本論文主要目的在探討使用護理推車時，施力方向（推、拉）、車行路徑（直線、轉彎、上坡）與負荷位置（18個位置，以X、Y、Z三個軸向來表示，X軸有3個水準，Y軸有2個水準，Z軸有3個水準）對肌肉活動反應與自覺施力評量的影響。本實驗共徵募10位女性受試者，每位受試者執行108個試驗，包含2個施力方向、3個路徑以及18個負荷位置，應變數為左右兩邊的屈指淺肌、伸指淺肌、斜方肌與背直肌之肌肉活動反應以及自覺施力評量。本研究使用雙重分裂集區變異數分析施力方向、路徑與負荷位置之肌肉活動反應與自覺施力評量。實驗結果顯示後拉（左右屈指淺肌、斜方肌、背直肌）的最大肌肉活動反應皆比前推高。前推自覺施力評量分數亦比後拉小。在上坡路徑時的肌肉活動反應與自覺施力評量皆明顯比直線和轉彎路徑高。在X軸的中心、Y軸的底層與Z軸的近端的肌肉活動反應與自覺施力評量皆明顯較低。根據實驗結果，本研究建議護理人員應儘量採用前推方式代替後拉方式移動護理推車；工作環境設計亦應避免上坡路徑設計；在護理推車的負荷配置上，建議較重的物件應放置於推車斗櫃的底部、中央並靠近推車手把位置以降低護理人員身體負荷。

The purpose of this study was to explore the effects of direction of exertion (DOE) (pushing, pulling), path (walking in a straight line, turning left, walking uphill), and load placement (LP) (the 18 blocks were indicated by X, Y and Z axis. There were 3 levels on the X axis, 2 levels on the Y axis, and 3 levels on the Z axis.) on muscle activity and ratings of perceived exertion in nursing cart pushing and pulling tasks. Ten participants who were female students and not experienced nurses were recruited to participate in the experiment. Each participant performed 108 experimental trials in the study, consisting of 2 directions of exertion (push and pull), 3 paths, and 18 load placements (indicated by X, Y and Z axes). A 23kg load was placed into one load placement. The dependent variables were electromyographic (EMG) data of four muscles collected bilaterally as follows: Left (L) and right (R) trapezius (TR), flexor digitorum superficialis (FDS), extensor digitorum (ED), and erector spinae (ES) and subjective ratings of perceived exertion (RPE). Split-split-plot ANOVA was conducted to analyze significant differences between DOE, path, and LP in the EMG and RPE data. Pulling cart tasks produced a significantly higher activation of the muscles (RTR:54.4%, LTR:50.3%, LFDS:57.0%, LED:63.4%, RES:40.7%, LES:36.7%) than pushing cart tasks (RTR:42.4%, LTR:35.1%, LFDS:32.3%, LED:55.1%, RES:33.3%, LES:32.1%). A significantly greater perceived exertion was found in pulling cart tasks than pushing cart tasks. Significantly higher activation of all muscles and perceived exertion were observed for walking uphill than walking in a straight line and turning left. Significantly lower muscle activity of all muscles and subject ratings were observed for the central position on the X axis, the bottom position on the Y axis, and the posterior position on the Z axis. These findings suggest that nursing staff should adopt forward pushing when moving a nursing cart, instead of backward pulling, and that uphill paths should be avoided in the design of work environments. In terms of distribution of the load in a nursing cart, heavier materials should be positioned at bottom of the cabinet, centered on the horizontal plane and close to the handle, to reduce the physical load of the nursing staff.

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