| 摘要: | 在醫院裡照顧病患的工作是無法間斷的，因此護理人員必須以輪值三班的方式給予病人24小時全年無休的連續性照護。若在工作過程中稍有一點分心，可能就會發生醫療疏失。然而，每個人都有自己習慣的日夜作息時間、以及早起或晚起的偏好，依照個體不同的晝夜節律可區分為不同的時間類型，稱之為睡眠型態偏好（Chronotype）。無可避免的三班輪值護理工作會使個體睡眠型態偏好與日常活動時間產生錯位，過去研究發現輪班工作會對輪班人員的認知功能產生影響，但對於不同睡眠型態偏好的個體在不同的輪班工作時間中是否會對護理人員的注意力表現造成影響尚不完全清楚，故本研究目的欲探討睡眠型態偏好是否可作為調節變項且與輪班工作班別發生交互作用，並共同對護理人員的注意力表現造成影響。
本研究為縱貫式研究設計，共納入40位有效研究樣本數，以立意取樣方式在北部某醫學中心之急診與加護病房的輪班護理人員作為研究對象。共進行兩階段資料收集，第一階段是以中文版輪班工作者慕尼黑睡眠時間偏好問卷（Munich Chronotype Questionnaire for shift workers, MCTQSHIFT）分析受測者的睡眠型態偏好；第二階段為在研究對象輪值白班、小夜班、大夜班等三種班別時各分別進行一次簡短版精神運動警覺性測試（The Brief Psychomotor Vigilance Test, PVT-B），以了解受測者輪值三種班別時的注意力表現變化。資料統計經SAS 9.4版套裝軟體以描述性統計、獨立樣本t檢定、費雪精確檢定、廣義估計方程式（Generalized Estimating Equations, GEE）等統計方法進行資料分析。
結果顯示，當睡眠型態偏好為夜晚型的護理人員輪值大夜班對比其輪值白班時，因睡眠型態偏好與輪班工作班別有匹配，平均反應時間顯著的降低了11.313毫秒（p=.044）。此外，也有觀察到當睡眠型態偏好為早晨型的護理人員輪值白班對比其輪值小夜班時，注意力缺失次數減少了1.182次（p=.054），達邊緣性顯著。但在總錯誤次數方面的結果則無看到顯著差異。
本研究結果表明護理人員注意力表現不會單獨因輪班班別的不同所影響，而是受睡眠型態偏好與輪班工作兩者的交互作用共同影響，睡眠型態偏好可作為輪班工作和注意力表現兩者關係間的調節變項，當睡眠型態偏好與輪值班別有匹配時，會使護理人員在注意力表現上平均反應時間更快、注意力缺失次數更少。期望本研究結果可作為日後護理人員安排輪班班別的參考，調節自身晝夜節律使其在三班輪值的照護工作中能夠保持專注，以提升護理品質並保障病患的健康安全。
To provide continuous care, nurses require shift work 24/7 throughout the year. Any slight lapse in attention during work can lead to medical errors. However, individuals have their own habitual sleep-wake patterns and preferences for early or late rising, categorized into different time types based on their circadian rhythms, known as chronotype. Previous research has shown that rotating shifts effect the cognitive functions, but it remains unclear whether different chronotypes influence the attentional performance during different shift work schedules in nurses. Therefore, this study aims to investigate whether chronotype can serve as a moderator and interact with rotating shift schedules, and collaboratively effecting attentional performance in nurses.
This study employed a longitudinal research design, involving 40 research samples. Participants were rotating shift nurses selected from emergency room and intensive care unit at a medical center in Taipei, Taiwan. Data were collected by using the Chinese version of the Munich Chronotype Questionnaire for shift workers (MCTQSHIFT) to analyze participants' chronotype, and the brief version of the Psychomotor Vigilance Test (PVT-B) to assess changes in attentional performance during three different shift schedules. Data were analyzed using SAS 9.4 software, employing descriptive statistics, independent samples t-test, Fisher's exact test, and Generalized Estimating Equations (GEE).
The results indicated that the late type nurses worked night shifts compared to day shifts, the mean reaction time significantly decreased by 11.313 milliseconds (p=.044). Additionally, in terms of lapses in attention, there was a borderline significant decrease by 1.182 occurrences (p=.054) when the early type nurses worked day shifts compared to evening shifts. However, there was no interaction between chronotype and rotating shifts on total number of errors.
In conclusion, attentional performance is influenced by the interaction between chronotype and rotating shifts. In other words, chronotype can act as a moderator on the relationship between rotating shifts and attentional performance. When chronotype matches the shift schedule, nurses show less mean reaction time and fewer lapses in attention. These results can serve as a reference for nurses to select their own shift work schedules, maintaining their attention during rotating shifts, enhancing the quality of nursing care, and ensuring patient health. |
