摘要
職場暴力近幾年逐漸受到大眾注意，現已經是超越國界，超越各種工作環境和各種職業，變成一種全球性的議題。醫療機構在職場暴力的角色，有其特殊的地位，一方面醫護人員負有照顧的責任，因為受害者及部份加害者會到醫療機構求醫，因此醫護人員對暴力事件最為熟悉，不管是收集資料，研究暴力的原因及對暴力預防措施的擬定都具有優勢，對社會大眾，不管是照顧受害者或預防暴力都負有重責大任。另一方面醫護人員是處在暴力高危險的環境，因為社會變遷、人際衝突、失業、貧窮等造成種種生活上的困難，會引發挫折和生氣，進而影響一個人的行為，並產生口頭或肢體暴力。醫護人員與這些愁苦的人接觸，是處在這種工作情境的前線在所有工作場合之中，因此職場暴力以醫療機構尤其是精神科病房最為嚴重。要預防暴力必須了解暴力的原因和找出它的危險因子，但因為沒有單一的因子可以解釋為什有些人容易攻擊人、有些人容易被人攻擊，因此預防暴力的策略必須採用聯合國所提出的生態模式，考慮四個層面的所有危險因子,包括社會的、社區的、互動關係的以及個人的因素。我國在今年訂立醫療保健服務業安全衛生規則草案，把職場暴力防範列入法規，具體規範雇主責任，如應訂定防止職場暴力危害的政策、方案或危害防止計畫等。本文第一章是為了解職場暴力的來籠去脈，於某精神科醫院針對2002年曾遭受病人肢體攻擊的受害員工，共13位做面對面，半結構性的深度訪談，結果發現所有被訪談者均表示事件後之支持不夠，另有一半以上在事件發生時無人可以求救至，於心理感受上，從最嚴重的創傷後症候羣、焦慮、害怕、失眠、到無所謂、甘之如飴都有，在預防的建議上則提到職前訓練及在職訓練的重要，個人因應技巧及職場文化的改善。第二章係採用國際勞工局/國際護理協會/世界衛生組織/國際公共服務協會所發展的問卷，翻譯成中文，在同一醫院針對護士及照顧服務員做全面之問卷調查，探討暴力之盛行率和其相關之危險因子。結果回收222份有效問卷，其中女性117人、男性105人；回收率達90%，在盛行率方面，肢體暴力為35.1%、口頭謾罵為50.9%、霸凌/排擠為15.8%、性騷擾為9.5%而種族岐視為4.5%。肢體暴力明顯比其他國家的報告為高；而員工的焦慮度高和遭受職場暴力的機會高，兩者間有所相關。第三章則於另一精神科醫院，針對一群護理人員，做半年之追縱研究，探討暴力之發生行率和其相關之危險因子。結果發現肢體暴力、口頭謾罵、霸凌/排擠、性騷擾和種族岐視之發生率分別為 2.4、7.9、0.3、1.0和0件/每人年；高焦慮度、年資較少以及未婚是肢體暴力和口頭謾罵之危險因子；而年齡較輕則是性騷擾之危險因子。總而言之，職場暴力是職業危害之一，讓職場零傷害，環境零污染，對暴力零容忍是我們努力的目標，所以營造醫院的職場文化，建立支持和安全的工作環境，並提供工作人員必要的職前及在職訓練是預防精神科職場暴力之必要措施，也是雇主無可避免的責任。
並列摘要
Workplace violence has become a global problem, crossing national border, work settings and occupational groups, and has received increasing attention as a substantial contributor to occupational injury. The role of health sector in workplace violence is uniquely placed to draw the public attention. One is because its closeness to and familiar with the problem, health sector has the potential to take a much more proactive role in violence prevention. The other one is because frustration and anger arising out of life difficulties such as poverty, illness, alcohol and substance abuse can make people violent, health care personnel is actually at the high risk situation of violence to deal with these people when they come to hospitals to seek for help. Therefore, it was realized that health sector, especially psychiatric department, was most serious in workplace violence among all working sites. To prevent violence, it is necessary to understand the causes and identify the factors that increase the likelihood of people becoming victims or perpetrators. But because there is no single factor can explain why a person is more or less likely to experience violence, the strategy to prevent violence should consider all the four levels of risk including individual, relationship, community and societal factors, the so called ecological model proposed by World Health Organization. In chapter I, in order to understanding the context of workplace violence, we conducted a face-to-face, in-depth, and semi-structured interview with 13 health care workers suffering from physical violence by patients in 2002. We found that all of the victims alleged they did not receive enough post-incident support, and more than a half of victims could not call others for help during the violence. The psychological harm include post-traumatic stress disorder and general anxiety disorder, and other feelings include shock, astonishment, anger, fear, and sadness, but some victims reported minimal or no psychological injury. In chapter II, we translated the questionnaire which was developed by ILO/ICN/WHO/PSI joint program on workplace in the health sector into the Traditional Chinese version and used this questionnaire to survey the workplace violence prevalence and its risk factors among all nursing assistants and nurses in the same hospital as aforementioned one. A total of 222 valid questionnaires, male 105 and female 117, response rate was about 90%. The prevalence of physical violence (PV), verbal abuse (VA), bully / mobbing (BM), sexual harassment (SH), and racial harassment (RH) were 35.1%, 50.9%, 15.8%, 9.5%, and 4.5% respectively. The prevalence of PV at this hospital was higher than that reported by other countries for the health sector. A high anxiety level was associated with the occurrence of PV. In chapter III, We recruited 80 volunteer nurses into this 6-month follow-up study to investigate the incidence and risk factors of workplace violence in another psychiatric hospital. The results of this study showed that the incidence rates of PV, VA, BM, SH, and RH were 2.4, 7.9, 0.3, 1.0, and 0 per staff-year respectively. A high level of anxiety, a shorter duration of employment, and married status were the risk factors for PV and VA. Young age was the only risk factor for SH. In conclusion, workplace violence is an occupational hazard, and we need zero injury in workplace, zero contamination in environment, and zero tolerance to violence. Therefore, re-engineering the organization to a supportive and safe working environment and providing training program for high risk groups are required for prevention of the workplace violence and the employer is obliged to do these jobs.