急診室護理人員職場暴力與防範策略之探討

An Investigation of Nurse Workplace Violence and Prevention Strategy in the Emergency Department.

楊春梅(Chun-Mei Yang 楊春梅)

指導教授 ： 盧美秀

臺北醫學大學/護理學院/護理學研究所/碩士(2011年)

https://doi.org/10.6831/TMU.2011.00044

摘要

本研究目的為探討分析目前急診護理人員遭受職場暴力的情況及發生頻率與影響，並發展建構相關防範策略，供主管單位及機構作為職場暴力預防措施及決策的參考，以有效的遏止急診室職場暴力的發生。
研究方法採量性橫斷式研究設計，立意取樣。以「新制醫院評鑑特優及新制教學醫院評鑑優等」之醫學中心級醫院，與「新制醫院評鑑優等及新制教學醫院評鑑合格」之區域級醫院綜合科別之急診單位護理人員及護理主管為研究對象。於2010年12月1日至2010年12月15日進行問卷調查。
研究結果顯示，急診護理人員近六個月內曾發生職場言語暴力63.2％（108人）；身體暴力19.3％（33人），兩者比率約3.27：1；發生頻率以1~3次居多（47.2％及81.8％）。暴力來源為病人，其次是與病人有關係的人。地點以檢傷掛號區最常見。言語暴力常見於小夜班（16~24點），身體暴力常見於大夜班（24~8點）。約一半以上的護理人員曾經因暴力事件而產生離職的想法。其中，身體暴力常見的傷害為瘀青擦傷、咬傷。在工作感受的部分，多數的急診護理人員經常認為工作的負荷程度高，達4.04分（1~5分）；並經常在工作時感受到暴力的威脅，認為安全性需要進一步提升。急診職場暴力對護理人員的影響最大者為：在其身心狀況方面，會讓護理人員感到生氣、委屈、失望、難過、無力、害怕、沮喪/憂鬱；在其工作狀況/照護品質方面，會使護理人員在工作上更加小心謹慎來避免職場暴力；在其工作看法/感受方面，會令護理人員的工作壓力增加、並降低其對工作的熱忱。且發生職場暴力的護理人員比未發生者，在生氣的感受、對病人照護上失去客觀性、在工作上更加小心謹慎來避免職場暴力、覺得工作壓力增加等影響較為明顯。「最近一年內有參加過預防及處理職場暴力等相關教育訓練課程」的人在身心狀況方面的影響程度，比未參加過的人為低，而男性急診護理人員在發生職場暴力，對工作狀況/照護品質方面之影響比女性的影響程度高。護理工作年資及急診工作年資愈長則愈易發生職場言語及身體暴力，且迴歸分析結果顯示，急診工作年資每增加1年，發生職場暴力的危險性增加1.157倍。
急診職場暴力防範策略會依醫院權屬別、評鑑等級之不同而在措施重要性看法上各有不同。有效的急診職場暴力防範策略包括：預防性醫療處理、保全系統設置與防衛裝備、學習與訓練、行政管理、人力配置、環境設計與控制等策略。建議急診室應依其評量的需求，訂定合適於機構的暴力防範及因應計畫。

關鍵字

急診室 ； 護理人員 ； 職場暴力 ； 侵害 ； 防範策略

並列摘要

The purposes of the study are to explore and analyze the situation, frequency and influence of workplace violence to nursing staff in emergency ward presently, to develop and to construct relevant prevention strategies as a reference for administrative units and organizations’ workplace violence prevention measures and policies making, to hold back the happening of workplace violence in emergency ward efficiently.
The study selects a quantitative research method cross-section design, purposive sampling. The subjects are nursing staff and nursing chief of emergency room (department, division) of general department in the“new hospital accreditation premium and new teaching hospital accreditation excellent”medical center hospitals and the“new hospital accreditation and new teaching hospital accreditation qualification”district level hospitals. The questionnaire survey is carried out from December 1st, 2010 to December 15th, 2010.
The result shows that 63.2% (108 people) of emergency room nurses have suffered from workplace verbal violence, and 19.3% (33 people) of them have suffered from physical violence; the ratio of the two is 3.27:1; the frequency of occurrence is mostly 1~3 times (47.2% and 81.8%). The sources of violence come from the patients, then the relatives of the patients. The violence mostly happens in the trauma examination section. Verbal violence is mostly seen during evening shift (16~24 o’clock); physical violence is mostly seen during night shift (24~8 o’clock). More than half of the nurse staffs want to resign because of the violence incidents. Among which, bruises, scrape, and bites are mostly seen in physical violence. In the part of working experiences, most emergency room nurses often think the work is overloaded, reach 4.04 points (1~5 points) and often feel threatened by violence during work. They think that the security level should be increased.The biggest influence of the workplace violence in the emergency room on the nurses is the physical and mental situation which will make the nurses feel angry, wronged, upset, sad, powerless, afraid, and depress/melancholy; on working situation/ nursing, the nurses will be more careful to avoid workplace violence; and on working opinion/feeling, the nurses will have more pressure and less
enthusiasm on the work. It is obvious that those who have encountered workplace violence are angrier, less objective on nursing, more careful to avoid workplace violence, and feel more pressure then those who haven't encountered workplace violence. The degree of physical and mental influences on “those who have participated in the related educational training programs of workplace violence prevention and disposal” is lower than those who haven’t participated in. The influences of working situation/ nursing quality on male emergency room nurses are higher than female. The longer working experiences in nursing and in emergency room, the likely to happen verbal and physical violence in workplace. The result of regression analysis shows that every yearly increase in emergency room, the dangerous of workplace violence occurrence increase 1.157 times.
The prevention strategy of workplace violence in emergency room will have different points of view in importance according to the authority and evaluation level of the hospital. Effective prevention strategy of workplace violence in emergency room including: preventive medical disposal, set up security system and defense equipment, learning and training, administration, manpower distribution, environmental design and control. It is suggested that the emergency room stipulates violence prevention and disposal plans suitable for the organization according to the evaluation requirements.

並列關鍵字

Emergency department ； nurses ； workplace violence ； aggression ； prevention strategy

參考文獻

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