以混合型研究法探討職場暴力與心理社會安全氛圍對護理人員心理健康及自評健康的影響

Abstract

目的：職場暴力已是許多國家重視的職場社會心理危害。在台灣，此問題也日益受到關注，政府並於2013年修訂並於2014年7月3日正式施行《職業安全衛生法》新增之不法侵害預防條款。工作者遭遇職場暴力後，除了身心健康受影響以外，亦可能面臨人際衝突、勞雇衝突與法律爭議；若處理職場暴力相關的流程與法規不完善或組織氛圍不佳，可能惡化其身心健康。在《職業安全衛生法》甫施行之際，本研究以護理人員為研究對象，探討護理職場的職場暴力現況與制度狀況。本研究目的有三：其一，以深度訪談瞭解遭受職場暴力之護理人員對於醫院通報申訴與處理流程之經驗與感受；其二，以護理人員為調查對象，檢視中文化「心理社會安全氛圍」量表之信效度；其三，以護理人員為調查對象，瞭解醫院層級的「心理社會安全氛圍」與自評健康與心理健康的相關。 方法：本研究採用混合研究方法，進行方式包括：(1)質性訪談：以最近一年曾經歷職場暴力的女性臨床護理人員共17人為訪談對象，瞭解其職場暴力經驗、以及通報申訴與醫院處理等制度經驗；(2) 建構並檢視中文版心理社會安全氛圍量表信效度：經過雙向翻譯與語意訪談確定題目，並招募408位臨床護理人員進行問卷調查，以檢視量表的信效度。(3) 量性調查：以標準化問卷進行調查，研究對象包括75家醫院的1755位護理人員及75位職業安全衛生管理人員份，採多階層分析探討職場社會心理安全氛圍與護理人員職場暴力經驗與身心健康之相關。 研究結果：在質性訪談方面，職場暴力對多數護理人員會造成身心健康的影響，遭受內部職場暴力的護理人員感受到企業組織氛圍較不佳，多數受訪者認為現行職場暴力處理及申訴的制度不透明也不便利，也未保護受害者。中文版心理社會安全氛圍量表量表信效度方面，研究結果顯示量表構念與原始量表一致，語意內容清晰，並具有良好的內在一致性度（Cronbach’s α=.83）及良好的建構效度。在量性分析方面，在控制教育程度與年資之後，夜班及輪班者、高工作負荷者、低職場正義及低心理社會安全氛圍之護理人員，發生職場暴力的風險顯著高於其他護理人員；遭受職場暴力的女性護理人員自評健康不佳（OR=1.840）且負面心理健康問題風險較高（OR=1.507）；多階層分析控制職場暴力經驗、學歷、年資及工作職場特質後，相較於組織心理社會安全氛圍高的女性護理人員，處於組織心理社會安全氛圍低的女性護理人員有較高的自評健康不佳的風險（OR=1.771），但對心理健康則無顯著相關。 結論：本研究指出，遭受職場暴力的護理人員除了暴力事件本身影響之外，也普遍感受到現行制度不佳及未保護受害者，而造成更多的心理壓力；中文版心理社會安全氛圍量表有良好之信效度，可用來測量組織氛圍；不良的職場心理社會安全氛圍可能伴隨著身心健康風險，值得勞動主管機關、醫療機構經營者與護理工作者重視。

Workplace violence has been recognized as a serious psychosocial work hazard in many countries. In addition to physical and mental health consequences, workers who experience workplace violence often encounter various forms of hardships, including interpersonal conflicts, employee-employer conflicts and/or legal dispute with employers or customer. Victims of workplace violence might experience further physical and meantl health impacts if their work environment failed to act supportively after the violent event or if the legal protection provision was fragmented. There were three study objectives: First, in-depth interviews with nurses who had experienced workplace violence were conducted to understand nurses’experiences in the notification and appealing processes and their perception of hospital’s responses toward workplace violence. Secondly, a survey of nurses was conducted to examine the psychometric properties of the Chinese version of psychosocial safety climate (PSC-12C). Thirdly, a cross-sectional survey was conducted to examine the associations of organizational psychosocial safety climate and mental and self-rated health status among nurses. Methods: Mixed-methods were used in this study. For the first objective, in-depth interviews were conducted with 17 female nurses. For the second objective, the PSC-12C was Translated and back-translated to ensure valid translation, following by a survey of 408 nurses to examine its internal consistency reliability, construct validity, convergent validity and discriminant validity. For the third objective, a cross-sectional survey of 1853 nurses and 75 occupational safety and health personnel from 75 hospitals was conducted. A standardized questionnaire was used to obtain information regarding the experiences of workplace violence over the previous 12 months. Organizational climate was measured by the PSC-12C and mental health status was measured by the Brief Symptom Rating Scale (BSRS-5). Also obtained were participants’ age, seniority, educational level, and work characteristics. Results: Results from the the qualitative study showed that a majority of nurses experienced poor health after violent events. Those who suffered internal workplace violence reported poor organizational climate. Most of the interviewees perceived low levels of psychosocial safety climate, and considered their work organization not supportive and processes not transparent to workers in issues of workplace violence. The validity study showed that the PSC-12C had a Cronbach’s αlevel of 0.83 and good construct validity, convergent validity and discriminant validity. Results from the survey study showed that night or rotating shifts, heavy workloads, low workplace justice and low PSC were found to be risk factors for workplace violence. After controlling for educational level and work characteristics, nurses who had experienced workplace violence over the previous 12 months were at a higher risk for poor mental health (OR=1.507) and poor self-rated health (OR=1.840). When further adjusted for the experience of workplace violence, lower PSC was associated with increased risks for poor self-rated health. Conclusion: Study findings showed that nurses with workplace violence experiencemultiple hardships, and there is much room for imrprovement in the prevention of workplace violence and protection of affected workers. The PSC-12C was found to have good reliability and validity and can be applied to other studies. We suggest that organizational climate should be improved to prevent workplace violence and to promote workers’ physical and mental health wellbeing.