護理人員「自然流產率」及其相關因素之探討

Spontaneous Abortion Rate and It's Related Factors for Nurses

本研究的目的欲探討護理人員自然流產率及其相關因素，為一橫斷性的調查研究，採回溯性的方法，一次懷孕視為一個樣本，以有自然流產的護理人員和沒有自然流產的護理人員互相對照作比較。從醫學中心、署立/市立醫院、私立區域醫院，以立意取樣的方式，各取兩家醫院，收集從20至45歲在2000年前5年時間內曾經懷孕的所有已婚有偶護理人員作調查。共回收有效問卷417份，懷孕事件565人次。護理人員平均自然流產率是18.1%，比一般婦女高。並隨懷孕時年齡和次數的增加而自然流產有增加的趨勢。自然流產一半以上發生在懷孕的前三個月，第二個月是高峰期。護理人員懷孕時感染到流行性感冒，暴露於消毒溶液的環境、直接接觸到感染分泌物則會增加自然流產的發生；上夜班、翻身的次數和量的增加、每天8小時工作時間小於25%的時間坐著及照顧嚴重的病人等項目在與無自然流產的護理人員之間有差異存在。在加護病房、急診室、恢復室工作護理人員有較多的自然流產發生。生活事件中發生『與配偶於大吵之後言歸於好、社交行為方式或次數及容貌或身材的重大改變』與護理人員自然流產有相關。工作壓力感受強度中『醫師對妳惡言相向、在緊急事件發生時，妳找不到醫師、護理長或資深護士拒絕妳所要求的輪休或是更改輪班或其他護士挑剔妳對病人的護理』等項目在有自然流產的護理人員感受強度較高。工作壓力感受頻率中『其他單位或部門未善盡職責，而使妳增加額外的工作量、妳看見醫生師對待病人的態度粗暴或輕率了事、妳的病人故意拿掉包紮物，如紗布、敷料等、為病人施行急救、難以適應日夜顛倒的夜班及假日需要值班，使作息無法和他人配合、聽到病人因痛苦而發出呻吟聲』等項目在有自然流產的護理人員感受頻率較多。建議相關決策單位或主管盡量去改善以上這些工作上的危險因素，維持工作環境的安全，和儘量舒解懷孕的護理人員在工作上的壓力，以減少自然流產的發生，維護護理人員的工作權益。依本研究結果有下列幾項建議：1.減少引起護理人員自然流產之危險因子，2.改善護理人員工作環境之安全性，3.減少懷孕護理人員之工作壓力。

The aim of this research was to investigate the rate of spontaneous abortions of nurses and the related factors by means of a descriptive cross-sectional survey research and retrospective method, taking each abortions as a sample. Nurses who had spontaneous abortion were compared to nursed who had not. This survey gathered samples from medical centers, provincial or municipal hospitals and private regional hospitals, collecting the data of all married nurses between 20 to 45 years of age when pregnant five years before 2000. The average rate of spontaneous abortion of the nurses' was 18.1%, higher than the women in other careers. The trends of nurses having spontaneous abortions increased with the age and frequency of being pregnant. More than of the nurses with spontaneous abortion occurred within the first trimester of pregnancy, with the peak in the second month. Being infected by contagious diseases, exposed to the environment of disinfectant solution, and having direct contact with the secretion of infected wounds were the main factors related to the pregnant nurses having spontaneous abortions. And there were many other factors such as night shifts increasing numbers of times of changing patients' positions, sitting less than 25% of the daily eight working hours, and the diversity of patients' conditions all had significant differences between nurses who had spontaneous abortion and those who had not. There were more instances of spontaneous abortion nurses working in intensive care units, emergency rooms and recovery rooms. Certain life events such as reconciliation with her spouse after an upsetting fight change in style or increasing social activities, or change in personal image or figure were also related to the spontaneous abortion. Considering the stressful load of work in the following four situations coming across a rude physician, failing to reach the physician in an emergency, requesting to change shifts as rejected by the head nurse or senior nurses, and the quality of care being criticized by other nurses were also related to spontaneous abortions. As to the frequency of work stress, the following seven items: extra increase of work load, seeing physicians' being rude or unmindful towards patients, patients' taking off wound cover bandages by themselves, increasing CPR frequency, arranging on duty on holidays, daily activities not adjust able with other people, listening to patients' groaning with pain; and failing to adjust night shifts were all related to the spontaneous abortion of nurse. The suggestions are that relative authoritative units or people in charge should do their best to improve the above mentioned dangerous working factors, to maintain the security of working units, and to lessen as much as possible the work stress of the pregnant nurses, lest the spontaneous abortion leaves would increase the work burden of the unit, and thereby the spontaneous abortion of nurses. According to the findings of this study the recommendations would be as follows: 1.to decrease the risk factors of causing spontaneous abortion of nurse. 2.to improve the working situation safety of nurses. 3.to decrease the working stress of pregnant nurses.