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題名 臺灣護理師與一般國民之健康差異探討
A Study on the Health Differences between Taiwan Nurse Practitioners and Ordinary People
作者 徐敬雯
Hsu, Ching-Wen
貢獻者 楊曉文<br>余清祥
徐敬雯
Hsu, Ching-Wen
關鍵詞 醫護人員
全民健康保險資料庫
醫療利用
生育率
離職率
Health Care Worker
National Health Insurance
Medical Utilization
Fertility Rate
Turnover Rate
日期 2022
上傳時間 2-Sep-2022 14:46:26 (UTC+8)
摘要 護理師在第一線接觸病人，擔任醫病關係中的溝通協調者，在醫療體系中扮演非常重要的角色。然而，我國國民在享受聞名全球的全民健保服務時，醫護人員卻承受過重的工作壓力，2018年臺灣護理產業工會調查顯示，勞基法二修後工時反而加長，護理師白班平均工時9.65小時，而醫學中心白班平均9.91小時，意謂超時工作2小時被當作功德（沒有加班費）。嚴苛的工作環境促使護理師出走，致使各醫療院所面臨嚴重的護理師短缺，根據中華民國護理師護士公會，護理師執業率僅為58.4%，平均工作壽命不到七年（來源：衛生福利部）。工作壓力對護理師身心造成影響，高達37%的護理師因壓力過大必須尋求治療（來源：臺灣護師醫療產業工會）。
本文以臺灣護理師與一般國民的健康比較為研究目標，希冀結果可供政府及相關單位參考，以提升護理師的健康及留職率，確保我國醫療體系的永續經營。本文使用全民健保資料庫2005年百萬人抽樣檔，以2011至2013年資料為代表，聚焦於護理師與一般國民之住院等醫療利用，作為衡量健康的依據。分析發現每年約有6%的女性護理師離職，其中離職率以25至34歲最高，且工作壽命不長，約20%在取得執照後一年便離職，且離職率與工作地區、醫療院所層級有關，39歲以前離職多與生產後有個人生涯規劃，而40歲後離職可能並非與身體狀況較差有關。雖然護理師的健康狀況可能並未較一般國民來得差，但某些疾病的發生率較高。另外，女性護理師因為妊娠、分娩和產後合併症等住院的可能性高於一般國人，背後可能代表女性護理師的生育率較高。
Professional nurses contact patients on the front line and act as communication coordinators in the doctor-patient relationship, playing a very important role in the health care system. However, while people enjoying the quality service of National Health Insurance (NHI) system, health care workers are under excessive work stress. A 2018 survey by the Taiwan Nurses Union showed that the working hours of nurses increased despite passing the second revision of the Labor Standards Act. The harsh working environment has prompted professional nurses to leave, causing medical care institutions to face a severe shortage of nurses. Working pressure also has an impact on their physical and mental health, and up to 37% of nurses seek treatment due to excessive stress.
In this study, we used data from the NHI Research Database from 2011 to 2013 to compare the health of professional nurses and ordinary people in Taiwan. The results show that about 6% of female nurses leave each year and the turnover rate of those aged 25-34 is the highest indicating that their working life is not long. We found that the high turnover rate is related to the working environment, including the location and the level of medical care institutions. The reasons of resignation may not be restricted to poor physical condition, for example, leaving before the age of 39 is related to family planning (e.g., giving birth to newborns). Also, the health of nurses may not be worse than that of general population, but they are more likely to be hospitalized for certain diseases, such as complications of pregnancy, suggesting higher fertility rates for female nurses.
參考文獻 一、中文文獻
1. 王金蓮、邱淑媞、簡莉盈、黃心苑（2017）。「台灣臨床護理人員離職與轉業意念之相關因素探討」。《醫務管理期刊》，18（2），105-123。
2. 王莉婷（2017）。「8小時與12小時輪班制度中護理人員疲勞與睡眠之相關性研究」，國立臺灣大學護理學研究所碩士論文。
3. 王靜琳、黃瓊玉、呂桂雲、何美瑤（2007）。「護理人員工作壓力與社會支持之探討」。《榮總護理》，24（1），59-68。
4. 邢慧芬、曾煥棠、李美玉（2015）。「臨床護理人員之休閒及心理健康關係探討」。《護理暨健康照護研究》，11（2），89-98。
5. 余清祥、王信忠、許筱翎（2019）。「從全民健保評估高齡人口的醫療需求」。《人口學刊》，58，89-120。
6. 余清祥、王信忠、陳譽騰（2021）。「年輪變動比用於小區域人口推估的探討」。《人口學刊》，63，99-133。
7. 余清祥、梁穎誼、林佩柔（2022）。「健康、醫療利用與人口移動的關聯」。《地理學報》，本論著未刊登但已被接受。
8. 余清祥、簡于閔、梁穎誼（2020）。「健保資料與抽樣調查」。《調查研究－方法與應用》，44，97-130。
9. 林怡芳、張秀如、王莉婷（2017）。「護理12小時輪班制度在臺灣可行嗎？」。《護理雜誌》，64（2），124-129。
10. 林郁雯（2012）。「臺灣護理人員精神疾病與自殺企圖之風險：回溯性研究」，臺北醫學大學護理學研究所碩士論文。
11. 凃明蕙（2020）。「臺灣居民健康與壽命之空間分析」，國立政治大學統計學系碩士論文。
12. 唐佩玲、陳玟伶、鄭琇分、張敬俐、林惠賢（2005）。「護理人員憂鬱程度及其相關因素之探討」。《中華心理衛生學刊》，18（2），55-74。
13. 唐若筑（2021）。「臺灣高齡人口移動與健康探討」，國立政治大學統計學系碩士論文。
14. 陳淑芬、黃璉華、陳靜敏、莊子嫻、彭美姿、王秀紅（2020）。「台灣護理人員在COVID-19防疫的關鍵角色」。《護理雜誌》，67（3），84-89。
15. 蔡惠娜、陳葒春、魏淑君、劉淑如、鄭靜瑜（2014）。「護理人員的工作壓力、倦怠及離職意願之相關探討」。《長庚科技學刊》，21，75-86。
16. 蕭桂榮（2009）。「輪班護理人員的睡眠品質、壓力、疲勞與相關生理指標之探討」，長榮大學職業安全與衛生研究所碩士論文。

二、英文文獻
1. Canuto, R., Garcez, A. S., and Olinto, M. T. (2013). “Metabolic Syndrome and Shift Work: A Systematic Review”, Sleep Medicine Reviews, 17(6), 425-31.
2. Chung, Y. C., Hung, C. T., Li, S. F., Lee, H. M., Wang, S. G., Chang, S. C., Pai, L. W., Huang, C. N., and Yang, J. H. (2013). “Risk of Musculoskeletal Disorder Among Taiwanese Nurses Cohort: A Nationwide Population-Based Study”, BMC Musculoskeletal Disorders, 14, 144.
3. Dimich-Ward, H., Lorenzi, M., Teschke, K., Spinelli, J. J., Ratner, P. A., Le, N. D., Chow, Y., Shu, D., and Gallagher, R. P. (2007). “Mortality and Cancer Incidence in a Cohort of Registered Nurses From British Columbia, Canada”, American Journal of Industrial Medicine, 50(12), 892-900.
4. Gershon, R. R., Stone, P. W., Zeltser, M., Faucett, J., MacDavitt, K., and Chou, S. S. (2007). “Organizational Climate and Nurse Health Outcomes in the United States: A Systematic Review”, Industrial Health, 45(5), 622-36.
5. Gunnarsdóttir, H., and Rafnsson, V. (1995). “Cancer Incidence Among Icelandic Nurses”, Journal of Occupational and Environmental Medicine, 37(3), 307-12.
6. Huang, C. C., Huang, Y. T., and Wu, M. P. (2016). “A Nationwide Population Analysis of Antenatal and Perinatal Complications Among Nurses and Nonmedical Working Women”, Taiwanese Journal of Obstetrics & Gynecology, 55(5), 635-640.
7. Huang, I. C., Yang, C. H., Sung, F. C., Chen, H. F., and Li, C. Y. (2009). “Incidence of Ambulatory Care Visits Among Female Nursing Staff in Taiwan: A Claim Data-Based Retrospective Cohort Analysis”, Journal of Clinical Nursing, 18(8), 1207-16.
8. Liao, K. L., Huang, Y. T., Kuo, S. H., Lin, W. T., Chou, F. H., and Chou, P. L. (2019). “Registered Nurses Are at Increased Risk of Hospitalization for Infectious Diseases and Perinatal Complications: A Population-Based Observational Study”, International Journal of Nursing Studies, 91, 70-76.
9. Lim, J., Bogossian, F., and Ahern, K. (2010). “Stress and Coping in Australian Nurses: A Systematic Review”, International Nursing Review, 57(1), 22-31.
10. Lim, J., Bogossian, F., and Ahern, K. (2010). “Stress and Coping in Singaporean Nurses: A Systematic Review”, Nursing & Health Sciences, 12(2), 251-8.
11. Lin, S. C., Lin, L. L., Liu, C. J., Fang, C. K., and Lin, M. H. (2020). “Exploring the Factors Affecting Musculoskeletal Disorders Risk Among Hospital Nurses”, PLOS ONE, 15(4), e0231319.
12. Luke, B., Mamelle, N., Keith, L., Munoz, F., Minogue, J., Papiernik, E., and Johnson, T. R. (1995). “The Association Between Occupational Factors and Preterm Birth: A United States Nurses’ Study. Research Committee of the Association of Women’s Health, Obstetric, and Neonatal Nurses”, American Journal of Obstetrics and Gynecology, 173(3), 849-62.
13. Park, C., Kang, M. Y., Kim, D., Park, J., Eom, H., and Kim, E. A. (2017). “Adverse Pregnancy Outcomes in Healthcare Workers: A Korean Nationwide Population-Based Study”, International Archives of Occupational and Environmental Health, 90(6), 501-506.
14. Quansah, R., and Jaakkola, J. J. (2010). “Occupational Exposures and Adverse Pregnancy Outcomes Among Nurses: A Systematic Review and Meta-Analysis”, Journal of Women’s Health, 19(10), 1851-62.
15. Simcox, A. A., and Jaakkola, J. J. (2008). “Does Work as a Nurse Increase the Risk of Adverse Pregnancy Outcomes?”, Journal of Occupational and Environmental Medicine, 50(5), 590-2.
16. Simpson, E. H. (1949). “Measurement of Diversity”, Nature, 163, 688.
17. Smith, D. R., Mihashi, M., Adachi, Y., Koga, H., and Ishitake, T. (2006). “A Detailed Analysis of Musculoskeletal Disorder Risk Factors Among Japanese Nurses”, Journal of Safety Research, 37(2), 195-200.
18. Suzumori N., Ebara T., Matsuki T., Yamada Y., Kato S., Omori T., Saitoh S., Kamijima M., Sugiura-Ogasawara M., and Japan Environment & Children’s Study Group (2020). “Effects of Long Working Hours and Shift Work During Pregnancy on Obstetric and Perinatal Outcomes: A Large Prospective Cohort Study-Japan Environment and Children’s Study”, Birth, 47(1), 67-79.
19. Yang, H. J., Kao, F. Y., Chou, Y. J., Huang, N., Chang, K. Y., and Chien, L. Y. (2014). “Do Nurses Have Worse Pregnancy Outcomes Than Non-Nurses?”, Birth, 41(3), 262-7.
20. Yue, J. C., Chou, E. P., Hsieh, M. H., and Hsiao, L. (2022). “A Study of Forecasting Tennis Matches via the Glicko Model”, PLOS ONE, 17(4), e0266838.
描述 碩士
國立政治大學
統計學系
109354023
資料來源 http://thesis.lib.nccu.edu.tw/record/#G0109354023
資料類型 thesis
dc.contributor.advisor 楊曉文<br>余清祥zh_TW
dc.contributor.author (Authors) 徐敬雯zh_TW
dc.contributor.author (Authors) Hsu, Ching-Wenen_US
dc.creator (作者) 徐敬雯zh_TW
dc.creator (作者) Hsu, Ching-Wenen_US
dc.date (日期) 2022en_US
dc.date.accessioned 2-Sep-2022 14:46:26 (UTC+8)-
dc.date.available 2-Sep-2022 14:46:26 (UTC+8)-
dc.date.issued (上傳時間) 2-Sep-2022 14:46:26 (UTC+8)-
dc.identifier (Other Identifiers) G0109354023en_US
dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/141550-
dc.description (描述) 碩士zh_TW
dc.description (描述) 國立政治大學zh_TW
dc.description (描述) 統計學系zh_TW
dc.description (描述) 109354023zh_TW
dc.description.abstract (摘要) 護理師在第一線接觸病人，擔任醫病關係中的溝通協調者，在醫療體系中扮演非常重要的角色。然而，我國國民在享受聞名全球的全民健保服務時，醫護人員卻承受過重的工作壓力，2018年臺灣護理產業工會調查顯示，勞基法二修後工時反而加長，護理師白班平均工時9.65小時，而醫學中心白班平均9.91小時，意謂超時工作2小時被當作功德（沒有加班費）。嚴苛的工作環境促使護理師出走，致使各醫療院所面臨嚴重的護理師短缺，根據中華民國護理師護士公會，護理師執業率僅為58.4%，平均工作壽命不到七年（來源：衛生福利部）。工作壓力對護理師身心造成影響，高達37%的護理師因壓力過大必須尋求治療（來源：臺灣護師醫療產業工會）。
本文以臺灣護理師與一般國民的健康比較為研究目標，希冀結果可供政府及相關單位參考，以提升護理師的健康及留職率，確保我國醫療體系的永續經營。本文使用全民健保資料庫2005年百萬人抽樣檔，以2011至2013年資料為代表，聚焦於護理師與一般國民之住院等醫療利用，作為衡量健康的依據。分析發現每年約有6%的女性護理師離職，其中離職率以25至34歲最高，且工作壽命不長，約20%在取得執照後一年便離職，且離職率與工作地區、醫療院所層級有關，39歲以前離職多與生產後有個人生涯規劃，而40歲後離職可能並非與身體狀況較差有關。雖然護理師的健康狀況可能並未較一般國民來得差，但某些疾病的發生率較高。另外，女性護理師因為妊娠、分娩和產後合併症等住院的可能性高於一般國人，背後可能代表女性護理師的生育率較高。		zh_TW
dc.description.abstract (摘要) Professional nurses contact patients on the front line and act as communication coordinators in the doctor-patient relationship, playing a very important role in the health care system. However, while people enjoying the quality service of National Health Insurance (NHI) system, health care workers are under excessive work stress. A 2018 survey by the Taiwan Nurses Union showed that the working hours of nurses increased despite passing the second revision of the Labor Standards Act. The harsh working environment has prompted professional nurses to leave, causing medical care institutions to face a severe shortage of nurses. Working pressure also has an impact on their physical and mental health, and up to 37% of nurses seek treatment due to excessive stress.
In this study, we used data from the NHI Research Database from 2011 to 2013 to compare the health of professional nurses and ordinary people in Taiwan. The results show that about 6% of female nurses leave each year and the turnover rate of those aged 25-34 is the highest indicating that their working life is not long. We found that the high turnover rate is related to the working environment, including the location and the level of medical care institutions. The reasons of resignation may not be restricted to poor physical condition, for example, leaving before the age of 39 is related to family planning (e.g., giving birth to newborns). Also, the health of nurses may not be worse than that of general population, but they are more likely to be hospitalized for certain diseases, such as complications of pregnancy, suggesting higher fertility rates for female nurses.		en_US
dc.description.tableofcontents 第一章 緒論 1
第一節 研究動機 1
第二節 研究目的 3
第二章 文獻回顧與研究方法 4
第一節 文獻回顧 4
第二節 資料庫介紹 6
第三節 研究方法 8
第三章 臺灣護理師的就業狀況 11
第一節 護理師人口結構 11
第二節 不同地區及醫療層級之護理師概況 23
第四章 臺灣護理師的健康 30
第一節 護理師與一般國民的健康差異 30
第二節 由特定病因探討健康差異 38
第三節 留職與離職護理師的健康比較 51
第五章 結論與建議 60
第一節 結論 60
第二節 建議與限制 61
參考文獻 63
附錄一、護理師地區別住院分析－住院率 67
附錄二、護理師地區別住院分析－住院天數 68		zh_TW
dc.format.extent 3961752 bytes-
dc.format.mimetype application/pdf-
dc.source.uri (資料來源) http://thesis.lib.nccu.edu.tw/record/#G0109354023en_US
dc.subject (關鍵詞) 醫護人員zh_TW
dc.subject (關鍵詞) 全民健康保險資料庫zh_TW
dc.subject (關鍵詞) 醫療利用zh_TW
dc.subject (關鍵詞) 生育率zh_TW
dc.subject (關鍵詞) 離職率zh_TW
dc.subject (關鍵詞) Health Care Workeren_US
dc.subject (關鍵詞) National Health Insuranceen_US
dc.subject (關鍵詞) Medical Utilizationen_US
dc.subject (關鍵詞) Fertility Rateen_US
dc.subject (關鍵詞) Turnover Rateen_US
dc.title (題名) 臺灣護理師與一般國民之健康差異探討zh_TW
dc.title (題名) A Study on the Health Differences between Taiwan Nurse Practitioners and Ordinary Peopleen_US
dc.type (資料類型) thesisen_US
dc.relation.reference (參考文獻) 一、中文文獻
1. 王金蓮、邱淑媞、簡莉盈、黃心苑（2017）。「台灣臨床護理人員離職與轉業意念之相關因素探討」。《醫務管理期刊》，18（2），105-123。
2. 王莉婷（2017）。「8小時與12小時輪班制度中護理人員疲勞與睡眠之相關性研究」，國立臺灣大學護理學研究所碩士論文。
3. 王靜琳、黃瓊玉、呂桂雲、何美瑤（2007）。「護理人員工作壓力與社會支持之探討」。《榮總護理》，24（1），59-68。
4. 邢慧芬、曾煥棠、李美玉（2015）。「臨床護理人員之休閒及心理健康關係探討」。《護理暨健康照護研究》，11（2），89-98。
5. 余清祥、王信忠、許筱翎（2019）。「從全民健保評估高齡人口的醫療需求」。《人口學刊》，58，89-120。
6. 余清祥、王信忠、陳譽騰（2021）。「年輪變動比用於小區域人口推估的探討」。《人口學刊》，63，99-133。
7. 余清祥、梁穎誼、林佩柔（2022）。「健康、醫療利用與人口移動的關聯」。《地理學報》，本論著未刊登但已被接受。
8. 余清祥、簡于閔、梁穎誼（2020）。「健保資料與抽樣調查」。《調查研究－方法與應用》，44，97-130。
9. 林怡芳、張秀如、王莉婷（2017）。「護理12小時輪班制度在臺灣可行嗎？」。《護理雜誌》，64（2），124-129。
10. 林郁雯（2012）。「臺灣護理人員精神疾病與自殺企圖之風險：回溯性研究」，臺北醫學大學護理學研究所碩士論文。
11. 凃明蕙（2020）。「臺灣居民健康與壽命之空間分析」，國立政治大學統計學系碩士論文。
12. 唐佩玲、陳玟伶、鄭琇分、張敬俐、林惠賢（2005）。「護理人員憂鬱程度及其相關因素之探討」。《中華心理衛生學刊》，18（2），55-74。
13. 唐若筑（2021）。「臺灣高齡人口移動與健康探討」，國立政治大學統計學系碩士論文。
14. 陳淑芬、黃璉華、陳靜敏、莊子嫻、彭美姿、王秀紅（2020）。「台灣護理人員在COVID-19防疫的關鍵角色」。《護理雜誌》，67（3），84-89。
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dc.identifier.doi (DOI) 10.6814/NCCU202201203en_US