台灣北部護理人員職場暴力探討──橫斷性調查

Workplace Violence Against Nurses in Northern Taiwan: A Cross-Sectional Study

背景：護理人員為醫療團隊中遭受職場暴力最高的群體，職場暴力會產生負向情緒，對身體、心理造成不良影響，而波及照護品質。目的：探討護理人員遭受職場身體及精神暴力的盛行率、暴力來源、遭受暴力後之行動及服務機構防範暴力的措施。方法：以橫斷式研究設計，分層抽樣調查台北市各層級醫療院所之護理人員，共計2,931位個案，有效問卷2,627份。結果：研究對象有70.6％遭受到暴力，其中31.0％為身體暴力，66.0％是精神暴力。多重迴歸分析顯示已婚及工作年資一年以下之護理人員遭受身體暴力及精神暴力的風險較低，年齡大於50歲遭受精神暴力風險較低，大學暨以上教育程度遭受精神暴力風險增加。施暴者以「病人」最多；暴力事件發生後受暴者採取之行動以「告訴施暴者停止施暴」、「告訴朋友或家人」及「報告上級主管」最多；施暴者處置以口頭警告最多，其次是沒有受到任何處置。通報異常事件的比率只有2.3－6.8％，沒有通報或未告訴他人主因為「沒有用」、「不重要」及「害怕負面後果」。本研究對象認為可以減少工作場所暴力事件的措施主要有：實施安全措施、改善工作環境及辦理職場暴力教育訓練。結論：暴力防範須從環境設施、管理、教育、政策面整體改善，以達有效預防暴力事件的產生，提升醫療院所的職場安全。 Background: Nurses comprise a group in the healthcare team that is exposed to the highest levels of workplace violence. This not only causes negative emotions in nurses and adversely impacts the institution and the body and spirit of the nurses but also affects the quality of nursing care. Purpose: The aim of this study was to determine the prevalence of physical and psychological workplace violence experienced by the nursing staff and to identify the perpetrators of violence, the reactions of the victims, and the policies developed by employers to prevent violence. Method: This cross-sectional study was conducted using a stratified sampling method across different levels of healthcare institutions on the nursing personnel registered with the Taipei Nurses Association. The number of subjects was allocated according to hospital level. A total of 2,931 subjects were recruited, of whom 2,627 participated in this study. Results: Over two-thirds (70.6%) of participants had experienced workplace violence, of whom 31.0% had experienced physical violence and 66.0% had experienced psychological violence. A multiple logistic regression analysis showed that nurses who were married, who had less than one year of work experience, or were over 50 years of age were at lower risk of physical and psychological violence. Those who had a university education or higher faced a higher risk of psychological violence. The most common perpetrators were identified as patients. The aftermath reactions from the victims were varied, with the most prevalent being “telling the perpetrator to stop the violence＂, “telling friends or family,＂ and “reporting the incident to a senior staff member＂. The perpetrators were mostly dealt with using a verbal warning, while the second-most common strategy was taking no action. Only 2.3%-6.8% of the victims notified the authorities about the violence because of the following primary reasons: “useless,＂ “not important,＂ and “fear of negative consequences.＂ The major strategies that were adopted by employers to prevent violence included “security measures,＂ “improvement of surroundings,＂ and “training.＂ Conclusion: Prevention of violence must be improved comprehensively using the strategies of physical facilities, management, education, and policies.