護理人員的職場霸凌相關因素之探討

霸凌常是被隱晦不報的，若長期處於護理職場霸凌的環境，輕者影響護理人員的工作表現，重者會導致憂鬱情緒，影響其照護品質及危害病患的生命安全。因此，早期發現護理職場霸凌的存在，並加以預防及妥善處置，刻不容緩。本研究計畫的研究目的乃在探討臨床護理人員的職場霸凌及其相關因素，尤其是霸凌與憂鬱兩者間的關係。採橫斷式相關性研究設計，以非隨機取樣法於南部三家醫院招募臨床護理人員，以結構式問卷收集資料，共發放513份問卷，回收有效問卷462份，回收率為90.8%，問卷包括基本屬性如人口學資料及工作相關資料、內外控人格量表、職場霸凌量表 (Negative Acts Questionnaire Revised, NAQ-R) 及台灣人憂鬱問卷 (Taiwan Depression Questionnaire, TQD) 等部分。收集到的資料以SPSS for Windows 18.0 套裝軟體進行統計分析，以描述性統計呈現護理人員人口學特性、工作相關因子、內外控人格分布狀況、及職場霸凌與憂鬱得分狀況；以雙變項分析法職場霸凌與憂鬱的相關因子；以複迴歸探討霸凌的重要決定因子。研究結果發現，研究對象以女性佔98.5%，平均年齡為31.23歲，從事護理工作平均年資為8.92年，60.2%服務於內外科單位，30.5%服務特殊單位。約有87.7% (n=405) 的護理人員在過去6個月內遭受過職場霸凌，頻率由偶爾到頻繁，其中以工作相關霸凌的頻率高於人身攻擊及身體恐嚇形式的霸凌。有29%的護理人員有明顯憂鬱情緒，影響職場霸凌之相關因子為有無配偶、服務單位科別、內外控人格特質、自覺工作負荷程度、及憂鬱。複迴歸分析顯示職場霸凌重要決定因子有五個，共解釋24.9%的變異量，依其解釋力由高至低分別為憂鬱(17.5%)、內外控人格特質 (3.6%)、配偶 (2.0%)、自覺工作負荷 (1.9%)、內外科病房工作(0.7%)。本研究結果支持護理職場霸凌的普遍存在，並建議醫院管理階層必須正視此問題，除必須提昇護理人員對職場霸凌的認知外，更應成立霸凌的預防及處理機制。憂鬱、內外控人格特質、配偶等變項對霸凌的發生有顯著相關，顯示協助護理人員進行情緒調適與尋求支持系統的重要性。此外，適當調整護理人員的工作負擔，營造具關懷氛圍的職場環境，更是行政主管未來必須積極面對的重要任務。

關鍵字

職場霸凌；護理人員；憂鬱

並列摘要

Workplace bullying is a serious problem and often goes unreported. Long-term workplace bullying at medical settings will affect nurses’ work performances in minor situations and, in serious cases, it can cause depressed mood and deteriorate care quality and jeopardize life and safety of patients. As a result, early detection and prevention of workplace bullying at medical settings is important and urgently needed. This study aimed to investigate the situation of workplace bullying of nurses at clinical settings and the relevant factors, with a special focus on the relationship between bullying and depression. This study employed cross-sectional study design, using nonrandomized sampling from three hospitals in Southern Taiwan to recruit clinical nurses as study subjects. Data collection was done by structural questionnaires, with 462 valid questionnaires returned from a total of 513 questionnaires, the return rate being 90.8%. The questionnaires included basic attributes, such as demographic data and work-related information, Internal-External Scale (I-E Scale), Negative Acts Questionnaire Revised (NAQ-R), and Taiwan Depression Questionnaire (TDQ). Data collected was analyzed by SPSS for Windows 18.0 software package for statistical analysis. Descriptive statistics showed demographic characteristics, work-related factors, distribution of I-E Scale, and workplace bullying and depression score status; bivariate analysis was done on workplace bullying and depression related factors; and multiple regression analysis was used to investigate determinant factors of bullying. The result showed that 98.5% of the study subjects were female, with an average age of 31.23 years and average 8.92 years working as a nurse. 60.2% worked in medical or surgical wards and 30.5% worked in special service units. About 87.7% (n=405) nurses had experienced workplace bullying in the past 6 months, with the frequency being from occasionally to frequently. To the form of bullying, work-related bullying happened more frequently than personal attacks and physical intimidation. 29% of the nurses exhibited obvious depressive moods. Factors affecting workplace bullying included whether having a spouse, service unit division, I-E Scale, perceived workload level, and depression. Multiple regression analysis indicated that five important determinant factors explained 24.9% of the variances, and according to the explanatory power, they were depression-mood (17.5%), I-E Scale (3.6%), spouses (2.0%) ,perceived workload level(1.9%), as well as medical and surgical wards (0.7%). The finding of the study suggested that nursing workplace bullying is prevalent and recommended the issue to be addressed by hospitals’ management level. In addition to the need to improve nurses’ awareness of workplace bullying, effective mechanisms toward workplace bullying prevention and management should be implemented. Variables including depression, I-E Scale, and spouse were significantly correlated with workplace bullying, indicating the importance of assisting nurses with mood management and providing support systems. Moreover, administrative executives should actively take charge of appropriate adjustments to the workload of nurses and creating a caring working environment in the future.