急診醫護人員職場暴力促發因素及影響

本研究旨在探討急診醫護人員遭受職場暴力的情況及其促發因素與影響，並就醫療職場暴力提出可能防範措施。採量性橫斷式研究設計，針對新竹以北12家醫院之急診室醫師、護理人員及專科護理師進行問卷調查。研究結果顯示，近二年內有73.6% (156人)的急診醫護人員曾遭受言語暴力，而曾遭受身體暴力則有14.6% (31人)，發生次數以1~3次占多數。急診暴力常見的施暴者均以病人為主(言語：51.3%、身體：90.3%)；發生地點以看診區最常見；發生班別則以小夜班居多。急診醫護人員遭受職場暴力後對個人生理的影響以感到「心悸」居多，「疼痛」次之；對個人心理的影響則以「感到憤怒生氣」居冠，其次為「感到沮喪無奈」、「感到失望」；至於對醫護專業的影響則為「日後與病人接觸或行事時更加謹慎小心」占多數，「日後與病人採取保持距離避免接觸態度」次之。進一步的分析還顯示加乘暴力對人體生理的影響，因為當與僅遭受「言語暴力」或「身體暴力」的受訪者比較，「同時經歷言語和身體暴力」的受訪者有顯著較高比例出現諸如「疼痛」、「腫脹/瘀傷」以及「擦傷」等生理影響。另針對促發急診職場暴力因素，次序迴歸分析（ordinal logistic regression）結果指出，「人際溝通能力」對於「遭受言語暴力的次數區間」有顯著影響，此外，「急診工作年資」、「人際溝通能力」、「不良的物理環境」、以及「不完善的組織管理」等因素，對於「遭受身體暴力的次數區間」皆有顯著影響。最後從第一線急診醫護人員回饋的寶貴意見來看，認為加強改善「醫院急診室防暴措施」、「醫療環境設置與控制」、「保全系統設置與防衛裝備」、「行政管理」、「教育訓練」與「預防性醫療處理」是他們認為最有效預防及減少職場暴力發生的防範措施。總言之，上述研究發現可提供政府與衛生主管機關、醫院管理者、急診單位主管及醫院教育訓練者等，在政策、行政管理、臨床實務、教育訓練等方面上的建議，確實檢視政策實用性及訂定有效改善方案。

關鍵字

職場暴力；急診；醫護人員

並列摘要

This purpose of this study was to understand the status and causes as well as developing possible interventions of workplace violence against physicians and nurses in the emergency room (ER). With a cross-sectional quantitative research design, a questionnaire was surveyed among ER physicians, nursing staff and specialist nurses at 12 hospitals located north of Hsinchu county in Taiwan. Results showed that 73.6% (n=156) of emergency medical staff had experienced verbal violence in the past two years, while 14.6% (n=31) had suffered physical violence, with the majority number of occurrences being one to three times. The common perpetrators of ER violence are mainly patients (speech: 51.3%, body: 90.3%); the most common place of occurrence is in the waiting room; the most frequent period of occurrence is in the early night shift. The major physiological impact of workplace violence perceived by emergency medical staff is "palpitations" with the second physiological impact being “pain.” Regarding the psychological impacts, the major reported perception is "furious and angry feelings”, followed by "frustration and helplessness" and "disappointment." Moreover, these impacts may result in a reformed healthcare administration in ER where “contacting or acting more cautiously with patients” is taken as the most common resort while "avoiding contact with patients by keeping them in a distance” is taken as the second common one. Further analysis also revealed the impacts of synergistic violence on the human body, because respondents who experienced both verbal and physical violence, as compared to those experiencing only “verbal violence” or “physical violence, had a significantly higher proportion in suffering physical impacts (i.e. "pain", "swelling/scarring" and "scratch"). As for promoting factors of workplace violence in ER, ordinal logistic regression pointed out that the “interpersonal communication skills” have a significant effect on “the ordinal number of occurrence of verbal violence.” In addition, factors such as "job tenure in ER", "interpersonal communication skills", "poor physical environment" and "inappropriate organizational management" are found to play an important role in the number of occurrence of “physical violence." Finally, valuable feedback were also surveyed from the front-line emergency medical staff, who suggested what they believe are the most effective strategies for preventing and reducing workplace violence. These include “developing countermeasures for ER workplace violence”, “improving medical environmental settings and control”, “increasing security and defensive equipment”, “ameliorating administrative management”, “strengthening education and training” and “preventive medical treatment”. Taken together, our finding can advise the government, health authorities, hospital managers, ER department heads or medical education providers in their policy making, administrative managements, clinical practice as well as educational training. Current study may also help review the feasibility of existed policy and help frame effective plans of improvements.