提示：前瞻性研究数据相对来说更真实。
今天分享源自《International Journal of Nursing Studies》上的一篇文献：Han K, Kim Y, Lee H Y, et al. Novice nurses’ sleep disturbance trajectories within the first 2 years of work and actual turnover: A prospective longitudinal study[J]. International Journal of Nursing Studies, 2020,112:103575.
新护士工作2年内的睡眠障碍轨迹及离职:一项前瞻性纵向研究
Abstract摘要
Background Novice nurses experience radical changes in their sleep-wake cycle and sleep difficulties after exposure to a rotating shift work schedule. The link between workplace hardship and employee turnover may be dependent on factors at the individual level, e.g., individual health. Nurses with sleep disturbance are more vulnerable to stressful stimuli and lack resilience at work compared with those without sleep disturbance.
研究背景：初入职场的护士在轮班工作后，睡眠周期和睡眠困难都发生了翻天覆地的变化。工作场所艰苦程度和员工离职率之间的联系可能取决于个人层面的因素，例如个人健康。与没有睡眠障碍的护士相比，有睡眠障碍的护士更容易受到压力刺激，在工作中缺乏弹性。
Objectives To classify novice nurses according to sleep disturbance trajectories during the first 2 years of work, to compare turnover rates according to trajectory classification, and to compare levels of sleep disturbance between stayers and leavers within each trajectory class.
研究目的：根据工作前2年的睡眠障碍轨迹对新护士进行分类，根据轨迹分类比较离职率，并比较每个轨迹类中在职和离职护士的睡眠障碍水平。
Design Prospective longitudinal design.
研究设计：前瞻性纵向研究
Settings A tertiary hospital in Seoul, South Korea.
设置：韩国一家三级医院
Participants A total of 465 newly graduated nurses who started work between September 2014 and December 2015.
研究对象：2014年9月-2015年12月，465名刚毕业参加工作的护士。
Methods Data were collected 6 times within the first 2 years of work (on the first day of orientation before ward placement, at 6 weeks after starting work, and at 6, 12, 18, and 24 months of work). Sleep disturbance was assessed using the General Sleep Disturbance Scale. Turnover information was retrieved from the hospital's administrative data system to determine whether anyone had left the hospital at each data collection point. Unconditional latent growth curve analysis was performed to identify latent classes of trajectories of sleep disturbance among novice nurses during the first 2 years of work.
研究方法：①在护士工作前两年内共收集6次数据（在病房安排前的第1天，开始工作后的6周，以及工作的6个月、12个月、18个月和24个月）。②使用睡眠障碍量表进行评估。③在每个测量时间点，利用医院的行政系统数据收集护士的离职情况数据。④采用潜增长曲线分析，分析护士入职前2年睡眠障碍的潜轨迹类别。
Results The 2-year trajectories of sleep disturbance were classified into two distinct groups: the high symptomatic group (Class 1: 57.4%) and the low symptomatic group (Class 2: 42.6%). In comparison with Class 2, Class 1 consistently showed a higher turnover in each period. In Class 1, leavers who left the hospital at the next measurement point tended to report more severe sleep disturbance at prior measurements. This pattern was also observed for the overall sample. However, in Class 2, an inconsistent pattern between stayers and leavers was observed.
研究结果：①可以按照前2年睡眠障碍的不同水平分为两个组：高症状组(1组:57 .4%)和低症状组(2组:42 .6%)。②与低水平睡眠障碍相比，高水平睡眠障碍的护士在任何一个测量时间段都表现出睡眠障碍。③在高水平睡眠障碍组中，如果护士在下一次测量点前离职，则之前其表现出更严重的睡眠障碍。在所有样本中，基本都是类似这种的模式。④但是，在低水平睡眠障碍组中，离职者与留职者之间的“模式”是不同的。（也就是说，睡眠障碍水平比较低的护士，他们的离职与留职的原因并不是因为睡眠障碍，并不符合高水平睡眠障碍的模式。）
Conclusions This study identified two distinct classes of sleep disturbance among novice nurses during the first 2 years of work. Given that many nurses experience sleep problems at pre-employment and during the early career period, a comprehensive approach to address this issue should be implemented in nursing schools and hospitals. The basic nursing curriculum should include self-care management strategies for sleep difficulties to ensure retention at work. At-risk nurses should receive organizational support and early monitoring to prevent the adverse effects of poor sleep.
研究结论：本研究发现，新护士在入职的前两年按照不同水平的睡眠障碍可以分为两类。鉴于许多护士在入职前和职业生涯早期都经历过睡眠问题，护理学校和医院应该采取综合措施来解决这个问题。基本护理课程应包括对睡眠困难的自我照顾管理策略，以确保在工作中保持睡眠。有睡眠障碍风险的护士应该得到组织的支持和早期监测，以防止不良睡眠的不良影响。
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