急診護理人員職場暴力預防和管理暴力介入措施之成效

Effects of Workplace Violence Prevention and Management Training Program for Emergency Nurses

張揚琴(Yang-Chin Chang)

指導教授 ： 許玫琪

義守大學/醫學院/護理學系/碩士(2021年)

摘要

近年來急診暴力事件時有所聞，嚴重威脅醫護人員的人身安全，這些醫療職場暴力未獲得適當處置，不僅有害於護理人員身心靈健康，團隊工作士氣及運作會受到影響，無法提供優良的病人照護品質，護理人員流失會增高，恐嚴重影響到醫療機構與護理專業。暴力行為是指工作職場上不公平對待，為衝突最主要來源，近年國內主管機關亦相當重視這個議題，因此將暴力事件防範和通報列入必要條文醫院評鑑項目之一，也成為許多醫療機構職場安全的議題。
本研究為實驗性設計，探討職場暴力預防和管理暴力介入措施，對急診護理人員對目標承諾、應對職業自我效能感、急診暴力態度、暴力攻擊行為的自信程度、對攻擊性行為的態度之成效。資料以SPSS軟體進行處理，統計方法之應用以描述性統計中類別變項以次數、百分比表示，針對實驗組與對照組檢定兩組基本人口學變項之差異，使用卡方檢定(chi-squared test)或費雪精確性檢定(Fisher's exact test)，連續變項以平均數、標準差描述。推論性統計類別變項以t檢定、ANOVA進行分析，連續變項以採用t檢定(t-test)，接著以重複測量變異數分析(Repeated measure ANOVA)進行統計分析。
將於南部某醫院急診進行收案，招募75位之急診護理人員為研究對象。護理人員將分別被叢集抽樣分派到實驗組與對照組，實驗組護理人員接受進行為期12小時的急診護理人員職場暴力預防和管理暴力介入措施(Workplace Violence Prevention and Management Training Program, WPVMP)和一般院內常規在職教育，控制組則維持接受一般院內常規在職教育。於課程進行前先第一次資料收集(前測)，課程結束後立即評估該訓練課程對急診護理人員職場暴力預防之成效。對照組將無任何介入措施，僅與實驗組介入課程前後相同時間點收集其前後測之資料。
本研究結果顯示，實驗組與對照組在執行介入措施後，對於目標的承諾度、應對職業自我效能、暴力攻擊行為的自信程度、對攻擊性行為的態度有明顯差異，然而針對急診暴力態度，分析結果顯示組內與組間的交互作用總分未達到顯著差異，顯示沒有交互作用的存在，介入措施採課室講授，多元化教學方式，內容多著重在以認知、技術、情感層面的教學訓練，人員因害怕臨床上面對暴力發生，雖然研究對象皆知道情境是擬真暴力事件，在接受介入措施訓練後了解各種的策略，但在內心面對暴力的壓力還是存在著，因此未來研究可以朝向給予正向能量的課程引導。
本研究結果應藉由介入措施進而推廣至其他高風險病房，使本研究運用性更加寬廣，能夠真正將實務應用在臨床上，達到預防職場暴力之效果，以提升急診護理師的暴力處置能力於改善急診暴力之成效，期望日後亦能降低急診暴力的發生，維護安全的工作與就醫環境。

關鍵字

目標承諾 ； 自我效能 ； 急診暴力態度 ； 自信程度 ； 對攻擊性行為的態度

並列摘要

In recent years, emergency violent incidents have been heard from time to time, which seriously threaten the personal safety of medical staff. The medical workplace violence are not properly dealt with, which not only harms the physical and mental health of nursing staff, but also affects the morale and operation of team work and cannot provide good patients. The quality of care, the loss of nursing staff will increase, which may seriously affect medical institutions and nursing professions. Violent behavior refers to unfair treatment in the workplace and is the main source of conflict. In recent years, the domestic competent authorities have also attached great importance to this issue. Therefore, the prevention and notification of violent incidents has been included in the necessary provisions of the hospital evaluation items, and it has become many medical institutions. The issue of workplace safety.
This study is an experimental design to explore the effectiveness of workplace violence prevention and management intervention measures for violence, and the effectiveness of emergency nurses' commitment to goals, occupational self-efficacy, emergency violence attitudes, violent aggressive behavior, and attitudes toward aggressive behavior. The data is processed by SPSS software. The application of statistical methods is expressed in descriptive statistics in terms of number and percentage of categorical variables. The difference between the two basic demographic variables in the experimental group and the control group is tested using chi-squared test. test) or Fisher's exact test (Fisher's exact test), continuous variables are described in terms of mean and standard deviation. Inferential statistical category variables were analyzed by t test and ANOVA, and continuous variables were analyzed by t test (t-test), followed by repeated measure analysis of variance (Repeated measure ANOVA) for statistical analysis.
A total of 75 emergency nurses were recruited as research subjects. Nursing staff were randomly assigned to the experimental group and the control group. The nursing staff in the experimental group received 12-hour emergency nursing staff Workplace Violence Prevention and Management Training Program (WPVMP) and general hospital routines On-the-job education, the control group maintained regular on-the-job education in general hospitals. The first data collection (pre-test) is conducted before the course, and the effectiveness of the training course on workplace violence prevention for emergency nurses is evaluated immediately after the course. The control group had no any intervention measures, and only collected data before and after the intervention course at the same time point as the experimental group.
The results of this study show that the experimental group and the control group have significant differences in their commitment to goals, professional self-efficacy, self-confidence in violent aggressive behaviors, and attitudes to aggressive behaviors after implementing intervention measures. Intervention measures are taught in the classroom and are diverse. The content of the teaching method focuses on cognitive, technical, and emotional training.
The results of this study should be extended to other high-risk wards through interventional measures, so that the application of this study can be more broad, and the practice can be truly applied to the clinical situations to achieve the effect of preventing workplace violence, so as to improve the violence treatment ability of emergency nurses. It is hoped that the occurrence of emergency violence will be reduced in the future, and a safe working and medical environment will be maintained.

並列關鍵字

goal commitment ； self-efficacy ； emergency violence attitude ； self-confidence ； attitude towards aggressive behavior

參考文獻

吳玲珠、馬素華、鍾蝶起、黃桂香、謝明珠、陳瓊華（2014）．某區域醫院護理人員專業自主性與工作滿意度及其相關影響因素之初探．護理雜誌，61（5），54-65。doi:10.6224/JN.61.5.54

中文文獻

王桂英、周傳姜、黃瑞蘭（2010）．臨床護理人員工作價值觀、專業承諾與離職傾向及其相關因素之探討．護理雜誌，57（1），22-34。doi:10.6224/JN.57.1.22

李選、白香菊、顏文娟（2010）．台灣護理人員職場暴力經驗及其相關因素研究．護理雜誌，57（2），61-69。doi:10.6224/JN.57.1.22

何清治、張睿欣、洪錦墩（2016）．中部某區域教學醫院職場霸凌之研究．澄清醫護管理雜誌，12（2），39-48。doi:10.30156/CCMJ