医院人文管理视角下医疗暴力问题探讨

发布时间：2018-07-01 15:59

本文选题：医院人文管理 + 医疗暴力　；参考：《遵义医学院》2017年硕士论文

【摘要】：目的:本研究第一个目的是从医院人文管理视角出发,分析医疗暴力案例,找出发生医疗暴力的原因及危险因素,为预防和减少医疗暴力,增加医务人员执业安全、提高医疗质量、加强医院的人文管理提供理论参考。本研究的第二个目的是针对医疗医疗法律法规的出台,医疗暴力问题尚有未解决的情况,医务人员的人身安全依然受到威胁,建议从医院人文管理的柔性视角,建立针对医务人员和患者的双重管理措施,以缓解医疗暴力。方法:本研究采用回顾性研究,选择从2000年-2015年在网络媒体上公开报道过的医疗暴力事件作为研究对象。利用“百度,搜狗、新浪、网易等搜索引擎”,输入检索词“医疗暴力”或“伤医”或“医院工作场所暴力”,即得到了大量的检索结果,然后逐个将网页打开,剔除不符合研究条件的检索结果,保存符合研究条件的检索结果,最后共获得326个符合研究条件的媒体公开报道过的医疗暴力事件案例作为研究对象,其中174个案例来自正规新闻网站如新华网、中国新闻网和光明日报电子版等;116个案例来自已出版过的的书籍附录,如《医患纠纷法律解读》;36个案例来自贴吧和个人微博,此类案例的可信度较低,故本研究不将此类案例作为典型案例分析,只将其纳入初步统计数据中。研究内容主要包括:医疗暴力发生的时间,发生的省份,发生的医疗机构名称及等级,发生医疗暴力的科室,发生医疗暴力的原因及过程简介,医疗暴力的袭击者及被袭击者,医疗暴力造成的人体损伤程度共十个方面。结果:本研究共收集了2000年-2015年的326个医疗暴力事件,除去中国台湾、青海省、西藏自治区,其余21个省,4个自治区,4个直辖市均有医疗暴力事件发生,其中医疗暴力事件发生最多的省份是广东省。2000年-2012年我国医疗暴力事件经媒体报道过的均为20件左右;2013年、2014年、2015年分别为42、75、70件,可见我国医疗暴力事件从2013年开始增加,且增加速度较快,2014年达到巅峰。在已发生的326件医疗暴力事件中,三级医院发生医疗暴力数量最多,为217件,占总数的66.56%,其次是二级医院、其他、一级医院,分别占21.78%、8.59%、3.07%。医疗暴力发生率由高到低科室分别是急诊科、外科、内科、妇产科、儿科、五官科,除去其它科室,急诊科是医疗暴力事件发生率最高的科室。发生医疗暴力的主要原因为不满意诊疗效果、患者死亡、医闹索赔、其它、沟通不到位/服务态度差,分别占总数的23.92%、16.27%、14.42%、12.89%、11.04%。医疗暴力的施暴者患者和家属。医疗暴力的受害者主要为医生和护士。结论:引起医疗暴力的原因涉及多方面,包括政府层面、社会层面、医院层面、患者层面等,医疗暴力的主要发生场所是医院,涉及的主要人员是医护人员、患者及其家属,因此从医院管理层面探讨解决医疗暴力问题是关键环节。平衡患者期望值,提高其满意度,以减少因相对剥夺感产生的消极情绪而诱发的医疗暴力;真实、真诚、相互理解的人性化交流模式与叙事医学结合,增加医患交流的人情味,提高患者依从性。医院成立医护人员心理评估及安全疏导委员会,及时评估和疏导医护人员因医疗暴力及其他事物而造成的心理问题,减少暴力对其的心理伤害;各专科自主制定防暴、制暴方案,减少急诊科、外科等发生医疗暴力较多科室的暴力。参考台湾长庚医院的绩效考核方案,平衡医生收入,减少其不利于医疗质量的不良情绪,减少因不满意医生医疗服务态度的医疗暴力。提高医院文化建设,改善就医环境;医护人员职业精神重塑,抵制过度医疗的金钱诱惑;建立暴力前合理疏导机制及暴力先兆因素识别培训,防止医疗暴力发生。
[Abstract]:Objective: the first purpose of this study is to analyze the cases of medical violence from the perspective of hospital humanistic management, to find out the causes and risk factors of medical violence, and to provide theoretical reference for preventing and reducing medical violence, increasing the safety of medical personnel, improving medical quality and strengthening the management of human text in hospitals. The second aims of this study are According to the introduction of medical and medical laws and regulations, the problem of medical violence still has not been solved, the personal safety of medical personnel is still threatened. It is suggested that the dual management measures for medical personnel and patients should be set up from the flexible perspective of hospital humanistic management in order to alleviate the medical violence. Methods: This study adopts a retrospective study and chooses from 200 The medical violence reported publicly in the Internet media in 0 -2015 was studied. Using "Baidu, Sogou, Sina, NetEase and other search engines", the retrieval words "medical violence" or "wound doctor" or "hospital workplace violence" were given a large number of retrieval results, and then the web pages were opened one by one to eliminate incompatibility. The retrieval results of the conditions were studied, and the results were preserved in accordance with the research conditions. In the end, 326 cases of medical violence reported publicly reported by the media were obtained. 174 of them were from the regular news websites such as Xinhuanet, China News Network and Guangming Daily electronic edition, and 116 cases came from already. The published book appendix, such as the legal interpretation of the doctor-patient dispute, 36 cases from the post bar and the personal micro-blog, is low in reliability. Therefore, this case is not analyzed as a typical case, and is only included in the preliminary statistical data. The main contents include: the time of the occurrence of medical violence, the province in which it occurred, and the medical treatment. The name and grade of the medical institution, the Department of medical violence, the cause and process of medical violence, the assailants and the assailants of the medical violence, the degree of human injury caused by the medical violence in ten aspects. Results: This study collects 326 medical violence events of -2015 in 2000, excluding Taiwan, Qinghai, Tibet, China. In the autonomous region, the remaining 21 provinces, 4 autonomous regions, and 4 municipalities directly under the central government had medical violence. Among the provinces where the most medical violence occurred in the province of Guangdong province.2000 -2012, the medical violence in China had been reported by the media to about 20 pieces. In 2013, 2014, and 2015, the incidents of medical violence in our country were from 201. 3 years began to increase and increase faster, reaching the peak in 2014. Among the 326 cases of medical violence that had occurred, three hospitals had the largest number of medical violence, 217, 66.56% of the total, followed by the two level hospitals, and the others, the first level hospitals, 21.78%, 8.59%, and the incidence of 3.07%. medical violence from high to lower departments was emergency department respectively. Department, surgery, Department of medicine, obstetrics and Gynecology, pediatrics, and five department, except for other departments, the emergency department is the highest incidence of medical violence. The main causes of medical violence are dissatisfied diagnosis and treatment effect, patient death, medical claim, other, poor communication / poor service attitude, accounting for 23.92%, 16.27%, 14.42%, 12.89%, 11.04%. medicine, respectively. The victims of violence are the victims and their families. The main victims of medical violence are doctors and nurses. Conclusion: the causes of medical violence are involved in many aspects, including the government level, the social level, the hospital level, the patient level and so on. The main place of the medical violence is the hospital, the main personnel involved are the medical and nursing staff, the patients and their families. It is the key link to discuss and solve the problem of medical violence from the hospital management level. Balance the patient's expectation, improve its satisfaction, reduce the medical violence induced by the negative emotion caused by the relative deprivation; the true, sincere, mutual understanding of the humanized communication mode combined with the narrative medicine, increase the human feelings of the doctor and patient communication, and improve the patient Compliance. The hospital set up the mental assessment and safety guidance committee of the medical and nursing staff to assess and guide the psychological problems caused by medical violence and other things in time and reduce the psychological harm of violence to them. Refer to the performance assessment scheme of Taiwan Chang g hospital, balance the doctor's income, reduce the bad mood which is not conducive to the medical quality, reduce the medical violence because of the dissatisfied doctor's medical service attitude, improve the hospital culture construction, improve the medical environment, reshape the professional spirit of the medical staff, resist the money temptation of excessive medical treatment, and establish the rationality before the violence. The training mechanism of the dredging mechanism and the precursor of violence can prevent the occurrence of medical violence.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.3

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