背景與目的
臺灣已進入高齡社會，亟需長期照護專業人力，以照顧服務員為最。然而，他們暴露於各式的職場危害，尤其人因性危害與會心理性危害；這些危害往往成為人力擴充的阻礙，但卻未受到重視。本研究旨在探究照顧服務員擔心職場危害的程度以及調查職場危害的盛行率，並比較典型雇傭（例如正式受雇機構或醫院病房）與非典型雇傭（多為醫院的特約看護）兩種身份的差異。此外，因應職業安全衛生法的施行，照顧服務員的所屬單位應負管理監督之責，以確保從業人員的安全與健康，但過去較少學者調查該職場推動職業安全衛生管理與勞工健康保護的情況，本研究也探究此議題。

材料與方法
本研究採用橫斷面設計進行立意取樣，收案對象包含長照機構專任、醫院病房專任與看護中心特約的照顧服務員及其主管，由研究員進行訪談或書面問卷發放。結果利用SPSS軟體進行描述性統計，另進行卡方檢定與多項式迴歸等分析。

結果
本研究回收238份照顧服務員問卷（分屬24個單位，回應率77.2%），有68.5%透過當面訪談照顧服務員而收案，其餘33.5%為書面填寫而後以電話確認；另回收22份主管問卷（回收率91.2%）。大部分的照顧服務員為全職(96.1%)、具有證照(91.2%)、女性(81.5%)、中高齡(52.1%)、高中職畢業(52.1%)，有較長的工時但收入卻低於全國平均；他們最擔心的危害是人因性危害與生物性危害，而實際報告過去一年曾發生最多的危害事件是人因性危害(每人平均0.6次)與社會心理性危害(每人平均0.3次)，尤其是非典型雇傭的工作者承受較大的風險。有60.1%的照顧服務員過去一年有長達一天以上的肌肉骨骼不適，集中於下背(39.8%)、肩膀(左30.9%、右35.9%)、上背(24.9%)、手腕(左17.3%、右23.2%)；個人過勞與工作過勞平均分數皆屬輕度。11.3%的照顧服務員表示過去一年曾遭受職場暴力事件，每人平均次數為0.3次。以上述數據對照主管回報的職業傷病數字，發現主管低報的現象，且在危害認知及預防人因性危害、異常工作負荷、不法侵害等勞工健康保護措施上，未臻完善。
若以「照顧服務員自述過去一年內發生人因性危害事件」作為結果，使用多項式迴歸分析，發現在機構因素的模型中，「單位有辦理人因性危害預防教育訓練」可降低人因危害風險(勝算比[odds ratio；OR] = 0.38，95%信賴區間[confidence interval；CI]：0.15–0.98)；加入身分與工時因素，發現每週工時60小時或更多會增加人因危害風險(OR=2.64，95% CI：1.02–6.88)；再加入個人因素，發現有肌肉骨骼病史(OR=2.31，95% CI：1.07–4.99)、有運動習慣(OR=2.30，95% CI：1.10–4.80)、過去一年內發生職場不法侵害事件(OR=7.23，95% CI：2.27–22.97)、個人對人因危害的擔心程度為經常或非常擔心(OR=13.74，95% CI：3.43–55.08)與自述發生人因性危害事件有相關。
而以「照顧服務員自述過去一年內發生不法侵害事件」為結果，使用多項式迴歸分析，發現在機構因素的模型中，有住民監視的措施可降低不法侵害的風險(OR=0.30，95% CI：0.10–0.88)；再放入工時、出勤狀況與人因危害的因素，發現個人曾經歷人因危害事件會增加不法侵害的風險(OR=6.52，95% CI：2.43–17.50)；再放入個人因素，曾有個人病史(OR=5.44，95% CI：1.51–19.54 )、個人曾經歷人因危害事件(OR=5.09，95% CI：1.57–16.45)會增加自述過去一年曾發生執行職務不法侵害的風險，而若有住民監視措施則會降低該發生風險(OR=0.23，95% CI：0.05–0.10)。
最後，比較典型雇傭與非典型雇傭身份的差異，發現後者的年紀較大，共病較多，工時較長，主訴較多的肌肉骨骼受傷事件，請較多病假，發生較多的生物性危害事件、輪班工作障礙、睡眠障礙、因工作而影響情緒、職場暴力事件、物理性危害事件。此外，醫院較長照機構缺乏移轉位的設備、提供較少的教育訓練。

結論
本研究概括性描述照顧服務員的職場危害。照顧服務員最擔心的是人因性危害與生物性危害，而實際報告過去一年曾發生危害的次數最多的是人因性危害與社會心理性危害，而且屬於非典型雇傭的工作者會比典型雇傭者承擔更大的風險。
未來在職場規劃預防措施時，在人因危害預防部分可加強教育訓練與控管合理工時，並針對個人情況（例如個人病史、對人因危害的認知與擔心程度、習慣轉移位的方式、歷經職場不法侵害的情況等）進行適切的指導；在不法侵害危害預防部分，宜加強住民監視措施，並宜針對個人情況（例如個人病史、歷經人因危害事件的情況等）進行評估與指導。在行政管理層面，目前各類危害事件明顯低報，而單位主管對危害的認知與預防措施、教育訓練、健康管理等層面，仍有改善空間。

Caregivers were exposed to various occupational hazards but often neglected. This study was to examine the occupational hazards among them in Taiwan, especially ergonomic and psychosocial hazards. We enrolled 238 caregivers and 22 supervisors in long-term care institutions and hospitals by purposive sampling with a response rate 77.2% and 91.7%, respectively. Most of the caregivers were full-time, certificated, female, and at middle age, and they had longer work hours and lower wages than the general population. They were worried most about ergonomic and biologic hazards. The most common adverse events were from ergonomic and psychosocial hazards, and the atypically employed caregivers (usually work at hospitals) had even higher risks. For preventing ergonomic hazards, enhancing on-the-job training, controlling work time, and offering personal risk evaluation and counseling to the staff were considered to be effective strategies. On the other hand, enhancing patient monitoring and offering personal risk evaluation and counseling to the staff may decrease the risks of workplace violence. At the management level, under-reporting of work-related disorders was observed, and there was still room for improvement in supervisors’ knowledge, preventative strategies, training courses, and health management.

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