長照機構失智患者身體攻擊行為之分析

Analysis for the Physical Aggressive Behavior of Persons with Dementia in Long-term Care Facilities

失智症患者的身體攻擊行為是照顧者的主要壓力源，照顧者能有效管理暴力情境將有助於提升照顧品質。本研究旨在探討失智症患者出現身體攻擊行為的常見情境與類型，以及照顧者面對失智老人身體攻擊行為的態度。以立意取樣招募臺灣地區11所失智症照顧機構共195人，透過結構性問卷收集資料。研究結果發現：過去一年82.1％照顧者有被失智症長者身體攻擊的經驗，發生頻率以每個月至少1次佔最多。在常見的17個引發攻擊情境中，以洗澡、穿脫衣服、制止患者拿取他人物品最常發生，其身體攻擊類型常見為抓、打與揮拳，照顧者最常受傷部位以上肢為主、胸腹部和頭臉部次之。照顧者覺得在處理洗澡、穿脫衣服與毫無預警的情境最困擾。自覺知識充足度和被攻擊頻率可以有效預測照顧服務員在處理攻擊情境的困擾程度。本研究結果能提供發展安全照護教育訓練之參考，期有助專業照顧者提升處理失智症長者攻擊行為之處理能力。

Physical aggressive behavior of persons with dementia is the main causes of stress of healthcare providers. If healthcare providers can effectively and efficiently manage violent situations, it will tremendously improve the care quality. The main purpose of this study is to discuss the common situations and types of physical aggressive behavior of dementia, and the response of healthcare providers in engaging of physical aggressive behavior of the persons with dementia. In this study, a purposeful sampling was used to enroll a total of 195 participants among 11 dementia care facilities in Taiwan. A structured questionnaire was used for the data collection. We found that 82.1% healthcare providers have the experiences of being attacked physically by the persons with dementia, and most of the occurring frequency is at least once monthly. Among 17 commonly occurred events in triggering physical aggressive behavior, we found that events including shower/bath, dressing/undressing, and the actions to prevent residents from grabbing other people's belongings are the common causes. These commonly physical aggressiveness encompassed grabbing, hitting, punching, and the most common injuries for healthcare providers were mainly located at upper limb, followed by chest/abdomen and head/face. Healthcare providers found it distressful to handle the events such as shower/bath, dressing/undressing, and the situations without early warming. The level of conscious knowledge and the frequency of physical aggressiveness can effectively predict the degree of distress for the healthcare providers in handling physical aggressiveness. This research provides an important basis in developing a violence prevention program, by which to improve healthcare providers' ability in handling the physical aggressiveness of persons with dementia in clinical aggressive behaviors.