急性病房病人拒絕服藥及暴力情境模擬訓練成效探討—以北部某區域醫院為例之研究

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题名:	急性病房病人拒絕服藥及暴力情境模擬訓練成效探討—以北部某區域醫院為例之研究
其它题名:	Discussion on the effect of refusing medication and violence situation simulation training in patients in acute ward: a case study of a regional hospital in the north
作者:	陳慧臻
贡献者:	黃庭鍾
关键词:	精神科病房;暴力;拒絕服藥;情境模擬;Psychiatric ward;violence;Refusing to take the medicine;Situational simulation
日期:	2019
上传时间:	2020-09-09T05:55:15Z
出版者:	經國管理暨健康學院;健康產業管理研究所
摘要:	職場暴力已被認為是職業危害之一，已經變成一種全球性的問題，在醫療機構以精神科病房最為嚴重，其暴力來源絕大部份是來自病人。國內外研究統計，精神分裂症或情感疾病合併物質濫用暴力盛行率為43.6％，住院精神疾患中約有20-45％具有攻擊性行為，且引發精神科病人暴力攻擊的因素，如:個體因素：如精神病急性期、藥物濫用、年齡輕、暴力史；情境因素：如過度擁擠、人際挑釁、常使用身體約束、工作人員缺乏經驗；結構性因素：如限制住院治療時間、提早出院等(林令世，2009;陳文慶、胡海國、林宜平、郭育良、蘇德勝、王榮德，2010) 。一旦暴力行為發生，常造成醫護人員身體或心理的傷害，遭受暴力後的心理感受，生氣、害怕、憂傷、冷淡、缺乏感情、自責等情緒反應，甚至最嚴重的創傷後症候?等；對病人的影響，會感到不滿或害怕，不配合治療，病房氣氛緊張不安，導致團隊合作困難，人員離職增加亦留任人員降低等後遺症(Kontio, R., V?lim?ki, M., Putkonen, H., Kuosmanen,L., Scott, A., & Joffe, G.，2010;林令世，2009)。於文獻指出工作人員在應對技巧上欠缺因應暴力處置能力，故本研究以北部某區域醫院教學醫院N1-N4精神科護理人員為研究對象。首先，針對研究對象進行「病人拒絕服藥」及「病人出現暴力」時之情境模擬前測，包括:溝通能力、問題解決能力、技術操作能力。採前後測之實驗設計。並加測情境模擬教學提升專業能力問卷，了解情境模擬教學介入後，研究對象自覺對暴力處置的專業能力提升情況。以SPSS19.0版統計軟體，採平均數、中位數、標準差、成對T檢定進行訓練評量成果之資料分析，再以描述性統計陳述教學評量滿意度問卷調查結果，分析模擬情境教學方法對精神科暴力處置臨床學習之成效。研究結果顯示本研究在介入「病人拒絕服藥」及「病人出現暴力」情境模擬教學後，結果整體成效在拒藥總平均1.44分經改善後達1.78分有明顯差異；暴力成效總平均1.52分經介入後達1.86分亦有明顯差異並情境模擬改善前後變異數分析，改善前拒藥平均值年資深者會比年資淺的高，年資21年以上平均1.54分，10年以下1.35分，有顯著差異，介入情境模擬後無論年資深淺都有改善，改善平均值拒藥0.27-0.43分，暴力0.29-0.33分，顯示情境模擬教學介入，確實可提昇護理人員溝通能力及對暴力處置之應對。於醫院評鑑持續性監測指標中，在經營管理層面更注重員工遭受暴力事件數之通報，如能建立有信效度的暴力處置之教案，透過訓練及演練來提升同仁對暴力處置的能力及默契，減少處置過程中工作同仁及病人的傷害，更符合病人安全及優質工作環境的評鑑要求。 Workplace violence has been recognized as one of the occupational hazards and has become a global problem. In medical institutions, the most serious part of the psychiatric ward is the source of violence. Domestic and foreign research statistics, the prevalence of violent prevalence of schizophrenia or emotional disease combined with substance abuse is 43.6%, and about 20-45% of inpatient mental disorders have aggressive behavior, and factors that cause violent attacks in psychiatric patients, such as: individual factors: Such as acute psychiatric period, drug abuse, age, history of violence; situational factors: such as overcrowding, interpersonal provocation, frequent physical constraints, lack of experience of staff; structural factors: such as limiting hospitalization time, early discharge, etc. (Lin Ling Shi, 2009; Chen Wenqing, Hu Haiguo, Lin Yiping, Guo Yuliang, Su Desheng, Wang Rongde, 2010). Once a violent act occurs, it often causes physical or psychological harm to the medical staff, psychological feelings after violence, anger, fear, sadness, coldness, lack of feelings, self-blame and other emotional reactions, even the most serious post-traumatic syndrome; Influence, will feel dissatisfied or afraid, do not cooperate with treatment, the ward atmosphere is nervous, resulting in teamwork difficulties, increased staff turnover and retention of personnel and other sequelae (Kontio, R., V?lim?ki, M., Putkonen, H., Kuosmanen, L ., Scott, A., & Joffe, G., 2010; Lin Lingshi, 2009). In the literature, it is pointed out that the staff lacks the ability to deal with violence in response to skills. Therefore, this study is based on the N1-N4 psychiatric nursing staff of a hospital in a northern region. First of all, the situational simulation pre-tests were conducted for the subjects, such as "patient refusal to take medicine" and "patient violent", including: communication ability, problem solving ability, and technical operation ability. Experimental design before and after mining. And the situational simulation teaching to enhance the professional ability questionnaire, to understand the situational simulation teaching intervention, the research object consciously raised the professional ability of violence. Using the SPSS19.0 version of the statistical software, the average number, median, standard deviation, and paired T-tests were used to analyze the data of the training evaluation results, and then the descriptive statistics stated the results of the teaching evaluation satisfaction questionnaire, and analyzed the simulation situation. Teaching methods for the effectiveness of psychiatric violence in the treatment of clinical learning. The results of the study showed that after the intervention of the "patient refusal to take medicine" and "patient violent" situation simulation teaching, the overall effect of the results was significantly different after the total average of 1.44 points of the rejection of the drug was 1.78 points; the average effective rate of violence was 1.52 points. After the intervention, there was a significant difference of 1.86 points and the analysis of the variance before and after the situation simulation improvement. The average number of seniors who improved the previous rejection rate would be higher than the seniority. The average annual income was over 1.5 years and the average was 1.54 points, and the following years were 1.35 points. Differences, after the intervention situation simulation, no matter how senior the seniors have improved, the average means of rejection is 0.27-0.43 points, and the violence is 0.29-0.33 points, which shows that the situational simulation teaching intervention can improve the communication ability of the nursing staff and the response to the violence. In the continuous evaluation indicators of hospital evaluation, the management management level pays more attention to the notification of the number of violent incidents of employees. If it is possible to establish a teaching plan with reliance on violent disposition, through training and drills to enhance the ability of colleagues to deal with violence and The tacit understanding reduces the harm of working colleagues and patients during the disposal process, and is more in line with the evaluation requirements of patient safety and high quality working environment.
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