護理職場情緒勒索經驗探討—以中區精神科護理人員為例

背景：精神醫療照護重視高度合作，護理人員處於居中角色，長期暴露在高情感表露的環境中，承受極大壓力與情緒負荷。近年來護理人員情緒與壓力相關研究受到多方重視，然而職場情緒勒索方面研究卻相對缺乏。目的：旨在探討精神科護理職場情緒勒索現象，護理人員遭受職場情緒勒索後之身心衝擊與調適歷程，以及對職場人際互動與工作信念之影響。方法：運用質性內容分析研究法，於2019年12月至2020年11月深度訪談中部三家區域及地區醫院，共計24位精神醫療單位護理人員，有意義呈現精神科護理職場情緒勒索多元面向特性、癥結與心境歷程之真實脈絡。結果：精神科護理職場情緒勒索來源普遍存在於護理主管、護理同儕、精神病人及其家屬；形式上常見「刁難指責迫使接受」、「威脅、剝奪權益」、「諷刺揶揄與質疑」、「壓迫性肢體語言」、「刻意示好」、「消極推拖」及「公開審視」等七種手段。護理人員在面對情緒勒索心境上，從困難覺知被情緒勒索的「混沌期」，邁向感受自身情緒、認知受制情緒勒索的「覺察期」，開始掙扎該如何應對情緒勒索壓力的「抉擇期」，到無法避免需犧牲身心健康及動搖工作意念的「承受期」，最後找到內外信念與支持達到生活平衡的「接受期」，五個階段的心路歷程顯示繁複情緒衝突矛盾中發展應對及自我調適最真實的樣貌。結論：護理職場情緒勒索造成醫療工作環境人際關係緊張與人才流失，影響層面涉及護理人員本身與組織機構，建議行政管理者規劃臨床完整的在職教育訓練、重視職場雙向溝通與自我調整，並建立輔導機制與危機諮詢，設立多元反映管道，以提供優善職場及人才留任之參考。

關鍵字

情緒勒索；護理職場；精神科護理人員；護理行政

並列摘要

Background：Psychiatric medical care requires a high degree of collaboration among different medical personnel. Sandwiched between other medical personnel and patients, nursing personnel are exposed to highly emotional environments for extended periods of time and sustain enormous amounts of pressure and emotional load. In recent years, numerous studies on the emotions and stress of nursing personnel have been conducted. However, those on workplace emotional blackmail remain scant. Objectives：This study explored workplace emotional blackmail experienced by psychiatric nursing personnel, the impact of said blackmail on their minds and bodies, their subsequent adjustment processes, and the effects of such experiences on their work beliefs and workplace interpersonal interactions. Methods：This study adopted a qualitative content analysis method and conducted in-depth interviews between Dec. 2019 and Nov. 2020 with 24 psychiatric nurses working at three district and regional hospitals in central Taiwan. The results truthfully and meaningfully displayed the diversified characteristics and cruxes of workplace emotional blackmail, and the mental journeys that psychiatric nurses underwent when exposed to such emotional blackmail. Results：In psychiatric nursing departments, nursing personnel experienced workplace emotional blackmail–induced oppression from their supervisor, colleagues, and patients and their families. The oppression was most commonly observed in the forms of “deliberate harassments, accusations, and forced acceptance,” “threats and deprivation of rights,” “sarcasms, ridicules, and questioning,” “oppressive body language,” “deliberate brown-nosing,” “passive and delay tactics,” and “public scrutiny.” When faced with emotional blackmail, nursing personnel underwent a five-stage mental journey, which comprised the “chaos stage,” “awareness stage,” “decision stage,” “enduring stage,” and “acceptance stage.” During the “chaos stage,” nursing personnel didn’t notice that they had been emotionally blackmailed. During the “awareness stage,” they witnessed their emotions and cognition being affected by emotional blackmail. During the “decision stage,” they began to struggle with finding ways to cope with the pressure of emotional blackmail. During the “enduring stage,” they sacrificed their physical and mental health and gave up their work beliefs. During the “acceptance stage,” they found internal and external beliefs and support to achieve a balance in life. The five-stage mental journeys revealed how nursing personnel responded and adapted to the complex emotional conflicts and contradictions encountered. Conclusion：Workplace emotional blackmail in nursing departments workplace creates strained interpersonal relationships and high turnover rates, negatively affecting nursing personnel and their organizations. Thus, relevant administrators are suggested to plan complete on-the-job clinical education and training, pay attention to two-way communications and self-adjustments in workplaces, establish counseling and crisis consultation mechanisms, and create multiple reporting channels to build favorable workplace environments and retain talents.