夜班輪班工作之身心健康影響：護理人員訪談及國際規範比較之研究

Health impacts of shift work and night work: An International comparison of regulations and an interview study of nurses in Taiwan

10.6342/NTU201600265

李佳旃

夜班輪班 ； 護理人員 ； 身心健康 ； 政策 ； 國際比較 ； night work and shift work ； nurses ； physical and mental health ； policy ； international comparison

國立臺灣大學健康政策與管理研究所學位論文

2016年

碩士

鄭雅文

繁體中文

背景與目的：流行病學文獻指出，夜班輪班工作型態對工作者身心健康造成負面影響，包括睡眠障礙、代謝疾病、心血管疾病、憂鬱症狀等。在台灣，勞動部於2014年起將原本屬責任制工時的護理人員全面回歸正常工時，但醫護工作者仍舊工時偏長，致使近年來過勞爭議不斷。如何使醫護工作者在夜班輪班工作型態之下，能維持充分休息並確保身心健康，為政府職業安全健康部門的關注重點。本研究首先比較國際有關夜班輪班工作之相關規範，接著探討醫院護理人員的夜班輪班型態、醫院相關管理制度、夜班輪班可能引發的身心健康問題，以及護理人員對醫院制度與政府政策的看法。 方法：本研究採文獻回顧與半結構式訪談。在訪談研究方面，訪談對象界定為年資一年或以上之女性，於台北市及新北市之醫學中心或區域醫院內科部或外科部擔任臨床護理人員，但排除懷孕及產後一年以內之工作者。研究期間為2015年11月至2015年12月，訪談對象共計23位。 研究結果：參考國際法規經驗，可發現西方國家對於夜班者工時規範較台灣目前法規完善。訪談結果發現，護理人員違反勞基法工時相關規定的問題仍普遍，但不少護理人員囿於勞雇關係而選擇隱忍不舉發，亦有不少護理人員並不清楚自己權益受損。 結論與建議：勞動與健康主管機關應重視夜班輪班對工作者帶來的安全健康危害。具體的策略包括，修訂法規並發行相關指引，提供護理人員適應時差之輪班方法，舉辦教育課程提升護理人員勞動權益意識，加強勞動檢查並提高罰則，以確實落實規範，保障工作者的職業安全健康權益。

Background and objective: Existing epidemiologic evidences show that shift work and night work are associated with increased health risks, including sleep disorders, metabolic diseases, cardiovascular or cerebrovascular diseases and depression. In Taiwan, long working hours and shift work are common among health care workers. In this occupational group, diseases associated with overwork problems have been a public health issue. The labor authority of Taiwan has taken measures to regulate working hours in attempt to safeguard occupational health of health care workers. Since January 1 of 2014, nurses are no longer exempted from working hour regulations of the Labor Standard Act. This study was conducted to compare with international regulations of shift work and night work, and to explore the patterns of shift work and night work status as well as hospital management concerning shift work and night work among nurses working in hospitals of Taipei City and New Taipei. Nurses’ perceived health impacts associated with night work and shift work and their attitudes toward organizational policies and governmental policies were examined. Methods: Literature review and in-depth interviews were conducted. In interview study, study subjects were female nurses in hospitals of the Taipei city or New Taipei city, with work tenure of 1 year or longer. Those who were pregnant or had given birth within a year were excluded. A total of 23 nurses were interviewed during the study period from November 2015 to December 2016. Results: Comparions with international regulations indicated that regulations on shift work and night work of Western countries are more comprehensive as compared to that of Taiwan. Results from interviews with nurses suggested that violations of the Labor Standards Law were commonplace, but many nurses chose to tolerate unlawful practices due to unbalance labor relation. Several nurses did not even know their rights had been infringed. Conclusion and recommendation: Labor authority should pay attention to the safety and health risks with night work and shift work. We suggest that regulations should be revised and guidelines should be promulgated to help workers to better adapt to night and shift work. In addition, labor right and occupational health education should be provided, and labor inspection should be forcefully implemented with sufficient level of punishment to truly safeguard the labor and health rights of working people in Taiwan.

1. Folkard, S. (2003). Shift work, safety and productivity. Occupational Medicine, 53(2), 95-101. doi:10.1093/occmed/kqg047
   連結：
2. Geiger, B. J., & McPhaul, K. (2011). Sleep promotion in occupational health settings. In N. Redeker & G. McEnany (Eds.), Sleep Disorders and Sleep Promotion in Nursing Practice. New York: Springer.
   連結：
3. Gold, D. R., Rogacz, S., Bock, N., Tosteson, T. D., Baum, T. M., Speizer, F. E., & Czeisler, C. A. (1992). Rotating shift work, sleep, and accidents related to sleepiness in hospital nurses. American Journal of Public Health, 82(7), 1011-1014.
   連結：
4. Gu, F., Han, J., Laden, F., Pan, A., Caporaso, N. E., Stampfer, M. J., . . . Schernhammer, E. S. (2015). Total and cause-specific mortality of U.S. nurses working rotating night shifts. American Journal of Preventive Medicine, 48(3), 241-252. doi:10.1016/j.amepre.2014.10.018
   連結：
5. Guidance on safe nurse staffing levels in the UK. (2010). In R. C. o. Nursing (Ed.).
   連結：
6. Ha, M., & Park, J. (2005). Shiftwork and metabolic risk factors of cardiovascular disease. Journal of Occupational Health, 47(2), 89-95.
   連結：
7. Han, K., Trinkoff, A. M., & Gurses, A. P. (2015). Work-related factors, job satisfaction and intent to leave the current job among United States nurses. Journal of Clinical Nursing, 24(21-22), 3224-3232. doi:10.1111/jocn.12987
   連結：
8. Harrison, Y., & Horne, J. A. (2000). The impact of sleep deprivation on decision making: a review. Journal of Experimental Psychology: Applied, 6(3), 236-249.
   連結：
9. Healy, C. M., & McKay, M. F. (2000). Nursing stress: the effects of coping strategies and job satisfaction in a sample of Australian nurses. Journal of Advanced Nursing, 31(3), 681-688.
   連結：
10. Horwitz, I. B. (2004). The impact of shift work on the risk and severity of injuries for hospital employees: an analysis using Oregon workers' compensation data. Occupational Medicine, 54(8), 556-563. doi:10.1093/occmed/kqh093
    連結：
11. Hours of Work Act, (1994).
    連結：
12. IARC. (2010). Painting, Firefighting, and Shiftwork. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, 98, 34-36.
    連結：
13. Kawada, T., & Otsuka, T. (2014). Effect of shift work on the development of metabolic syndrome after 3 years in Japanese male workers. Archives of Environmental & Occupational Health, 69(1), 55-61. doi:10.1080/19338244.2012.732123
    連結：
14. Knauth, P. (2003). Preventive and compensatory measures for shift workers. Occupational Medicine, 53(2), 109-116. doi:10.1093/occmed/kqg049
    連結：
15. Knutsson, A. (2003). Health disorders of shift workers. Occupational Medicine (Oxford, England), 53(2), 103-108.
    連結：
16. Knutsson, A., & Kempe, A. (2014). Shift work and diabetes--a systematic review. Chronobiology International, 31(10), 1146-1151. doi:10.3109/07420528.2014.957308
    連結：
17. Labour Code, (2007).
    連結：
18. Lambert, V. A., Lambert, C. E., Itano, J., Inouye, J., Kim, S., Kuniviktikul, W., . . . Ito, M. (2004). Cross-cultural comparison of workplace stressors, ways of coping and demographic characteristics as predictors of physical and mental health among hospital nurses in Japan, Thailand, South Korea and the USA (Hawaii). International Journal of Nursing Studies, 41(6), 671-684.
    連結：
19. Lazarus, R. S., & Folkman, S. (1984). Stress, Appraisal, and Coping. New York: Springer.
    連結：
20. Lazarus, R. S., & Folkman, S. (1988b). Ways of Coping Questionnaire Manual. [Press release]
    連結：
21. LH, A., DM, S., L, B., K, V. d. H., P, G., R, B., . . . consortium, R. C. (2014). Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. Lancet, 383(9931), 1824-1830.
    連結：
22. Lipscomb, J. A., Trinkoff, A. M., Geiger-Brown, J., & Brady, B. (2002). Work-schedule characteristics and reported musculoskeletal disorders of registered nurses. Scandinavian Journal of Work, Environment & Health, 28(6), 394-401.
    連結：
23. Loudoun, R. (2008). Balancing shiftwork and life outside work: do 12-h shifts make a difference? Applied Ergonomics, 39(5), 572-579. doi:10.1016/j.apergo.2007.12.004
    連結：
24. Miller, W. L., & Crabtree, B. F. (1992). Doing qualitative research. London: Sage.
    連結：
25. Minors, D. S., & Waterhouse, J. M. (1983). Does 'anchor sleep' entrain circadian rhythms? Evidence from constant routine studies. Journal of Physiology, 345, 451-467.
    連結：
26. Mrayyan, M. T. (2005). Nurse job satisfaction and retention: comparing public to private hospitals in Jordan. Journal of Nursing Management, 13(1), 40-50. doi:10.1111/j.1365-2834.2004.00453.x
    連結：
27. Nakata, A., Haratani, T., Takahashi, M., Kawakami, N., Arito, H., Kobayashi, F., . . . Araki, S. (2004). Association of sickness absence with poor sleep and depressive symptoms in shift workers. Chronobiology International, 21(6), 899-912.
    連結：
28. Nelson, D. (2007). Prevention and Treatment of Sleep Deprivation Among Emergency Physicians. Pediatric Emergency Care, 23(7), 498-503. doi:10.1097/01.pec.0000280519.30570.fa
    連結：
29. NHS terms and conditions of service handbook. (2015).
    連結：
30. Night Work Convention, (1990).
    連結：
31. Night Work Recommendation, (1990).
    連結：
32. Nurse Overtime and Patient Safety Act, (2007).
    連結：
33. Nurse-to-Patient Staffing Ratio Regulations, (2005).
    連結：
34. Nursing Personnel Convention, (1977).
    連結：
35. Nursing Personnel Recommendation, (1977).
    連結：
36. Parkes, K. R. (2015). Work environment, overtime and sleep among offshore personnel. Accident Analysis & Prevention. doi:10.1016/j.aap.2015.11.022
    連結：
37. Pasqua, I. C., & Moreno, C. R. (2004). The nutritional status and eating habits of shift workers: a chronobiological approach. Chronobiology International, 21(6), 949-960.
    連結：
38. Payne, N. (2001). Occupational stressors and coping as determinants of burnout in female hospice nurses. Journal of Advanced Nursing, 33(3), 396-405.
    連結：
39. Petrov, M. E., Clark, C. B., Molzof, H. E., Johnson, R. L., Jr., Cropsey, K. L., & Gamble, K. L. (2014). Sleep Strategies of Night-Shift Nurses on Days Off: Which Ones are Most Adaptive? Frontiers in Neurology, 5, 277. doi:10.3389/fneur.2014.00277
    連結：
40. Poissonnet, C. M., & Veron, M. (2000). Health effects of work schedules in healthcare professions. Journal of Clinical Nursing, 9(1), 13-23.
    連結：
41. Puttonen, S., Harma, M., & Hublin, C. (2010). Shift work and cardiovascular disease - pathways from circadian stress to morbidity. Scandinavian Journal of Work, Environment & Health, 36(2), 96-108.
    連結：
42. Radetsky, L. C., Rea, M. S., Bierman, A., & Figueiro, M. G. (2013). Circadian Disruption: comparing humans with mice. Chronobiology International, 30(8), 1066-1071. doi:10.3109/07420528.2013.797428
    連結：
43. Rajaratnam, S. M., & Arendt, J. (2001). Health in a 24-h society. Lancet, 358(9286), 999-1005. doi:10.1016/s0140-6736(01)06108-6
    連結：
44. Rogers, A. E., Hwang, W. T., Scott, L. D., Aiken, L. H., & Dinges, D. F. (2004). The working hours of hospital staff nurses and patient safety. Health Affairs, 23(4), 202-212.
    連結：
45. Scheer, F. A. J. L., Hilton, M. F., Mantzoros, C. S., & Shea, S. A. (2009). Adverse metabolic and cardiovascular consequences of circadian misalignment. Proceedings of the National Academy of Sciences. doi:10.1073/pnas.0808180106
    連結：
46. Schernhammer, E. S., Laden, F., Speizer, F. E., Willett, W. C., Hunter, D. J., Kawachi, I., & Colditz, G. A. (2001). Rotating night shifts and risk of breast cancer in women participating in the nurses' health study. Journal of the National Cancer Institute, 93(20), 1563-1568.
    連結：
47. Scott, L. D., Rogers, A. E., Hwang, W. T., & Zhang, Y. (2006). Effects of critical care nurses' work hours on vigilance and patients' safety. American Journal of Critical Care, 15(1), 30-37.
    連結：
48. Shields, M. A., & Ward, M. (2001). Improving nurse retention in the National Health Service in England: the impact of job satisfaction on intentions to quit. Journal of Health Economics, 20(5), 677-701.
    連結：
49. A shift in the right direction. (2012). Royal College of Nursing, London.
    連結：
50. Skipper, J. K., Jr., Jung, F. D., & Coffey, L. C. (1990). Nurses and shiftwork: effects on physical health and mental depression. Journal of Advanced Nursing, 15(7), 835-842.
    連結：
51. Tyler, P., & Cushway, D. (1995). Stress in nurses: The effects of coping and social support. Stress Medicine, 11(1), 243-251.
    連結：
52. V, V. M., X, G. A., V, I. A., John, C., Allan, D., E, L. L., . . . G, H. D. (2012). Shift work and vascular events: systematic review and meta-analysis. BMJ, 345, e4800.
    連結：
53. van Amelsvoort, L. G., Schouten, E. G., & Kok, F. J. (1999). Duration of shiftwork related to body mass index and waist to hip ratio. International Journal of Obesity and Related Metabolic Disorders, 23(9), 973-978.
    連結：
54. Wedderburn, A. (1991). guideline for shiftworkers: European Foundation.
    連結：
55. Wilkins, K., & Shields, M. (2009). Employer-provided support services and job dissatisfaction in Canadian registered nurses. Nursing Research, 58(4), 255-263. doi:10.1097/NNR.0b013e3181a308de
    連結：
56. Winwood, P. C., Winefield, A. H., & Lushington, K. (2006). Work-related fatigue and recovery: the contribution of age, domestic responsibilities and shiftwork. Journal of Advanced Nursing, 56(4), 438-449. doi:10.1111/j.1365-2648.2006.04011.x
    連結：
57. Wong, I. S., McLeod, C. B., & Demers, P. A. (2011). Shift work trends and risk of work injury among Canadian workers. Scandinavian Journal of Work, Environment & Health, 37(1), 54-61. doi:10.5271/sjweh.3124
    連結：
58. WORKING TIME ACT, (1997).
    連結：
59. Working Time Directive, (2003).
    連結：
60. Working Time Regulations, (1998).
    連結：
61. Wu, S., Zhu, W., Wang, Z., Wang, M., & Lan, Y. (2007). Relationship between burnout and occupational stress among nurses in China. Journal of Advanced Nursing, 59(3), 233-239. doi:10.1111/j.1365-2648.2007.04301.x
    連結：
62. Zverev, Y. P., & Misiri, H. E. (2009). Perceived effects of rotating shift work on nurses' sleep quality and duration. Malawi Medical Journal, 21(1), 19-21.
    連結：
63. Guidance for Employers and Employees on Night and Shift Work. (2012). In T. H. a. S. Authority (Ed.).
64. Hughes, R. G., & Rogers, A. E. (2004). Are you tired? American Journal of Nursing, 104(3), 36-38.
65. ILO. (2004). Shift work.
66. Jansen, N. W., van Amelsvoort, L. G., Kristensen, T. S., van den Brandt, P. A., & Kant, I. J. (2003). Work schedules and fatigue: a prospective cohort study. Occupational and Environmental Medicine, 60 Suppl 1, i47-53.
67. Jorgensen, H., & Lonnie, G. (2002). Time After Time: Mandatory Overtime in the U.S. Economy . Retrieved from Economic Policy Institute:
68. Kogi, K. (2011). Sleep Deprivation. Retrieved from http://www.iloencyclopaedia.org/part-iv-66769/ergonomics-52353/organizational-aspects-of-work/44-organizational-aspects-of-work/sleep-deprivation
69. Koller, M., Haider, M., Kundi, M., & Cervinka, R. (1985). Health risks due to long-term stress--night work as an example. Zentralbl Bakteriol Mikrobiol Hyg B, 180(5-6), 548-566.
70. Krueger, G. (1994). Fatigue, performance, and medical error. Human error in medicine. (pp. 311-326). Lawrence Erlbaum Associates: Hinsdale, NJ.
71. McMillan, D. E., & Fallis, W. M. (2011). Benefits of napping on night shifts. Nursing Times, 107(44), 12-13.
72. Minors, D. S., & Waterhouse, J. M. (1981). Anchor sleep as a synchronizer of rhythms on abnormal routines. International Journal of Chronobiology, 7(3), 165-188.
73. Rogers, A. E. (2008). Chapter 40. The Effects of Fatigue and Sleepiness on Nurse Performance and Patient Safety Patient Safety and Quality:An evidence-based handbook for nurses. Agency for Healthcare Research and Quality: U.S. Department of Health and Human Services.
74. Rogers, A. E. (2008). The Effects of Fatigue and Sleepiness on Nurse Performance and Patient Safety.pdf. In R. Hughes (Ed.), Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Agency for Healthcare Research and Quality (US): Rockville (MD).
75. Rosa, R. R., & Colligan, M. J. (1997). Plain Language About Shiftwork. In N. I. f. O. S. a. Health (Ed.). USA.
76. Shift work. (2004). Coonditons of Work and Employment. Retrieved from http://www.ilo.org/wcmsp5/groups/public/---ed_protect/---protrav/---travail/documents/publication/wcms_170713.pdf
77. Vener, K. J., Szabo, S., & Moore, J. G. (1989). The effect of shift work on gastrointestinal (GI) function: a review. Chronobiologia, 16(4), 421-439.