以系統性文獻回顧探討護理人員職場暴力現況與影響

A systematic review of workplace violence in nursing

為瞭解醫療機構中護理人員遭受職場暴力狀況，本文運用系統性文獻回顧，經納入與排除條件篩選後，共納入37篇符合條件之文章。分別就不同調查期間、不同臨床環境與不同地區進行探討職場暴力盛行率，測量時間以一年時期的盛行率，肢體暴力有6-74%，非肢體暴力-言語暴力15.2-97.6%，職場霸凌11.6-47.6%，性騷擾33.7-34.9%；言語暴力高於肢體暴力，肢體暴力較常發生於急診室及精神科，言語暴力與職場霸凌則普遍發生於各單位，常見施暴者依序為病人、家屬或訪客、工作人員，高風險因素可歸類為工作人員、工作環境與攻擊者，不僅對受暴者身心有負面影響，亦對機構與護理專業造成危害，結論為遭受暴力後之因應方式分為生理、心理掌控及提升自尊等。高達40-80%人員遭受暴力後未向管理者通報，主要是認為不需協助、自己能處理及認為通報是無用的。因此建議提供顧客有表達意見的管道，建構良好護理工作環境，安全有效的硬體設備，支持職場暴力零容忍政策，建立暴力事件處理通報流程，並依不同職場暴力類型、不同臨床情境，發展創新與系統性職場暴力防治課程及因應策略，藉由有效的在職教育，提升護理人員對職場暴力預防與處置技能，以期有效改善工作環境，留任第一線臨床護理人員。

This systematic review evaluated the workplace violence in nursing. Thirty-seven studies that met the criteria were included, reviewed, and analyzed. The one-year prevalence rates of physical violence ranged from 6-74%, sexual harassment 33.7-34.9%, while nurses experienced non-physical violence including 15.2-97.6% verbal violence and 11.6-47.6% bullying behavior. Verbal violence is more common than physical violence. The later is commonly happened in emergency room or psychiatry department. The common perpetrators of these types of violence included the patients, family members, visitors and hospital staff. The nurses were apt to affected by these type of violence not only physically and psychologically, but also damaging the nursing profession and the whole hospital organization. Workplace violence victims have several coping strategies including physical mental support and promote self dignity. Unreported violence in nursing ranged from 40-80%, because violence victims believed that they were capable to handle and solve the problems or didn’t trust the reported system. Based on these, the most priority are provide the mutual feedback and communication pathway, and In conclusion, various types of violence in nursing are prevalent. It is a great challenge to establish a safe and healthy nursing environment with zero tolerance of workplace violence. Nursing education deserves courses and strategies to enable nursing professionals in handling the workplace violence with confidence and to promote their professional contribution.