社会经济学杂志

抽象的

针对护士的暴力行为增加的风险以及我们能做些什么来解决这个问题？

萨加尔

来自患者及其亲朋好友的身体和言语攻击不仅在当时难以应对，而且会对我们的幸福感和心理健康产生长期而持久的负面影响。然而，此类事件似乎呈上升趋势，截至 2017 年 2 月，2016-17 年度南澳大利亚州公立医院共发生 6,245 起黑色警戒事件（威胁医院工作人员安全的事件），而 2015-16 年同期为 4,765 起。澳大利亚犯罪学研究所早在 1999 年就将医疗机构列为该国最暴力的工作场所，无论是在国内还是在世界其他地方，攻击趋势一直在持续增长。事实上，在世界各地，如果你是一名护士，你在工作中受到袭击的可能性比警察更大。

这些数据令人震惊。根据国际护士理事会 (ICN) 的数据，

护士是最容易受到袭击的医护人员，尤其是女护士 身体攻击几乎全部由病人实施 在英国的一项调查中，97% 的护士表示，自己知道过去一年内有护士受到过人身攻击 高达 95% 的护士报告称在工作中受到欺凌 72% 的护士在工作场所感到不安全 高达75%的护士在工作中遭受过性骚扰。

尽管急诊室是暴力事件发生率最高的部门，高达 90% 的工作人员在其职业生涯中经历过某种形式的暴力，但普通病房现已取代精神病房和单位成为第二大最常发生袭击的区域。暴力行为和虐待可能发生在临床或社区环境中的任何医护人员身上，包括老年护理机构和私人诊所。最近，一项活动向医务工作者和广大民众强调了这一问题。虽然我们可以尝试教育我们的社区了解这一问题并执行零虐待政策，但通常，这种负面行为来自受酒精、毒品和其他物质影响的患者，或正在经历情绪动荡时期的朋友和亲戚。

任何人都不能为工作场所的暴力或虐待行为找借口，但了解其发生的原因有助于防止进一步的事件发生并平息情绪激动的局面。第一步是认识到什么是侵略性和不受欢迎的行为。

We all know that extreme acts are unacceptable, but there is a spectrum of abuse ranging from swearing and eye-rolling, invasion of personal space, spitting and scratching right through to physical assault and attacks with weapons (which can range from scalpels to chairs dependent on what is close to hand).

Violent incidents are currently under-reported. When asked why victims don’t report violence, the most commonly cited reasons include:

No injury or time off work Reporting is too time-consuming Reporting lacks supervisory support Reporting won’t make any difference

In fact, a study by Gerberich et al. found that 44% of nurses don’t report physical violence because it is just ‘part of the job’.

None of these acts of aggression are ok, and all of them should be reported. Although it might feel like it at times, violence and aggression is never ‘part of the job’, no matter what the person might be going through at that time.

Make sure you know what to do when you witness or experience violence or aggression – no matter how mild it might seem. Repetitive attacks can build and have a cumulative effect on your wellbeing, and that of your colleagues. So, use the reporting mechanisms you have in your workplace to keep your employer informed of what’s going on.

Your employer should be offering you appropriate support following aggressive incidents. If you or anyone you know needs immediate help in a crisis you can contact organizations like Nurse & Midwife Council Support or Lifeline. 

One of the best things we can do as healthcare workers have a conversation with our peers and colleagues regarding aggressive behavior in our workplace. Staff that might have been affected by physical or verbal abuse might feel it’s a waste of time reporting incidents if nothing is done. What’s the point of filling in an incident report form if it gets filed away and nothing changes?

Regular briefings to go through reported incidents can not only help with identifying the triggers in that situation and how they could be addressed in the future but can also ensure that the staff affected have a full and frank opportunity to reflect on what happened. Events like these can often play on the mind and cause problems days or even weeks down the line.

One of the long-lasting effects of an aggressive incident is that it can affect the way that we interact with our patients. With less empathy and a self-imposed ‘distance’ – the quality of care can certainly suffer. In fact, there is a clearly identified link between violence experienced by nurses and subsequent adverse events in patients, including increased medication errors, patient falls, and late administration of medication (Roche et al. 2010). 

预防是处理工作场所暴力行为的最佳方法，其中的一些措施包括： 
大多数医院会在急诊室等“高风险”区域安排保安人员，较小的诊所和设施可以采取其他方法，例如紧急警报、对员工进行攻击性最小化培训，甚至工作场所设计。 

工作场所设计正越来越多地用于预防工作场所暴力。澳大利亚急诊医学院对工作场所设计提出了一些建议，包括： 
• 急诊室外没有隐藏空间 
• 分诊区有玻璃屏等物理屏障 
• 限制出入区域 
• 良好的照明     
• 使用闭路电视摄像机 
• 可见的安全存在