Chung Hwa University of Medical Technology

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    遠距醫療照護及醫療網路廣告需求調查

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    [[note]]合作廠商:日生光生物科技公司合約期間:98.7.20~100.7.1

    中草藥萃取物製劑化研究

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    [[note]]合作廠商:立安生物科技製藥股份有限公司合約期間:98.1.1~98.12.3

    利用基因工程及分子模擬改造生長因子以提高其生物活性及熱穩定性

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    [[note]]合作廠商:臺大生科有限公司合約期間:98.1.1~98.12.3

    膠凍粉產品製程品管檢驗及稽核之方法、技術與制度之研討

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    [[note]]合作廠商:金屬中心+秀明科技有限公司合約期間:98.4.1~98.9.3

    油污染之土壤基本性質測定計畫

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    [[note]]合作廠商:成功大學永續環境科技研究中心合約期間:98.5.15~98.11.3

    員工資訊補給站

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    [[note]]合作廠商:三生規劃設計工作室合約期間:98.7.1~98.12.3

    Investigation on nursing staff is physiological fatigue and work related stress

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    論文口試委員會審定書...... II 授權書.................. III 誌謝.................... IV 摘要.................... V Abstract............... VI 目錄.................... VII 圖目錄.................. X 表目錄.................. XIII 附錄.................... XVIII 第壹章 前言.............. 1 1.1 研究背景........... 1 1.2 研究目的........... 3 1.3 研究架構........... 4 第貳章 文獻回顧.......... 5 2.1 護理人員在台灣之概述. 5 2.2 疲勞之相關研究...... 7 2.2.1 疲勞之定義....... 7 2.2.2 疲勞之相關量測... 9 2.3 工作壓力之相關研究... 16 2.3.1 壓力之定義....... 16 2.3.2 工作壓力之定義... 17 2.4 護理人員工作壓力之相關研究.... ........19 2.5 護理人員人口學特質與工作壓力之相關研究..21 第参章 研究材料與方法..... 25 3.1 研究設計........... 25 3.1.1 研究對象........ 25 3.1.2 問卷內容........ 30 3.1.3 生理疲勞測定項目. 34 3.2 資料處理與分析...... 38 第肆章 結果.............. 39 4.1 受訪者基本資料、個人健康狀況及工作負荷情形...... 39 4.2 自覺疲勞症狀調查結果. 49 4.2.1 工作前後自覺疲勞症狀的盛行率....... 49 4.2.2 工作後自覺疲勞症狀的發生率......... 102 4.2.3 疲勞類型分析..... 129 4.2.4 自覺疲勞症狀盛行率及發生率與其他行業別比較之結果..... 134 4.3 工作壓力調查結果.... 135 4.3.1 工作壓力與三班間之相關性.. 135 4.3.2 護理人員工作特質之各項平均分數比較.. 140 4.4 生理疲勞測定結果.... 157 第伍章 討論.............. 185 5.1 基本資料、個人健康狀況及工作負荷...... 185 5.2 自覺疲勞症狀調查.... 186 5.3 工作壓力調查........ 189 5.4 生理疲勞測定........ 194 第陸章 結論與建議......... 198 6.1 結論............... 198 6.2 建議............... 199 參考文獻................ 200 參考文獻 1.Anderson C. (2002) Past Victim Future Victim. Nursing Management 33(3): 26-30。 2.Beehr TA, Newman JE. (1978) Job stress,employee health and organizational effectiveness:a facet analysisi,model and literature review .Personnel Psychology 31(4): 665-669。 3.Bourbonnais R, Comeau M, Vezina M, Dion G. (1998) Psychological disress, and bourout in nurses. American Journal of Industrial Medicine 34: 20-28。 4.Bullimore MA, Fulton PA. (1990) Howarth, “Assessment of visual performance,” in Evaluation of Human Work: A Practical Ergonomics Methodology, J. R. Wilson and E. N. Corelett (eds.), Taylor and Francis, London。 5.Copp G. (1988) The reality behind stress.Nursing Time 84(45): 50-53。 6.Fietze I, Dingli K, Diefenbach K. (2004) Night-to-night variation of the oxygen desaturation index in sleep apnoea syndrome. Eur Respir J 24(6): 987-93 。 7.Erlen J, Sereika S. (1997) Critical care nurses,ethical decision:Making and stress.Journal of advanced Nursing 26(5): 953-961。 8.Folkman S, Lazarus R. 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Megaw (eds.), Taylor and Francis, London 251-252。 15.K. Rodahl, The Physiology of Work, Taylor & Francis, 2005。 16.Lee I, Wang HH. (2002) Perceived Occupational Stress and Related Factor in Public Health Nurses. Journal of Nursing Research 10: 253-260。 17.NIOSH (National Institute of Occupational Safety and Health) (1999) Stress at Work, Institute of Occupational Safety and Health。 18.Nishiyama K. (1991) Ergonomic aspects of the health and safety of VDT work in Japan: a review, Ergonomics 33: 659-685。 19.Numerof RE, Abrams MN. (1984) Sources of stress among nurses:An empirical Investigation.Journal of Human Stress 10(2): 88-100。 20.Scott KP, Edward TH. (2001) Exercise Physiology 4/e , Mcgraw- Hill.Compahies,Inc。 21.So HM, Chan DS. (2004) Perception of stressors by patients and nurses of critical care units in Hong Kong. International Journal of Nursing Studies 41(1): 77-84。 22.Tzeng HM. (2002) The influence of nurses'working motivation and job satisfaction on intention to quit:an empirical investigation in Taiwan. International Journal of studies 39(8): 867-878。 23.Vrendenburgh DJ, Trinkaus RJ. (1983) An analysis of role stress among hospital nurses.Journal of Vocational Behavior 23(1): 82-95。 24.Weber A, Jermini C, Grandjean EP. (1975) Relationship between objective and subjective assessment of experimentally induced fatigue, Ergonomics 18: 151-156 (1975)。 25.三浦豐彥、池田正之、小山內博 (1973),現代勞動衛生-第二版,日本勞動科學研究所, 1109-1201。 26.王玉麟 (2006),高職科主任工作壓力之探討,學校行政雙月刊,45: 140-153。 27.王瑋(1989),臨床護理人員工作壓力及其調適行為。榮總護理,5(4): 97-111。 28.毛義方、陳美蓮、葉文裕、楊冠洋 (1993),勞動疲勞測定方法技術探討,行政院勞委會勞工安全衛生研究所研究報告。 29.毛義方、陳美蓮 (2003),監視性作業員工生理疲勞及工作負荷調查研究,行政院勞委會勞工安全衛生研究所研究報告。 30.毛義方、陳美蓮、黃如瑋、陳秋蓉 (2000),郵政主要作業人員疲勞及生理狀況評估之影響,行政院勞委會勞工安全衛生研究所研究報告。 31.毛家聆、李引玉 (1992),精神科護士的壓力感受與因應行為,護理雜誌,39(1): 107-118。 32.吉竹博 (1992),日本人的生活上疲勞,財團法人勞動科學研究所。 33.巫慧芳、蕭淑貞 (1995),護理人員面對病患家屬時的工作壓力與因應方式之探討•中華衛誌,14(5): 417-425。 34.林志銘、韋哲啟、張昭、楊冠洋、趙秀雄 (1996),醫療服務業之職業災害-某醫學中心員工之工傷害事件分析,中華職業醫學雜誌,3(1): 9-16。 35.台北榮總教育研究部 (2010),99年新制醫院評鑑基準。 36.李逸 (2004),公共衛生護理人員工作壓力感受、因應策略與壓力結果之探討-以互動型工作壓力模式為架構,台灣衛誌,23(5) : 398-405。 37.李逸、王秀紅 (2002),衛生所護理人員工作壓力感受與相關因素探討,護理衛誌,10(4) : 253-260。 38.李選 (1992),某綜合醫院新進護理人員專業規劃與諮商對改善工作壓力與離職率成效之探討,護理雜誌,39(2) : 115-125。 39.李選 (2004),護理人員壓力感、疲潰與自我主見度之探討,護理雜誌,36(1) : 85-98。 40.李品珠 (1999),麻醉護理人員工作壓力與工作滿意度之研究—以北部醫學中心為例,國立陽明大學醫務管理研究所碩士論文。 41.陳秋蓉 (2003),女性作業員工健康危害調查研究-醫護人員,行政院勞委會勞工安全衛生研究所研究報告。 42.陳秋蓉 (2005),航管人員工作與生理疲勞負荷調查研究,行政院勞委會勞工安全衛生研究所研究報告。 43.陳美滿 (2003),臨床護理人員之職業危害,護理雜誌,43(2): 29-34。 44.陳鳳櫻、程子芸、陳蕙玲 (1997),台灣地區居家護理人員工作壓力源及其相關因素之探討,護理研究,5(3): 223-231。 45.陳梅麗、林小玲、連金延、余先敏、蔡欣玲 (2000),醫學中心護理人員工作壓力、離職意願與離職行為之相關性研究,榮總護理,17(3): 260-268。 46.行政院勞工委員會 (2003),勞動疲勞管理與預防技術手冊,勞工安全衛生研究所。 47.行政院主計處 (2004),九十三年台灣地區社會發展趨勢調查(時間運用)統計結果,行政院主計處新聞稿。 48.行政院衛生署 (2009),98年醫療衞生服務人力統計調查。 49.胡瑞桃 (2000),加護單位護理人員對其工作壓力來源之反應及調適,長庚護理,11(2): 20-29。 50.許森彥、蘇世斌 (2003),夜班及輪班工作者的健康問題,中華職業醫學雜誌,10(2): 71-80。 51.祝年豐、林承箕、劉紹興 (1994),工作壓力與心臟血管疾病之關 係,中華職業醫學雜誌,1: 156-161。 52.洪雪芝、翁麗雀、方揪雅 (2005),外科護理人員照護SARS病患的壓力及調適行為,實證護理,1(1): 45-51。 53.楊克平、王櫻諭 (1999),台灣地區護理人員流動因素之統合分析•行政院衛生署委託研究計劃成果報告。 54.馬君、李麗傳、劉紹興、張媚、楊冠洋、林燈賦 (2003),某醫學中心護照人員下背痛盛行因子之探討,中華職業醫學雜誌,10(3): 175-184。 55.粘秋桂、柯德鑫 (1998),護理人員下背痛及其職業相關危險因子之調查,中華職業醫學雜誌,3(1): 37-44。 56.狩野弘之 (1972),現場調查之手法,勞動科學,48: 663-680。 57.張春曉 (1983),專業人員工作疲乏研究模式-以社會工作員為例 (上) ,思與言,21(1)。 58.張和美、陳昭惠、藍麗美(2005),新生兒加護病房預期醫護人員流動與工作壓力之研究,榮總護理,22(2): 139-148。 59.張瑩如、楊素蘋(1992),護理長工作壓力及其因應之探討,長庚護理,3(2): 60-68。 60.張春興(2000),現代心理學,東華書局,台北。 61.夏萍回(2000),認識及處理壓力,榮總護理,7(3): 292–298。 62.陸洛 (1997),工作壓力之歷程:理論與研究的對話,中華心理衛生學刊,10(4): 19-51。 63.吳淑蓉、王秀紅 (2005),護理人員情緒勞務及其相關因素探討,實證護理,1(4): 243-248。 64.蔡欣玲、陳梅麗、王偉 (1996),醫學中心護理人員工作壓力相關因素之探討。榮總護理,13(3): 263-269。 65.蔡欣玲、陳麗梅 (1996),護理人員壓力量表之信效度測試•護理研究,4(4): 355-362。 66.馮兆康、李中一 (1998),護理人員自覺疲勞盛行率及其相關因子,中華職業醫學雜誌,5: 129-138。 67.繆敏志 (1993),組織變革策略與文化對經理人工作壓力與適應影[[abstract]]本研究之目的在於了解三班的護理人員之工作前後型態之疲勞程度現況及工作壓力現況,以南部區域教學醫院的護理人員作為對象,以自覺疲勞症狀問卷、工作壓力評量問卷及勞動生理測量工具作為調查工具。本研究共分兩個階段:第一階段共完成344名護理人員,分別在工作前、工作後進行填寫自覺疲勞問卷工作壓力評量問卷;第二階段共完成109名護理人員,分別在工作前、工作後進行生理疲勞測定。結果顯示,自覺疲勞方面上發現,工作後自覺疲勞盛行率、發生率前五名依序為眼睛疲勞(83%、65%)、想睡(74%、47%)、打哈欠(67%、42%)、想躺下(59%、41%)及肩痛(57%、39%),護理人員疲勞情形和經前一晚睡眠之疲勞恢復率有關;工作壓力方面上發現,在工作控制層面,工作年資愈久者,其工作控制分數也愈高。結果顯示可能與「工作年資」有關。若以三班來看,平均分數以小夜班最低。在心理負荷層面,此層面分數越高者,表示工作負荷愈大,所感受的壓力愈大。結果顯示可能與「睡眠品質」有關。若以三班來看,平均分數以小夜班最低;生理疲勞測定方面上發現,三班的護理人員工作後除了「反應棒」這項中有呈現變好的情形,其它生理測定項目均都呈現負值情形。 The purpose of this study is to investigate the fatigue and pressure of the nursing staff before and after their three shifts working. The investigating tools are Subjective fatigue symptom Questionnaire, Stress Assessment Questionnaire, and Physical Labor Measurement Tool. This study has two stages. In the first stage, 344 nurse staffs fill in the Subjective Fatigue Symptom Questionnaire before and after their shifts. In the second stage, 109 nurses complete the Physiological Fatigue Measurement, before and after shift, respectively. The results show that after shift the top five in the Subjective Fatigue Symptoms are “strained eyes” (83%, 65%), “sleepiness” (74%, 47%), “yawning” (67%, 42%), “want to lie down” (59%, 41%), and “shoulder pain” (57%, 39%), and the fatigue condition relates to the recovery from their sleep in the night before. Regarding to the pressure of the shifts, it is found that the job (or work) control has to do with the staff’s seniority (work experience), the longer of work experience, the higher of work control score. Among the 3 different shifts (day shift, night shift, and midnight shift), night shift in average has the lowest score. In regard to the mental loading level, higher score shows greater pressure. This result relates to staff’s quality of sleep. In average, night shift staff has the lowest score. In the physiological aspects of fatigue, it is found that all the results from the physiological measurement in the three different shifts present negative, except the “reaction bar” showing positive progressing

    The optimization of design parameters in negative-pressured isolation room

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    摘要 i Abstract ii 誌謝 iii 目錄 iv 圖目錄 vi 表目錄 viii 符號表 x 第一章 前言 1 1-1研究背景 1 1-2研究目的 3 1-3負壓隔離病房設計相關規範 5 1-4 吹吸式通風系統 14 1-5負壓隔離病房性能評估方式 18 1-6 田口實驗計劃法 21 第二章 研究方法 28 2-1 研究架構 28 2-2 實驗設備 30 2-2-1 體積可調整之組合式模擬暴露艙 30 2-2-2 微粒釋放系統 34 2-2-3 參數量測儀器 38 2-3 系統測試與實驗設計 41 2-3-1 暴露艙通風系統測試 41 2-3-2 微粒釋放系統測試 43 2-3-3以田口方法進行實驗條件配置 44 2-3-4 微粒去除效率評估方式 53 第三章 結果與討論 56 3-1 通風系統風量與變頻馬達頻率關係之建立 56 3-2 通風系統風量穩定性及準確度測試結果 58 3-3 微粒釋放系統濃度穩定性與再現性結果 60 3-4 田口實驗設計分析結果 64 3-4-1微粒瞬間去除效率結果 64 3-4-2微粒累積去除效率結果 73 3-4-3 S/N比與品質損失減少百分比之關係 79 3-4-4 風速分佈結果 81 第四章 結論與建議 84 第五章 參考文獻 87 參考文獻 Aiden, J. L. and Kane, J.M. (1982). Design of industrial ventilation systems(chapter 2). Industrial Press Inc. American Conference Governmental Industrial Hygienists (ACGIH). (1988). Industrial ventilation(chapter6, pp:14). American Conference Governmental Industrial Hygienists Inc. American Institute of Architects(AIA). (1996). Guidelines for design and construction of hospitals and health care facilities. Beggs, C. B., Kerr, K. 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Cheong, K. W. D., & Phua, S. Y. (2006). Development of ventilation design strategy for effective removal of pollutant in the isolation room of a hospital. Building and Environment, 41, 1161-1170. Foord, N., & Lidwell, O. M. (1972). The control by ventilation of airborne bacterial transfer between hospital patients, and its assessment by means of a particle tracer. I. An airborne-particle tracer for crossinfection studies. Journal of Hygiene, 70, 279-287. Francis J. Curry National Tuberculosis Center, Institutional Consultation Services. (1999). Isolation rooms:design, assessment,and upgrade (page:22). Francis J. Curry National Tuberculosis Center, Institutional Consultation Services. Hayden, C. S., Earnest, G. S., & Jensen, P. A. (2007). Development of an empirical model to aid in designing airborne infection isolation rooms. Journal of Occupational and Environmental Hygiene, 4, 198-207. Hewett, M. J. & Hermans, R. D. (2006). 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A volume adjustable chamber with similar push-pull ventilation system was adopted to simulate airborne infection isolation room without anteroom. The exhaust efficiency of mono-disperse particles with 1.5 m diameter and S/N ratio was measured and calculated for nine combined experimental conditions generated by Taguchi’s L9 orthogonal array. The results show that the optimal design parameter combination is middle room volume (36.93 m3), 12 air change per hour (ACH), 5 Pa pressure differential and particle released at head region on the bed. ACH was the main factor in this study. By considering both performance and energy saving conception, reducing air change rate to 8 ACH is adequate to meet the performance requirement. It is practicable to evaluate the performance of negative pressured isolation room using the particle exhaust efficiency. It was also found that the air velocity within certain ranges below 0.5 m/s yields the best exhaust efficiency. The findings obtained in this study provide useful information for performance verification analysis, optimal operation condition, and future design of airborne infection isolation room

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