醫療暴力事件之原因與防治措施-以中部某體系醫院為例

Cause Medical Events Of Violence And Prevention Measures-In A Hospital System In Central Case

周佳霓(CHIA-NI CHOU)

指導教授 ： 陳慈幸博士

國立中正大學/教育學院/犯罪防治學系/碩士(2016年)

摘要

為降低醫療院所的暴力問題，本研究探討醫療暴力事件發生的脈絡及其對醫療工作人員所帶來的影響，藉由整體社會意識、醫療品質與職場安全三方面來建構相關防範策略，以遏止暴力事件的再發生。 本研究以量性橫斷式問卷調查的方式蒐集資料，將研究對象區分為醫療工作人員與一般民眾，再以描述性及推論性統計分析探討醫療暴力防治實施之缺失與對策。在醫療工作人員的部分施測500份樣本，回收476份樣本，回收率95.2%，扣除作答不完整、資料不齊全等無效樣本，計418份有效樣本(83.6%)；在一般民眾的部分，進行電子問卷施測，回收226份有效樣本。 研究第一部分結果發現:1.六成的醫療工作人員在醫院曾目睹或親身遭受醫療暴力事件，其中以「言語暴力」最多，其次為「肢體暴力」。2.年齡、工作內容、年資與醫療暴力互有關聯，越頻繁與病患發生互動的工作人員，越容易發生醫療暴力事件，因此，容易發生暴力區域為「病房」與「急診」；工作類型為「護理人員」。發生時間為「白班」與「小夜班」。3.施暴病患意識狀況以「清楚」居多，主因為施暴者「情緒控制不佳」。4.遭遇暴力事件時醫療工作人員的情緒中以「生氣反應」、「莫名其妙」及「驚恐反應」為主要反應症狀。立即反應則為「通報上級」、「冷靜處理」及「離開現場」。5.醫院地區屬性可能受相關設備設施與防治情形不同影響，導致中南部發生醫療暴力發生率較北部高。 研究第二部分結果發現:1.民眾對醫療暴力事件的態度與認知部分，不可容忍醫療暴力行為的發生、醫療院所不應出現暴力行為、發生醫療暴力行為後應付諸法律裁判皆為最高。2.「預防醫療暴力的相關法規」的部分，僅有四成民眾清楚知道預防醫療暴力的相關法規。 綜歸上述，雖然我國對醫療暴力相關問題已日益重視，但仍應不斷思考如何建構友善醫療職場與提供安全設備措施，並給予醫療工作人員更多訓練與充足人力。針對施暴者危險因子加以辨識與管控，減少醫療過程中的刺激，再從整體文化社會觀念提升等幾方面共同努力，才能夠真正預防並避免醫療暴力事件的發生。

關鍵字

職場暴力 ； 醫療暴力 ； 暴力

並列摘要

To lower the violence occurred in hospitals, the purpose of this study is to explore the influence and the background of medical violence for nursing staffs. By developing and constructing relevant prevention strategies from the aspect of the whole social awareness, medical quality and workplace security hopefully can hold back the happening of workplace violence efficiently.
In this study, the amount of the cross - sectional questionnaire survey to collect information, the subjects were divided into the medical staff and the general public, and then to descriptive and inferential statistical analysis to explore the implementation of the missing medical Violence Prevention and Countermeasures. In some medical staff Surveying 500 samples, 476 samples recovered, the recovery rate was 95.2%, after deducting answer is incomplete, invalid samples and other information is not complete, total 418 valid samples (83.6%); part of the general public in, Surveying the electronic questionnaire recovered 226 valid samples.
The result shows that:1. 60% of nursing staffs have witnessed or suffered from medical violence. The ratio of occurrence of verbal violence is the first, and physical violence is the second.2. The age, working content and length of service are related to medical violence. The more frequent the nursing staffs interact with patients, the more likely the nursing staffs encounter medical violence. The violence mostly happens in the wards and emergency rooms. Among the nursing staffs, the nurses are the most likely vulnerable to medical violence, and medical violence is mostly seen during evening shift and during night shift.3. Most of patients use violence are conscious; the main reason is they have bad temper control. 4.When the nursing staffs face violence incident, their main emotional reflections are angriness, baffle and shock. Their immediate reactions are that inform the supervisor, stay calm and leave the spot. 5.Hospital properties are different in relevant equipment and preventive situation, which leads to the frequency of violence occurring in middle-south area is higher than north area is.
Peoples’ understanding and attitude following three are the most: 1.They can’t tolerate the occurrence of medical violence; violence should not occur in the hospitals and resort to law after the occurrence of violence.2. Only forty percent of the public understand clearly about relevant regulations about prevention of medical violence.
To sum up, although our country has gradually paid more attention on medical violence, it is supposed to think about how to create friendly medical workplace and to provide security measures. Also, the nursing staffs should be giving more training and sufficient manpower. By working together on identifying and controlling risk factors for perpetrators, reducing stimulus of medical procedure, and leveling up the whole social cultural concept can truly prevent and avoid the occurrence of medical violence.

並列關鍵字

Workplace Violence ； Medical violence ； Violence

參考文獻

1.王俊麒（2015）。急診職場暴力之成因探討：多元利害關係人之不同觀點。國立台灣大學研究所學位論文，未出版，台北。

2.李選、白香菊、顏文娟（2009）。台灣護理人員職場暴力經驗及相關因素研究。護理雜誌，57（2），61-69。

3.李绣惠、李佩蓉、明勇（2005）。提升護理人員暴力處置知識與態度之方案，志為護理，6（2），86-95。

4.林小玲、尹祚芊、黃惠美（2012）。某醫學中心護理工作職場暴力評估之研究。榮總護理，29（2），176－186。

5.林作彥、邱素珍(2012)。淺談台灣急診暴力。台灣急診專科醫師期刊，4（3），61-65。