護理人員肌肉骨骼不適之相關因素研究

Abstract

肌肉骨骼問題是引起護理人力短缺的其中一個主因。護理人員肌肉骨骼不適盛行率是醫療工作者中最高的，肌肉骨骼不適除了會使護理人員提早離職之外，還會使病假的天數增多，也會影響到護理人員對生活與工作的滿意度與病人所得到的照護品質。本研究旨在瞭解護理人員肌肉骨骼不適之盛行率與其工作中的危險因子，希望能夠從中找出有效預防的方式。 本研究以自填式問卷進行橫斷性研究，首先經由文獻查證，並參考標準化之北歐肌肉骨骼傷害問卷（Standardized Nordic Questionnaire for the analysis of musculoskeletal symptoms, NMQ）以及侯與蕭建構之肌肉骨骼傷害問卷(Hou& Shiao, 2006)後擬出之問卷。問卷內容包含個人基本資料、肌肉骨骼不適症狀以及工作內容三部分。問卷內容效度為0.96、個人基本資料與工作特質部分再測信度值為0.99，而過去一年各部位肌肉骨骼不適之情形部分再測信度值為0.80。本研究在詢問60家醫療人員安全衛生中心之合作醫院意願後，得到22家醫療院所的同意，共發放4,390份問卷，回收3,561份，其中有效問卷共3,282份，回收率為74.8％。 結果發現在3,282位受訪者中，有58％（1,902人）表示最近一年內有肌肉骨骼不適的症狀，而盛行率較高的部位為頸部49.7％、下背或腰45％、肩部（右肩40.9％、左肩39.4％）以及小腿（右小腿28.3％、左小腿26.1％）；不適的症狀以酸最多，於各部位所佔比例為24.3％∼43.9％不等，其次為疼痛佔8.7％∼23.9％不等。而護理人員的工作年資、年齡都與肌肉骨骼不適有相關，工作項目方面，主要以手部進行的清潔護理與鋪床兩項工作項目中，相關的不適部位多集中在下背或腰、小腿與腳踝等身體下半部，而久站相關的工作項目主要卻集中在頸身體上半部的部分。原因可能是因為護理人員在工作時常時間站立的狀況，因此反而與下肢部位不適相關較多，同時久站是與許多部位不適症狀相關的因子，但在其他國家甚至日本的文獻中，卻很少提到久站這個工作因子，這可能與台灣的文化較不鼓勵護理人員以坐姿進行工作項目有關，而使工作人員長時間維持站姿所致，因此研究者建議除了教導護理人員調整床位高低之外，也應該鼓勵在適合的情況下使用坐姿工作。 在與不同研究比較後發現，本研究的頸部不適盛行率大幅上升，可能是因為現在醫療人員用到電腦的機會越來越多，建議院方應該開始去重視並改善醫院中電腦工作站的人因工程，尤其更應注意書記與門診護理人員對電腦工作站人因工程的知識瞭解程度，並安排適合護理人員的人因工程相關知識教育。

Musculoskeletal discomforts (MSDs) is one of the major causes of nursing shortage. Nurses account for the highest MSD prevalence rate compared to other groups of healthcare workers. Suffering from MSDs may result in nurses’ quitting their job earlier, increasing sick leaves, and decreasing the quality of personal life and job satisfaction. The purpose of this study was to understand the magnitude of and risk factors for MSDs in Taiwan nurses, and to identify the preventive strategies of MSDs. This cross-sectional study employed a self-report questionnaire for data collection. Questions included demographic information, symptoms of MSDs and contents of average daily work. The content validity was 0.96 and the test re-test reliability was 0.99 for demographic information and was 0.80 for contents of work. A total of 4,390 questionnaires were distributed and 3,282 completed it, resulting in a high response rate of 74.8%. Among 3,282 nurses, 1,902 (58%) suffered from MSDs in the last one year. The prevalence of MSDs was 49.7% in neck, 45% in low back, 40.9% in right shoulder, 39.4% in left shoulder, 28.3% in right leg, and 26.1% in left leg. The most common symptom being sourness, and the prevalence rate was between 24.3% and 43.9%, followed by pain with the prevalence rate between 8.7% and 23.6%. Both age and seniority were highly associated with the incidence of MSDs, and standing for longer hours was also an important risk factor for MSDs. This study has identified a higher prevalence rate of MSDs in neck in our nurses compared to overseas studies. Advanced continuing education programs focused on ergonomic factors and preventive, measures for MSDs among nurses are warranted.