執業中的安全健康議題：從護理人員之病患轉移位方式談起

Occupational Safety and Health Issues: Nurse Professional's Patient Handling Methods

護理工作是肌肉骨骼不適（musculoskeletal disorders, MSDs）盛行率最高的職業之一，造成護理人力流失及影響照護品質。過去研究顯示：協助病患轉移位（patient handling）是造成護理人員肌肉骨骼傷害的主因，且使用不同的方式協助病患轉移位對肌肉骨骼系統之風險程度不同，但缺乏對護理人員於臨床工作中協助病患轉移位方式之系統性調查。因此，本研究之目的為瞭解護理人員MSDs概況（包含：各科別護理人員MSDs之盛行率、不適部位、嚴重程度、影響工作程度等），以及護理人員協助病患執行各項轉移位活動之方式（是否使用輔具、使用輔具的種類）。本研究採橫斷面研究設計，以自填問卷蒐集資料，收案對象為北部醫學中心、區域醫院、地區醫院及醫院附設護理之家之護理人員。問卷包含三部分：人口學與工作環境之基本資料、身體各部位MSDs概況，及協助病患轉移位概況。問卷分送至科別護理站，填完後回收，有效問卷共470份。調查結果顯示，88.3%護理人員最近六個月有一個部位以上之MSDs，約五成有四個部位以上之MSDs。各部位盛行率以下背部（77.2%）、頸部（64.2%）及肩部（58.7%）最高。各部位MSDs者中，手/手腕（21.6%）不適者因MSDs嚴重影響工作及請假之比例最高，下背部（20.0%）次之。不同病房單位之肩膀、上背、手/手腕、及足踝/足部不適比例達顯著差異，各部位MSDs盛行率普遍以綜合外科、加護病房、長期照護單位較高，內科及急診較低，下背部之盛行率於神經內外科高達92.0~95.7%，且在各病房單位均高，值得關注。協助病患轉移位概況部分，十個轉移位活動全數需執行之比例皆高於六成，其中四個與床相關之活動（移動床上位置、床上翻身、床上平躺坐起、床到床）需執行比例高達九成。十項活動中僅有四個與床相關之活動使用輔具的比例較高（55.4~93.8%），其他照護活動仍以徒手操作為主。使用之輔具以非動力輔具為主，最常使用之輔具為床單/布中單、轉位滑墊/滑板、及電動床。研究結果顯示國內護理人員執行轉移位活動頻繁、肌肉骨骼不適盛行率高且使用輔具之質與量不佳，該如何使用適切輔具以減少協助病患轉移位對護理人員MSDs之風險，應是重要的課題。

Nurses have one of the highest prevalence of musculoskeletal disorders (MSDs) among all the occupations and healthcare practitioners, resulting in nursing shortage and decreasing the quality of healthcare. The main cause of musculoskeletal injuries in nurses is showed to be patient handling. Few studies examined nurses' patient handling methods in working situation. Thus, the purposes of this study include: 1) To survey MSDs (prevalence, affected body parts, pain intensity, and functional impact on work) among nurses in Taiwan. 2) To examined patient handling methods (whether to use assistive technology, and types of assistive technology) executed by hospital nurses in Taiwan. In this cross-sectional study, a questionnaire survey was carried out among nurses in one medical center, four metropolitan hospitals and belonging nursing homes in northern Taiwan. A self-reported questionnaire was used to investigate 1) demographic and workplace characteristics. 2) MSDs of each body part. 3) Nurses' handling methods of 10 patient handling tasks. Questionnaires were distributed by nursing stations, and 470 valid questionnaires were collected. The 6-month prevalence of MSDs at any body part was 88.3%, and half of the participants reported at least MSDs of four body parts. Lower back (77.2%), neck (64.2%) and shoulder (58.7%) were the most prevalent body parts. Nurses with wrist/hand complaints had the highest proportion (21.6%) of severe functional impact on work and absence from work due to MSDs, followed by nurses with lower back complaint s (20%). There's a significant difference of MSDs prevalence among different wards. In general, surgical, intensive care, and long-term care units had higher prevalence of MSDs, contrary to internal medical and emergency units. The prevalence of lower back MSDs is high among all units, and up to 92~95.7% in neurosurgical and neurology units. Four patient handling tasks in bed (moving in the bed, turning or rolling over in bed, from lying to sitting in bed, from bed to bed) were performed by at least 90% of surveyed nurses. In average, nurses in Taiwan preferred to use transfer equipment in four out of ten patient handling tasks, Four tasks in bed had the highest proportion to use transfer equipment, ranging from 55.4% to 93.8%, and the other tasks were mostly carried out manually. The equipment most often used was bed sheets, slide boards/ slippery sheets, and electric beds. In conclusion, the frequency of patient handling and the 6-month prevalence of MSDs were both high among nurses surveyed. The quantity and quality of assistive technology used by nurses was insufficient. In order to decrease the burden of patient handling and risks of MDSs among nurses, providing transfer equipments and education on how to properly handle patients is crucial.