广州市医院工作场所暴力流行病学研究
发布时间：2018-08-02 16:21
【摘要】：背景和目的 暴力是一个国家和地区无可讳言的社会安全问题。广泛渗透于社会各个领域的暴力并没有被阻隔于医院之外,实际上,社会暴力正流向医院,卫生工作人员在其工作场所遭受暴力对待经常发生。暴力作为公共卫生问题被忽略的原因之一是缺乏明确的定义。关于工作场所暴力,国际上过去一直没有完整而统一的定义。世界卫生组织关于工作场所暴力的最新定义是：工作人员在其工作场所,受到辱骂、威胁或袭击,从而造成对其安全、幸福或健康的明确或含蓄的挑战。此概念的拓展解释还包括以下三点：①暴力事件必须发生在工作场所；②暴力发生在工作人员上班期间；③暴力受害者一定是工作人员。按照受害者遭受暴力的部位不同,工作场所暴力分为心理暴力、身体暴力和性暴力。心理暴力是指故意用力(含体力威胁)反对他人或集体,从而导致对身体、脑力、精神、道义和社会发展的损害,包括口头的辱骂、威胁、攻击和折磨,但当事人之间没有身体接触。身体暴力指任何以体力伤害身体的攻击行为,例如打、踢、拍、扎、推、咬等。体力攻击的结果可能未导致承受暴力的一方任何伤害,也可能造成轻度损伤、明显损伤、功能障碍或永久性残疾等。性暴力是指任何违背受害者意愿的有关性的言语和动作,包括性骚扰(或性挑逗)、性袭击以及强奸(或强奸未遂)。到目前为止,国内的情况是,一方面,社会各界对医院工作场所问题未予足够的重视,尚未见到比较成熟的相关行政法律条文,工作场所暴力方面的专业研究开展得并不多；另一方面,由于国内政治经济及文化背景、医院配置、卫生管理制度等方面和国外不太一样,故其他国家有关工作场所暴力的研究成果及防治经验也就不一定完全适合我国。在一定范围内对有代表性人群进行抽样调查,可以反应某一种暴力在特定时间中的发生情况。通过在广州市辖区内医院开展工作场所暴力流行病学调查,探讨医院工作场所暴力发生现况及影响因素,可以为如何处理存在已久的医患纠纷问题提供新的思路和解决之道。只有处理好医患纠纷,解决好医患矛盾,才能保障医院正常的医疗秩序,还医务人员一个宽松安全的工作场所,还病人一个舒适满意的诊疗环境。本研究通过在广州市辖区内部分医院开展工作场所暴力流行病学调查,探讨医院工作场所暴力发生现况及影响因素,最终旨在提供国内有关医院工作场所暴力的基线资料,唤起广大一线卫生工作人员乃至全社会对医院工作场所暴力问题的重视,同时为卫生行政部门制定医院工作场所暴力预防与控制措施以及维护医院正常工作秩序提供理论依据。 方法 广州市下辖10个区、2个县级市。本研究以广州市辖区内12个行政区划的20家不同级别医院共7198名在岗工作人员作为研究对象。此次调查的医院在岗工作人员包括在医院工作的所有职业人群,例如医生、护士、临床工人、医技人员、行政人员、后勤人员和保卫人员等,因休假、出差、旅游或外出学习等原因而不在岗达一周以上的工作人员不在本次研究之列。本研究采取整群抽样与分层抽样相结合的调查方法。首先,将广州市辖区内医院总体按行政区划分成12个群；其次,按医院级别将每个群分成3个组别,并在每个组别中随机抽取一定数量的医院,抽取拟调查的医院；最后,对于被抽中的医院,原则上将所有医院工作人员作为研究对象。每家医院在经过培训的调查专职人员(各科室主任和／或护士长)指导下,所有在岗工作人员在同一时间段内(一般1—3天,最长不超过7天)集中填写调查前12个月在医院场所本人所遭受的暴力情况,然后由各科室主任和／或护士长逐一收回本科室调查表。根据世界卫生组织的有关文件和工作场所暴力的定义设计调查表,此调查表经不同年龄的医院工作人员试填,收集反馈意见,根据发现的问题和反馈的意见对调查表的项目进行补充、修改和删除；修改后的调查表先在一家医院进行小样本(30人)的预调查,再次校正调查表。正式调查开始后调查表的内容不再做任何改动。医院工作场所暴力定义如下：卫生工作人员本人在工作时间内,在医院场所遭受到心理暴力、身体暴力和(或)性暴力。本研究使用社会学统计软件包SPSS17.0进行调查表的录入和数据分析处理。包括对医院工作场所暴力的流行特征作统计描述,针对暴力相关特征及暴力认知作卡方检验。建立单因素及多因素logistic回归模型,分析探讨工作场所暴力经历与受访者相关因素的关系。第一步,将8个受访者相关因素逐一进行单因素二分类logistic回归分析,筛选出包括性别、年龄、教育程度、婚姻状况、聘用形式、职业类别和工龄等7个特征变量；第二步,为了排除混杂因素的干扰,就单因素回归筛选出来的变量采用向后删除法进行多因素logistic回归分析,最终共有4个变量进入回归模型,分别是受访者性别、年龄、聘用形式、职业类别。本次研究采取以下质量控制方法：①采用封闭式调查表,减少了受访者主观臆断,每份调查表简明附上调查的目的、要求及填写方法,使受访者一目了然,也减少了顾虑；②只对过去12月中发生的暴力事件进行调查。为减少回忆偏倚的发生,对于暴力的详细描述只调查过去12个月中印象最深刻的一次暴力事件；③调查前取得每家医院相关领导的支持,做好科主任和护士长的动员和培训工作,以确保调查工作顺利完成；④调查样本包含了不同级别、性质、地理位置的20家医院,样本量大,具有较好的代表性；⑤回收的调查表严格按统一标准筛选,排除无效问卷后,由专人录入。 结果 本研究共调查了广州市辖区内20家不同级别医院共7198名在岗工作人员。有3家医院因种种原因造成调查表回收率过低被全部弃用(共111份)。最终实际作为本次研究对象者为来自17家医院的5950名工作人员,共收回调查表5147份,应答率为86.50%(5147/5950)。5147份调查表经过逐一筛选,排除无效问卷(86份),得到有效问卷5061份,有效应答率为98.33%(5061/5147)。最终分析结果显示,5061名医院工作人员在过去的12个月中遭受工作场所暴力者2947人,工作场所暴力的发生率为58.23%。其中心理暴力的发生率为56.85%,身体暴力的发生率为12.85%,性暴力的发生率为6.99%。至少有14名医院工作人员曾因暴力伤害造成了身体功能障碍或永久残疾,7人曾遭受强奸(或强奸未遂)。急诊科、精神病医院工作人员,医生和护士,正式职工,男性、年龄小于30岁的工作人员是医院工作场所暴力的危险职业人群。心理暴力以急诊科工作人员发生率最高,为83.02%,身体暴力和性暴力则以精神病医院工作人员发生率最高,分别为45.10%和20.23%。病人亲属、年龄在40岁以下,尤其是31—40岁的男性施暴者是医院工作场所暴力最常见的施暴者人群；病房和白班时间分别是医院工作场所暴力最常见发生地点和发生时间。工作场所暴力发生的原因包括病人死亡、病人意识不清、酗酒或药物滥用、施暴者精神障碍、病情无好转、诊疗费用太高、候诊时间过长、对服务不满意、未满足病人的要求等因素。 结论 广州市辖区内医院工作场所暴力高发,发生率为58.23%。医院工作场所暴力以心理暴力为主,心理暴力的发生率为56.85%,身体暴力的发生率为12.85%,与国际上同类研究相似。性暴力的发生率为6.99%,迄今尚未检索到国内外有关针对医院职业人群性暴力发生情况的专业研究。医院工作场所暴力危害严重,造成受害者身体、心理和精神上的伤害。如前所述,心理暴力发生率极高,尤其是在急诊科工作人员中,发生率高达83.02%,很少有人能幸免；身体暴力和性暴力的发生尽管不及心理暴力普遍,但其所造成的后果比心理暴力严重得多。医院工作场所暴力还给受害者个人、医院和国家带来沉重的经济负担。医生或护士,正式职工,男性、年龄小于的30岁的工作人员等是医院工作场所暴力的危险职业人群。医院工作场所暴力的干预重点应落实在急诊科、精神病医院工作人员。建议在二级或以上综合性医院急诊科以及精神病医院加强安全保卫工作,增加员工工作场所暴力防范意识。医院工作场所暴力的高危因素来自于医院(医院管理部门及医务工作者个人)和病人两个方面,包括病人死亡、病人意识不清、酗酒或药物滥用、施暴者精神障碍、病情无好转、诊疗费用太高、候诊时间过长、对服务不满意、未满足病人的要求等。其中未满足病人的要求、病情无好转、诊疗费用太高最容易导致医院工作场所暴力的发生,特别是未满足病人的要求,对23.40%的暴力事件难辞其咎。该结果提示医院应规范管理、提高服务质量与诊疗技术,卫生行政部门推行、促进及深化医疗卫生改革迫在眉睫,亦势在必行。工作场所暴力尚未引起全社会的重视,打骂医务人员被认为是不必大惊小怪的小事,医院工作人员中也有1/5左右的人从未听说过工作场所暴力和认为没有必要重视这一问题。工作场所暴力的预防与控制是一项系统工程,建议从政策、管理、工程、教育等多方面实施干预。在所有干预措施中,政策干预是关键,建议卫生行政部门就医院工作场所暴力问题立法,并成立包括流行病学、立法、司法及公安等领域的专家组成工作场所暴力防治委员会(或防治小组),处理工作场所暴力相关问题和提供法律及专业指导。此外,开展职业道德、职业安全和尊重医务人员工作的宣传,营造讲文明的社会风尚亦是防制工作场所暴力的重要措施。
[Abstract]:Background and purpose
Violence is an unspoken social security problem in a country and region. Violence widely permeated in all fields of society is not obstructed from hospitals. In fact, social violence is going to hospitals, and health workers are often subjected to violence in their workplace. Violence is one of the reasons for the neglect of public health problems. There is a lack of clear definition. There has been no complete and unified definition of workplace violence in the past. The latest definition of workplace violence by the WHO is that staff are being abused, threatened or attacked in their workplace, resulting in a clear or implicit challenge to their safety, happiness or health. The expansion of the explanation also includes the following three points: (1) violence must occur in the workplace; (2) violence occurs during the work of the staff; (3) the victims of violence must be the staff. The workplace violence is divided into psychological violence, physical violence and sexual violence according to the different parts of the victims' violence. Force (including physical threat) against others or collectives, resulting in damage to the body, brain, spirit, moral and social development, including verbal abuse, threat, attack, and torture, but there is no physical contact between the parties. Physical violence refers to any physical assault, such as beating, kicking, shooting, lapping, pushing, biting and so on. Physical attack. The result of the attack may not cause any injury to the party suffering from violence, and may also cause minor injuries, obvious injuries, dysfunction or permanent disability. Sexual violence refers to any related speech and movements that violate the wishes of the victim, including sexual harassment (or sexual provocation), sexual assault and rape (or attempted rape). On the one hand, on the one hand, all walks of life have not paid enough attention to the problem of hospital workplace, have not yet seen more mature relevant administrative laws and regulations, and do not carry out much professional research in the field of workplace violence; on the other hand, due to domestic political and cultural background, hospital allocation, health management system and other aspects and countries, It is not quite the same, so the research results and prevention experience of workplace violence in other countries are not necessarily well suited to our country. In a certain range, a sample survey of representative people can reflect the occurrence of a certain kind of violence in a specific time. By carrying out the violent flow of workplace in the hospital in the District of Guangzhou. In order to deal with the medical and patient disputes and solve the contradiction between doctors and patients, we can guarantee the normal medical order of the hospital and a loose and safe working field for the medical staff. Through the epidemiological investigation of workplace violence in some hospitals in Guangzhou District, the present study explored the current situation and the influencing factors of workplace violence in the hospital, and finally aimed at providing the baseline information about the violence of the workplace in the hospital, and arousing the majority of the frontline health workers. The personnel and even the whole society pay attention to the violence in the hospital workplace, and provide the theoretical basis for the health administration department to formulate the prevention and control measures of the violence in the hospital workplace and to maintain the normal work order of the hospital.
Method
Guangzhou has jurisdiction over 10 districts and 2 county-level cities under the jurisdiction of the city. In this study, a total of 7198 workers from 20 different levels of hospitals in the 12 administrative divisions of the District of Guangzhou were studied. The staff of this survey included all the occupational groups working in the hospital, such as medical students, nurses, clinical workers, medical and technical personnel, and administrative personnel. Staff and security personnel, such as vacation, travel, travel or study for more than one week for more than one week of the staff are not in this study. This study adopts a combination of cluster sampling and stratified sampling method. First, the Guangzhou district hospital in general according to the administrative area into 12 groups; secondly, according to medical treatment. At the hospital level, each group is divided into 3 groups, and a certain number of hospitals are selected in each group, and the hospitals are selected to be investigated. Finally, all the hospital staff are considered as the object of research in principle. Each hospital is guided by the trained investigators (head of department and / or head nurse). In the same time (1 to 3 days, the longest, not more than 7 days), all the workers in the job will fill out the violence in the hospital for the first 12 months of the investigation, and then take back the questionnaire by the chief and / or the head nurses of the Department. According to the relevant documents of the WHO and the definition of workplace violence The questionnaire was designed. The questionnaire was filled by the staff of the hospital of different ages, collected feedback, supplemented, modified and deleted the items of the questionnaire according to the problems and feedback. The revised questionnaire first investigated the small sample (30 people) in a hospital and corrected the questionnaire again. After the official investigation began, the formal investigation began. The contents of the questionnaire are no longer changed. The hospital workplace violence is defined as follows: the health workers themselves suffer psychological violence, physical violence and / or sexual violence during the working hours in the hospital. This study uses the social statistics package SPSS17.0 to carry out the entry and data analysis of the questionnaire, including the hospital. The epidemiological characteristics of workplace violence were described by a statistical description. A single factor and multiple factor Logistic regression model was set up to analyze the relationship between the workplace violence and the interviewees. The first step was to classify the related factors of 8 interviewees to the single factor and two classification of logistic. Regression analysis, screening out the 7 characteristic variables including sex, age, education, marital status, employment form, career category and work age; second, in order to exclude the interference of mixed factors, the variable selected by single factor regression using backward deletion method to carry out multiple factor Logistic regression analysis, and finally a total of 4 variables entered the regression. In this study, the following quality control methods were adopted: (1) a closed questionnaire was adopted to reduce the subjective assumptions of the interviewees. Each questionnaire was simply attached to the purpose, requirements and filling methods of the survey, which made the interviewees clear and reduced concerns; (2) only the past 12 A survey of violence in the middle of the month. In order to reduce the occurrence of recollection bias, the detailed description of violence only investigates the most impressive violence in the past 12 months; (3) the support of the relevant leaders of each hospital before the survey, the mobilization and training of the director and head of the nurse in order to ensure the smooth completion of the investigation. The survey sample contains 20 hospitals of different grades, properties and geographical locations, with large sample size and good representation; 5. The questionnaires are screened strictly according to the unified standard, and after the invalid questionnaire is excluded, special persons are entered.
Result
In this study, a total of 7198 workers in 20 different levels of hospitals in the Guangzhou district were investigated. 3 hospitals were totally discarded (111) for the low recovery rate of the questionnaire for a variety of reasons. In the end, 5950 staff from 17 hospitals were used to recover 5147 questionnaires and the response rate was 86.. 50% (5147/5950).5147 questionnaires were screened by one by one, the invalid questionnaire (86) was excluded, 5061 effective questionnaires were obtained, and the effective response rate was 98.33% (5061/5147). The final analysis showed that 5061 hospital staff had suffered 2947 people from workplace violence in the past 12 months, and the incidence of workplace violence was 58.23%. psychology. The incidence of violence was 56.85%, the incidence of physical violence was 12.85%, the incidence of sexual violence was 6.99%. at least 14 hospital staff had caused physical dysfunction or permanent disability due to violence, 7 had been raped (or attempted rape). Emergency department, psychiatric hospital staff, doctors and nurses, official workers, men, years. Staff less than 30 years old are the most dangerous occupational groups in hospital workplace violence. The incidence of psychological violence in the emergency department is the highest, 83.02%. Physical violence and sexual violence are the highest in mental hospital staff, 45.10% and 20.23%., aged under 40 years of age, especially from 31 to 40 years old. Sexual violence is the most common perpetrator in hospital workplace violence; ward and shift time are the most common place and time for violence in the workplace. The causes of violence in the workplace include the death of the patient, the ill awareness of the patient, the indiscriminate use of alcohol or drugs, the mental disorder of the perpetrators, the no improvement of the condition, and the diagnosis and treatment. The cost is too high, the waiting time is too long, the service is not satisfied, and the patients' demands are not satisfied.
conclusion
There is a high incidence of violence in the workplace in the hospital in Guangzhou. The incidence of violence in the workplace of 58.23%. hospital is mainly psychological violence, the incidence of psychological violence is 56.85%, the incidence of physical violence is 12.85%, which is similar to similar studies in the world. The incidence of sexual violence is 6.99%. So far, it has not been retrieved to the hospital occupation at home and abroad. A professional study of the occurrence of sexual violence in the crowd. The violence in the workplace is serious, causing physical, psychological and mental harm to the victims. As mentioned above, the incidence of psychological violence is very high, especially in the emergency department, the incidence is as high as 83.02%, few people can be spared; physical violence and sexual violence are not as good as they are. Psychological violence is common, but the consequences are much more serious than psychological violence. The violence in the workplace of the hospital returns to the victims individuals, hospitals and countries bring heavy economic burdens. Doctors or nurses, official workers, men, workers with age less than 30 years old are dangerous occupational groups in hospital workplace violence. The focus of the violent intervention should be carried out in the emergency department and the mental hospital staff. It is suggested that the security work should be strengthened in the emergency department of the two or above general hospital and the psychiatric hospital to increase the awareness of the prevention of violence in the workplace. The high risk factors for the workplace violence are from the hospital (hospital management department and medical work). Two aspects of the patient, including the patient's death, the ill consciousness of the patient, the alcohol or drug abuse, the mental disorder of the perpetrator, the illness, the high cost of the diagnosis and treatment, the long waiting time, the dissatisfaction of the service, the failure to meet the requirements of the patient, etc., which did not meet the requirements of the sick person, the condition was not better, and the cost of diagnosis and treatment was too high to lead the most easily to the doctor. The occurrence of violence in the workplace, especially the requirement of unsatisfied patients, is very difficult to blame for 23.40% of the violence. This result suggests that the hospital should standardize the management, improve the service quality and diagnosis and treatment technology, promote the health administration department, promote and deepen the reform of medical and health care, and it is imperative. The workplace violence has not yet caused the whole society. It is considered that the medical staff is regarded as a small incident that does not have to make a fuss. There are about 1/5 in the staff of the hospital who have never heard of workplace violence and think it is unnecessary to pay attention to this problem. The prevention and control of workplace violence is a systematic project, and it is recommended to do many aspects of policy, management, engineering, education and so on. In all interventions, policy intervention is the key. It is recommended that the health administration have legislation on violence in the workplace in the hospital, and to form an expert on the prevention and control of workplace violence, including the epidemiology, legislative, judicial and public security areas, to deal with issues related to workplace violence and to provide legal and technical expertise. In addition, the promotion of professional ethics, occupational safety and respect for the work of medical staff, and the creation of a civilized social fashion are also important measures to prevent violence in the workplace.
【学位授予单位】：南方医科大学
【学位级别】：博士
【学位授予年份】：2011
【分类号】：R181.3
本文编号：2159999
[Abstract]:Background and purpose
Violence is an unspoken social security problem in a country and region. Violence widely permeated in all fields of society is not obstructed from hospitals. In fact, social violence is going to hospitals, and health workers are often subjected to violence in their workplace. Violence is one of the reasons for the neglect of public health problems. There is a lack of clear definition. There has been no complete and unified definition of workplace violence in the past. The latest definition of workplace violence by the WHO is that staff are being abused, threatened or attacked in their workplace, resulting in a clear or implicit challenge to their safety, happiness or health. The expansion of the explanation also includes the following three points: (1) violence must occur in the workplace; (2) violence occurs during the work of the staff; (3) the victims of violence must be the staff. The workplace violence is divided into psychological violence, physical violence and sexual violence according to the different parts of the victims' violence. Force (including physical threat) against others or collectives, resulting in damage to the body, brain, spirit, moral and social development, including verbal abuse, threat, attack, and torture, but there is no physical contact between the parties. Physical violence refers to any physical assault, such as beating, kicking, shooting, lapping, pushing, biting and so on. Physical attack. The result of the attack may not cause any injury to the party suffering from violence, and may also cause minor injuries, obvious injuries, dysfunction or permanent disability. Sexual violence refers to any related speech and movements that violate the wishes of the victim, including sexual harassment (or sexual provocation), sexual assault and rape (or attempted rape). On the one hand, on the one hand, all walks of life have not paid enough attention to the problem of hospital workplace, have not yet seen more mature relevant administrative laws and regulations, and do not carry out much professional research in the field of workplace violence; on the other hand, due to domestic political and cultural background, hospital allocation, health management system and other aspects and countries, It is not quite the same, so the research results and prevention experience of workplace violence in other countries are not necessarily well suited to our country. In a certain range, a sample survey of representative people can reflect the occurrence of a certain kind of violence in a specific time. By carrying out the violent flow of workplace in the hospital in the District of Guangzhou. In order to deal with the medical and patient disputes and solve the contradiction between doctors and patients, we can guarantee the normal medical order of the hospital and a loose and safe working field for the medical staff. Through the epidemiological investigation of workplace violence in some hospitals in Guangzhou District, the present study explored the current situation and the influencing factors of workplace violence in the hospital, and finally aimed at providing the baseline information about the violence of the workplace in the hospital, and arousing the majority of the frontline health workers. The personnel and even the whole society pay attention to the violence in the hospital workplace, and provide the theoretical basis for the health administration department to formulate the prevention and control measures of the violence in the hospital workplace and to maintain the normal work order of the hospital.
Method
Guangzhou has jurisdiction over 10 districts and 2 county-level cities under the jurisdiction of the city. In this study, a total of 7198 workers from 20 different levels of hospitals in the 12 administrative divisions of the District of Guangzhou were studied. The staff of this survey included all the occupational groups working in the hospital, such as medical students, nurses, clinical workers, medical and technical personnel, and administrative personnel. Staff and security personnel, such as vacation, travel, travel or study for more than one week for more than one week of the staff are not in this study. This study adopts a combination of cluster sampling and stratified sampling method. First, the Guangzhou district hospital in general according to the administrative area into 12 groups; secondly, according to medical treatment. At the hospital level, each group is divided into 3 groups, and a certain number of hospitals are selected in each group, and the hospitals are selected to be investigated. Finally, all the hospital staff are considered as the object of research in principle. Each hospital is guided by the trained investigators (head of department and / or head nurse). In the same time (1 to 3 days, the longest, not more than 7 days), all the workers in the job will fill out the violence in the hospital for the first 12 months of the investigation, and then take back the questionnaire by the chief and / or the head nurses of the Department. According to the relevant documents of the WHO and the definition of workplace violence The questionnaire was designed. The questionnaire was filled by the staff of the hospital of different ages, collected feedback, supplemented, modified and deleted the items of the questionnaire according to the problems and feedback. The revised questionnaire first investigated the small sample (30 people) in a hospital and corrected the questionnaire again. After the official investigation began, the formal investigation began. The contents of the questionnaire are no longer changed. The hospital workplace violence is defined as follows: the health workers themselves suffer psychological violence, physical violence and / or sexual violence during the working hours in the hospital. This study uses the social statistics package SPSS17.0 to carry out the entry and data analysis of the questionnaire, including the hospital. The epidemiological characteristics of workplace violence were described by a statistical description. A single factor and multiple factor Logistic regression model was set up to analyze the relationship between the workplace violence and the interviewees. The first step was to classify the related factors of 8 interviewees to the single factor and two classification of logistic. Regression analysis, screening out the 7 characteristic variables including sex, age, education, marital status, employment form, career category and work age; second, in order to exclude the interference of mixed factors, the variable selected by single factor regression using backward deletion method to carry out multiple factor Logistic regression analysis, and finally a total of 4 variables entered the regression. In this study, the following quality control methods were adopted: (1) a closed questionnaire was adopted to reduce the subjective assumptions of the interviewees. Each questionnaire was simply attached to the purpose, requirements and filling methods of the survey, which made the interviewees clear and reduced concerns; (2) only the past 12 A survey of violence in the middle of the month. In order to reduce the occurrence of recollection bias, the detailed description of violence only investigates the most impressive violence in the past 12 months; (3) the support of the relevant leaders of each hospital before the survey, the mobilization and training of the director and head of the nurse in order to ensure the smooth completion of the investigation. The survey sample contains 20 hospitals of different grades, properties and geographical locations, with large sample size and good representation; 5. The questionnaires are screened strictly according to the unified standard, and after the invalid questionnaire is excluded, special persons are entered.
Result
In this study, a total of 7198 workers in 20 different levels of hospitals in the Guangzhou district were investigated. 3 hospitals were totally discarded (111) for the low recovery rate of the questionnaire for a variety of reasons. In the end, 5950 staff from 17 hospitals were used to recover 5147 questionnaires and the response rate was 86.. 50% (5147/5950).5147 questionnaires were screened by one by one, the invalid questionnaire (86) was excluded, 5061 effective questionnaires were obtained, and the effective response rate was 98.33% (5061/5147). The final analysis showed that 5061 hospital staff had suffered 2947 people from workplace violence in the past 12 months, and the incidence of workplace violence was 58.23%. psychology. The incidence of violence was 56.85%, the incidence of physical violence was 12.85%, the incidence of sexual violence was 6.99%. at least 14 hospital staff had caused physical dysfunction or permanent disability due to violence, 7 had been raped (or attempted rape). Emergency department, psychiatric hospital staff, doctors and nurses, official workers, men, years. Staff less than 30 years old are the most dangerous occupational groups in hospital workplace violence. The incidence of psychological violence in the emergency department is the highest, 83.02%. Physical violence and sexual violence are the highest in mental hospital staff, 45.10% and 20.23%., aged under 40 years of age, especially from 31 to 40 years old. Sexual violence is the most common perpetrator in hospital workplace violence; ward and shift time are the most common place and time for violence in the workplace. The causes of violence in the workplace include the death of the patient, the ill awareness of the patient, the indiscriminate use of alcohol or drugs, the mental disorder of the perpetrators, the no improvement of the condition, and the diagnosis and treatment. The cost is too high, the waiting time is too long, the service is not satisfied, and the patients' demands are not satisfied.
conclusion
There is a high incidence of violence in the workplace in the hospital in Guangzhou. The incidence of violence in the workplace of 58.23%. hospital is mainly psychological violence, the incidence of psychological violence is 56.85%, the incidence of physical violence is 12.85%, which is similar to similar studies in the world. The incidence of sexual violence is 6.99%. So far, it has not been retrieved to the hospital occupation at home and abroad. A professional study of the occurrence of sexual violence in the crowd. The violence in the workplace is serious, causing physical, psychological and mental harm to the victims. As mentioned above, the incidence of psychological violence is very high, especially in the emergency department, the incidence is as high as 83.02%, few people can be spared; physical violence and sexual violence are not as good as they are. Psychological violence is common, but the consequences are much more serious than psychological violence. The violence in the workplace of the hospital returns to the victims individuals, hospitals and countries bring heavy economic burdens. Doctors or nurses, official workers, men, workers with age less than 30 years old are dangerous occupational groups in hospital workplace violence. The focus of the violent intervention should be carried out in the emergency department and the mental hospital staff. It is suggested that the security work should be strengthened in the emergency department of the two or above general hospital and the psychiatric hospital to increase the awareness of the prevention of violence in the workplace. The high risk factors for the workplace violence are from the hospital (hospital management department and medical work). Two aspects of the patient, including the patient's death, the ill consciousness of the patient, the alcohol or drug abuse, the mental disorder of the perpetrator, the illness, the high cost of the diagnosis and treatment, the long waiting time, the dissatisfaction of the service, the failure to meet the requirements of the patient, etc., which did not meet the requirements of the sick person, the condition was not better, and the cost of diagnosis and treatment was too high to lead the most easily to the doctor. The occurrence of violence in the workplace, especially the requirement of unsatisfied patients, is very difficult to blame for 23.40% of the violence. This result suggests that the hospital should standardize the management, improve the service quality and diagnosis and treatment technology, promote the health administration department, promote and deepen the reform of medical and health care, and it is imperative. The workplace violence has not yet caused the whole society. It is considered that the medical staff is regarded as a small incident that does not have to make a fuss. There are about 1/5 in the staff of the hospital who have never heard of workplace violence and think it is unnecessary to pay attention to this problem. The prevention and control of workplace violence is a systematic project, and it is recommended to do many aspects of policy, management, engineering, education and so on. In all interventions, policy intervention is the key. It is recommended that the health administration have legislation on violence in the workplace in the hospital, and to form an expert on the prevention and control of workplace violence, including the epidemiology, legislative, judicial and public security areas, to deal with issues related to workplace violence and to provide legal and technical expertise. In addition, the promotion of professional ethics, occupational safety and respect for the work of medical staff, and the creation of a civilized social fashion are also important measures to prevent violence in the workplace.
【学位授予单位】：南方医科大学
【学位级别】：博士
【学位授予年份】：2011
【分类号】：R181.3
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