展與維持，方能持續而穩定的收集生殖健康相關資料，進行相關研究與分析。建議未來研究設計可考慮建立世代追蹤研究，建議增加生物標記(biomarkers)檢測，作為本研究之健康效應變項。

Nursing often comes with shift work due to their patient care responsibilities. Consequently some occupational hazards in nursing profession include physical and mental fatigue, exposure to radiation and chemicals including antineoplastic drugs, job stressors. Shiftwork has been associated with circadian rhythm disorders and sleep problems. However, effects of shiftwork on reproductive functioning in female nurses remain unclear, including those on menstrual abnormalities, hormonal changes, fecundability, and birth outcomes. In this study, we established nurses’ cohort for follow-up. Graduating students from four nursing schools were recruited for long-term follow-up. The participants were invited to record menstrual characteristics, including dysmenorrhea, cycle length, bleeding days and amount. These characteristics will be compared before and after entering nursing job, and among those working dayshift, night shift, and rotating shift. There were 404 graduating students participated in our study, a total of 108 participants completed and were eligible for final analysis. Participants were categorized into two groups according to whether they started their nursing job after the completion of nursing school. The Nurse group were more likely to have dysmenorrhea problem then Non-Nurse group. The nurses who changed their work shift would more likely to have dysmenorrhea problem than those who worked fixed shift. Night work nurses were more likely to have dysmenorrhea problem then nurses who worked day time. We also found the cycle length of nurses became longer after their entering nursing profession. This study is the first nurses’ reproductive cohort study in Taiwan. Further investigations with prospective long term follow-up studies and urine hormonal measurements are recommended to provide additional evidence.