輪班工作、職場環境與女性護理人員飲食型態之相關性研究

Abstract

研究目的： 了解我國臨床女性護理人員於輪班工作下，各班別之不健康食品攝取現況，以及護理師飲食型態（正常用餐時間、攝取餐次及飲食種類）與工作負荷、影響其飲食抉擇的（職場環境）因子間之相關性，同時亦比較於不同單位（一般病房/急重症單位）服務之護理師，飲食型態是否有所差異。 研究方法： 本研究使用之工具為自擬結構式問卷，內容包括：個人屬性、影響用餐時間原因、班內用餐時間長度、各班別飲食型態、下班後飲食習慣及飲食種類選擇影響因子等問題。採橫斷性資料收集方式，自財團法人醫院評鑑暨醫療品質策進會網站登記在案的466家「衛生福利部2014~2017年醫院評鑑及教學醫院評鑑（含精神科）」合格醫院中，以隨機取樣的方式選取各區、各層級醫院共38家，待聯繫確認其參與意願及可發送之問卷數量後，即郵寄之，問卷若經填寫並寄回即代表受試者同意參與本研究。使用JMP 10統計軟體進行建檔及資料分析，描述性統計包含人口學資料、飲食型態於各班別或下班後以及不同單位之分布情形；推論統計則比較上班及休假日、班內完整用餐時間或輪班影響食慾與否、各班別護病比、不同單位之各班別，在攝取餐次上之差異性；或是將班別、工作負荷以及職場環境因素與飲食型態共同放入邏輯斯回歸模型中，探討此三者與護理師飲食行為（攝食種類、用餐時間）之間的關聯性。 研究結果： 總計發放1,079份問卷，扣除未寄回並剔除資料有闕漏者後，餘有效問卷672份（有效問卷回收率62.3 %）進入分析。結果顯示，護理師平均年齡30.84歲、BMI平均為22.25，有慢性病史者則不及5%。服務單位大致上一般病房與急重症單位各半，每週平均工時45.20小時，三班平均護病比則為9.74（符合護病比標準之比率為38.78 %）。「正常用餐時間」最受影響班別首位為「不固定班」（28.76%）、「班內用餐時間」最受影響班別則屬8小時白班（41.42%）最多，三班中，白班最容易在班內及下班後攝取不建康飲食，且上、下班的攝取有相關性存在（p< .01）。攝取比率上，白班與小夜班相近、手搖飲料的攝取皆高於七成；大夜班乃以即食食品與咖啡的攝取大幅領先他班。各班別的護理師以不健康種類食品取代正餐的比率都超過六成，「攝取餐次」則出現一致的休假日多於上班日之情況（p< .001），且大夜班的上班日更有超過七成的人一天吃少於三餐，以整體（三班）來看，飲食規律性受輪班工作影響的護理師約占43%。班內完整30分鐘用餐的機會越少，上班日攝取的餐次也較少，在白班及小夜班尤其明顯。超過五成護理師認為輪班工作使其食慾降低，之中有「上班壓力大吃不下」情形的勝算比為5.45（p <.001），因輪班影響食慾的情況不同，上班日所攝取的平均餐次及班內飲食種類亦有所差異（p <.05）。工作負荷大（每週工時較長或班內較少完整用餐時間者）時，護理師正常用餐時間被影響的機率增加，但班內攝取不健康食品則未有顯著差異，此外，三班的上班日攝取餐次皆隨護病比的增加而減少，但只有白班的結果呈現顯著邊緣。職場環境因子方面，醫院附近覓食方便會使下班後攝取不健康食品之可能性增加（OR=1.49, p< .05），員工餐的方便與否則是影響護理師能不能在正常用餐時間進食的主因（OR=2.93, p< .001），至於上班日略餐情形，僅與「單位休息室食物的可及性」相關，結果達顯著（p <.05）。最後，護理師的單位屬性，僅在白班時平均攝取餐次於一般病房及急重症單位之間有顯著差異（p< .05）。 結論與建議： 不同班別的飲食行為不盡相同，促使各班別攝取不健康食品的原因各異─大夜班可能是受晝夜節律、缺乏飲食供應源影響；白班及小夜班則因受干擾的班內用餐時間所致。輪班工作容易擾亂作息，進而改變進食時間點、影響食慾，大夜班更是平均只攝取兩餐。輪班工作於護理專業乃無可避免，應考慮由其他層面改善，例如提供護理師上班期間健康飲食的選擇。 首先，高工作負荷會增加正常用餐時間被干擾的機會並可能透過「上班壓力」促進班內不健康食品的攝取，如：甜食或零食（OR=2.10, p<.05）、即食食品（OR=2.39, p< .001），而種類的選擇可能因個人對壓力之感受及應對方式而有所不同，未來研究設計應可進一步探討護理師進食前後壓力程度、食慾（量表）、飲食種類與攝取原因之關聯性。 再者，「職場環境」是本研究五項內、外在因子中，唯一與所有種類之不健康食品攝取增加皆顯著相關的變項，是以欲增進輪班護理師的飲食健康，應由改善護理職場飲食環境著手。主要影響護理師飲食行為的職場因子可統整為「食物取得的方便性」，醫院若能供應各班別護理師健康的熟食，或是安排充足的人力配置以保障護理師於臨床工作時皆能享有完整、固定的用餐時間，預期將可有效減少輪班護理師的不健康飲食行為。此外，藉由本研究發現「上、下班不健康食品的攝取間存在有相關性」的概念，期望透過改善護理師班內飲食行為，連帶促進其下班後之飲食型態。至於「同事」在上班日飲食的影響因素中，也占了一席之地（43.41%），唯其影響機轉更為複雜且多樣，卻是營造職場健康飲食不可或缺的一環，因此值得後續研究深入探討。 總結上述，希望本研究之結果可作為改善我國護理職場環境、飲食健康與相關改善策略之參考。

Objective: To understand the dietary habit among Taiwan female clinical nurses in different shifts, and to determine the relationship among shiftwork, workload, food choices at work, and the nurses’ eating habits (EH, e.g. normal meal time, meal frequency, and food types). Methods: A self-administered questionnaire we used for data collection, including demographic characteristics, the reason of interfered meal time, the time for meal break when working, EH in different shifts and off days, and factors influencing the food choices. A total of 38 hospitals out of 466 qualified hospitals (Hospital Accreditation of 2014-2017 by Ministry of Health and Welfare) were randomly sampled. Data analysis was conducted using JMP 10 software. Descriptive statistics included demographic characteristics, EH in different shifts, units, or off duty. Inferential statistics included comparison of the meal frequency (MF) between: workday and holiday, whether there was complete meal time, shiftwork affected appetite or not, nurse-to-patient ratio (NP ratio) and unit differences in different shifts. Besides, putting shift, work load, and workplace factors with EH into nominal logistic regression model, to investigate the relationship among them. Results: The response rate was 62.3% (672/1,079). Mean age of the participants was 30.8 years old, and less than 5% being diagnosed with a chronic disease. The average weekly working hours was 45.20h, and NP ratio was 9.74 (38.78% met standard). “Irregular shift” interfered the normal meal time (NMT) most (28.76%), while the “8h day shift” disturbed the meal break at work most (41.42%). Among shifts, day shift nurses consumed unhealthy foods (UF) at work and off duty most easily (p< .01). As for food types, proportions were similar in day- and afternoon- shift, the consumption of handmade drinks was over 70%; while instant foods and coffee were consumed much more in night shift than other shifts. It also showed consistency in the substitution of meals with UF (over 60%), and more meals on holidays than workdays in all shifts (p< .001). In addition, over 70% night shift nurses had less than 2 meals on workdays. About 43% nurses’ dietary regularities were impacted. The less the chances one had complete meal time, the less frequent they ate on workdays, especially for day and afternoon shifts. Over half of nurses believed that shiftwork would reduce their appetite (OR=5.45; p< .001). The average MF in day shift showed significant discrepancy between unit types (p< .05). Conclusions and recommendations: Eating habits vary across work shifts. Factors influencing the type of foods chosen in night shift may possibly be affected by circadian rhythm, lack of accessibility to healthy foods, whilst the “interrupted meal break at work” being the major factor for day and evening shifts. Shiftwork often disturbs daily schedule, alters the time for meals, and impacts one’s appetite. Shiftwork is inevitable in nursing profession, measures to create a healthier dietary environment for nurses are warranted. Firstly, heavy workload increases the chance of interfered NMT and may enhance the intake of UF- sweets and snacks, or instant foods. The choice of food types depends on one’s feeling and coping skills toward stress. Further investigation of the correlation among the extent of nurses’ stress and appetite (scale) before and after eating, the food types and reason for consumption. Secondly, “workplace” is the only variable that is associated to the increase of all types UF. To improve nurses’ dietary health, provision of healthy foods at workplace environment should be considered and designed.