居家醫療與長期照護工作者之職場暴力現況與因應策略

Current Status of Workplace Violence and Coping Strategies among Home Healthcare and Long-Term Care Workers

本文著重在職場暴力對居家醫療與長期照護從業人員的健康威脅。職場暴力可分為四種類型：第一型為具犯罪意圖之暴力，第二型是「客戶對員工」施加之暴力，第三型是「員工間」發生的暴力，第四型是親密伴侶間的暴力。其中，醫療保健與社會服務業之勞工被認為是職場暴力之高風險族群，其所受到的暴力通常來自患者或患者親屬（第二型職場暴力）。而對於居家醫療與長期照護工作者而言，由於其工作環境與工作性質，於各類型之職場暴力皆有很高的暴露風險。研究顯示，相當比例的居家醫療與長期照護從業人員經歷過第二型職場暴力，其中，居家醫療從業人員的發生率普遍高於長期照護從業人員。然而，由於通報率偏低，學者們認為醫療場域之職場暴力盛行率有被低估的可能性。本文提出對居家醫療與長期照護從業人員有所裨益的職場暴力預防策略，囊括四種面向。首先，健康與安全之教育訓練可以有效促進居家訪視的安全性，包含成立安全及諮詢委員會、提供教育訓練、加強溝通技巧、強化事件通報流程，以及重視事件之後續追蹤等。其次，對於居家訪視進行風險評估有助於改善居家之環境安全，目前已有數種評量工具。其三，防身物品、緊急電話及合宜之應對態度是面對暴力事件時的重要應對技巧。其四，為預防醫療職場暴力，《職業安全衛生法》與《醫療法》也逐年修訂。綜上所述，本文蒐集醫療場域之職場暴力現況，並提供預防及因應策略，以期居家醫療與長期照護從業人員能擁有更友善健康的工作環境。

 

Workplace violence (WPV) is a serious occupational threat for healthcare workers (HCWs). WPV can be divided into the following four types: Type I concerning criminal intent, Type II client-on-worker violence, Type III worker-on-worker violence, and Type IV personal relationship (or intimate partner violence). A high level of exposure to WPV has been identified in the healthcare and social work settings where patients form a common source of WPV (more specifically Type II WPV). Of all healthcare professionals, home healthcare workers (HHCWs) and long-term care workers (LTCWs) are particularly vulnerable to WPV due to the unique characteristics and requirements of their services, and home healthcare workers appear to be at a greater risk of experiencing WPV than their long-term care counterparts. Moreover, most scholars are of the opinion that the prevalence of WPV is very likely to be underestimated due to underreporting. Accordingly, the paper proposed four major WPV coping strategies for the two groups of healthcare workers. First, training courses should be planned and implemented to improve communication skills of workers and safeguard their safety during home and long-term care visits. Relevant committees or advisory boards should be established to streamline incident reporting SOP, provide counseling, develop safety manual, and monitor follow-ups of reported incidents. Second, home environment safety should be assessed using one of the several tools that have already been developed. Third, HHCWs and LTCWs should equip themselves with personal defense and protection gadgets and memorize emergency phone numbers for every visit. Fourth, related laws and regulations, notably Occupational Safety and Health Act and Medical Care Act, should be reviewed and amended on a regular basis to better prevent WPV in the home and long-term care settings. In the paper, we comprehensively report the prevalence of medical workplace violence, prevention and intervention strategies for HHCWs and LTCWs to stay safe while working.