臺灣診所護理人員執業環境與健康之相關性研究

Abstract

研究目的：了解診所護理人員執業環境與可能暴露之職業危害因子對於工作壓力、工作滿意度與自覺健康狀況之影響。 方法：選取登記聘用註冊護士/護理師3人以上之1,953家診所，依各家診所聘僱護理人員數目發放問卷；此外，亦進行診所實際工作現場訪視，評估診所護理人員執業時人因工程方面的暴露狀況。 結果：本研究共發出3,819份問卷，回收2,075份（回收率54.33%），扣除非護理人員填寫之問卷(n=28)、男性(n=1)、純行政單位(n=1)及未填答完整問卷(n=73)，再依各家聘僱護理人員數抽出1,322份問卷（3∼9人之診所1份、10人以上之診所2份），並扣除兼職工作之問卷(n=49)後有1,273份問卷進入最後之分析。在生物性危害中，診所護理人員的年針扎盛行率為21.05%，且有53.50%的診所護理人員暴露於高呼吸道傳染性工作；在化學性危害方面，14.69%診所護理人員接觸消毒溶液且發生不適；在社會心理危害部分，診所護理人員的工作控制高；而工作心理負荷較一般女性受僱者高，但低於醫院護理人員；而在人因工程危害部分，診所護理人員與工作有關之肌肉骨骼不適盛行率為80.28%，且常出現快速的姿勢轉換及不自然的工作姿勢造成腰椎的受力較大。此外，在洗腎室和衛生所工作、有接觸高呼吸道傳染性工作、高工作負荷、高個人疲勞、高工作疲勞及有與工作有關之肌肉骨骼不適症狀之診所護理人員其自覺工作壓力高；高工作負荷、高工作疲勞及工作中搬運重物次數＞10次之診所護理人員其自覺工作滿意度低；工作中搬運重物次數＞10次及有與工作有關肌肉骨骼不適症狀的診所護理人員其自覺健康狀況較差。 結論：本研究結果發現我國診所之護理執業環境有針扎、高工作負荷、肌肉骨骼不適等危害會導致高工作壓力、工作不滿意與自覺健康狀況不好；建議應針對診所護理人員工作負荷高及護理工作內容擬定職業安全衛生指引供做護理養成教育及繼續教育訓練之用。

Objective: To understand working conditions and potential occupational hazards of nurses in clinics, and the effect of job stress, job satisfaction and perceived health status. Method: A total of 1,953 clinics (which employed more than 3 nurses) were included for the questionnaire survey. We conducted field visits to the clinics, to evaluate the ergonomic issues of the nurses while working. Results: A total of 2,075 (54.33% response rate) questionnaires were completed and returned by nurses, and 1,273 were eligible for final analysis. As for biological hazards, 21.05% nurses sustained at least one needlestick injury in the past 12 months, and 53.50% of the nurses had direct contact with highly contagious patients with respiratory diseases. In regard to chemical hazards, 14.69% of nurses had been exposed to disinfectants and had skin problems due to such exposure. For psychosocial hazards, clinics nurses had higher job control and higher job demand than general women workers and lower job demand than hospital nurses. As for ergonomic hazards, the prevalence of work-related musculoskeletal discomforts was high (80.28%) due to rapid movement and awkward posture at work. Nurses of dialysis room and community health centers, nurses had direct contact with highly contagious patients with respiratory syndromes, nurses who reported to have high job strain and high personal or work-related burnout, and had work-related musculoskeletal discomforts were significantly associated with self-perceived high job stress. Factors influencing nurses’ job satisfaction included high job strain, high work-related burnout and heavy lifting over 10 times per shift. In addition, for those whose job involved in heavy lifting and had work-related musculoskeletal discomforts, self-perceived poor health was also reported. Conclusion: Needlestick injury, high job strain and musculoskeletal discomforts were major occupational hazards for clinic nurses, and were found to be highly associated with self-perceived job stress, job dissatisfaction and poor health status. We suggest that occupational safety and health guidelines for nursing routines/practices to be formulated if the best working conditions for all nurses in Taiwan are to be achieved.