本文選題：醫(yī)院人文管理 + 醫(yī)療暴力��； 參考：《遵義醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:本研究第一個(gè)目的是從醫(yī)院人文管理視角出發(fā),分析醫(yī)療暴力案例,找出發(fā)生醫(yī)療暴力的原因及危險(xiǎn)因素,為預(yù)防和減少醫(yī)療暴力,增加醫(yī)務(wù)人員執(zhí)業(yè)安全、提高醫(yī)療質(zhì)量、加強(qiáng)醫(yī)院的人文管理提供理論參考。本研究的第二個(gè)目的是針對(duì)醫(yī)療醫(yī)療法律法規(guī)的出臺(tái),醫(yī)療暴力問(wèn)題尚有未解決的情況,醫(yī)務(wù)人員的人身安全依然受到威脅,建議從醫(yī)院人文管理的柔性視角,建立針對(duì)醫(yī)務(wù)人員和患者的雙重管理措施,以緩解醫(yī)療暴力。方法:本研究采用回顧性研究,選擇從2000年-2015年在網(wǎng)絡(luò)媒體上公開報(bào)道過(guò)的醫(yī)療暴力事件作為研究對(duì)象。利用“百度,搜狗、新浪、網(wǎng)易等搜索引擎”,輸入檢索詞“醫(yī)療暴力”或“傷醫(yī)”或“醫(yī)院工作場(chǎng)所暴力”,即得到了大量的檢索結(jié)果,然后逐個(gè)將網(wǎng)頁(yè)打開,剔除不符合研究條件的檢索結(jié)果,保存符合研究條件的檢索結(jié)果,最后共獲得326個(gè)符合研究條件的媒體公開報(bào)道過(guò)的醫(yī)療暴力事件案例作為研究對(duì)象,其中174個(gè)案例來(lái)自正規(guī)新聞網(wǎng)站如新華網(wǎng)、中國(guó)新聞網(wǎng)和光明日?qǐng)?bào)電子版等;116個(gè)案例來(lái)自已出版過(guò)的的書籍附錄,如《醫(yī)患糾紛法律解讀》;36個(gè)案例來(lái)自貼吧和個(gè)人微博,此類案例的可信度較低,故本研究不將此類案例作為典型案例分析,只將其納入初步統(tǒng)計(jì)數(shù)據(jù)中。研究?jī)?nèi)容主要包括:醫(yī)療暴力發(fā)生的時(shí)間,發(fā)生的省份,發(fā)生的醫(yī)療機(jī)構(gòu)名稱及等級(jí),發(fā)生醫(yī)療暴力的科室,發(fā)生醫(yī)療暴力的原因及過(guò)程簡(jiǎn)介,醫(yī)療暴力的襲擊者及被襲擊者,醫(yī)療暴力造成的人體損傷程度共十個(gè)方面。結(jié)果:本研究共收集了2000年-2015年的326個(gè)醫(yī)療暴力事件,除去中國(guó)臺(tái)灣、青海省、西藏自治區(qū),其余21個(gè)省,4個(gè)自治區(qū),4個(gè)直轄市均有醫(yī)療暴力事件發(fā)生,其中醫(yī)療暴力事件發(fā)生最多的省份是廣東省。2000年-2012年我國(guó)醫(yī)療暴力事件經(jīng)媒體報(bào)道過(guò)的均為20件左右;2013年、2014年、2015年分別為42、75、70件,可見我國(guó)醫(yī)療暴力事件從2013年開始增加,且增加速度較快,2014年達(dá)到巔峰。在已發(fā)生的326件醫(yī)療暴力事件中,三級(jí)醫(yī)院發(fā)生醫(yī)療暴力數(shù)量最多,為217件,占總數(shù)的66.56%,其次是二級(jí)醫(yī)院、其他、一級(jí)醫(yī)院,分別占21.78%、8.59%、3.07%。醫(yī)療暴力發(fā)生率由高到低科室分別是急診科、外科、內(nèi)科、婦產(chǎn)科、兒科、五官科,除去其它科室,急診科是醫(yī)療暴力事件發(fā)生率最高的科室。發(fā)生醫(yī)療暴力的主要原因?yàn)椴粷M意診療效果、患者死亡、醫(yī)鬧索賠、其它、溝通不到位/服務(wù)態(tài)度差,分別占總數(shù)的23.92%、16.27%、14.42%、12.89%、11.04%。醫(yī)療暴力的施暴者患者和家屬。醫(yī)療暴力的受害者主要為醫(yī)生和護(hù)士。結(jié)論:引起醫(yī)療暴力的原因涉及多方面,包括政府層面、社會(huì)層面、醫(yī)院層面、患者層面等,醫(yī)療暴力的主要發(fā)生場(chǎng)所是醫(yī)院,涉及的主要人員是醫(yī)護(hù)人員、患者及其家屬,因此從醫(yī)院管理層面探討解決醫(yī)療暴力問(wèn)題是關(guān)鍵環(huán)節(jié)。平衡患者期望值,提高其滿意度,以減少因相對(duì)剝奪感產(chǎn)生的消極情緒而誘發(fā)的醫(yī)療暴力;真實(shí)、真誠(chéng)、相互理解的人性化交流模式與敘事醫(yī)學(xué)結(jié)合,增加醫(yī)患交流的人情味,提高患者依從性。醫(yī)院成立醫(yī)護(hù)人員心理評(píng)估及安全疏導(dǎo)委員會(huì),及時(shí)評(píng)估和疏導(dǎo)醫(yī)護(hù)人員因醫(yī)療暴力及其他事物而造成的心理問(wèn)題,減少暴力對(duì)其的心理傷害;各�？谱灾髦贫ǚ辣⒅票┓桨�,減少急診科、外科等發(fā)生醫(yī)療暴力較多科室的暴力。參考臺(tái)灣長(zhǎng)庚醫(yī)院的績(jī)效考核方案,平衡醫(yī)生收入,減少其不利于醫(yī)療質(zhì)量的不良情緒,減少因不滿意醫(yī)生醫(yī)療服務(wù)態(tài)度的醫(yī)療暴力。提高醫(yī)院文化建設(shè),改善就醫(yī)環(huán)境;醫(yī)護(hù)人員職業(yè)精神重塑,抵制過(guò)度醫(yī)療的金錢誘惑;建立暴力前合理疏導(dǎo)機(jī)制及暴力先兆因素識(shí)別培訓(xùn),防止醫(yī)療暴力發(fā)生。
[Abstract]:Objective: the first purpose of this study is to analyze the cases of medical violence from the perspective of hospital humanistic management, to find out the causes and risk factors of medical violence, and to provide theoretical reference for preventing and reducing medical violence, increasing the safety of medical personnel, improving medical quality and strengthening the management of human text in hospitals. The second aims of this study are According to the introduction of medical and medical laws and regulations, the problem of medical violence still has not been solved, the personal safety of medical personnel is still threatened. It is suggested that the dual management measures for medical personnel and patients should be set up from the flexible perspective of hospital humanistic management in order to alleviate the medical violence. Methods: This study adopts a retrospective study and chooses from 200 The medical violence reported publicly in the Internet media in 0 -2015 was studied. Using "Baidu, Sogou, Sina, NetEase and other search engines", the retrieval words "medical violence" or "wound doctor" or "hospital workplace violence" were given a large number of retrieval results, and then the web pages were opened one by one to eliminate incompatibility. The retrieval results of the conditions were studied, and the results were preserved in accordance with the research conditions. In the end, 326 cases of medical violence reported publicly reported by the media were obtained. 174 of them were from the regular news websites such as Xinhuanet, China News Network and Guangming Daily electronic edition, and 116 cases came from already. The published book appendix, such as the legal interpretation of the doctor-patient dispute, 36 cases from the post bar and the personal micro-blog, is low in reliability. Therefore, this case is not analyzed as a typical case, and is only included in the preliminary statistical data. The main contents include: the time of the occurrence of medical violence, the province in which it occurred, and the medical treatment. The name and grade of the medical institution, the Department of medical violence, the cause and process of medical violence, the assailants and the assailants of the medical violence, the degree of human injury caused by the medical violence in ten aspects. Results: This study collects 326 medical violence events of -2015 in 2000, excluding Taiwan, Qinghai, Tibet, China. In the autonomous region, the remaining 21 provinces, 4 autonomous regions, and 4 municipalities directly under the central government had medical violence. Among the provinces where the most medical violence occurred in the province of Guangdong province.2000 -2012, the medical violence in China had been reported by the media to about 20 pieces. In 2013, 2014, and 2015, the incidents of medical violence in our country were from 201. 3 years began to increase and increase faster, reaching the peak in 2014. Among the 326 cases of medical violence that had occurred, three hospitals had the largest number of medical violence, 217, 66.56% of the total, followed by the two level hospitals, and the others, the first level hospitals, 21.78%, 8.59%, and the incidence of 3.07%. medical violence from high to lower departments was emergency department respectively. Department, surgery, Department of medicine, obstetrics and Gynecology, pediatrics, and five department, except for other departments, the emergency department is the highest incidence of medical violence. The main causes of medical violence are dissatisfied diagnosis and treatment effect, patient death, medical claim, other, poor communication / poor service attitude, accounting for 23.92%, 16.27%, 14.42%, 12.89%, 11.04%. medicine, respectively. The victims of violence are the victims and their families. The main victims of medical violence are doctors and nurses. Conclusion: the causes of medical violence are involved in many aspects, including the government level, the social level, the hospital level, the patient level and so on. The main place of the medical violence is the hospital, the main personnel involved are the medical and nursing staff, the patients and their families. It is the key link to discuss and solve the problem of medical violence from the hospital management level. Balance the patient's expectation, improve its satisfaction, reduce the medical violence induced by the negative emotion caused by the relative deprivation; the true, sincere, mutual understanding of the humanized communication mode combined with the narrative medicine, increase the human feelings of the doctor and patient communication, and improve the patient Compliance. The hospital set up the mental assessment and safety guidance committee of the medical and nursing staff to assess and guide the psychological problems caused by medical violence and other things in time and reduce the psychological harm of violence to them. Refer to the performance assessment scheme of Taiwan Chang g hospital, balance the doctor's income, reduce the bad mood which is not conducive to the medical quality, reduce the medical violence because of the dissatisfied doctor's medical service attitude, improve the hospital culture construction, improve the medical environment, reshape the professional spirit of the medical staff, resist the money temptation of excessive medical treatment, and establish the rationality before the violence. The training mechanism of the dredging mechanism and the precursor of violence can prevent the occurrence of medical violence.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R197.3

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