健康照護服務工作者的職場社會心理環境及鎮靜安眠藥物使用行為：以護理師為主要研究對象

Abstract

前言： 健康照護服務工作者長期處於高度壓力的職場環境中，面臨高工作負荷、職場攻擊行為與工作家庭衝突等社會心理危害，這些因素與其心理健康問題密切相關。先前研究亦指出，護理師族群的鎮靜安眠藥物使用盛行率顯著偏高。然而，目前針對職場社會心理危害對健康照護服務工作者心理健康與鎮靜安眠藥物使用之影響，實證研究仍相當缺乏。 研究方法： 本研究採取多階段混合研究設計，結合次級資料庫分析、問卷調查與質性訪談，以不同研究方法相互補充與詮釋，提供全面性的結果討論。 (1) 勞動環境安全衛生認知調查分析：本研究使用2022年勞動環境安全衛生認知調查，研究變項包括職場社會心理危害、心理健康問題、疲勞及鎮靜安眠藥物使用，將健康照護服務與社會工作者（n=202）與一般工作者（n=808）依據性別、年齡及教育程度進行1:4配對，比較其差異。此外，運用條件式羅吉斯回歸及分層分析，檢視職場社會心理危害與心理健康問題、疲勞與鎮靜安眠藥物使用的相關性。 (2) 問卷調查：針對臺灣三家區域醫院的護理師進行問卷調查，以到職三個月以上之正職護理師為研究對象（n = 575）。問卷涵蓋工作心理負荷、工作家庭衝突與職場攻擊行為等職場社會心理危害、心理健康問題及鎮靜安眠藥物使用情形。本研究運用羅吉斯回歸分析探討職場社會心理危害與心理健康問題及鎮靜安眠藥物使用之關聯性，並透過路徑分析檢視鎮靜安眠藥物使用是否在職場社會心理危害與心理健康問題之間扮演中介角色。 (3) 護理師使用鎮靜安眠藥物的動機與經驗：針對護理師進行訪談（n = 21），受訪對象為目前仍有使用鎮靜安眠藥物的護理師，探討其藥物使用動機、取得途徑、個人用藥調整歷程與自我照護策略。透過反思性主題分析，探討護理師如何發展藥物使用策略，並檢視其中的職場與社會脈絡。 結果： (1) 勞動環境安全衛生認知調查分析：配對分析後，健康照護服務與社會工作者有較高工作心理負荷、高工作家庭衝突、職場攻擊行為、心理健康問題、疲勞及鎮靜安眠藥物使用。此外，鎮靜安眠藥物使用與身為健康照護服務與社會工作者有顯著相關（adjusted OR；95% CI：2.47；1.21-5.03），顯示除職場社會心理危害外，職場脈絡也扮演重要因素。 (2) 問卷調查：高工作心理負荷、高工作家庭衝突與職場攻擊行為均與護理師的心理健康問題呈現顯著相關。此外，鎮靜安眠藥物使用在高工作心理負荷、高工作家庭衝突對心理健康問題的影響之間具有部分中介效果，顯示護理師可能透過藥物使用來應對壓力，然而，這種策略可能進一步惡化心理健康狀態。 (3) 護理師使用鎮靜安眠藥物的動機與經驗：護理師的鎮靜安眠藥物使用行為，是透過個人知識、社會網絡與實踐經驗發展而出的自我照護策略。他們運用專業知識支持，經由醫療體系內網絡的正式與非正式途徑取得藥物，並透過反覆實踐進行自我照護的調整。然而非正式的藥物取得途徑，可能潛藏藥物濫用與衍生的健康風險。 結論： 本研究整合量化與質性資料，系統性驗證並補充不同研究方法下之觀察結果，強化對護理師鎮靜安眠藥物使用行為的整體理解。研究顯示，此行為不僅為個人壓力因應策略，更深植於職場文化與倫理實作中，強調從結構風險與照護脈絡雙重視角切入，方能有效設計相關介入措施與政策建議。

Background: Healthcare workers face significant psychosocial work hazards, including high psychological job demands, workplace violence, and work-to-family conflicts, which are closely associated with mental health problems. Previous studies have indicated a higher prevalence of sedative-hypnotic drug use among this population, particularly among nurses. However, there is a lack of empirical research examining the impact of psychosocial work hazards on the mental health problems of healthcare workers and their use of sedative-hypnotic drugs. Methods: This study adopted a multiphase mixed methods design, integrating secondary data analysis, a survey, and qualitative interviews to provide a comprehensive analysis through different methodological perspectives. (1) Analysis of the Perceptions of Safety and Health in the Work Environment Survey: Data was from the 2022 Survey of Perceptions of Safety and Health in the Work Environment. We conducted a comparison between healthcare and social workers and general employees, applying a 1:4 matching ratio based on sex, age, and education. This comparison focused on assessing differences in psychosocial work hazards, mental health problems, fatigue, and sedative-hypnotic use. Conditional logistic regression and stratified analysis were conducted to examine the associations between psychosocial work hazards and mental health problems /sedative-hypnotic use across different occupational groups. (2) Survey study: A cross-sectional survey was conducted among nurses from three regional hospitals in Taiwan (n = 575). The survey assessed psychosocial work hazards, including psychological job demands, work-to-family conflicts, and workplace violence, mental health problems, and sedative-hypnotic use. Logistic regression was employed to examine the associations between psychosocial work hazards, mental health problems, and sedative-hypnotic use. Additionally, path analysis was used to investigate whether sedative-hypnotic drug use mediates the relationship between psychosocial work hazards and mental health problems. (3) Motivations and Experiences of Nurses Using Sedatives-Hypnotics: Semi-structured interviews were conducted with nurses (n = 21) who reported using sedatives-hypnotics. The interviews explored motivations for drug use, access to medication, patterns of medication use, and self-care strategies. Reflective thematic analysis was used to identify how nurses develop their medication-use strategies and the occupational and social contexts influencing these behaviors. Results: (1) Analysis of the Perceptions of Safety and Health in the Work Environment Survey: After matching for relevant covariates, healthcare and social workers exhibited higher levels of psychological job demands, work-to-family conflicts, workplace violence, mental health problems, fatigue, and sedative-hypnotic use than general employees. Furthermore, being a healthcare and social worker is a risk factor for sedative-hypnotic use(adjusted OR；95% CI: 2.47；1.21-5.03), suggesting that occupational context plays a crucial role in shaping medication-use behaviors beyond the impact of psychosocial work hazards. (2) Survey study: High psychological job demands, high work-to-family conflicts, and workplace violence were all significantly associated with nurses' mental health problems. Furthermore, sedative-hypnotic use partially mediated the effects of high psychological job demands and high work-to-family conflicts on mental health problems, suggesting that while nurses may use these medications as a coping strategy, such behavior may further deteriorate their mental well-being. (3) Motivations and Experiences of Nurses Using Sedatives-Hypnotics: The interviews revealed that sedative-hypnotic use among nurses is not merely an individual coping behavior but rather a self-care strategy shaped by personal knowledge, social networks, and repeated practice. Nurses leveraged their professional expertise, peer support, and both formal and informal channels within the healthcare system to obtain and regulate their medication use. However, informal medication acquisition methods may pose risks of misuse and adverse health consequences. Conclusion: This study integrates quantitative and qualitative data to systematically validate and complement findings across different methodological approaches, thereby enhancing the overall understanding of sedative-hypnotic use among nurses. The results indicate that such behavior is not merely an individual coping strategy but is deeply embedded in workplace culture and ethical care practices. The study underscores the importance of addressing both structural risks and care contexts to effectively inform intervention strategies and policy recommendations.