EFFECTS OF OSHA GUIDELINES ON VIOLENCE PREVENTION IN MEN

工作场所暴力在精神卫生保健机构普遍存在。对华盛顿州医院工作人员进行的关于人身攻击发生率的调查发现，每年每100名病房工作人员发生386-437次人身攻击，造成至少轻伤（1993年）。1996年，针对这些数据，联邦职业安全与卫生管理局为卫生和社区工作者发布了预防暴力准则。虽然这些准则是基于健全的安全和健康原则，但它们从未在实地得到正式评价。迫切需要对精神卫生环境中的准则进行评估，以证明这些建议的有效性，并审查与实施这些建议相关的真实成本和收益。该项目将评估职业卫生和健康管理局准则在纽约儿童健康医院的三个设施中的有效性：一个成人精神病院、一个儿童精神病院和一个法医设施。干预措施将在选定的三个设施中的每个设施的两个单元中实施，并包括职业安全与健康管理局指导方针的关键要素。管理承诺和员工参与是拟议研究设计中固有的内容，包括劳资联合咨询小组的形成和工作。现场分析将包括对OIRS数据的审查、焦点小组、干预前调查、风险绘图和演练评估。危害预防和控制将通过实施演练调查的建议来完成。咨询小组将与项目工作人员协商，审查医疗管理和事后报告以及培训和教育方面的政策和程序并提出建议。每年将提供关于全面预防暴力方案的培训。项目的形成性评估将持续进行。该计划的评估将在干预实施一年后通过对干预后调查和OIRS数据的分析来完成。将对干预措施的成本和效益进行深入分析。本研究有以下具体目的。1)记录和描述在三种类型的精神卫生设施（一个成人精神病院、一个儿童精神病院和一个法医设施）内执行职业安全与卫生管理局预防暴力准则的过程；2)比较三种机构在实施基于OSHA指导方针的暴力预防方案前后一年的攻击率、攻击风险因素和工作满意度；3)评估在州精神卫生机构实施OSHA暴力预防指导方针的成本和收益。

Workplace violence is pervasive in the mental health care setting. Washington State hospital workers surveyed regarding the incidence of physical assaults were found to have a rate of 386-437 physical assaults resulting in at least minor injury per 100 ward staff members per year (1993). In 1996, in response to data such as these, Federal OSHA published violence prevention guidelines for health and community workers. Although the guidelines are based on sound principles of safety and health, they have never been formally evaluated in the field. Evaluation of the guidelines in mental health settings is critically needed to demonstrate the effectiveness of the recommendations, and to examine the true costs and benefits associated with their implementation. This project will evaluate the effectiveness of the OSHA guidelines in three NYSOMH facilities: one adult psychiatric, one child psychiatric and one forensic facility. The intervention will be implemented in two units in each of the three facilities selected and include key elements of the OSHA guidelines. Management Commitment and Employee Involvement are inherent in the design of the proposed study and include the formation and work of joint labor-management advisory groups. A Worksite Analysis will include review of OIRS data, focus groups, a pre-intervention survey, risk mapping and walk-through evaluation. Hazard Prevention and Control will be accomplished by implementing recommendations from the walk-through surveys. The advisory groups in consultation with project staff will review and make recommendations for policies and procedures on Medical Management and Post-incident Reporting and Training and Education. Training on a comprehensive violence prevention program will be offered annually. Formative evaluation of the project will be on-going. Evaluation of the Program, will be accomplished through analysis of a post-intervention survey and OIRS data one year following the implementation of the intervention. An in-depth analysis of the cost and benefit of the intervention will be conducted. The study has the following specific aims. 1) To document and describe a process for implementing OSHA violence prevention guidelines within three types of mental health facilities: one adult psychiatric, one child psychiatric and one forensic facility; 2) To compare assault rates, risk factors for assault and job satisfaction in three types of facilities one year prior to and one year following implementation of a comprehensive OSHA guideline-based (violence prevention program; 3) To assess the cost and benefit of implementing OSHA violence prevention guidelines within a state mental health facility.