| Violence in the hospital which severely hinders the regular working order of hospitals, work and life of medical workers and has much negative influence on health and medical service has become a vital issue of public health. At present, some developed and developing countries have noticed that violence in the premises of hospital apparently reduces the quality of health services and causes the waste of health source. The exploration and prevention of violence in the premises of hospital is a novel field for study which is earlier started in foreign countries, In recent years, though there are some surveys data on violence in the hospital, all surveys are subject to a certain hospital or some offices. The content of surveys are general and lack of systematic study, especially, there are few advices on the establishment of practical countermeasures for comprehensive prevention of violence in the hospital.Purpose of Study: The aim is to ascertain the situation of violence phenomenon in the hospital such as First Class of the Third Level Hospitals in Changchun City, at the same time, have knowledge of patient satisfaction level to the hospital work. Also this study is to find and analyze causes for violence in the hospital and discover resolutions and adopt favorable countermeasures by providing first-hang data in order to gain protection for both hospitals and patients. By the survey of patient satisfaction level, the needs and expectation of patients should be understood, the cultural environment of "taking patients' needs as improvement direction, taking patient satisfaction as quality standard" is to be created and finally, the occurrence of violence in the hospital is to be reduced. Method and Details: With reference to relating studies inside and outside China, the survey and research is carried out in the form of questionnaires with tables. The questionnaire design and the definition of mental or physical violence suffered by hospital workers in workplace are done according to the definition norms concerned with violence in the hospital made by WHO, which include demographical features (gender, age, level of education, post, professional title), working background (working life, the grade of the hospital worked in), situation of violence suffered by hospital workers (the type of violence, causes, frequency, the time of occurrence, impact on victims, countermeasures, whether causing injury or disability, the cognitive situation of violence, the way to handle violence and etc. ). The survey of patient satisfaction level is done by adopting the popular grading scale of 1, 2,3,4,5, which mean "very dissatisfied, dissatisfied, common, satisfied, very satisfied". According to the evaluation criteria of hospital satisfaction "first class of three levels" established by the Ministry of Health and combining hot topics in present medical care market concerned by common people, questionnaires are designed including mainly medical expenses, service quality, the level of medical technology, hospital environment, hospital administration and others. Investigation Targets: With the method of cluster random sampling, the survey on violence suffered by hospital workers in work place is conducted by targeting at doctors working in clinical frontline, nurses, nurses who are employed, care workers, medical technicians in five hospitals with first class of three levels in Changchun(such as the First Hospital of Jilin University, the Second Hospital of Jilin University, Sino-Japan Friendship Hospital of Jilin University, Jilin People's Hospital, Changchun Central Hospital) for 12 months from June, 2006 to June, 2007. 1,500 copies of questionnaires are discharged; among which 1366 copies are effective ones with 91.1% effective responses and male workers occupying 42.8 %( 584/1366), female ones 57.2%(782/1366). Also the survey on patient satisfaction with hospital work is carried out which is oriented toward in-patients and out-patients in the above five hospitals with first class of three levels in Changchun from May,2007 to July, 2007. Questionnaires are filled out under the guidance of full-time investigators in every hospital in a unified time which varies from 3 days to 7 days. The total copies are 1436 with 1310 effective ones, and the rate of effective responses is 91.2%(1310/1436) Quality Control: In order to guarantee the authenticity and effectiveness of the survey result, instructions of questionnaires and tables are given in the design of questionnaires, and questions and options are set clearly. Investigators who have received specialized trainings conduct pre-surveys and discover flaws in the questionnaires timely and make modification timely for the purpose that responders can fill questionnaires in accordance with the requirement of questionnaires faithfully. Statistical Analysis: The effectiveness of tables is given unified inspection by persons specially appointed. If two items in every questionnaire are disqualified, the questionnaire is considered as ineffective one. Statistical analysis is made on all data by using SPSS10.0 statistical software after ineffective questionnaires are eliminated. Survey Results: Investigation Situation on Violence in the Premises of Hospital: Among all violent attacks, the incidence rate of language attack is the highest with 79.8%, body attack is next with 26.1% and sexual attack is the lowest one with the rate of 7.7%. There is no prominent difference in the number of people who are different in posts and professional titles while the number of people with different ages and lengths of service that are suffered violent attacks are noticeably different. The Occurrence Time of Violence: The incidence rate of violence in night shift is the highest. The Occurrence Spot: Violent attacks mostly occur in clinics rooms, nursing stations and treatment rooms and so on. Violent Attackers: Most of them are families of patients. Age: The age group with highest risk factors is from 31 to 40. Violence Impact on Hospital Workers: Victims feel wronged, anxious, depressed or angry with decreased working passion and insomnious. They want to quit this profession and dare not to be on duty alone. Three of them even had the idea of suicide. The Cognitive Situation of hospital workers to violence in the premises of hospital. 81.1% of 1366 health care workers have heard the violence in the premises of hospital, while, still 18.9% of them never have heard of it. Whether to set up organs to secure rights of which the purpose is to protect rights and interests of medical care workers, 10% of interviewees think it is not essential to set up the organ to preserve rights and interests. Causes for Violence Occurrence in the Hospital: It is presented in survey 1090 medical care workers who suffered from violent attack before consider main causes are the impeded communication between doctors and patients, medical inform not in place, distrust of many patients to the hospital and doctors. Next causes are high expectations of patients to the hospital, dissatisfaction of patients and their families to the hospital, patients' thinking of unconformity of medical expenses and expected effects; besides these, and other causes like patients' alcoholism or drug addiction, the guide of public opinion and media, no improvement in illness, the death of patients, long-time clinics waiting for medical advice, cumbersome medical process, medical negligence caused by hospital. There are both superficial reasons caused by two parties of hospitals and patients directly and deeper reasons caused by the service and management level of hospital, medical care and health management system and the establishment of social legal system and others. All these are predisposing causes of the violence occurrence in the premise of hospital. Patient Satisfaction with Hospital Work: The patient satisfaction rate on waiting time to see a doctor is 62.0%; satisfaction rate on the service of medical care workers is 68.3%; satisfaction rate on the hospital management is 57.1%; as to patients' loyalty to hospital, the rate of turning round to the hospital is 50.1% while the rate of recommendation the hospital to others is 54.6%. Conclusion: In order to satisfy various desires of patients on medical care service, reduce conflicts between doctors and patients, prevent or avoid the occurrence of violent attacks in the premises of hospital, effectively preventive measures should be adopted based on causes for the violence occurred in hospitals, "patient-centered" conception should be set up and also humanistic medical care service should be promoted. What is more, fee transparency should be executed in order to meet the new requirements of medical care reform and also the sense of service should be strengthened to improve service quality. The treatment process can be improved with the shortness of treatment time; meanwhile, the positive publicity of law enforcement efforts in law enforcement organs should be strengthened positively and health education should be popularized. We also need to rationalize the distribution of human resource, make the security settings in hospitals sound, reinforce the training of the capacity of response to violence, and strengthen the cultivation of legal awareness. Only by doing so, can medical care disputes be avoided or reduced and the harmonious relationshipbetween doctors and patients can be achieved. |
PDF Full Text Request