以系統性文獻回顧探討護理人員職場暴力現況與影響

A systematic review of workplace violence in nursing10.6288/TJPH201635104045

10.6288/TJPH201635104045

明金蓮(Jin-Lain Ming)；黃惠美(Hui-Mei Huang)；洪曉佩(Shiao-Pei Hong)；曾麗華(Li-Hua Tseng)；黃美淑(Mei-Shu Huang)；江淑華(Su-Hua Chiang)；董貞吟(Chen-Yin Tung)

系統性文獻回顧 ； 職場暴力 ； 護理職場 ； 護理人員 ； systematic review ； workplace violence ； nursing workplace ； nurses

台灣公共衛生雜誌

35卷2期（2016 / 04 / 01）

116 - 135

繁體中文

為瞭解醫療機構中護理人員遭受職場暴力狀況，本文運用系統性文獻回顧，經納入與排除條件篩選後，共納入37篇符合條件之文章。分別就不同調查期間、不同臨床環境與不同地區進行探討職場暴力盛行率，測量時間以一年時期的盛行率，肢體暴力有6-74%，非肢體暴力-言語暴力15.2-97.6%，職場霸凌11.6-47.6%，性騷擾33.7-34.9%；言語暴力高於肢體暴力，肢體暴力較常發生於急診室及精神科，言語暴力與職場霸凌則普遍發生於各單位，常見施暴者依序為病人、家屬或訪客、工作人員，高風險因素可歸類為工作人員、工作環境與攻擊者，不僅對受暴者身心有負面影響，亦對機構與護理專業造成危害，結論為遭受暴力後之因應方式分為生理、心理掌控及提升自尊等。高達40-80%人員遭受暴力後未向管理者通報，主要是認為不需協助、自己能處理及認為通報是無用的。因此建議提供顧客有表達意見的管道，建構良好護理工作環境，安全有效的硬體設備，支持職場暴力零容忍政策，建立暴力事件處理通報流程，並依不同職場暴力類型、不同臨床情境，發展創新與系統性職場暴力防治課程及因應策略，藉由有效的在職教育，提升護理人員對職場暴力預防與處置技能，以期有效改善工作環境，留任第一線臨床護理人員。

This systematic review evaluated the workplace violence in nursing. Thirty-seven studies that met the criteria were included, reviewed, and analyzed. The one-year prevalence rates of physical violence ranged from 6-74%, sexual harassment 33.7-34.9%, while nurses experienced nonphysical violence including 15.2-97.6% verbal violence and 11.6-47.6% bullying behavior. Verbal violence is more common than physical violence. The later is commonly happened in emergency room or psychiatry department. The common perpetrators of these types of violence included the patients, family members, visitors and hospital staff. The nurses were apt to affected by these type of violence not only physically and psychologically, but also damaging the nursing profession and the whole hospital organization. Workplace violence victims have several coping strategies including physical mental support and promote self dignity. Unreported violence in nursing ranged from 40-80%, because violence victims believed that they were capable to handle and solve the problems or didn’t trust the reported system. Based on these, the most priority are provide the mutual feedback and communication pathway, and In conclusion, various types of violence in nursing are prevalent. It is a great challenge to establish a safe and healthy nursing environment with zero tolerance of workplace violence. Nursing education deserves courses and strategies to enable nursing professionals in handling the workplace violence with confidence and to promote their professional contribution.

1. 王佳雯、鄭雅文、李論昇、徐儆暉(2010)。職場社會心理危害調查監測制度之國際概況。台灣衛誌，29，551-60。
   連結：
2. 勞動部勞動及職業安全衛生研究所： 職場暴力預防指引。http://www.ilosh.gov.tw/wSite/public/Attachment/f1395045130633.pdf。引用2014/10/01。Institute of Labor, Occupational Safety and Health, Ministry of Labor, R.O.C. (Taiwan). Guidelines for preventing workplace violence. Available at: http://www.ilosh.gov.tw/wSite/public/Attachment/f1395045130633.pdf. Accessed October 1, 2014. [In Chinese]
3. Abualrub, RF,Al-Asmar, AH(2011).Physical violence in the workplace among Jordanian hospital nurses.J Transcult Nurs,22,157-65.
4. Ahmed, AS(2012).Verbal and physical abuse against Jordanian nurses in the work environment.East Mediterr Health J,18,318-24.
5. Albashtawy, M(2013).Workplace violence against nurses in emergency departments in Jordan.Int Nurs Rev,60,550-5.
6. Anderson, L,FitzGerald, M,Luck, L.(2010).An integrative literature review of interventions to reduce violence against emergency department nurses.J Clin Nurs,19,2520-30.
7. Angland, S,Dowling, M,Casey, D(2014).Nurses' perceptions of the factors which cause violence and aggression in the emergency department: a qualitative study.Int Emerg Nurs,22,134-9.
8. Araujo, S,Sofield, L(2011).Workplace violence in nursing today.Nurs Clin North Am,46,457-64.
9. Autrey, PS,Howard, JL,Wech, BA(2013).Sources, reactions, and tactics used by RNs to address aggression in an acute care hospital: a qualitative analysis.J Nursing Adm,43,155-9.
10. Berry, PA,Gillespie, GL,Gates, D,Schafer, J.(2012).Novice nurse productivity following workplace bullying.J Nurs Scholarsh,44,80-7.
11. Brunetti, L,Bambi, S(2013).Aggressions towards nurses in emergency departments: an international literature review.Prof Inferm,66,109-16.
12. Cashmore, AW,Indig, D,Hampton, SE,Hegney, DG,Jalaludin, BB(2012).Workplace violence in a large correctional health service in New South Wales, Australia: a retrospective review of incident management records.BMC Health Serv Res,12,245.
13. Cevik, Akyil, R,Tan, M,Saritas, S,Altuntas, S(2012).Levels of mobbing perception among nurses in Eastern Turkey.Int Nurs Rev,59,402-8.
14. Chapman, R,Styles, I,Perry, L,Combs, S.(2010).Nurses' experience of adjusting to workplace violence: a theory of adaptation.Int J Ment Health Nurs,19,186-94.
15. di Martino, V.(2003).Relationship between Work Stress and Workplace Violence in the Health Sector.Geneva, Switzerland:ILO/ICN/WHO/PSI Joint Programme on Workplace Violence in the Health Sector.
16. Dillon, BL.(2012).Workplace violence: impact, causes, and prevention.Work,42,15-20.
17. Distasio, CA.(2002).Protecting yourself from violence in the workplace.Nursing,32,58-63.
18. Edward, KL,Ousey, K,Warelow, P,Lui, S(2014).Nursing and aggression in the workplace: a systematic review.Br J Nurs,23,653-4+6-9.
19. Efe, SY,Ayaz, S.(2010).Mobbing against nurses in the workplace in Turkey.Int Nurs Rev,57,328-34.
20. Farrell, GA,Shafiei, T(2012).Workplace aggression, including bullying in nursing and midwifery: a descriptive survey (the SWAB study).Int J Nurs Stud,49,1423-31.
21. Fornés, J,Cardoso, M,Castelló, JM,Gili, M.(2011).Psychological harassment in the nursing workplace: an observational study.Arch Psychiatr Nurs,25,185-94.
22. Gallant-Roman, MA(2008).Strategies and tools to reduce workplace violence.AAOHN J,56,449-54.
23. Gates, DM,Gillespie, GL,Succop, P(2011).Violence against nurses and its impact on stress and productivity.Nurs Econ,29,59-66.
24. Gillespie, GL,Gates, DM,Berry, P.(2013).Stressful incidents of physical violence against emergency nurses.Online J Issues Nurs,18,2.
25. Gillespie, GL,Gates, DM,Miller, M,Howard, PK(2010).Workplace violence in healthcare settings: risk factors and protective strategies.Rehabil Nurs,35,177-84.
26. Jackson, D,Wilkes, L,Luck, L.(2014).Cues that predict violence in the hospital setting: findings from an observational study.Collegian,21,65-70.
27. Khademloo, M,Moonesi, FS,Gholizade, H(2013).Health care violence and abuse towards nurses in hospitals in north of Iran.Glob J Health Sci,5,211-6.
28. Kvas, A,Seljak, J(2014).Unreported workplace violence in nursing.Int Nurs Rev,61,344-51.
29. Kynoch, K,Wu, CJ,Chang, AM(2011).Interventions for preventing and managing aggressive patients admitted to an acute hospital setting: a systematic review.Worldviews Evid Based Nurs,8,76-86.
30. Laschinger, HK,Grau, AL,Finegan, J,Wilk, P.(2010).New graduate nurses' experiences of bullying and burnout in hospital settings.J Adv Nurs,66,2732-42.
31. Leiper, J.(2005).Nurse against nurse: how to stop horizontal violence.Nursing,35,44-5.
32. Losa Iglesias, ME,Becerro de Bengoa Vallejo, R(2012).Prevalence of bullying at work and its association with self-esteem scores in a Spanish nurse sample.Contemp Nurse,42,2-10.
33. Magnavita, N(2013).The exploding spark: workplace violence in an infectious disease hospital-a longitudinal study.BioMed Res Int,2013,316358.
34. Morphet, J,Griffiths, D,Plummer, V,Innes, K,Fairhall, R,Beattie, J(2014).At the crossroads of violence and aggression in the emergency department: perspectives of Australian emergency nurses.Aust Health Rev,38,194-201.
35. Ogundipe, KO,Etonyeaku, AC,Adigun, I(2013).Violence in the emergency department: a multicentre survey of nurses' perceptions in Nigeria.Emerg Med J,30,758-62.
36. Pich, J,Hazelton, M,Sundin, D,Kable, A(2010).Patientrelated violence against emergency department nurses.Nurs Health Sci,12,268-74.
37. Pich, J,Hazelton, M,Sundin, D,Kable, A.(2011).Patientrelated violence at triage: a qualitative descriptive study.Int Emerg Nurs,19,12-9.
38. Purpora, C,Blegen, MA,Stotts, NA(2012).Horizontal violence among hospital staff nurses related to oppressed self or oppressed group.J Prof Nurs,28,306-14.
39. Roche, M,Diers, D,Duffield, C,Catling-Paull, C(2010).Violence toward nurses, the work environment, and patient outcomes.J Nurs Scholarsh,42,13-22.
40. Rodwell, J,Demir, D(2012).Psychological consequences of bullying for hospital and aged care nurses.Int Nurs Rev,59,539-46.
41. Rodwell, J,Demir, D,Steane, P(2013).Psychological and organizational impact of bullying over and above negative affectivity: a survey of two nursing contexts.Int J Nurs Pract,19,241-8.
42. Sharon, JS.,Daniel, S.(2010).Effectiveness of bullying and violence prevention programs: a systematic review.AAOHN J,58,419-24.
43. Simons, SR,Mawn, B.(2010).Bullying in the workplace-a qualitative study of newly licensed registered nurses.AAOHN J,58,305-11.
44. Spector, PE,Zhou, ZE,Che, XX(2014).Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: a quantitative review.Int J Nurs Stud,51,72-84.
45. Speroni, KG,Fitch, T,Dawson, E,Dugan, L,Atherton, M(2014).Incidence and cost of nurse workplace violence perpetrated by hospital patients or patient visitors.J Emerg Nurs,40,218-28+295.
46. Stone, T,McMillan, M,Hazelton, M,Clayton, EH(2011).Wounding words: swearing and verbal aggression in an inpatient setting.Perspect Psychiatr Care,47,194-203.
47. Truman, A,Goldman, M,Lehna, C,Berger, J,Topp, R.(2013).Verbal abuse of pediatric nurses by patients and families.Ky Nurse,61,6-8.
48. Ünsal Atan, S,Baysan Arabaci, L,Sirin, A(2013).Violence experienced by nurses at six university hospitals in Turkey.J Psychiatr Ment Health Nurs,20,882-9.
49. Wand, TC,Coulson, K.(2006).Zero tolerance: a policy in conflict with current opinion on aggression and violence management in health care.Australas Emerg Nurs J,9,163-70.
50. Williamson, R,Lauricella, K,Browning, A(2014).Patient factors associated with incidents of aggression in a general inpatient setting.J Clin Nurs,23,1144-52.
51. 尹祚芊(2007)。正向護理執業環境的建構與發展。全聯護訊，60，7-9。
52. 李選、白香菊、顏文娟(2010)。台灣護理人員職場暴力經驗及其相關因素研究。護理雜誌，57，61-9。
53. 林小玲、尹祚芊、黃惠美(2012)。某醫學中心護理工作職場暴力評估之研究。榮總護理，29，176-86。
54. 陳柑伴、楊秀芬、陳慧蘭、楊美賞(2010)。醫院護理人員遭受職場暴力後情緒反應及調適處理。護理暨健康照護研究，6，163-71。
55. 蔡曉婷、韓錦樺、陳麗芳、周汎澔(2014)。護理職場霸凌與離職傾向及其相關因素探討─以南部某醫學中心為例。護理雜誌，61，58-68。

1. 翁芝爾(2017)。探討職場暴力對護理人員身心健康的影響-以某區域教學醫院為例。國立臺灣大學健康政策與管理研究所學位論文。2017。1-63。 
2. 蘇慧怡(2017)。不同職域社區衛生護理人員生活品質相關因素探討。長榮大學護理學系(所)學位論文。2017。1-52。