2011-03-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/650571摘要：全球對健康照護產業所面臨的挑戰與日俱增，其中之一是護理人員短缺。造成護理人力短缺的原因相當複雜，但有一主因是工作環境不佳。因此，國際護理協會（International Council of Nurses，ICN）選定2007年護士節的主題是：正向執業環境，有品質的工作環境成就有品質的病人照顧（positive practice environments: quality workplaces＝quality patient care ）。所謂不健康的工作環境乃指工作量太大、工時太長、工作環境內棘手的人際關係、執行護理專業角色的難題，及各種工作環境中的危害（如針扎、暴力）。反之，健康的執業環境，就是能將護理人員的健康與安寧美滿狀態發揮到極致，成就有品質的病人照顧成果，及組織的績效。本研究將針對護理人員在工作環境中各種常見的安全衛生問題作背景之探討，調查全台執業護理人員職業環境現況，作為衛生署擬訂相關政策的參考。我們將推動三年之計畫，第一年研究對象為地區醫院以下之醫院；我們將在各地區，依床數之多少分成多、中、少三層，在各層隨機取樣其總家數之1/10作為研究對象醫院。總共在北部地區挑選17家、中部地區挑選15家、南部地區及金馬澎湖地區挑選19家、東部地區挑選2家。其步驟先以專家訪談、實際工作場所訪視，及質性訪談，再使用結構性問卷，深入了解地區醫院以下之醫院不同之工作性質及可能接觸之職業危害因子，包含生物性(針扎危害、血液體液暴觸、呼吸及飛沫傳染性疾病之可能危害)物理化學(輻射線性、治癌藥品、消毒溶液等)、心理社會性危害因素(控制-需求-支持情況、付出-回饋失衡問題、暴力傷害等)、及人因工程的危害(輪班、動作、肌肉骨骼問題)等。對必須抬舉物品或患者之動作，另外將以3D-SSPP軟體，經觀察工作內容之後，照相及依所抬舉物品或患者之重量，分析其L4-L5椎間盤之受力狀態。第二年研究對象為診所；向衛生署申請所有診所之名單及註冊護士聘用人數。以聘用註冊護士5人或以上之診所為研究對象。以專家訪談、實際工作場所訪視，及質性訪談，再使用結構性問卷，了解診所工作性質及可能接觸之職業危害因子，預期完成5000份問卷。亦包含生物性(針扎危害、血液體液暴觸、呼吸及飛沫傳染性疾病之可能危害)物理化學(輻射線性、治癌藥品、消毒溶液等)、心理社會性危害因素(控制-需求-支持情況、付出-回饋失衡問題、暴力傷害等)、及人因工程的危害(輪班、動作、肌肉骨骼問題)等。對必須抬舉物品或患者之動作，亦以3D-SSPP軟體，經觀察工作內容之後，照相及依所抬舉物品或患者之重量，分析其L4-L5椎間盤之受力狀態。第三年為護理機構之護理人員；向衛生署申請所有護理機構之名單，及註冊護士聘用人數。擬以聘用註冊護士10人或以上之護理機構為研究對象。每個護理機構請一位實際執行護理業務之註冊護士代表填答問卷。以專家訪談、實際工作場所訪視，及質性訪談，再使用結構性問卷，了解診所工作性質及可能接觸之職業危害因子，預期完成400份問卷。亦包含生物性(針扎危害、血液體液暴觸、呼吸及飛沫傳染性疾病之可能危害)物理化學(輻射線性、治癌藥品、消毒溶液等)、心理社會性危害因素(控制-需求-支持情況、付出-回饋失衡問題、暴力傷害等)、及人因工程的危害(輪班、動作、肌肉骨骼問題)等。對必須抬舉物品或患者之動作，亦以3D-SSPP軟體，經觀察工作內容之後，照相及依所抬舉物品或患者之重量，分析其L4-L5椎間盤之受力狀態。完成以上工作後，並對以上各項危害，跟據暴露者之人數，其各項暴露所引起之健康與心理之影響大小，對各護理人員族群進行危險性及風險評估。根據以上研究結果，比較分析國內護理職業環境狀況與國外職業安全設施標準之差異。並提出解決護理人員執業環境危險因子的建議方案。<br> Abstract: Manpower shortage in nursing expertise has become a global problem. That problem also involve Taiwan. One of the important factors for such manpower shortage has been the unsatisfactory working environment, including unsafe and unhealthy working conditions. Known occupational hazards among nursing personnel include exposure to infectious agents, physical and chemical hazards, psychological strain, and ergonomic stress, etc. We propose to conduct investigations for 3 years: the 1st year to understand working environments of nurses in district hospitals or smaller hospitals, the 2nd year to understand working environments of nurses in clinics, and the 3rd year to understand working environments of nurses in nursing institutions. Through representative sampling after stratification, we will identify candidates for study. We will conduct expert group interview, workplace inspection, and qualitative approach, structured questionnaires will be designed to investigate the following potential work hazards: (1) exposure to infectious agents through needlestick, blood and body fluid contacts, and inhalation of pathogens; (2) exposure to physical agenst such as radiation, and chemical hazards such as chemotherapeutic pharmaceuticals and antiseptics; (3) psychosocial hazards such as overworking, poor control-high demand jobs, effort-reward imbalance, and assaults; and (4) ergonomic hazards such as shiftwork, movement, lifting, and musculoskeletal strains. In addition to questionnaire, for those works including lifting heavy objects or patients, intervertebral force will be calculated using 3D-SSPP software after careful observation of working procedures. Risk assessment will be performed for each group of subjects of nurses considering the magnitute of hazards and the number of nurses exposed. We will also examine the similarities and differences between the working conditions in Taiwan and international workplaces, especially among countries that pay greater attention to occupational safety and health. After the above efforts, recommendations on the safety and health conditions of nurses will be made to the policy makers, for future improvement of working conditions of nurses in Taiwan.護理人員職業危害及危險因子執業環境職業安全與衛生風險評估性別