以航空業觀點探討急診暴力辨識及處理

醫療行為不單單只是提供專業的身體上的生理治療，同時也包含了醫治心理的行為，在提供醫療行為的同時，也能照顧到病人的心理，消除因生病產生的焦慮，及對病情未知的莫名壓力。在服務業的客訴行為中，最多的案例是個人的需求沒被重視或注意。急診暴力也可以視為較極端的客訴行為之一。醫院急診室暴力有逐年攀升的趨勢，急診暴力除了對於醫療人員身體及心理的傷害之外，同時對周遭其他病患也造成了恐懼的傷害，處在醫療場所裡的相關人員都承載著不可負荷的壓力，對醫護人員所產生的心靈傷害嚴重程度更是無法衡量。本研究以個人在航空專業觀察視角，來辨識醫院急診室容易有暴力傾向行為人，及探討發生急診暴力的原因，讓醫療環境裡的護理人員(包含新進護理人員) 融合航空業溝通服務品質，來提升急診室服務品質並營造更安心溫馨的看診氛圍，來舒緩病人因為不舒服的病識感產生的焦慮造成急診暴力的可能性，藉此防範暴力的發生。本研究採用深度訪談，共訪談11位護理人員，輔以航空業27年的專業視角，以探究下列三項目的:1.以個人在航空專業的觀察辨別的經驗模式，找出在急診室裡容易有暴力傾向的行為模式，藉此來防範暴力行為的產生。2.探討可能發生急診暴力的原因。3.結合航空業的溝通服務品質融合在醫療體系中，在有限的時間，空間裡如何讓病人能減緩焦慮更安心的等待治療。本研究重要結果包括兩部分：(一)對醫療場域的專業護理同仁訪談結果，(二)基於本身工作經驗彙整急診室就診流程體驗歷程與飛安流程呼應。訪談結果發現暴力主要有病人不了三時是工作人員應對仍有進步的空間。其中，本研究發現特別需要深入探討的議題是，護理人員針對可以辨識出的暴力行為人不會特別採取行為去應對，護理人員傾向於採忽略或是靜觀其變暫不處理。建議未來可結合航空業的溝通服務品質融合在醫療體系中，在有限的時間，空間裡如何讓病人能減緩焦慮更安心的等待治療，包括理解病人家屬焦慮與需求、使用對方理解的語彙說明、確認對方是否理解、關心與尊重、黃金十秒的時間管理、.外在環境影響等。未來更可利用AI功能協助人臉辨識來輔助辨別潛在施暴者。期待透過本研究，從護理端來探討可能之辨識與因應方法，應用航空業的相關經驗，提出初步建議，期能對減少急診暴力貢獻一份心力。

關鍵字

急診暴力；醫護人員；航空業服務；溝通

並列摘要

There has been a growth in violence in emergency departments (EDs) in recent years. Medical care staffs are more likely than other staff members to be involved in violent occurrences with patients or their relatives. This research study aimed to understand nurses’ perceptions of communicate ability to avoid causing violence in the ED. Using a qualitative service design research approach and experience from avation industry, eleven nurses working in ED of region hospital were interviewed. Service design builds upon contributions from multiple areas, including management, information technology, and interaction design. Yet more integration to leverage the service design to ED is needed. Using a design science research approach, we synthesizes management perspective models, we try to propose primary strategies which focus on creating new method to educate for improving identification and responses. This work presents applications of the method in two different service industries, i.e., air transportation and health care, to demonstrate the differences and simularities and attempt to advance interdisciplinary service research. Analysis of the interview data in our work revealed that environmental and communication factors contributed to violence in the ED. Participants perceived longer waiting times then they expected and lack of communication as contributing factors to aggression, and triage was the area in the ED where aggression was most likely to occur. A number of key recommendations arise from the study findings and which are mostly to mindset shifting and communication. Information guides and videotapes on the patient’s journey through the ED may be of benefit. Consideration to the appointment of a communication officer in the ED and communication training for ED staff is also recommended.