本文的目的在介紹某教學醫院精神科病房設計與推行護理人員月輪班制度的過程 ，並初步探討實施 18 個月後此制度對護理品質的影響。研究方法是比較月輪班制及快速輪 班制各 18 個月期間，相關護理品質指標的差異。資料收集採回溯性方式，整理兩個時期的 相關電腦存檔資料：「病房護士基本資料」、「護士每日工作分配表」以及「住院病人意外 事件報告」。結果顯示，在快速輪班制 (N=23 人 ) 與月輪班制 (N=18 人 ) 各一年半期間 內，兩組護理人員在性別、年齡、教育程度、年資與婚姻狀況等基本屬性上並無顯著差別； 兩種不同班別制，期間的病房佔床率及護理人力配置也無明顯不同；護理人員每個月的班別 轉換頻率由 5.8 ± 3.2 減為 2.3 ± 2.0 次 (t=15.0，p<.001)， 病人得到主護護士照顧 的日數從每月 7.8 ± 1.2 天增為 14.9 ± 1.6 天 (t=11.0，p<.001)，住院病人發生意外 事件的數量在兩種班別期間並沒有差異，但在月輪班制期間，病人因意外事件造成的損傷則 有顯著的減輕 (t=2.72，p<.001)。 本研究的結果可以和其他的研究互相印証，即快速輪班 制可能影響護理人員的生物節律或下降其警覺性，進而對病患安全有不良後果，月輪班制則 可以減少這些不良影響，而且可以提升護理照顧的連續性。

　　　　　The purposes of this study were (1)to report on a monthly-rotating shiftwork system applied applied in an acute psychiatric ward, and (2)to compare the effects of monthly-rotating and rapid-rotating shift systems on quality of nursing care. The research data were obtained retrospectively from computerized files related to the work schedules in the psychiatric ward, sociodemographic characteristics of the nursing staff, and records of accidents involving psychiatric inpatients. For an 18-month period of rapid-rotating (N=23) and monthly-rotating (N=18) shift, the demographic characteristics of nurses were similar; the rate of bed occupancy and manpower in the ward were not significantly different. The frequency of rotating shift decreased from 5.8 ± 3.2 to 2.3 ± 2.0 times/month (t=15.0,p<.001)and the days that the patients were directly cared for by their primary nurses increased from 7.8 ± 1.2 to 14.9 ± 1.6 days/month (t=11.0,p<.001). There was no marked difference in the rate of accidents between the two rotating periods, but the severity of injuries caused by the accidents was significantly less in the monthly-rotating period (t=2.72,p<.001). The results were compatible with previous studies. That is, a monthly-rotating shift system, compared to a rapid-rotating system, may be favorable to quality of psychiatric nursing care.