三甲医院医务人员遭受工作场所暴力情况及评估

Workplace violence against medical staff in tertiary grade A hospitals in Shanxi province: a cross-sectional analysis

目的分析医务人员工作场所暴力的人口社会学影响因素,探讨医务人员在工作场所遭受的暴力形式与程度,研究与评估工作场所暴力对医务人员的影响。方法本研究于2015年7月开始实地调查,以整群抽样的方法选取山西省10个地市15所三甲医院共3 663名医务人员作为调查对象,以已有问卷为模板设计本次工作场所暴力问卷并展开调查。结果单因素分析结果显示,工作年限、最高学历、职称、聘用形式、科室等是医院工作场所遭受暴力的影响因素。医院急诊科室遭受暴力发生率最高,为89.84%;最高学历是本科的医务人员遭受暴力发生率最高,为67.43%;医务人员遭受暴力形式主要为语言暴力且暴力主要发生于病房、医生办公室和护理站;工作场所暴力的施暴者主要为患者家属,占68.72%,且男性比例占到76.77%,施暴者年龄多在30～40岁;因不满意医生的治疗或手术方案,认为病情无好转而施暴的占42.94%,未满足病人无理要求而施暴的占44.46%;应对医院暴力的方式中,忍让回避与耐心解释占比分别为52.10%、67.48%。结论医院工作场所遭受暴力中最常见的是责骂、辱骂,在暴力发生后,医务人员往往感到委屈、气愤,导致其工作态度发生变化,产生离职意愿,严重影响其心理健康,因此有关部门和社会各界应重点关注医务人员心理健康,做好心理健康的评估、干预,预防和减少心理障碍。

Objective To analyze the prevalence and sociological influence factors of workplace violence (WPV) against medical staff and the impacts of MPV upon medical staff. Methods We conducted a survey among 3 663 physicians and nurses recruited with random cluster sampling in 15 tertiary grade A hospitals located in 10 prefectures or municipalities of Shanxi province between January and July 2015. We used a self-modified existing questionnaire on medical staff′s exposure to WPV in the study. Results The results of univariate factor analysis revealed following influencing factors of WPV against medical staff: years of working,high education backgroud,professional title,employment form,and working department. The medical staff in emergency department were most frequently (89.84%) exposed to WPV and those with undergraduate education reported a higher rate (67.43%) of WPV exposure. Verbal violence was a major form of WPV reported and most of the MPV occurred at wards,doctor ′s offices,and nurse stations. Of the reported WPV perpetrators, 68.72% were family members of patients;76.77% were male;and 63.32% were aged 30-49 years. Based on the medical staff ′s reporting,major origins of the WPV incidents included dissatisfaction for doctors ′ therapeutic regimen or surgical option and treatment outcome (42.94%) and no response to patients′ unreasonable requirements (44.46%). The major strategies for coping with the WPV were tolerance or avoidance (reported by 52.10% of the medical staff) and patient explanation (67.48%). Conclusion Verbal attack is a most common workplace violence in hospitals and has serious impact on medical staff ′s mental health and could induce medical staff ′s turnover intention. Relevant measures should be adopted to reduce workplace violence in hospitals.