臨床情境模擬教學促進護理人員因應職場暴力之成效研究

Clinical Simulation Teaching Program to Promote the Effectiveness of Nurses in Coping With Workplace Violence

背景：職場暴力是一個嚴重的全球性現象，護理人員乃為醫療職場暴力中最常受攻擊之對象，不僅危害身心健康，影響工作士氣，甚至導致人員流失，對機構與護理專業造成嚴重傷害。目的：本研究以職場暴力情境模擬教學訓練課程做為介入措施，期望能提升護理人員對職場暴力之認知、態度與因應自信。方法：以類實驗設計，隨機分配選取臺北市某醫學中心臨床護理人員400人，實際參與392人，實驗組200人接受臨床情境模擬教學訓練課程，對照組192人未提供介入措施；於課程介入前、後，以問卷進行資料收集，並採SPSS V23版統計軟體以GEE（generalized estimating equations）模式進行統計分析。結果：臨床情境模擬教學課程介入後，護理人員對於職場暴力認知、態度與因應自信，實驗組的前後測得分變化皆高於對照組，達統計上顯著之差異（p＜.001）。進一步分析認知方面：年齡愈大、護理級階為N3者，得分較高；態度方面：護理級階越高，得分越高；因應自信：男性優於女性、急診與精神科護理人員較佳。結論：「臨床情境模擬教學課程」可提升護理人員對於職場暴力之認知、態度與因應自信，期可降低遭受職場暴力之風險與傷害。未來亦建議可以針對不同級階、科別或單位特性，發展相關職場暴力預防之情境教學課程。 Background: Workplace violence is a phenomenon that is prevalent around the world. Nursing personnel are one of the most frequent victims of workplace attacks. Beyond the harm done to physical health, mental health, and workplace morale, workplace violence also leads to the loss of personnel and causes severe injury to institutions and nursing professionals. Purpose: The aim of this study is to improve the awareness, attitudes, and self-confidence of nurses with regard to workplace violence using clinical simulation teaching and training courses. Methods: A total of 400 clinical nurses at a tertiary hospital in Taipei City were enrolled and randomly assigned into either the experimental group, which received the education intervention, or the control group, which received no intervention. A total of 392 enrolled participants completed the study, including 200 in the experimental group and 192 in the control group. Before and after the intervention, a structured questionnaire was used to collect data, which were analyzed using a GEE model with SPSS V.23. Results: After the clinical simulation teaching course, awareness of workplace violence as well as related attitudes and self-confidence were higher in the experimental group than the control group. Moreover, the posttest scores and pretest-posttest differences in scores were significantly higher in the experimental group than in the control group (p < .001). Advanced analysis of the data showed that cognition scores, being older in age, and having a registered nurse grade of N3 were all associated with earning a higher score. In addition, in terms of attitude, registered nurse grade was found to correlate positively with score. Further, male participants earned higher self-confidence scores than their female colleagues and participants who worked in either the emergency or psychiatric departments earned higher scores. Conclusions: The ＂Workplace Violence Clinical Simulation Teaching and Training Course＂ was shown to improve the awareness, attitudes, and self-confidence of clinical nurses with regard to workplace violence and may thus help reduce the risk and harm of violence in this category. In the future, contextual teaching courses on workplace violence prevention should be developed for different nursing levels, divisions, and units based on their specific characteristics and needs.