中文摘要
醫院是發生職場暴力的高風險環境，職場暴力又是目前醫療執業安全之重要議題，政府雖然在硬體設備及保全人力上有因應的相關政策，但從研究調查發現，多數護理人員在面對職場暴力時的處理技巧和因應都缺乏自信能力；情境式教學可以提供一個較真實的學習情境，讓學習者除了瞭解實用的知識外，還可藉由實地操作，應用到相關情境，不僅能有效提升學習者的認知能力，更可以培養問題的解決能力。本研究之目的為驗證「臨床情境式教學訓練課程」介入措施對護理人員職場暴力認知、態度及因應自信之成效，期望藉由提升護理人員對職場暴力之因應能力，來降低遭受職場暴力之風險及傷害。本研究以隨機分派實驗設計，樣本來自台北某醫學中心臨床護理人員，分配方式採亂數表隨機於母群體中抽樣，對照組及實驗組各200人，將「臨床情境式教學訓練課程」作為研究介入措施，兩組於介入措施前，以「臨床護理師職場暴力防制評量表」進行前測，內容包括：對於職場暴力認知能力、職場暴力態度與職場暴力因應自信等。實驗組於接受「臨床情境式教學訓練課程」之介入措施後進行後測，對照組無特殊介入，僅與實驗組同時間點接受後測。有效問卷392，回應率為98.0%。以SPSS V23，採用 GEE分析，檢驗兩組研究對象職場暴力認知、面對職場暴力時的態度、暴力情境因應自信之差異。結果顯示：經介入「職場暴力臨床情境式教學訓練課程」後，護理人員對於職場暴力認知、面對職場暴力時的態度、暴力情境中的因應自信，實驗組得分高於對照組，並達統計上顯著之差異(p<.001)。證明「職場暴力臨床情境式教學訓練課程」可加強臨床護理人員對於職場暴力認知、態度與因應自信。建議：⑴本介入措施課程於未來可針對特定的部門進行更細項規劃，或針對常見狀況進行套裝課程演練，如：急診、精神科、內外科病房和門診。(2)未來可開發相關職場暴力線上自學課程，藉由文字、實際案例影片，讓護理人員不受時間空間之限制，持續線上學習或複習職場暴力策略，定期舉辦臨床情境式演練課程，以便醫護人員強化自我防護能力。(3)院方組織應召集相關人員，定期舉行會議及擬定配套措施，使臨床工作人員得以承擔較複雜與病人互動之情境，提升緊急應變之能力，降低遭受職場暴力之風險與傷害。

Workplace Violence is a severe and global issues in healthcare theatre and beyond. Prevention focused situational education is somehow a good strategy to reduce and minimize the risk of workplace violence. The aim of this study was determining the perception, attitudes and confidence in dealing workplace violence following a situational educational intervention of an experimental design. Four hundred nurses were enrolled and randomly assigned into two groups. 392 of them completed program of the workplace violence prevention in the study. Data were analyzed by SPSS V.23 Generalized Estimating Equation. The results indicated that the situational education group’s participants had improve considerably in their perception, attitudes and confidence in dealing workplace violence at post-test (p<.001). Meanwhile, the participants in the post situational training program showed considerable improvements in their ability compared with control group. We concluded that using workplace violence prevention training can increase the Workplace Violence awareness, established the correct attitude for facing Workplace Violence, improve communication skills and confidence in the case of Workplace Violence. We recommended that situational teaching education of Workplace Violence prevention may be used as a standard training program for nurse staff. Implications for different department of healthcare setting practice and future studies were also suggested.

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