Verbal Abuse among Nurses Working in a Nepalese Hospital

Abstract

언어폭력은 간호사가 경험하는 가장 흔한 폭력 중 하나이며 간호실무에 부정적인 영향을 미친다. 본 연구는 네팔 간호현장의 언어폭력 실태와 간호사의 반응 양상을 분석하기 위해 일개 공공병원에 근무하는 201명의 간호사를 대상으로 설문조사를 시행하였다. 대상자 선정 기준은 근무경력 6개월 이상인 전일제, 시간제 간호사였으며, Manderino와 Berkey (1997)가 개발하고 Pejic (2005)이 수정보완한 Verbal abuse scale을 사용한 자가보고식 설문지에 응답하도록 하였다. 자료수집은 2019년 1월 21부터 27일까지 시행되었다. 수집된 자료는 SPSS를 사용하여 분석하였으며 대상자의 일반적 특성을 알아보기 위해 기술통계를 실시하였고, 변수 간 차이는 t-test로 분석하였다. 본 연구의 결과는 다음과 같다. 1. 연구에 참여한 대상자는 모두 여성이었으며 연령은 최소 20세, 최대 52세였다. 근무경력은 평균 6.71±6.44년이었으며, 1-5년이 67.2%로 가장 많았다. 결혼상태는 응답자의 57.7%가 미혼, 42.3%가 기혼이었으며, 3년제 학사학위 취득자가 68.6%로 가장 많았다. 고용 형태는 정규직이 43.3%, 계약직이 56.7%였으며 전일제 근무자가 96.5%였고, 직위는 일반간호사가 77.1%로 가장 많았다. 근무부서는 일반병동이 35.8%로 가장 많았으며 대상자의 75.1%가 3교대 근무를 하는 것으로 나타났다. 2. 자료 분석 결과, 대상자들은 지난 3개월 동안 언어 폭력에 자주 노출된 것으로 나타났다. 언어폭력 유형 중 화를 내며 소리를 지른 유형을 경험한 대상자가 96.4%로 가장 많았고, 이 중 7.0%는 지난 3개월 동안 20회 이상 경험한 것으로 조사되었다. 또한 61.2%의 대상자들이 모욕적인 말을 경험했으며, 지난 3개월 간 빈도는 1-5번 경험한 대상자가 55.2%로 가장 많았다. 3. 언어폭력 제공자에 대해 조사한 결과 보호자가 49.8%로 가장 많았고, 동료 간 언어폭력은 2.0%로 가장 적게 나타났다. 4. 언어폭력을 경험한 대상자의 33.8%가 폭력에 대해 보고하지 않은 것으로 조사되었다. 보고하지 않은 이유는 ‘상황이 해결됨’ 90.5%, ‘환자의 취약성에 대한 염려’ 87.1% 순으로 나타났다. 5. 언어폭력에 대한 간호사의 반응을 조사한 결과, 개인적 반응으로 대상자의 86.6%가 지지받지 못하는 느낌을 경험했고, 77.6%에게서 분노와 스트레스 증가가 나타났다. 대상자의 직업 관련 반응은 직업에 대한 well being 감소(86.6%), 사기 감소(82.6%), 직무만족도 감소(80.1%) 순으로 나타났다. 네팔의 공공병원에서 일하는 간호사들은 언어폭력에 노출되어 있으며 이러한 상황은 간호사들에게 다양한 개인적, 전문적 반응을 야기하였다. 간호사들은 행정 부서에서 실태를 파악하고 예방 조치를 취할 수 있도록 언어폭력에 대한 보고율을 높여야 할 것이다. 또한 언어폭력의 발생을 줄이고 건강한 업무환경을 조성하기 위하여 보호자와 의료진 간 라포 형성 및 의사소통기술, 폭력적인 행동의 인식과 관리에 대한 계속교육 등의 훈련프로그램이 필요하다. 마지막으로, 행정부서와 정책 결정자는 의료기관의 언어폭력 문제 해결과 안전한 업무환경 조성에 지속적인 관심을 가져야 할 것이다.;Verbal abuse among nurses is the most prevailing type of violence encountered by nurses that has negative impacts on nursing practice. A cross-sectional research design was used to identify the incidence of verbal abuse among 201 nurses working in a public hospital of Nepal and their reactions to this abuse. All the full time and part-time nurses with more than 6 months of nursing experience in that hospital were included in the study. A standardized self-administered survey questionnaire, Verbal abuse scale developed by Maderino and Berkey (1997) which was further adapted by Pejic (2005) that consisted 38 items was used to collect the data between 21st and 27th January, 2019. Descriptive statistics and independent sample t- test were adapted to analyze the data using SPSS version 22. The findings from this study are summarized as follows: 1. All the respondents were female with the age range of 20-52 years and the average work experience was 6.71 ± 6.44 years, with 1-5 years being 67.2%; 57.7% respondents were single and 42.3% were married. Almost 69% of the respondents were having diploma in nursing. With regards to type of employment, 56.7% were having temporary job status and 43.3% were full time nurses. Seventy seven percent were working as a staff nurse; 96.5% working as a full time nurse and 35.8% were working in a general specialty unit. Seventy five percent of the respondents were working in a 3 shift rotation schedule. 2. Findings indicated that the respondents were frequently exposed to verbal abuse within the period of past 3 months. Person yelling at them in an angry fashion was reported as the most frequent type of verbal abuse experienced by 96.4% respondents with 7.0% participants experiencing more than 20 episodes and 61.2% of the respondents were reported being victims of insulting comments, with 55.2% experiencing more than 1-5 times. 3. The most common source of verbal abuse were reported as patient relatives 49.8% and co-workers 2.0% being the least common source of verbal abuse reported within past 3 months period. 4. It was found that 33.8% of the respondents did not report the incidence of verbal abuse officially to the management. The most common reasons that affect nurses not to report the verbal abuse incidence to the management were that the respondents believe the situation was handled by themselves 90.5% and 87.1% felt concerned for a vulnerable patient. 5. With regard to personal reaction of the nurses towards verbal abuse, 86.6% of the nurses felt unsupported, 77.6% had anger as well as increased stress level. The most common professional reaction reported were decreased sense of well-being in the job (86.6%) followed by decreased job morale (82.6%) and decreased job satisfaction (80.1%). 6. Regarding the relationship between general characteristics with incidence of verbal abuse. Age was found significantly associated with swearing (t = -6.24 and p < .001) and ignoring (t = -3.38 and p < .001). The marital status of the respondents was significantly associated with the swearing and ignoring (t = -2.35 and p = .02), (t = -2.33 and p = .02) respectively. Type of employment was found significantly associated with exposure to yelling (t = 4.81 and p < .001), insulting (t = 14.14 and p < .001) and direct threat of physical harm (t = 5.34 and p < .001). Work schedule was found being significantly associated with various types of verbal abuse swearing (t = -2.83 and p < .001), insulting (t = -2.01 and p = .04), indirect threat of physical harm (t = 2.07 and p = .04) and ignoring (t = -2.29 and p = .02). Nepalese nurses working in a public tertiary hospital were found being vulnerable to verbal abuse resulting in various types of personal and professional reactions. Nurses should be supported and motivated to report the verbal abuse incidence in the hospital so that hospital administration could take action to prevent further incidence. Patient relatives were the reported as the most common source of verbal abuse followed by physicians. Hence it is crucial to maintain effective communication between nurses, patients’ relatives and physicians to minimize the incidence of verbal abuse among nurses. Furthermore, in-service education and training in recognition and management of aggressive behavior could prevent such incidence creating a healthy work environment in the hospital. Thus it is necessary to pay attention from hospital management and policy makers to address the verbal abuse and its impacts in the hospital to create a safe working environment.