轮班制对ICU女护士昼夜活动节律与疲倦的影响

Associations between circadian activity rhythms and perceived fatigue before and after shift work among female nurses in intensive care units

目的比较ICU女护士不同工作时长(8 h和12 h)昼夜活动节律相关指标与工作前后疲倦的差异,并分析疲倦程度的影响因素。方法采用便利抽样法选取北京市3所三级甲等综合医院228名ICU女护士,通过一般资料问卷、李氏疲倦量表(Lee’s Fatigue Scale)进行调查,使用活动记录仪实施客观测量。结果护士昼夜活动节律相关指数中静息-活动周期(r24)和昼夜节律整体偏低,8 h轮班制护士总睡眠时间明显低于12 h轮班制护士,差异有统计学意义(P<0.001)。8 h轮班制护士在值夜班前的疲倦程度比12 h轮班制护士高,但12 h轮班制护士在值夜班后的疲倦程度比8 h轮班制护士高,差异有统计学意义(P<0.001)。多元线性回归分析显示,昼夜活动节律指标中的工作时活动水平、总睡眠时间、静息-活动周期(r24)是工作后疲倦度的显著预测因子,尤其是ICU12 h轮班制护士。结论通过昼夜活动节律相关指标与工作前后疲倦度相关性探讨,有助于护理管理者了解护士工作状态,为改善ICU护士轮班方式、限定夜班数量及量化工作负荷提供依据。

Objective To compare the differences of circadian activity rhythms indexes and fatigue severity among female nurses(8-and 12-hour shift)in intensive care units(ICU)before and after their shift work;further more,to explore the influencing factors of fatigue. Methods A convenience sample of 228 female nurses from ICU of 3 hospitals in Beijing was involved. A demographic form and Lee’s Fatigue Scale were included as measurements,and objective data was collected from motion sensor monitor(wrist actigraph). Results The circadian rhythms indexes(r24 and circadian activity rhythms)among nurses in ICU were generally low. The total sleep time(TST) of the 8-hour shift nurse was significantly lower than that of the 12-hour shift nurse(P<0.001). The 8-hour shift nurses had significantly higher fatigue severity before night shift,and 12-hour shift nurses had significantly higher fatigue after night shift(P<0.001),with statistically significant differences. The circadian rhythms indexes of working activity level,TST and rest-activity cycles(r24) were significant predictors for fatigue severity after night shift work(P<0.05),especially for 12-hours shift nurses in ICU. Conclusion By exploring the associations between circadian activity rhythms indexes and fatigue severity before and after work,it helps nursing managers understand the working status of nurses in ICU. It can also provide a basis for scheduling shift-work and quantifying workload.