初探醫療機構員工面臨敵意環境經驗之連續光譜與感知落差

A Preliminary Exploration of the Gap Between Legal Classification and Frontline Perception: The Hostile Experience Continuum in Healthcare Settings

本文探討醫療現場中的敵意經驗，是否真能依現行法規分類被第一線工作者清楚辨識與處理。不同於以性騷擾、職場霸凌、醫療暴力或執行職務遭受不法侵害等法規類型作為分析起點，本文關注的是，當這些情境在工作場域中交錯出現時，醫療工作者究竟如何排序其因擾程度與處理優先性。研究資料來自一場醫療場域演講後蒐集之47份匿名問卷，受訪者就13項貼近工作現場的情境題，分別勾選常過到與需要優先處理之項目。研究結果顯示，醫療現場中的敵意經驗可初步整理為三個相互連動的區段，包括直接敵意事件、灰色權勢互動，以及求助保護失靈。其中，直接敵意事件兼具高度可見性與急迫性；灰色權勢互動雖未必劇烈，卻具有日常化與慢性耗損特徵；程序與保障失靈則未必最常出現，卻在優先處理上被認定為相對重要。本文據此主張，醫療工作者對敵意經驗的理解，並非先依據法規名稱加以分類，而是先從風險、關係與制度後果進行判斷。也因此，若要有效防治敵意環境，不能僅依頼事件發生後的法規分流，而須建立更早期、可被信任且能提供保護的回應機制。

This article examines whether hostile experiences in healthcare settings can in fact be clearly recognized and addressed by frontline workers according to existing legal classifications. Rather than taking legal categories such as sexual harassment, workplace bullying, medical violence, or unlawful infringement in the course of work as the analytical point of departure, this study focuses on how healthcare workers prioritize the degree of distress and the urgency of response when these situations intersect in everyday work settings. The study draws on 47 anonymous questionnaires collected after a lecture delivered in a healthcare context. Respondents were asked to identify, from 13 workplace-based situational items, those they encountered most frequently and those they considered most in need of priority intervention.
The findings suggest that hostile experiences in healthcare settings can be provisionally organized into three interconnected zones: direct hostile incidents, gray-zone power interactions, and failures of procedure and protection. Among these, direct hostile incidents are marked by both high visibility and urgency; gray-zone power interactions may not always be dramatic, but they are characterized by routinization and chronic erosion; and failures of procedure and protection may not occur most frequently, yet are regarded as relatively important in terms of priority response. Based on these findings, this article argues that healthcare workers do not first classify hostile experiences according to legal labels. Rather, they assess them in terms of risk, relational dynamics, and institutional consequences. Effective prevention of hostile environments therefore cannot rely solely on post-incident legal differentiation; instead, it requires earlier, trustworthy, and protective response mechanisms.