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

Exploring the Influence of Workplace Violence on Physical and Mental Health among Nurses of a Regional Teaching Hospital

10.6342/NTU201800014

翁芝爾

護理人員 ； 職場暴力 ； 心理健康 ； 自評健康 ； 疲勞 ； 知識 ； 態度 ； nurse ； workplace violence ； mental health ； self-rated health ； burnout ； knowledge ； attitude

國立臺灣大學健康政策與管理研究所學位論文

2017年

碩士

鄭雅文

繁體中文

職場暴力屬於社會心理危害，對工作者身心健康與工作組織造成重大影響，目前已逐漸受到國內職業健康管理領域的重視。本研究旨在探討護理人員職場暴力盛行率，及瞭解遭遇職場暴力對其身心健康與疲勞的影響。採橫斷性研究設計，方便取樣以北部某區域醫院為研究場域，使用結構性問卷進行資料收集，共回收有效樣本(女性)288份，以SPSS22中文套裝統計軟體進行資料分析。 研究結果發現，（1）護理人員自評過去一年曾遭遇職場暴力的盛行率為，言語暴力60.1%、心理暴力29.2%、肢體暴力17.4%、性騷擾6.9%，而曾遭遇上述任一型式職場暴力之盛行率為63.9%；其中，依暴力類型的不同，通報比例在12.9%-23.7%間。（2）護理人員對於職場暴力的知識程度正確性達八成，態度方面為中立偏正向。(3)自評個人疲勞程度高的比例為68.7%；對服務對象疲勞高的比例為40.6%；自評健康不佳的比例為12.2%；心理健康不佳的比例為58.0%。（4）「平均每天實際工作時數≧8.5小時、工作心理負荷程度高」，為護理人員發生自評健康不佳與心理健康不佳之相關因子，而「夜班及輪班」的護理人員，對服務對象疲勞程度高。(5)職場工作特質方面，研究結果發現「工作心理負荷程度中等及職場正義程度低」的護理人員，發生職場暴力風險高於其他護理人員。(6)曾遭遇任一職場暴力的護理人員，其自評健康不佳(OR=2.624)、心理健康不佳(OR=2.029)、個人疲勞高(OR=2.717)之風險均顯著高於未遭遇職場暴力的護理人員。 本研究建議應落實合理護理工時、完善通報系統檢討機制的建置，並建議醫院行政體系定期監測員工遭遇職場暴力的盛行率及健康影響，以建立安全工作環境。

Workplace violence, as a major type of psychosocial work hazards, has been known to impost significant physical and mental health risks on workers. This issue has gained growing attentions in the field of occupational health management in Taiwan. This study was designed to examine the prevalence of workplace violence in nursing staff and to understand its impacts on physical and mental health as well as burnout status. A cross-sectional questionnaire survey was conducted among female nurses of a regional hospital which is located in the Northern Taiwan. Recruited through convenience sampling methods, a total of 288 female nurses participated and completed questionnaires. SPSS 22 software was used for data analysis. The findings of the research are listed as below: (1) The 12-month prevalence of workplace violence among nurses were 60.1% for verbal violence, 29.2% for psychological violence, 17.4% for physical violence and 6.9% for sexual harassment; the prevalence of workplace violence in any of the above types was 63.9%; among them, the percentages of nurses who had ever filed complaints were in the range of 12.9% and 23.7%, depending on the type of violence.(2) As high as 80% of nurses correctly answered the questions which were to assess their knowledge regarding workplace violence, indicating that nurses’ attitude is Neutral to Positive.(3)The prevalences of high personal burnout, high client-related burnout, poor self-rated health, and poor mental health were 68.7%, 40.6%, 12.2%, and 58.0%, respectively. (4)Average daily working hours ≧ 8.5 hours and heavy psychological workloads were found to associated with poor self-rated health and poor mental health, while night and rotating shifts were found to associate with high client-related burnout.(5) In terms of job characteristics, nurses with medium levels of psychological job demands and low levels of workplace justice were found to be at higher risk of workplace violence. (6) Nurses who had experienced any type of workplace violence were found to have increased risks for poor self-rated health (OR=2.624), poor mental health (OR=2.029) and high personal burnout (OR=2.717), as compared to nurses without experiences of workplace violence. The risks of poor performance are significantly higher than those who never suffer from workplace violence. Findings of this study suggested that reasonable working hour arrangement should be ensured and reporting mechanism for workplace violence should be established. To improve occupational health, the research also suggests the hospital administration to monitor workplace violence and its potential impacts on employees’ health.

1. Abualrub, R. F., & Al-Asmar, A. H. (2011). Physical violence in the workplace among Jordanian hospital nurses. Journal of transcultural nursing : official journal of the Transcultural Nursing Society, 22(2), 157. doi:10.1177/1043659610395769
   連結：
2. AbuAlRub, R. F., & Al Khawaldeh, A. T. (2014). Workplace physical violence among hospital nurses and physicians in underserved areas in Jordan. Journal of Clinical Nursing, 23(13-14), 1937-1947. doi:10.1111/jocn.12473
   連結：
3. Aksakal, F. N. B., Karaşahin, E. F., Dikmen, A. U., Avci, E., & Ozkan, S. (2015). Workplace physical violence, verbal violence, and mobbing experienced by nurses at a university hospital. Turkish journal of medical sciences, 45(6), 1360.
   連結：
4. Al-Ali, N. M., Al Faouri, I., & Al-Niarat, T. F. (2016). The impact of training program on nurses' attitudes toward workplace violence in Jordan. Applied Nursing Research, 30, 83-89. doi:10.1016/j.apnr.2015.11.001
   連結：
5. American Organization of Nurse, E., & Emergency Nurses, A. (2015). AONE and ENA Develop Guiding Principles on Mitigating Violence in the Workplace. J Emerg Nurs, 41(4), 278-280. doi:10.1016/j.jen.2015.04.018
   連結：
6. Chappell, S. (2015). The American Organization of Nurse Executives and Emergency Nurses Association Guiding Principles on Mitigating Violence in the Workplace. J Nurs Adm, 45(7-8), 358-360. doi:10.1097/nna.0000000000000214
   連結：
7. Cheng, Y., & Chen, C.-J. (2014). Modifying effects of gender, age and enterprise size on the associations between workplace justice and health. International archives of occupational and environmental health, 87(1), 29-39.
   連結：
8. Cheng, Y., Chen, I.-S., Chen, C.-J., Burr, H., & Hasselhorn, H. M. (2013). The influence of age on the distribution of self-rated health, burnout and their associations with psychosocial work conditions. Journal of psychosomatic research, 74(3), 213-220.
   連結：
9. Cheng, Y., Luh, W.-M., & Guo, Y.-L. (2003). Reliability and validity of the Chinese version of the Job Content Questionnaire in Taiwanese workers. International journal of behavioral medicine, 10(1), 15-30.
   連結：
10. Chirilă, T., & Constantin, T. (2013). Understanding workplace bullying phenomenon through its concepts: A literature Review. Procedia-Social and Behavioral Sciences, 84, 1175-1179.
    連結：
11. DeSalvo, K. B., Bloser, N., Reynolds, K., He, J., & Muntner, P. (2006). Mortality prediction with a single general self‐rated health question. Journal of general internal medicine, 21(3), 267-275.
    連結：
12. Edward, K.-L., Stephenson, J., Ousey, K., Lui, S., Warelow, P., & Giandinoto, J.-A. (2016). A systematic review and meta-analysis of factors that relate to aggression perpetrated against nurses by patients/relatives or staff. Journal of Clinical Nursing, 25(3-4), 289. doi:10.1111/jocn.13019
    連結：
13. Enriquez, D., Traverso, R. G., Szyld, E., Pumara, E. D., Battolla, J., Firenze, L., Lamborizio, J. (2016). Behavior of pediatric medical residents during a clinical simulation of a violent mother in a pediatric emergency. Archivos Argentinos De Pediatria, 114(3), 232-236. doi:10.5546/aap.2016.eng.232
    連結：
14. Farrell, G. A., & Shafiei, T. (2012). Workplace aggression, including bullying in nursing and midwifery: A descriptive survey (the SWAB study). International Journal of Nursing Studies, 49(11), 1423-1431. doi:10.1016/j.ijnurstu.2012.06.007
    連結：
15. Jiao, M., Ning, N., Li, Y., Gao, L., Cui, Y., Sun, H., . . . Hao, Y. (2015). Workplace violence against nurses in Chinese hospitals: a cross-sectional survey. BMJ Open, 5(3), e006719. doi:10.1136/bmjopen-2014-006719
    連結：
16. Khademloo, M., Moonesi, F. S., & Gholizade, H. (2013). Health care violence and abuse towards nurses in hospitals in north of Iran. Global journal of health science, 5(4), 211. doi:10.5539/gjhs.v5n4p211
    連結：
17. Moore, L. W., Sublett, C., & Leahy, C. (2016). Nurse managers' insights regarding their role highlight the need for practice changes. Appl Nurs Res, 30, 98-103. doi:10.1016/j.apnr.2015.11.006
    連結：
18. Pilch, I., & Turska, E. (2015). Relationships between Machiavellianism, organizational culture, and workplace bullying: Emotional abuse from the target’s and the perpetrator’s perspective. Journal of Business Ethics, 128(1), 83-93.
    連結：
19. Pompeii, L., Dement, J., Schoenfisch, A., Lavery, A., Souder, M., Smith, C., & Lipscomb, H. (2013). Perpetrator, worker and workplace characteristics associated with patient and visitor perpetrated violence (Type II) on hospital workers: A review of the literature and existing occupational injury data. Journal of Safety Research, 44, 57-64. doi:10.1016/j.jsr.2012.09.004
    連結：
20. Rippon, T. J. (2000). Aggression and violence in health care professions. Journal of advanced nursing, 31(2), 452-460.
    連結：
21. Spector, A., Orrell, M., & Goyder, J. (2013). A systematic review of staff training interventions to reduce the behavioural and psychological symptoms of dementia. Ageing Res Rev, 12(1), 354-364. doi:10.1016/j.arr.2012.06.005
    連結：
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47. Abualrub, R. F., & Al-Asmar, A. H. (2011). Physical violence in the workplace among Jordanian hospital nurses. Journal of transcultural nursing : official journal of the Transcultural Nursing Society, 22(2), 157. doi:10.1177/1043659610395769
    連結：
48. AbuAlRub, R. F., & Al Khawaldeh, A. T. (2014). Workplace physical violence among hospital nurses and physicians in underserved areas in Jordan. Journal of Clinical Nursing, 23(13-14), 1937-1947. doi:10.1111/jocn.12473
    連結：
49. Aksakal, F. N. B., Karaşahin, E. F., Dikmen, A. U., Avci, E., & Ozkan, S. (2015). Workplace physical violence, verbal violence, and mobbing experienced by nurses at a university hospital. Turkish journal of medical sciences, 45(6), 1360.
    連結：
50. Al-Ali, N. M., Al Faouri, I., & Al-Niarat, T. F. (2016). The impact of training program on nurses' attitudes toward workplace violence in Jordan. Applied Nursing Research, 30, 83-89. doi:10.1016/j.apnr.2015.11.001
    連結：
51. American Organization of Nurse, E., & Emergency Nurses, A. (2015). AONE and ENA Develop Guiding Principles on Mitigating Violence in the Workplace. J Emerg Nurs, 41(4), 278-280. doi:10.1016/j.jen.2015.04.018
    連結：
52. Chappell, S. (2015). The American Organization of Nurse Executives and Emergency Nurses Association Guiding Principles on Mitigating Violence in the Workplace. J Nurs Adm, 45(7-8), 358-360. doi:10.1097/nna.0000000000000214
    連結：
53. Cheng, Y., & Chen, C.-J. (2014). Modifying effects of gender, age and enterprise size on the associations between workplace justice and health. International archives of occupational and environmental health, 87(1), 29-39.
    連結：
54. Cheng, Y., Chen, I.-S., Chen, C.-J., Burr, H., & Hasselhorn, H. M. (2013). The influence of age on the distribution of self-rated health, burnout and their associations with psychosocial work conditions. Journal of psychosomatic research, 74(3), 213-220.
    連結：
55. Cheng, Y., Luh, W.-M., & Guo, Y.-L. (2003). Reliability and validity of the Chinese version of the Job Content Questionnaire in Taiwanese workers. International journal of behavioral medicine, 10(1), 15-30.
    連結：
56. Chirilă, T., & Constantin, T. (2013). Understanding workplace bullying phenomenon through its concepts: A literature Review. Procedia-Social and Behavioral Sciences, 84, 1175-1179.
    連結：
57. DeSalvo, K. B., Bloser, N., Reynolds, K., He, J., & Muntner, P. (2006). Mortality prediction with a single general self‐rated health question. Journal of general internal medicine, 21(3), 267-275.
    連結：
58. Edward, K.-L., Stephenson, J., Ousey, K., Lui, S., Warelow, P., & Giandinoto, J.-A. (2016). A systematic review and meta-analysis of factors that relate to aggression perpetrated against nurses by patients/relatives or staff. Journal of Clinical Nursing, 25(3-4), 289. doi:10.1111/jocn.13019
    連結：
59. Enriquez, D., Traverso, R. G., Szyld, E., Pumara, E. D., Battolla, J., Firenze, L., Lamborizio, J. (2016). Behavior of pediatric medical residents during a clinical simulation of a violent mother in a pediatric emergency. Archivos Argentinos De Pediatria, 114(3), 232-236. doi:10.5546/aap.2016.eng.232
    連結：
60. Farrell, G. A., & Shafiei, T. (2012). Workplace aggression, including bullying in nursing and midwifery: A descriptive survey (the SWAB study). International Journal of Nursing Studies, 49(11), 1423-1431. doi:10.1016/j.ijnurstu.2012.06.007
    連結：
61. Jiao, M., Ning, N., Li, Y., Gao, L., Cui, Y., Sun, H., . . . Hao, Y. (2015). Workplace violence against nurses in Chinese hospitals: a cross-sectional survey. BMJ Open, 5(3), e006719. doi:10.1136/bmjopen-2014-006719
    連結：
62. Khademloo, M., Moonesi, F. S., & Gholizade, H. (2013). Health care violence and abuse towards nurses in hospitals in north of Iran. Global journal of health science, 5(4), 211. doi:10.5539/gjhs.v5n4p211
    連結：
63. Moore, L. W., Sublett, C., & Leahy, C. (2016). Nurse managers' insights regarding their role highlight the need for practice changes. Appl Nurs Res, 30, 98-103. doi:10.1016/j.apnr.2015.11.006
    連結：
64. Pilch, I., & Turska, E. (2015). Relationships between Machiavellianism, organizational culture, and workplace bullying: Emotional abuse from the target’s and the perpetrator’s perspective. Journal of Business Ethics, 128(1), 83-93.
    連結：
65. Pompeii, L., Dement, J., Schoenfisch, A., Lavery, A., Souder, M., Smith, C., & Lipscomb, H. (2013). Perpetrator, worker and workplace characteristics associated with patient and visitor perpetrated violence (Type II) on hospital workers: A review of the literature and existing occupational injury data. Journal of Safety Research, 44, 57-64. doi:10.1016/j.jsr.2012.09.004
    連結：
66. Rippon, T. J. (2000). Aggression and violence in health care professions. Journal of advanced nursing, 31(2), 452-460.
    連結：
67. Spector, A., Orrell, M., & Goyder, J. (2013). A systematic review of staff training interventions to reduce the behavioural and psychological symptoms of dementia. Ageing Res Rev, 12(1), 354-364. doi:10.1016/j.arr.2012.06.005
    連結：
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