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研究生:孫曉芬
研究生(外文):SUN, HSIAO-FEN
論文名稱:探討急診護理人員職場暴力與工作焦慮
論文名稱(外文):Investigation of Workplace Violence and Anxiety among Emergency Nurses
指導教授:江采宜江采宜引用關係
指導教授(外文):CHIANG, TSAY-I
口試委員:陳夏蓮周志中
口試委員(外文):CHEN, SHIAH-LIANCHOU, CHU-CHUNG
口試日期:2018-06-21
學位類別:碩士
校院名稱:弘光科技大學
系所名稱:護理研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2018
畢業學年度:106
語文別:中文
論文頁數:119
中文關鍵詞:職場暴力焦慮
外文關鍵詞:Workplace ViolenceAnxiety
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背景:職場暴力是全球關注之公共健康議題,特別是醫療院所為常遭受暴力攻擊之高危險職場。急診的照護環境,與病患及家屬接觸頻率最高的是護理人員,當患者或家屬有不滿意的情緒,容易直接發洩在護理人員身上,而出現暴力行為或言語,因此,急診護理人員經常暴露在職場暴力行為中。

目的:探討急診護理人員職場暴力與工作焦慮之現況,護理人員職場暴力經驗、工作焦慮之相關性及對急診護理人員工作焦慮之影響。

方法:本研究為橫斷式研究,採方便取樣,以結構式問卷收集方式,受試者為彰化、南投、雲林之醫院等級為地區(含)以上之八家教學醫院,急診護理人員為對象,依據過去一年的職場暴力及工作焦慮經驗,共發放167份問卷,共得有效問卷151份,回收率為90.4%。研究測量工具為自擬「急診職場暴力調查表」及黃(2013)「工作焦慮量表」進行調查。研究結果以SPSS 22.0 for Windows統計套裝軟體進行次數分配、百分比、平均數、標準差、獨立樣本t檢定(Independent t test)、皮爾森(Pearson)積差相關分析、單因子變異數分析(ONEWAY ANOVA)、多元逐步回歸分析等方式進行統計分析。

結果:本研究結果以地區醫院(49%)人員佔最多、其次為醫學中心(44.4%)、最後為區域醫院(6.6%);急診護理人員大多為女性(91.4%)、平均年齡為30.5歲、未婚(66.2%)、大學學歷(68.9%)、平均急診工作年資為7年、N2年資佔最多、大多醫院為非固定的輪班方式上班。急診護理人員有超過八成以上(84.1%)有職場暴力經驗,其中以言語暴力居多(96.1%);最常發生的班別為小夜班(60.6%),施暴者的特性以酒精濫用者(66.1%)為最多,而發生職場暴力的地點最多為檢傷分類處、其次為急診護理站、第三名為病人床側;發生職場暴力因素以病患/家屬因素居多。在急診護理人員發生職場暴力之工作焦慮狀態,平均得分為47.11分(SD=6.01),屬於中度焦慮狀態;而研究發現工作焦慮與急診工作年資具顯著低相關(r=.245,p=.002),也就是工作年資越高其工作焦慮越高;而急診護理人員對各類暴力事件擔心害怕程度與工作焦慮之相關性,以遭受威脅暴力事件之工作焦慮程度最高(r=.372,p=.000);而在施暴者為病人家屬(r=.192,p=.030)、護理同僚(r=.176,p=.048)、醫師者(r=.206,p=.020)其工作焦慮越高,但當施暴者為病人(r=-.026,p=.773)時,其工作焦慮越低;同樣的,發生職場暴力之因素,也是以患者/家屬因素(r=.258,p=.003)導致工作焦慮最高。而在發生職場暴力的地點,以急救區(r=.328,p=.000)、急診檢傷(r=.207,p=.020)、看診區(r=.194,p=.029) ,其中以職場暴力發生於急救區工作焦慮最高。而在影響層面上,可以發現在急診工作年資(β=.202,t=2.142,p=.034)、在急救區發生暴力事件(β=1.156,t=2.526,p=.013)、對威脅暴力事件的擔心害怕程度(β=.758,t=4.203,p=.000)、認為「職場暴力」事件是可以預防(β=1.277,t=2.453,p=.016),是影響工作焦慮之預測因素,其解釋力為26.1%。

結論/實務應用:本研究顯示急診護理人員超過八成有遭受職場暴力經驗,以言語暴力居多,當發生言語衝突時,勿再進行正面衝突,以避免後續衝突加大,而急診護理人員因急診的環境,長期處在中度工作焦慮狀態,雖員工不會受到明顯影響,但都會對員工產生不同程度的身心傷害,研究結果也發現急診醫護人員對威脅暴力事件擔心害怕程度影響最大,此結果也提供護理主管對急診護理人員關懷之參考;除了鼓勵醫院通報,以提高政府的重視外,也應大力積極推廣教育民眾對醫療從業人員之尊重,讓國人對於掛急診的態度,應是按照疾病的嚴重度優先處置,從基礎教育做起,給予急診醫護大力的支持。而對於發生職場暴力事件地點以急救區之工作焦慮最高,亦提醒醫院管理者,在急診急救區應該設置監視器、錄音設備、警民連線系統、門禁管制、張貼反暴力宣傳海報…等,保護醫護同仁及後續蒐證等設備,以提高急診職場的環境安全。另發現施暴者的特性,以酒精濫用佔最多數,是否酒後要掛急診這件事,是個討論空間很大的議題,是否無酒精戒斷問題之醫療需求可以不用掛急診,將有限的急診資源用在最適當病人身上,也避免不必要的衝突發生。本研究結果盼能作為醫院在預防及面臨職場暴力事件時,能減少職場工作焦慮,營造安全之護理工作環境之參考。

關鍵詞:職場暴力、工作焦慮
Background: The workplace violence is the public health issue in the world, especially hospitals where are dangerous and often be suffered the violent attack. The care environment in the emergency, nursing staffs often contact with patients and their family. When patients and their family have unsatisfied emotion, they will release their anger to nursing staffs directly. Also, they will have violent behavior and verbal violence. Therefore, nursing staffs in the emergency often be in the workplace violence.

Objective: Explore the situation of emergency nurses’ workplace violence and working anxiety, and relation of workplace violent experience and working anxiety for the impact of emergency nursing staffs’ working anxiety.

Methods: In this study, a cross-sectional study and convenience sampling were conducted. The subjects were emergency nurse from eight teaching hospitals whose grade were the district hospital above in Changhua, Nantou, and Yunlin. According to workplace violence and working anxiety of the subjects in the past one year, we disturbed 167 questionnaires. However, the total of 151 questionnaires were effective. The response rate was 94%. The research measurement tool was to use effective emergency workplace violence questionnaires which were made by the researcher, and Hang’s working anxiety scale (2013). The results of study were analyzed by frequency distribution, percentage, mean, standard deviation, independent sample t test, Pearson product-moment correlation coefficient, ONEWAY ANOVA in SPSS 22.0.

Results: In this results of study, the most subjects were from district hospitals (49%). Secondly, some subjects were from medical center (44.4%). Finally, others were from regional hospitals (6.6%). The emergency nursing staffs were female (91.4%), the average age for 30.5, unmarried (66.2%), university grades (68.9%). Her average emergency working seniority was about 7 years. Also, the level of N2 seniority was the most. Most of emergency nurses were not regular shift working. Emergency nurses had the workplace violence experience of 84.1%. The verbal attack is the majority (96.1%). It most occurred in the night shift (60.6%). The most perpetrators were drunks (66.1%). The workplace violence always occurred in the emergency examination. Secondly, it happened at the emergency stations. Thirdly, workplace violence occurred at the patients’ the bad side. The most elements of workplace violence were from patients and their family.
The emergency nurses for working anxiety of workplace violence was 47.11 grade on the average that was moderate anxiety. Also, the research showed that working anxiety and working seniority in emergency were related (r=.245, p=.002 ). If the working seniority was higher, the working anxiety was also higher. Besides, the between fear and working anxiety of various violent incidents, the degree of working anxiety was the highest while suffering the violent incidents(r=.372, p=.000). When the perpetrators were patients’ family(r=.192, p=.030) ,nursing staffs (r=.176, p=.048 ), physician (r=.206, p=.020), the working anxiety was higher. However, while perpetrators were patients (r=-.026, p=.773), the working anxiety was lower. Similarly, the major element of occurring the workplace violence was from patients’ family who raised the working anxiety. Also,
The emergency area (r=.328, p=.000) , emergency examinations (r=.207, p=.020) , and consultation areas (r=.194, p=.029) were major place which often occurred violent incident. The working anxiety was higher when the workplace violence occurred in the emergency area. In the effect side, researcher showed that emergency working seniority (β=.202, t=2.142, p=.034), occurring violent incident in emergency area(β=1.156, t=2.526, p=.013), the grade of fear for violent incident(β=.758, t=4.203, p=.000), prevented violent incident(β=1.277, t=2.453, p=.016). Those affected the predictable elements of working anxiety (26.1%).

Conclusion: This study showed that more than 80% of emergency nurses had experienced violence in the workplace, and most of them were verbal violence. When there was a verbal conflict, they must not engage in frontal conflict in order to avoid increased follow-up conflicts. Since the emergency nursing staffs were in emergency working environment, they would be in the long-term anxiety. Although employees would not be significantly affected, it would have different levels of physical and mental harm to employees. The results of this study also found that emergency medical staffs for fear of violent incident of the effect was the greatest. The result could be provided the reference of emergency nursing care for nursing supervisors. In addition to encourage hospitals to inform and to improve the government's attention, the hospitals should vigorously promote to educate the public to respect for medical practitioners, and let the attitude of people to the emergency room that should be in accordance with the disease of the severity of the priority. We should start from basic education and giving vigorous support to emergency medical care. As for the place of occurring working violence, the working anxiety in emergency area was the highest. That also reminded hospital administrators that should be set in monitors, recording equipment, police wired systems, access control, putting up anti-violence posters ... and so in the emergency first aid area. That way could protect colleagues and the evidence to improve safety emergency workplace. In addition, we found the perpetrators’ feature, which was the largest number of alcohol abuse. Whether the drunk to the emergency room, it is a great topic. Since we had to use the limited emergency resources in appropriate patients, and avoid unnecessary conflicts occurring. The results of this study hope to serve as a reference for hospitals to reduce workplace anxiety and create a safe working environment when they are preventing and facing workplace violence.

Key Words: Workplace Violence and Anxiety
致謝I
中文摘要III
英文摘要VII
第一章 緒論1
第一節 研究動機與背景2
第二節 研究目的5
第三節 研究問題5
第四節 名詞解釋6
第二章 文獻探討8
第一節 職場暴力8
一、職場暴力的定義8
二、職場暴力的種類與影響10
三、急診室之屬性與職場暴力12
四、職場暴力與急診護理人員之相關研究14
第二節 工作焦慮20
一、工作焦慮的定義20
二、工作焦慮的原因及因應22
三、工作焦慮與護理人員之相關研究23
第三節 急診護理人員職場暴力與工作焦慮的相關研究29
第三章 研究方法33
第一節 研究設計33
第二節 研究架構33
第三節 研究假設34
第四節 研究對象與場所34
第五節 研究工具與信效度35
第六節 研究流程41
第七節 研究倫理考量 42
第八節 資料處理及分析方法43
第四章 研究結果47
第一節 急診護理人員相關之基本屬性、發生職場暴力經驗、頻率以及工作焦慮之現況分布47
一、急診護理人員相關之基本屬性分布現況47
二、急診護理人員發生職場暴力經驗51
三、急診護理人員面對職場暴力之工作焦慮現況60
第二節 急診護理人員發生職場暴力經驗與工作焦慮之關係64
第三節 急診護理人員發生職場暴力經驗與工作焦慮之影響69
一、急診護理人員相關之基本屬性與工作焦慮之差異69
二、急診護理人員職場暴力對工作焦慮之影響74
第五章 討論76
第一節 探討急診護理人員相關基本屬性、發生職場暴力經驗、頻率以及工作焦慮之現況分布76
一、探討急診護理人員相關基本屬性、發生職場暴力經驗、頻率現況76
二、探討急診護理人員面對職場暴力之工作焦慮現況80
第二節 分析急診護理人員發生職場暴力經驗與工作焦慮之關係影響81
第六章 結論與建議84
第一節 研究及結論84
一、急診護理人員相關之基本屬性、發生職場暴力經驗、頻率以及工作焦慮之現況分布84
二、急診護理人員發生職場暴力經驗與工作焦慮之關係 86
三、急診護理人員發生職場暴力經驗與工作焦慮之影響 89
第二節 實務應用與建議90
一、對政府機關的建議90
二、對醫療單位的建議91
第三節 研究限制92
中文參考文獻94
英文參考文獻99
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蔡哲福、蔡哲宏、李怡慶、謝良博、黃子齡(2013)‧急診檢傷分類等候制度與病人知覺等候時間之相關性研究-以某區域教學醫院為例‧澄清醫護管理雜誌,9(4),20-28。
謝亞芸(2011)‧探討門、急診照護人員在H1N1流行期間之焦慮程度、防疫相關措施及其影響因素‧臺北醫學大學‧Available from Airiti AiritiLibrary database.
謝惠貞、楊美雪、曾于庭、鄭麗芳(2012)‧焦慮、個人創越、自我效能於病歷檔案管理人員之關聯研究‧病歷資訊管理, 11(1),65-80。
顏秀珍、楊美賞(2004)‧社區精神病患之主要照顧者被病患身體攻擊後的反應‧臺灣醫學,8(6),786-793。
魏芳君(2014)‧淺談職場暴力‧全聯護訊,(99),10-12。
戴鳴智(2009)‧急診室護理人員的工作壓力與工作倦怠對工作投入與離職傾向影響之研究‧銘傳大學管理研究所在職專班,未出版之碩士論文。

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