医院工作场所暴力的流行病学特征及危险因素分析

目的 探讨医院工作场所暴力的流行病学特征及危险因素。方法 抽样调查医院工作人员工作场所暴力发生情况,根据2002年5月10日世界卫生组织在题为《新的研究表明工作场所暴力威胁卫生服务》的公报中关于工作场所暴力的定义,采用频数分析和logistic回归等统计学方法对资料进行处理。结果 调查的4062名医院工作人员中1年内有2619人遭受过工作场所暴力,暴力的发生率为64.48％,其中心理暴力为49.12％,身体暴力为15.36％。男性更容易遭受多次暴力,且更容易遭受身体暴力;30～39岁年龄组医院工作人员是工作场所暴力的主要受害者,医生、护士。(含助理护士)是工作场所暴力的高危职业人群;白班是发生工作场所暴力事件的高峰时问,病房是多发地点。患者(或探视者)的要求未能得到满足、患者自认病情无好转和诊疗费用太高是工作场所暴力发生的主要危险因素。患者亲属和患者本人是主要的肇事者。结论 医院工作场所暴力问题严重,实施以医院为主导和改善医患关系的综合干预措施,尽量减少和避免工作场所暴力发生。     

Workplace violence in a large correctional health service in New South Wales, Australia: a retrospective review of incident management records

ABSTRACT: BACKGROUND: Little is known about workplace violence among correctional health professionals. This study aimed to describe the patterns, severity and outcomes of incidents of workplace violence among employees of a large correctional health service, and to explore the help-seeking behaviours of staff following an incident. METHODS: The study setting was Justice Health, a statutory health corporation established to provide health care to people who come into contact with the criminal justice system in New South Wales, Australia. We reviewed incident management records describing workplace violence among Justice Health staff. The three-year study period was 1/7/2007-30/6/2010. RESULTS: During the period under review, 208 incidents of workplace violence were recorded. Verbal abuse (71%) was more common than physical abuse (29%). The most (44%) incidents of workplace violence (including both verbal and physical abuse) occurred in adult male prisons, although the most (50%) incidents of physical abuse occurred in a forensic hospital. Most (90%) of the victims were nurses and two-thirds were females. Younger employees and males were most likely to be a victim of physical abuse. Preparing or dispensing medication and attempting to calm and/or restrain an aggressive patient were identified as 'high risk' work duties for verbal abuse and physical abuse, respectively. Most (93%) of the incidents of workplace violence were initiated by a prisoner/patient. Almost all of the incidents received either a medium (46%) or low (52%) Severity Assessment Code. Few victims of workplace violence incurred a serious physical injury - there were no workplace deaths during the study period. However, mental stress was common, especially among the victims of verbal abuse (85%). Few (6%) victims of verbal abuse sought help from a health professional. CONCLUSIONS: Among employees of a large correctional health service, verbal abuse in the workplace was substantially more common than physical abuse. The most incidents of workplace violence occurred in adult male prisons. Review of the types of adverse health outcomes experienced by the victims of workplace violence and the assessments of severity assigned to violent incidents suggests that, compared with health care settings in the community, correctional settings are fairly safe places in which to practice.     

Prevalence and determinants of workplace violence of health care workers in a psychiatric hospital in Taiwan

Workplace violence, a possible cause of job stress, has recently become an important concern in occupational health. This study determined the prevalence of workplace violence and its risk factors for employees at a psychiatric hospital in Taiwan. A questionnaire developed by ILO/ICN/WHO/PSI was first translated and validated. It was then used to survey the prevalence of workplace violence in the last 12 months experienced by all nursing aides, nurses, and clerks at the hospital. Multiple logistic regression models were constructed to discover the determinants of violence. A total of 222 out of 231 surveyed workers completed a valid questionnaire. The one-year prevalence rates of physical violence (PV), verbal abuse, bullying/mobbing, sexual harassment, and racial harassment were 35.1, 50.9, 15.8, 9.5, and 4.5%, respectively. The prevalence of PV at this hospital was higher than that reported by other countries for the health sector. A high anxiety level was associated with the occurrence of PV. These results need to be corroborated by future investigation. A training program may be required for high risk groups to reduce workplace violence.     

Alice Hamilton and the FBI

Abstract

We surveyed 222 nurses, nursing assistants, and clerks at a psychiatric hospital in Taiwan on responses to workplace violence, treatment of violent patients, and reporting behavior. Staff reported 78 incidents of physical violence (PV), 113 of verbal abuse (VA), 35 of bullying/mobbing (BM), 21 of sexual harassment (SH), and 10 of racial harassment (RH) over the course of one year. Among affected staff, only 31% of those experiencing PV and <10% of those experiencing other categories of violence completed a formal report. Highest levels of reporting to senior staff were among those affected by SH. Patients who were physically violent were more likely to be injected with medication than patients showing other violent behaviors. More VA-affected staff considered the incident not important enough to report. Other reasons for not reporting the incident were fear of negative consequences, especially for BM, and shame for SH. Reliable systems for responding to and reporting patient violence should be developed.     

Written violence policies and risk of physical assault against Minnesota educators

Few research studies on school violence policies use quantitative methods to evaluate the impact of policies on workplace violence. This study analyzed nine different written violence policies and their impact on work-related physical assault in educational settings. Data were from the Minnesota Educators' Study. This large, nested case control study included cases (n=372) who reported physical assaults within the last year, and controls (n=1116) who did not. Multivariate logistic regression analyses, using directed acyclic graphs, estimated risk of assault. Results of the adjusted multivariate model suggested decreased risks of physical assault were associated with the presence of policies regarding how to report sexual harassment, verbal abuse, and threat (OR 0.53; 95 per cent CI: 0.30-0.95); assurance of confidential reporting of events (OR 0.67; 95 per cent CI: 0.44-1.04); and zero tolerance for violence (OR 0.70; 95 per cent CI: 0.47-1.04).     

大学校园暴力发生情况及危险因素分析

目的探讨大学校园暴力的发生情况及相关危险因素。方法以某省两所高校大学生为调查对象，对一年来校园暴力发生情况及相关因素进行匿名问卷调查。分析各类型暴力的发生率，并用多因素logistic回归分析暴力发生的危险因素。结果（1）共发放问卷5300份，得到有效问卷3910份，应答率73．77％。3910人中最近一年内发生校园暴力者703人，发生率为17．98％。其中，男生发生率为29．60％，女生发生率为7．27％。男生发生率高于女生（x^2=329．89，P=0．000）。（2）一年来男生受暴力发生率为28．00％，女生为7．27％。各受暴力类型中，威胁、勒索、情感虐待、躯体攻击、语言的性骚扰、躯体的性骚扰发生率，男生分别为18．03％、13．97％、10．77％、085％、0．48％；女生分别为3．64％、5．84％、1．38％、1．33％、1．13％。暴力来源主要为校内同学。（3）一年来男生施暴他人发生率为10．40％，女生为1．47％。施暴对象主要为校内同学。（4）多因素logistic回归分析结果表明，吸烟、饮酒、经常上网是遭受暴力（OR值分别为1．48、2．96、1．66）和施暴他人（OR值分别为2．92、1．88、2．09）的危险因素。结论大学校园暴力的发生率很高，一些危险因素也不容忽视，应积极采取干预措施预防校园暴力的发生。     

恩施土家族苗族自治州医院工作场所暴力流行病学调查

目的了解湖北省恩施士家族苗族自治州医院工作场所暴力的现状、发生原因及危险因素.方法采用分层整群抽样方法,调查了恩施州21所医院的医院工作人员.结果被调查的1 369名医院工作人员在12个月内有1011人遭受工作场所暴力,总发生率为73.85%,其中心理暴力为61.87%,身体暴力为21.11%.30～39岁年龄组的医生和护士是医院暴力的高危人群;暴力的多发地点在病房,其次为医生办公室和护士站;高发时间为白班.主要的危险因素是肇事者不够理智、认为费用太贵、医院没有满足其要求;主要的肇事者是患者亲属,以男性居多.结论恩施土家族苗族自治州医院工作场所暴力问题十分严重,医院应加强内部管理,有关部门应立法保护医患双方权益,预防和控制医院暴力的发生.     

Domestic violence and childhood sexual abuse in HIV-infected women and women at risk for HIV

OBJECTIVES: The purpose of this study was to determine the prevalence and effect of domestic violence and childhood sexual abuse in women with HIV or at risk for HIV infection. METHODS: Participants with HIV or at risk for HIV infection enrolled in the Women's Interagency HIV Study. Childhood sexual abuse; all physical, sexual, and coercive violence by a partner; HIV serostatus; demographic data; and substance use and sexual habits were assessed. RESULTS: The lifetime prevalence of domestic violence was 66% and 67%, respectively, in 1288 women with HIV and 357 uninfected women. One quarter of the women reported recent abuse, and 31% of the HIV-seropositive women and 27% of the HIV-seronegative women reported childhood sexual abuse. Childhood sexual abuse was strongly associated with a lifetime history of domestic violence and high-risk behaviors, including using drugs, having more than 10 male sexual partners and having male partners at risk for HIV infection, and exchanging sex for drugs, money, or shelter. CONCLUSIONS: Our data support the hypothesis of a continuum of risk, with early childhood abuse leading to later domestic violence, which may increase the risk of behaviors leading to HIV infection.     

精神病医院与综合医院工作场所暴力比较研究

目的了解精神病医院和综合医院工作场所暴力发生状况并比较其特点。方法采用问卷调查方法，同期调查广州市1所精神病医院和1所综合医院在职工作人员工作场所暴力发生率及影响因素。依据世界卫生组织关于工作场所暴力的定义。纳入标准为：工作人员在被调查前的12个月内遭受过暴力，且事件发生在工作中或当班时。结果医院工作场所暴力发生率较高，精神病医院为70．52％，综合医院为69．73％。精神病医院中90．82％的受害者曾反复遭受暴力伤害，多次暴力发生率达64．06％；49．45％的应答者1年中遭受过身体暴力；综合医院较少发生身体暴力，发生率仅为7．57％。精神病医院以患者本人肇事为主，综合医院则以患者亲属为主。肇事者精神障碍，患者(或陪护、探视者)要求未能得到满足，患者自认病情无好转，是精神病医院发生工作场所暴力的主要危险因素；综合医院前3位原因依次为患者(或陪护、探视者)要求未能得到满足，患者自认病情无好转及诊疗费用太高。医院工作人员对工作场所暴力认知程度很低，精神病医院尤为突出。结论精神病医院比综合医院工作场所暴力问题更为严重，应针对各类医院特点，开展综合性的工作场所暴力防控工作。     

温州市两所综合性医院医务人员工作场所暴力现状的调查分析

目的 了解医院工作场所暴力事件发生的频率及其分布特征,探讨预防医院工作场所暴力事件的应对措施.方法 采用整群抽样方法抽取温州市2所医院所有在职医务人员作为调查对象,通过自填式问卷调查收集其基本信息及2010年11月～2011年10月期间医院工作场所遭受暴力的情况.结果 共发放调查问卷600份,收回有效问卷568份,有效应答率为94.7％.568名医务人员中有369人遭受过工作场所暴力,暴力发生率为65.0％,其中言语攻击最常见,发生率为60.2％,躯体攻击次之,发生率为18.5％,还有少部分人遭受过性攻击,发生率为2.6％.不同年龄、工作年限、教育程度、工作岗位和职称的医务人员工作场所暴力发生率的差异均有统计学意义(均有P＜0.05).趋势x2检验显示,年龄、工作年限、职称越低,暴力发生率越高.经过单因素和多因素Logistic回归分析,最终年龄、工作岗位、工作年限、职称4个特征变量进入回归模型.结论 医务人员工作场所暴力发生率较高,开展暴力预防应结合医务人员的年龄、工作年限、教育程度、工作岗位和职称等因素.     

广州市急诊护士遭受工作场所暴力现状

目的描述广州市急诊护士遭受工作场所暴力的现状。方法采用描述性研究的方法,运用便利抽样,调查广州市5家三级甲等综合性医院急诊科工作至少1年的护士143名。结果①广州市急诊护士遭受工作场所暴力的总体发生率为86．7％,言语暴力是主要形式;②工作场所暴力可发生在各个班次,以前夜班和正常白班居多;主要的发生地点为护士站／分诊台,其次是注射室／治疗室和病房：施暴者特征为：男性,31～40岁;③发生暴力的主要原因是：施暴者素质太低、施暴者粗暴无礼、候诊时间太长、施暴者饮酒及不合理要求被拒绝;④急诊护士在遭受暴力时的主要应对措施有：耐心解释、忍让回避以及求助保安和同事等,25％会报警,仅0．8％争锋相对;⑤急诊护士在遭受暴力后产生委屈、气愤、工作热情下降、精神无法集中以及转行等负性情绪．甚至有人产生自杀念头。结论急诊护士面临的工作场所暴力情况日益严峻,应引起充分重视。     

Physical and psychological violence in Jamaica's health sector.

OBJECTIVE: To determine the prevalence of experiences with physical violence and psychological violence that health staff have had in the workplace in Jamaica, and to identify factors associated with those experiences of violence. DESIGN AND METHODS: A total of 832 health staff answered the standardized questionnaire that was used in this cross-sectional study. Sampling was done at public facilities, including specialist, tertiary, and secondary hospitals in the Kingston Metropolitan Area; general hospitals in the rural parishes; and primary care centers in urban and rural areas. Sampling was also done in private hospitals and private medical centers. RESULTS: Psychological violence was more prevalent than was physical violence. Verbal abuse had been experienced in the preceding year by 38.6% of the questionnaire respondents, bullying was reported by 12.4%, and physical violence was reported by 7.7%. In multivariate analyses there was a lower risk of physical violence for health staff who were 55 years or older, worked during the night, or worked mostly with mentally disabled patients, geriatric patients, or HIV/AIDS patients. Staff members working mostly with psychiatric patients faced a higher risk of physical assaults than did other health staff. Of the various health occupations, nurses were the ones most likely to be verbally abused. In terms of age ranges, bullying was more commonly experienced by health staff 40-54 years old. CONCLUSIONS: Violence in the health sector workplace in Jamaica is an occupational hazard that is of public health concern. Evaluation of the environment that creates risks for violence is necessary to guide the formulation of meaningful interventions for the country.     

Occupational violence problems in an emergency hospital in Londrina, Paraná, Brazil

Workplace violence is currently a worrying factor at many hospitals. The objectives of this study were to characterize the occupational violence problems detected by health workers in an emergency hospital. The study was exploratory and transversal, with a quantitative data approach. It took place at the emergency ward of a general hospital in Londrina, Paraná. The study population included 33 people from the nursing team and 14 medical doctors. Data were collected through interviews with health workers and staff managers, as well as assessment of violence records from the last seven years. 100% of nurses, 88.9% of technicians, 88.2% of nurse assistants, and 85.7 % of doctors said that they had been victims of workplace violence, although not documented. The types of violence suffered included verbal assault (95.2%) and moral and sexual battery (33.3%). Preventive measures to reduce occupational violence should be applied.     

A Challenging Job: Physical and Sexual Violence Towards Group Workers in Youth Residential Care

Background

Residential or group care social workers appear to be at increased risk for experiencing physical violence at work. However, little is known about sexual harassment in addition to physical victimization of social workers in youth residential or group care.

Objective

We investigated the prevalence of physical and sexual victimization of youth care workers in residential care and tested whether characteristics of the group care workers and the type of care facility influenced this prevalence.

Methods

One hundred seventy-eight participants reported whether they had experienced verbal threat, physical threat, physical violence, verbal sexual harassment, and physical sexual harassment by one or more of the youth they worked with in a 1-year period.

Results

Eighty-one percent of the group workers experienced violence. Most incidents were verbal threats, but about half of the participants experienced physical violence. Youth care workers from secure care were most at risk for experiencing physical and verbal violence and workers from juvenile detention facilities were most at risk for experiencing sexual harassment. Rates of violence were increased for participants working with children with a mild intellectual disability. Gender of the youth care workers was not related to the rate of victimization, but age was: younger group workers reported more incidents than older group workers.

Conclusions

The high levels of violence in residential youth care indicate that residential care is not the best workplace for professionals nor the best rearing setting for youth. Alternative care settings, such as treatment in a family-type environment, should be explored.     

Intimate partner violence among men and women--South Carolina, 1998

Few studies provide population-based estimates of intimate partner violence (IPV) for men and women, especially at the state level. IPV may result in adverse health effects for victims and perpetrators (1-3). To estimate the lifetime incidence of IPV by type of violence (e.g., physical, sexual, and perceived emotional abuse) and to explore demographic correlates of reporting IPV among men and women, the South Carolina Department of Health and Environmental Control and the University of South Carolina conducted a population-based random-digit-dialed telephone survey of adults in the state. This report summarizes the results of the survey, which indicated that approximately 25% of women and 13% of men have experienced some type of IPV during their lifetime. Although women were significantly more likely to report physical and sexual IPV, men were as likely as women to report emotional abuse without concurrent physical or sexual IPV.     

Sexual and physical abuse: a threat to reproductive and sexual health

According to the cross-cultural data, violence has two fundamental certainties: 1) that the overwhelming majority of perpetrators are men; and 2) that the targets are usually women. Sexual and physical abuse subsume a wide variety of violent behaviors, some of which are legally recognized as criminal acts. Evidence indicates that the most invisible of all is child sexual abuse, in which nonreporting of crime is prevalent. Although there appears to be no simplistic response to the question as to why men are violent towards women, it is noted that it involves several contributing factors. These include inequalities between women and men at the societal level, and cultural norms and expectations about behaviors of women and men at another level. In terms of the identity of the perpetrators, research has found that a large majority of perpetrators are socialized for violence. The effects of violence on the sexual and reproductive health of the victim are multiple and long lasting. For example, physical consequences of rape include sexually transmitted diseases and HIV infection, as well as unwanted pregnancy, miscarriage, unsafe abortion, homicide, and suicide. With respect to the psychological consequences, the most common symptoms are anxiety, depression, sexual dysfunction, and difficulties with interpersonal relationships. In view of this, there is a need for a long-term management of victims of sexual abuse.     

广州市两所医院工作场所暴力现象调查

目的 了解医院工作场所暴力的发生现况并分析其原因,为维护医院正常工作秩序提供依据。方法 调查广州市2所三级甲等医院的卫生工作人员2001年10月至2002年10月中遭受工作场所暴力的情况。工作场所暴力事件的判断标准是,卫生工作人员本人在上述调查时间的1年中,在医院场所遭遇到心理暴力和(或)身体暴力。结果 1043名被调查者在1年中有678人遭受过工作场所暴力,以个人为单位,发生率为65．0％,以心理暴力为主。医生比护士更容易受到暴力威胁,发生率分别为70．3％和67．7％。30～39岁年龄段、工龄为11～20年的医院工作人员发生率最高。男性(11．7％)比女性(5．3％)更容易遭受身体暴力,但心理暴力和性暴力在性别上均差异无显著性。护士和护士助理最容易遭受性暴力。患者家属(64．2％)与患者本人(50．0％)是主要的肇事者,以患者家属为主。没有满足肇事者要求、患者病情无好转或患者自认无好转是发生工作场所暴力的主要原因。结论广州市医院工作场所暴力多发,必须引起重视,实施以法律与教育为主导的综合干预措施,以维护医院的正常工作秩序。     

珠海市职业高中学生人际间暴力的相关因素分析

目的了解高中学生人际间暴力的现状、发生原因及危险因素,为有效防控校园暴力提供依据。方法采用整群抽样的方法对586名珠海市职业高中学生进行问卷调查。结果被调查的学生在12个月内,有286人遭受人际间暴力,总发生率为48.81%,其中语言暴力占44.82%,躯体暴力占38.22%,性暴力占16.96%。年龄相仿的同校男生是主要的施暴者,其次为教职工;校外是主要的施暴场所,其次是校内;最主要的施暴原因是无缘无故即兴所为,其次与恋爱有关;暴力事件对学生的影响从无到身心健康严重受损均存在。报复是主要的应对方式。同学是主要的倾诉对象。男生、学习差、本地户口、家庭结构不完整、激惹他人是主要的危险因素。结论珠海市职业高中学生人际间暴力问题严重,必须尽快采取有效措施予以预防和控制。     

Predictive validity of a screen for partner violence against women.

BACKGROUND: While public health leaders recommend screening for partner violence, the predictive value of this practice is unknown. The purpose of this study was to test the ability of a brief three-question violence screen to predict violence against women in the ensuing months. METHODS: We conducted a prospective cohort study of adult women participating in the Colorado Behavioral Risk Factor Surveillance System (BRFSS), a population-based, random-digit-dialing telephone survey. During 8 monthly cohorts, 695 women participated in the BRFSS; 409 women participated in follow-up telephone interviews approximately 4 months later. Violent events during the follow-up period, measured using a modified 28-item Conflict Tactics Scale, were compared between women who initially screened positive and those who screened negative. RESULTS: Among BRFSS respondents, 8.4% (95% confidence interval [CI]=6.3%-10.5%) had an initial positive screen. During the follow-up period, women who screened positive were 46.5 times (5.4-405) more likely to experience severe physical violence, 11.7 times (5.0- 27.3) more likely to experience physical violence, 3.6 (2.4-5.2) times more likely to experience verbal aggression, and 2.5 times (1.2-5.1) more likely to experience sexual coercion. In a multivariate model, separation from one's spouse and a positive screen were significant independent predictors of physical violence. CONCLUSIONS: A brief violence screen identifies a subset of women at high risk for verbal, physical, and sexual partner abuse over the following 4 months. Women with a positive screen who are separated from their spouse are at highest risk.