某二级甲等医院工作场所暴力调查——采用世界卫生组织研制的医院工作场所暴力调查工具调查
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摘要
目的探讨医院医务工作者遭受工作场所暴力的现况及其影响因素。方法采用典型抽样方法,选取我国中部某二级甲等公立医院978名医务工作者为研究对象。采用世界卫生组织研制的《医疗部门工作场所暴力国家案例研究工具——调查问卷》调查过去1年所发生的医院工作场所暴力情况,分析其发生率、分布特点和施暴者来源等。结果医务工作者遭受工作场所暴力的发生率为48.5%(474/978);遭受工作场所身体暴力的发生率为8.8%(86/978),其中有62人(占72.1%)认为此次身体暴力事件可以预防;遭受工作场所心理暴力的发生率为47.1%(461/978),其中,语言侮辱发生率为45.7%(447/978);施暴者主要为患者家属(占49.4%)和患者(占41.4%)。多因素Logistic回归分析结果显示,内科、外科、门急诊医务工作者发生工作场所暴力的风险高于非临床科室医务工作者(P<0.01);门急诊医务工作者发生工作场所身体暴力的风险高于非临床科室(P<0.01),轮班医务工作者发生工作场所身体暴力的风险高于非轮班者(P<0.01);内科、外科、门急诊医务工作者发生工作场所心理暴力的风险高于非临床科室(P<0.01)。结论医院工作场所暴力多发生于内科、外科、门急诊医务工作者;亟待构建医院职业卫生防护体系,并将暴力防护纳入其中。
Objective To identify the current status and influencing factors associated with workplace violence in hospital medical staffs. Methods A typical sampling method was used to select 978 medical workers as the research subjects in a Grade 2A hospital in central China. The Workplace Violence in the Health Sector Country Case Studies Research Instruments-Survey Questionnaire was adopted for a cross-sectional survey to investigate the workplace violence in hospital in the past year, and analyze its incidence, distribution characteristics and sources of perpetrators. The survey questionnaire was developed by the World Health Organization. Results The incidence of workplace violence among medical workers was 48.5%(474/978). The incidence of physical violence in the workplace was 8.8%(86/978), of which 62(72.1%) was considered as preventable incident. The incidence of psychological violence in the workplace was 47.1%(461/978), with the incidence of verbal abuse in the workplace was 45.7%(447/978). The perpetrators were mainly family members of patients(49.4%) and patients themselves(41.4%). Multivariate logistic regression analysis results showed that the overall risk of workplace violence among medical workers in internal medicine, surgery, outpatient and emergency departments was higher than that among medical workers in non-clinical departments(P<0.01). The risk of workplace physical violence of outpatient and emergency medical workers was higher than that of non-clinical departments(P<0.01), and the risk of workplace physical violence of shift medical workers was higher than that of non-shift medical workers(P<0.01). The risk of workplace psychological violence among medical workers in internal medicine, surgery, outpatient and emergency departments was higher than that in non-clinical departments(P<0.01). ConclusionWorkplace violence of hospital is common in internal medicine, surgical, outpatient and emergency medical workers. It is urgent to build the hospital occupational health protection system including the violence protection.
Objective To identify the current status and influencing factors associated with workplace violence in hospital medical staffs. Methods A typical sampling method was used to select 978 medical workers as the research subjects in a Grade 2A hospital in central China. The Workplace Violence in the Health Sector Country Case Studies Research Instruments-Survey Questionnaire was adopted for a cross-sectional survey to investigate the workplace violence in hospital in the past year, and analyze its incidence, distribution characteristics and sources of perpetrators. The survey questionnaire was developed by the World Health Organization. Results The incidence of workplace violence among medical workers was 48.5%(474/978). The incidence of physical violence in the workplace was 8.8%(86/978), of which 62(72.1%) was considered as preventable incident. The incidence of psychological violence in the workplace was 47.1%(461/978), with the incidence of verbal abuse in the workplace was 45.7%(447/978). The perpetrators were mainly family members of patients(49.4%) and patients themselves(41.4%). Multivariate logistic regression analysis results showed that the overall risk of workplace violence among medical workers in internal medicine, surgery, outpatient and emergency departments was higher than that among medical workers in non-clinical departments(P<0.01). The risk of workplace physical violence of outpatient and emergency medical workers was higher than that of non-clinical departments(P<0.01), and the risk of workplace physical violence of shift medical workers was higher than that of non-shift medical workers(P<0.01). The risk of workplace psychological violence among medical workers in internal medicine, surgery, outpatient and emergency departments was higher than that in non-clinical departments(P<0.01). ConclusionWorkplace violence of hospital is common in internal medicine, surgical, outpatient and emergency medical workers. It is urgent to build the hospital occupational health protection system including the violence protection.
引文
[1] International Labor Organization,International Council of Nurses,World Health Organization,et al.Framework guidelines for addressing workplace violence in the health sector,in Framework guidelines for addressing workplace violence in the health sector[M].Geneve:International Labour Office Publications Bureau,2002:1-30.
[2] KRAMER E J,DODINGTON J,HUNT A,et al.Violent reinjury risk assessment instrument (VRRAI) for hospital-based violence intervention programs[J].J Surg Res,2017,217:177-186.
[3] HAHN S,HANTIKAINEN V,NEEDHAM I,et al.Patient and visitor violence in the general hospital,occurrence,staff interventions and consequences:a cross-sectional survey[J].J Adv Nurs,2012,68(12):2685-2699.
[4] TAYLOR J L,REW L.A systematic review of the literature:workplace violence in the emergency department[J].J Clin Nurs,2011,20(7/8):1072-1085.
[5] HECKEMANN B,ZELLER A,HAHN S,et al.The effect of aggression management training programmes for nursing staff and students working in an acute hospital setting.A narrative review of current literature[J].Nurse Educ Today,2015,35(1):212-219.
[6] International Labor Organization,International Council of Nurses,World Health Organization,et al.Workplace violence in the health sector country case studies research instruments:survey questionnaire[M].Geneve:International Labor Office,2003:21-25.
[7] di MARTINO V.Workplace violence in the health sector:country case studies[M].Geneve:International Labour Office,2002:3-7.
[8] AVANDER K,HEIKKI A,BJERS? K,et al.Trauma nurses experience of workplace violence and threats[J].J Trauma Nurs,2016,23(2):51-57.
[9] WOLF L A,DELAO A M,PERHATS C,et al.Nothing Changes,Nobody Cares:understanding the experience of emergency nurses physically or verbally assaulted while providing care[J].J Emerg Nurs,2014,40(4):305-310.
[10] HAHN S,MüLLER M,HANTIKAINEN V,et al.Risk factors associated with patient and visitor violence in general hospitals:results of a multiple regresssion analysis[J].Int J Nurs Stud,2013,50(3):374-385.
[11] International Labor Office.International Labor Conference 107th Session.Ending violence and harassment in the world of work[R].Geneve:International Labor Office,2019:26-29.
[12] 谢秋林,葛莉,金浪,等.医院Ⅱ型暴力影响因素定性研究的系统评价[J].护理学杂志,2018,33(10):101-105,109.
[13] TUCKER J D,CHENG Y,WONG B,et al.Patient-physician mistrust and violence against physicians in Guangdong Province,China:a qualitative study[J].BMJ Open,2015,5(10):1-10.
[14] 刘旭,李海燕,毛大川,等.集体行为理论视角下暴力伤医现象诱发因素的研究[J].中国医院管理,2015,35(11):59-61,73.
[15] KELLEY E C.Reducing violence in the emergency department:a rapid response team approach[J].J Emerg Nurs,2014,40(1):60-64.
[16] 张敏,徐李卉,刘拓,等.我国医护人员职业卫生防护体系研究[J].中国安全生产科学技术,2018,14(5):51-60.
[17] 向静.医院门诊工作场所暴力的现状分析及对护士心理健康的影响[J].中国卫生事业管理,2018(7):504-506.
[18] 刘拓,张敏,徐李卉,等.中国医疗机构工作场所暴力防治法律法规体系梳理[J].中国职业医学,2017,44(3):290-296.
[19] GALLANT-ROMAN M A.Strategies and tools to reduce workplace violence[J].AAOHN J,2008,56(11):449-454.
[20] 张敏.医院层面如何开展工作场所暴力的预防控制[J].中国护理管理,2019,19(4):481-486.
[21] U.S.Department of Labor.Guidelines for preventing workplace violence:for healthcare and social service workers[M].Washington:Occupational Safety and Health Administration,2015:24-27.
[22] 徐小平,贾梅霞,林曼娜,等.深港模式下的医院工作场所暴力管理实践[J].中国护理管理,2019,19(4):494-497.
[23] International Labor Organization,World Health Organization.Health WISE action manual:work improvement in health services[M].Geneve:International Labor Office Publications Bureau,2014:85-101.
[24] BLANDO J D,NOCERA M,RIDENOUR M L,et al.Workplace violence and hospital security programs:regulatory compliance,program benchmarks innovative strategies[J].J Healthc Prot Manage,2017,33(3):89-105.
[25] HAMBLIN L E,ESSENMACHER L,LUBORSKY M,et al.Worksite walkthrough intervention:data-driven prevention of workplace violence on hospital units[J].Amer Occup Envir Med,2017,59(9):875-884.
[26] 孙璐露,杨淑娟,李森,等.医疗纠纷中医院与媒体博弈关系调查研究[J].中国医院管理,2014,34(3):66-68.
[2] KRAMER E J,DODINGTON J,HUNT A,et al.Violent reinjury risk assessment instrument (VRRAI) for hospital-based violence intervention programs[J].J Surg Res,2017,217:177-186.
[3] HAHN S,HANTIKAINEN V,NEEDHAM I,et al.Patient and visitor violence in the general hospital,occurrence,staff interventions and consequences:a cross-sectional survey[J].J Adv Nurs,2012,68(12):2685-2699.
[4] TAYLOR J L,REW L.A systematic review of the literature:workplace violence in the emergency department[J].J Clin Nurs,2011,20(7/8):1072-1085.
[5] HECKEMANN B,ZELLER A,HAHN S,et al.The effect of aggression management training programmes for nursing staff and students working in an acute hospital setting.A narrative review of current literature[J].Nurse Educ Today,2015,35(1):212-219.
[6] International Labor Organization,International Council of Nurses,World Health Organization,et al.Workplace violence in the health sector country case studies research instruments:survey questionnaire[M].Geneve:International Labor Office,2003:21-25.
[7] di MARTINO V.Workplace violence in the health sector:country case studies[M].Geneve:International Labour Office,2002:3-7.
[8] AVANDER K,HEIKKI A,BJERS? K,et al.Trauma nurses experience of workplace violence and threats[J].J Trauma Nurs,2016,23(2):51-57.
[9] WOLF L A,DELAO A M,PERHATS C,et al.Nothing Changes,Nobody Cares:understanding the experience of emergency nurses physically or verbally assaulted while providing care[J].J Emerg Nurs,2014,40(4):305-310.
[10] HAHN S,MüLLER M,HANTIKAINEN V,et al.Risk factors associated with patient and visitor violence in general hospitals:results of a multiple regresssion analysis[J].Int J Nurs Stud,2013,50(3):374-385.
[11] International Labor Office.International Labor Conference 107th Session.Ending violence and harassment in the world of work[R].Geneve:International Labor Office,2019:26-29.
[12] 谢秋林,葛莉,金浪,等.医院Ⅱ型暴力影响因素定性研究的系统评价[J].护理学杂志,2018,33(10):101-105,109.
[13] TUCKER J D,CHENG Y,WONG B,et al.Patient-physician mistrust and violence against physicians in Guangdong Province,China:a qualitative study[J].BMJ Open,2015,5(10):1-10.
[14] 刘旭,李海燕,毛大川,等.集体行为理论视角下暴力伤医现象诱发因素的研究[J].中国医院管理,2015,35(11):59-61,73.
[15] KELLEY E C.Reducing violence in the emergency department:a rapid response team approach[J].J Emerg Nurs,2014,40(1):60-64.
[16] 张敏,徐李卉,刘拓,等.我国医护人员职业卫生防护体系研究[J].中国安全生产科学技术,2018,14(5):51-60.
[17] 向静.医院门诊工作场所暴力的现状分析及对护士心理健康的影响[J].中国卫生事业管理,2018(7):504-506.
[18] 刘拓,张敏,徐李卉,等.中国医疗机构工作场所暴力防治法律法规体系梳理[J].中国职业医学,2017,44(3):290-296.
[19] GALLANT-ROMAN M A.Strategies and tools to reduce workplace violence[J].AAOHN J,2008,56(11):449-454.
[20] 张敏.医院层面如何开展工作场所暴力的预防控制[J].中国护理管理,2019,19(4):481-486.
[21] U.S.Department of Labor.Guidelines for preventing workplace violence:for healthcare and social service workers[M].Washington:Occupational Safety and Health Administration,2015:24-27.
[22] 徐小平,贾梅霞,林曼娜,等.深港模式下的医院工作场所暴力管理实践[J].中国护理管理,2019,19(4):494-497.
[23] International Labor Organization,World Health Organization.Health WISE action manual:work improvement in health services[M].Geneve:International Labor Office Publications Bureau,2014:85-101.
[24] BLANDO J D,NOCERA M,RIDENOUR M L,et al.Workplace violence and hospital security programs:regulatory compliance,program benchmarks innovative strategies[J].J Healthc Prot Manage,2017,33(3):89-105.
[25] HAMBLIN L E,ESSENMACHER L,LUBORSKY M,et al.Worksite walkthrough intervention:data-driven prevention of workplace violence on hospital units[J].Amer Occup Envir Med,2017,59(9):875-884.
[26] 孙璐露,杨淑娟,李森,等.医疗纠纷中医院与媒体博弈关系调查研究[J].中国医院管理,2014,34(3):66-68.