婚姻受暴婦女之臨床照護能力量表發展與急診護理人員之臨床照護勝任感受程度現況探討

婚姻暴力長期以來是社會重要議題，醫療照護體系中也將此列入特殊事件通報及照護。美國司法統計局資料指出每年家庭暴力中以婚姻暴力高居第一位，約佔49%。我國於1998年起實施家庭暴力防治法，2012年度婚姻暴力通報人數為61,309人，佔家庭暴力通報總人數之53.22%。急診護理人員在婚姻受暴婦女之臨床照護中扮演極重要的角色，其臨床照護能力直接影響婚姻受暴婦女就醫品質。因此本研究目的在發展量表及探討急診護理人員對婚姻受暴婦女之臨床照護能力勝任感受程度現況。第一階段以焦點團體法，立意取樣邀請39位曾照護婚姻受暴婦女經驗急診護理人員，粹取出婚姻暴力照護應具備之能力項目，並發展出「婚姻受暴婦女臨床照護能力量表」。第二階段進行專家效度檢測並以橫斷式調查研究，立意取樣以苗栗以南、台南以北之19家區域以上醫院之急診護理人員為研究對象，共發出627份問卷，回收率為89.63%，最後得有效問卷476份。　　研究結果發現，量表發展經因素分析「婚姻受暴婦女臨床照護能力量表」共37題，歸納為三個面向，分別命名為：｢資源提供、保護措施及關懷｣、｢評估、通報、記錄、處置及預防｣及｢法律相關規範處理｣等能力。依據婚姻受暴婦女臨床照護能力量表分析急診護理人員對婚姻受暴婦女臨床照護能力勝任感受程度現況結果得：量表採用Likert 5點尺度計分，得分範圍為37-185分之間，得分越高表示急診護理人員自覺該項勝任感受程度越高。研究對象在婚姻受暴婦女臨床照護勝任感受程度量表整體量表總平均得分為3.56，三因素得分分別為：資源提供、保護措施及關懷能力勝任感受程度之平均得分3.69；評估、通報、記錄、處置及預防能力勝任感受程度之平均得分3.33；法律相關規範處理之能力勝任感受程度之平均得分3.54。　　本研究發現研究對象之人口學特性中有接受臨床照護教育、有過去照護經驗變項為整體婚姻受暴婦女臨床照護勝任感受之重要預測變項，其解釋變異量為6.0%；有接受臨床照護教育為資源提供、保護措施及關懷勝任感受程度之重要預測變項；其解釋變異量為3.4%。有接受臨床照護教育為評估、通報、記錄、處置及預防能力之勝任感受程度之重要預測變項，其解釋變異量為3.2%。有臨床照護教育經驗、區域醫院之急診工作年資、有過去照護經驗為處理法律相關規範能力之勝任感受程度之重要預測變項，能解釋的變異量為10.2%。　　由本研究結果發展出｢婚姻受暴婦女臨床照護能力量表」，在護理實務方面可藉由此量表評估急診護理人員對婚姻受暴婦女臨床照護能力勝任感受程度，除可提供護理人員自我了解及專業成長外，亦可做為急診護理人員教育訓練及相關行政管理之參考。

關鍵字

急診；急診護理人員；婚姻暴力；受暴婦女；臨床照護能力；量表發展

並列摘要

Domestic violence against women has long been considered an important social issue. The emergency health care system has also been required to report the incidents and provide health care services to victims. The United States Bureau of Justice Statistics stated that the violence against women ranked first in domestic violence for about 49%. In Taiwan, the Family Violence Prevention Act has been implemented since 1998. In 2012, there were 61,309 cases of domestic violence against women reported, accounting for 53.22% of total number of domestic violence cases. Emergency nurses play an important role in clinical care of women who have experienced domestic violence. The clinical competences of emergency nurses would directly affect the quality of care for abused women. The purpose of this study is to develop the questionnaire and explore emergency nurses' perceptions of their clinical competences on domestic violence against women. The study first applied focus group method using purposive sampling to interview 39 emergency nurses who had experiences of caring for abused women, sort out the clinical competences on domestic violence against women which are necessary for emergency nurses and develop the "Clinical Competence Scale on Violence against Women." After testing the validity of the Scale, a cross-sectional survey was then conducted using convenience sampling. There were 627 questionnaires issued to emergency nurses from 19 hospitals. A total of 476 valid questionnaires were returned with response rate of 89.63%. 　　Through factor analysis, the results of this study found three factors of the "Clinical Competenc Scale on Domestic Violence against Women" containing 37 questions. The three factors were named as: (1) resources arrangement, protection interventions and caring; (2) assessment, reporting, recording, medical treatments and prevention; (3) legal issues management. The Scale obtained the 5-point Likert response to measure emergency nurses’ perception of clinical competence on domestic violence against women. The score range was from 37 to 185 points. The higher scores indicate the better results of emergency nurses’ perception of clinical competence on domestic violence against women. The total average scores of the "Clinical Competence Scale on Domestic Violence against Women" were 3.56. The results of the study showed the average scores of 3.69 in resources arrangement, protection interventions and caring, 3.33 in reporting, recording, medical treatments and prevention and 3.54 in legal issues management. 　　In addition, the study found that the variables “receiving clinical trainings in domestic violence” and “having experiences of caring abused women” were the two important predictors to emergency nurses’ perception of clinical competence on domestic violence against women. It explained 6.0% of the variance. “Receiving clinical trainings in domestic violence” was the important predictor of "resources arrangement, protection interventions and caring." It explained 3.4% of the variance. “Receiving clinical trainings in domestic violence” was the important predictor of "reporting, recording, medical treatments and prevention." It explained 3.2% of the variance. “Receiving clinical trainings in domestic violence”, “the seniority of emergency department in regional hospitals” and “having experiences of caring abused women” were the important predictors of "legal issues management." It explained 10.2% of the variance. 　　The "Clinical Competence Scale on Domestic Violence against Women" developed in this study could be used to help emergency nurses perceive their clinical competence on domestic violence against women. In addition to enhancing nurses' self-perception and professional growth, the Scale could also be the reference to emergency nursing education and training and nursing administration.