||Exploring the effect of Health promoting lifestyle on insomnia among psychiatric nurses with shift work in Taiwan: A Nationwide Survey
||Department of Nursing
Health Promoting Lifestyle Profile-II
方法：採橫斷式研究法，以全國精神專科醫院護理人員為研究對象，使用「個人基本資料問卷表」、「中文版健康生活型態II-52 ( Health promotion lifestyle profile II」共52題及「中文版雅典失眠量表(Chinese version of the Athens Insomnia, CAIS- 8）」共8題之問卷調查表，以階層迴歸統計分析方法了解於控制精神科護理人員人口學變項、健康危害因子及不同輪班方式後，健康生活型態對失眠的影響。
結果：有效樣本數1669位護理人員，以女性為主（n = 1,549；佔92.8％）；平均年齡為34.39歲（SD = 8.72），教育程度大學以上者佔68.4％（n = 1,142），護理服務工作年資平均為11.8年，小於5年者居多佔29.8％（n = 498）；有健康危害因子佔10.4%（n = 174）；健康促進生活型態總平均分數為2.45（SD = 0.41），分項次中以人際關係（2.69; SD = 0.47）和靈性成長（2.60; SD = 0.53）得分最高，得分較低的分別為身體活動（2.08; SD = 0.57）和營養（2.40; SD = 0.44）；有失眠佔47.1%（n = 696）。階層迴歸結果顯示人口學變項、輪班方式及健康促進生活型態可以預測失眠解釋力為23.5%，其中有健康危害因子（β = .160; p < .001）、護理人員輪班工作包括固定夜班（β = .066; p < .05）、固定晚班（β = .148; p < .001）及不固定班別（β = .121; p < .001）和健康促進生活形態分項次中健康責任（β = - .121; p < .01）、靈性成長（β = - .202; p < .001）、人際關係（β = - .155; p < .001）及壓力管理（β = - .427; p < .001）對失眠有關係達統計上顯著影響。
Background: Hospitals provide uninterrupted medical care services that require nursing staff to work in shifts to assist in providing care services. However, the circadian rhythm of shift work may affect physical and mental health of nursing staff. Physical and mental burden among psychiatric nursing staff are heavier when compared with nurses in other departments due to the behavioral problems generated from the mental and emotional disorders of psychiatric patients. Therefore, it is an important issue to pay attention to health problems of psychiatric nursing staff.
Objectives: To explore the relationship between health promoting lifestyle and insomnia among psychiatric nurses in Taiwan.
Methods: This study was a cross-sectional research. The subjects of psychiatric nurses were recruited from psychiatric hospitals in Taiwan with a nationwide survey approach. Instruments used in the study includes 52-item “Chinese Health Promoting Lifestyle Profile-IIC”, and an 8-item “Chinese Version of the Athens Insomnia Scale (CAIS- 8). Hierarchical regression analysis was used to test the effects of healthy lifestyles on insomnia after controlling demographic characteristics, health risk factors, and different shift patterns among psychiatric nurses.
Results: Of 1669 nurses participated in this study. Most of the subjects were females (n = 1,549 ; 92.8％); the average age was 34.39 years (SD = 8.72); 68.4％ (n = 1,142) had a bachelor’s degree or above, the average years of service was 11.8 years (SD = 8.55) whereas 29.8％ (n = 498) had less than 5 years of service; 10.4% (n = 174) had health risk factors; The mean score of health promotion lifestyle was 2.45 points (SD = 0.41) with a scale of 1 to 4, and the sub-scales with the highest mean scores were Interpersonal Relationship (Mean = 2.69 points; SD = 0.47) and Spiritual Growth (Mean = 2.60 points; SD = 0.53) while Physical Activity (Mean = 2.08 points; SD = 0.57) and Nutrition (Mean = 2.40 points; SD = 0.44) scored lower. Of 696 (42%) nurses reported having insomnia. It was found through hierarchical regression that demographic variables, shift patterns and health promotion lifestyles provided 23.5% of explanatory power in the prediction of insomnia. Among them, health risk factors (β= .160; p < .001), nursing staff working in shifts including night shifts (β = .066; p < .05), evening shift (β = .148; p < .001) and non-fixed shift (β = .121; p < .001) as well as the sub-scales in Health Promotion Lifestyle including Health Responsibility (β = - .121; p < .01), Spiritual Growth (β = - .202; p < .001), Interpersonal Relationship (β = - .155; p < .001) and Stress Management (β= - .427; p < .001) all reached statistical significance.
Conclusion: In this study psychiatric nurses are found shift work and unhealthy lifestyle would cause insomnia among psychiatric nurses. Hospital managers still need to pay attention to the health promotion lifestyle of nursing staff working in the evening and night shifts and plan health promotion activities for different shifts. The health promotion behavior in the sub-scales of the Health Promotion Lifestyle, Health Responsibility, Spiritual Growth, Interpersonal Relationship and Stress Management in particular should be enhanced to reduce health risk factors and insomnia.
Abstract in Chinese i
Table of Contents vii
List of Tables ix
List of Figures x
Chapter I Introduction 1
Chapter II Literature Review 4
2.1 Working shifts 4
2.2 Shift work psychiatric nurses 6
2.3 Development of Health Promoting Lifestyle-II (HPLP-II) 8
2.4 Health Promoting Lifestyle-II (HPLP-II) related research 10
2.5 Shift-Work Nurses and Health-Promoting Lifestyles 14
2.6 Insomnia 16
2.7 Shift-Work Nurses and Insomnia 17
2.8 Insomnia and Health-Promoting Lifestyles 19
2.9 Summary 21
2.10 Knowledge gap 22
Chapter III Purpose of the Study 23
3.1 Research Questions 24
Chapter IV Method 25
4.1 Definition of terms 25
4.2 Study Design 26
4.3 Subjects 27
4.4 Instrument 28
4.5 Data colleection 30
4.6 Data analysis 32
4.7 Ethical considerations 33
Chapter V Results 34
5.1 Subject Demographics 34
5.2 Insomnia and Health- promoting lifestyles- IIC Assessment 36
5.3 Hierarchical regression Socio- demographic and difference shift work psychiatry and health-promoting lifestyles to incident insomnia 39
Chapter VI Discussion 42
6.1 Demographics 42
6.2 Insomnia 43
6.3 HPLP-IIC 44
6.4 Insomnia is association with shifts work and HPLP – IIC 45
6.5 Study Limitations 47
Chapter VII Conclusion 48
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