臺灣臨床工作者面臨醫療暴力及後續產生職場壓力的歷程探究

Taiwanese Clinical Workers' Workplace Stress Associated with Medical Violence

醫院暴力傷害事件成為醫護新興職場壓力主因之一，因此醫療暴力議題逐漸受到 重視。然而傳統觀念下，因過去醫療暴力採取結果論，醫事人員無實質受到傷害，施 暴者就無法被定罪，常導致臨床工作者現身說法的困難與施暴者遊走法律邊緣，而選 擇不控訴病患與家屬乃導致不堪壓力去職；在不符合期待下，現身說法會為其帶來什 麼樣的變化？本文主要目的探討臨床工作者面臨醫療暴力之心理歷程，包括現身說法 過程所遭遇的問題與之後面對壓力的過程。本文採質性研究方法，以立意取樣方式從 四家醫院曾遇過醫療暴力行為之臨床工作者進行訪談，共計17 人，經同意後透過深 度訪談做為引導進行資料收集，全程以匿名方式進行。研究結果歸納：臨床工作者面 臨醫療暴力後，所產生職場壓力的歷程包括四大主題：(1)工作價值與暴力行為的阻 礙性；(2)病患與家屬暴力動機與反應的複雜性；(3)病患與家屬接納與排斥的適當性； (4)工作態度與職場壓力的銜接性。最後，病患或家屬對臨床工作者持有錯誤觀念， 多數是把責任歸屬轉嫁給臨床工作者，使其面對困難與看待差異而出現離職傾向，為 確保醫事人員執行醫療業務的安全，《醫療法》已於2017 年5 月10 日修法通過，要 求醫院應採必要措施。此外，建議醫院除應加強輔導臨床工作者法律權利與溝通技巧 外，應多模擬處理暴力事件發生的應變能力與尋求諮商管道。

For medical workers， the violent injury incident in hospital has become one of the emerging major causes of workplace stress. Therefore， the topic of medical violence gradually gains more attentions. However， under the influence of traditional concepts， consequentialism was adopted in the past medical violence， i.e. as long as the medical workers had not been injured virtually， the perpetrators could not be convicted. Thus， it was difficult for clinical workers to appear in public to protect their rights and perpetrators would be in legal limbo. Clinical workers chose not to accuse the patients and their relatives and they could not bear the great stress to leave office. Beyond the expectation， if the clinical workers chose not to make a complaint against the perpetrators， what changes would they bring to themselves? The main purpose of this research is to discuss clinical workers’ mental process of exposing when they face the medical violence， including problems encountered during the process of exposing and the stress faced after the exposing. This research adopted qualitative research method and purposive sampling method to interview the clinical workers who had ever experienced medical violence behavior from 4 hospitals， with a total of 17 interviewees. Upon their permission， in-depth interview was used as guidance to collect data and the whole process was conducted anonymously. The research results were concluded as follows: the workplace stress process generated after clinical workers have experienced the medical violence includes the 4 themes: 1) the impediment between work value and violent behavior; 2) the violence motivation of patients and their relatives as well as the complexity of response; 3) the appropriateness of patients and their relatives’ acceptance and rejection; 4) the coherence between work attitude and workplace stress. The holistic analysis shows that patients or their relatives hold the wrong conception for clinical workers and most of them blame the responsibility on clinical workers. Thus， it is difficult for clinical workers to expose to make an explanation and view the difference to cause turnover intention. Therefore， an amendment to the Medical Care Act to stiffen the penalties was announced in May 10， 2017 to require medical institution to take necessary steps to ensure safety of medical care personnel. In addition to the reinforcement of clinical workers’ legal rights and communication skills， the hospital is also advised to frequently simulate the strain capacity to deal with violence incident and seek for counseling.