医护人员遭受医院场所暴力PTSD及对职场行为影响机制研究

In recent years, workplace violence in hospitals has been on the rise. A spate of violent hospital incidents have posed a serious threat to the health and safety of healthcare workers, which has become a significant public health problem. Based on the perspective of protecting medical staffs' mental and physical health and safety, the project is aimed to explore the PTSD which medical staffs suffered from violence and its impact on workplace behavior. Firstly, using the cross-sectional epidemiological survey on a large sample, the project team screened healthcare workers who suffered from workplace violence in hospitals. Secondly, on the basis of cross-sectional survey, the project team selected 1000 cases of hospital medical staffs respectively from those who experiences violence or non-violence within 12 months from different regions. Doctors and nurses accounted for half of each case-control study group, to reveal the PTSD's incidence rates and risk factors of violence against the healthcare workers in hospitals and to explore their physiological, psychological and behavioral changes. Finally, by longitudinal experimental study, the project team explored in-depth the mechanism of the impact of workplace violence in hospitals on workplace behavior, to reveal the PTSD dynamic response process, including the medical staffs' response in emotion, body and mentality at different stages after the violence, and the expression of impact on occupational burnout, job involvement and job embedding behavior.Proposed the policies that reagulate the workplace violence in hospitals have the effects to the health care workers. The research outcome will provide the basis for any intervention measures to prevent psychological disorders and negative workplace behavior. It will also lay the foundation to the crisis of workplace violence in hospitals.

近年医院场所暴力呈上升趋势,接连发生恶性事件对医护人员健康与安全造成严重威胁,已成为重要公共卫生问题。基于医护人员身心健康与安全视角，探索医护人员遭受医院场所暴力PTSD及对职场行为的影响。本研究专题一通过大样本横断面流行病学调查,筛检出遭受医院场所暴力的医护人员。专题二在横段面调查基础上从不同地区共抽取12个月内遭受和未遭医院场所暴力的医护人员各1000例,医生、护士各半进行病例对照研究,揭示医护人员遭受医院场所暴力PTSD发生率与危险因素，探索PTSD者躯体、心理、行为的改变。专题三通过纵向试验研究深入探索医院场所暴力对职场行为影响机制，揭示医护人员受暴后不同时间段在躯体、心理-PTSD的动态响应过程，以及对职业倦怠、工作投入和工作嵌入影响的表达，提出防控医院场所暴力对医护人员健康影响的策略。其研究成果为预防心理障碍和消极的职场行为采取干预措施打下基础，为医院场所暴力危机干预提供依据。

近些年来，我国医患关系日益紧张，医院场所暴力事件频发，成因复杂多元，社会负面影响日趋扩大。这不仅损害了医护人员的身心健康，也使得部分患者不能获得良好的医疗服务。通过调查全国30252名医护人员发现在过去1年中，遭受工作场所暴力的为20024人，总发生率为66.19%。其中三级医院医护人员遭受工作场所暴力的发生率为65.26%，县级医院医护人员遭受工作场所暴力的发生率为67.38%。县级医院遭受暴力的发生率高于三级医院，且差异有统计学意义（x2=15.008, P<0.001）。医护人员和患者的医院场所暴力诱发因素调查表明，医护人员认为暴力诱发因素权重排在前三位分别是患方因素（22.89%）、医方因素（19.72%）和环境因素（15.78%），而患方认为是医方因素（48.53%）、政策制度因素（18.23%）和社会因素（13.56%）。过去一个月，医护人员在遭受医院场所暴力后出现创伤后应激障碍症状的患病率是18.7%。创伤后应激障碍症状与焦虑（r=0.614，P<0.01）、抑郁（r=0.370，P<0.01）和消极应对方式（r=0.193，P<0.01）呈正相关，创伤后应激障碍症状与积极应对方式（r=-0.120，P<0.01）和社会支持（r=-0.073，P<0.01）呈负相关。医护人员遭受医院场所暴力后工作投入低占 4.2%，职业倦怠非常严重占44.1%，离职倾向很高占11.4%。暴力频次与工作倦怠（r=0.216，P<0.001）、离职倾向（r=0.162，P<0.001）呈正相关。倾向性得分匹配后暴力组和非暴力组不同医护人员的工作投入、职业倦怠与离职倾向差异均具有统计学意义。急性应激反应总均分为40.36±33.86，医护人员的不同性别、工作性质、接触患者时间对急性应激反应的影响具有统计学意义。医护人员在遭受医院场所暴力后1个月、3个月、6个月整体心理健康水平呈现不同的变化，医护人员遭受医院场所暴力后工作投入、职业倦怠、离职倾向也呈现出动态变化。本项目有利于加强医院场所暴力管理，甄别高危科室；提高医护人员身心健康与安全，为预防心理障碍和消极的职场行为采取干预措施提供依据；为指导心理治疗，危机干预，在时间、方法上的选择更具有针对性打下基础，对于维护医院医护人员职场安全、医院安全文化建设有着重要的实践意义。